Guide To Effective Psoriasis Treatment

Having psoriasis can not only be embarrassing but it can also be quite annoying at times. Those who are experiencing the signs of this chronic autoimmune condition will attest to the fact that having such a disorder can be really painful (both literally and psychologically speaking). You won’t even know that something you have eaten or done can trigger a flare-up not until you start seeing red patches of flaking skin start to show up on any part of your body. It can be quite itchy and painful at the same time. Having one of the best wash for psoriasis can help. However, a thorough understanding of the condition will be your best hope for the proper management of the condition if you or any of your loved ones is suffering from psoriasis.

What is psoriasis?

More than 7 million Americans and about 125 million people all over the world have psoriasis. That would be more than about 2% of the whole US or the world population that has been experiencing the effects of this common skin disorder. Those who have the condition may experience the following symptoms:

  • Pain in the joint areas
  • Skin rashes, dryness, fissures, flakiness, peeling, small bump, thickness, redness
  • Other symptoms associated with the condition: depression, inflamed tendons, itching, joint stiffness, plaque, or small dents in nails

What causes psoriasis?

Many have tried to determine the exact cause of such a medical condition. However, as factors influencing the appearance of such a disorder vary from one person to another, it is quite difficult to ascertain the exact cause of psoriasis. Many health experts have determined links between genetics and the quality of an individual’s immune system. Abnormalities in these two have been reported to trigger an abnormal growth of their skin cells, which results in the buildup of psoriasis lesions.

Psoriasis may develop in any part of the skin, scalp, even the nails. It can be quite itchy and may bleed if you try to rub or pick it. Those with psoriasis may also develop psoriatic arthritis which can really be painful as it affects the joints.

Those who have psoriasis will have an immune system that unknowingly attacks healthy skin cells as if it is fighting an infection in the body that is not actually there. As this happens the skin sheds off quickly and not the usual 28-30 days cycle, causing a build-up of skin cells that turns out to flake soon.

Psoriasis Triggers

Some have found their condition to show up because of one or more of these factors: infection, skin injury, emotional stress, medication, smoking, taking alcoholic drinks, and vitamin D deficiency. There could be other possible triggers to a reaction, so it is really important that you take care of yourself. A good understanding of the condition is also necessary for the proper treatment and management of the condition.

Taking Care of Your Skin When You Have Psoriasis

Proper and regular bathing and showering can improve psoriasis lesions as moisture can soften your lessions. It can also hydrate your skin and give immediate relief to itching skin and scalp. However, if you stay too long in the shower, it may just aggravate your condition and cause even more itching and flaking.

Psoriasis experts recommend limiting shower time to up to ten minutes only and use lukewarm water as this can increase the blood flow as this will lessen the reddening of the skin as well as the irritation. It will also help if you can find and use one of the best body wash for psoriasis as this is more gentle on the skin. Applying moisturizer on your skin can also help lock in the moisture on your skin.

Wear comfortable loose-fitting dresses that are made of natural fibers such as cotton as this will keep the sweat off your skin and won’t rub against your skin.

As for your diet, there is no one-size-fits-all that will work for everyone who has the condition. The best thing that you can do is to keep a journal to monitor all the foods that you eat to see which will trigger or aggravate your condition.

Too much sun exposure, stress, and certain medications can also trigger or aggravate your condition. Make sure that you take note of anything that may cause a flare-up. It would also help if you join online support groups so you can reach out with others who may be experiencing the same symptoms of psoriasis.

What If It’s Too Late? Healing After Circumcision

I began my urology career biased. Like many Americans, I thought circumcision was a normal choice and a healthy one.

Since I’ve come to understand the normal anatomy and function of the male genitalia, it has been impossible to overlook the harms caused by circumcision. I have witnessed firsthand how circumcision directly interferes with normal sexual functionsand also frequently causes other complications such as meatal stenosis, irregular healing, and disruptions in sensation.

This compels me to speak out against non-therapeutic male circumcision. My professional experience confirms the truth in the position statement from the Royal Dutch Medical Association:

The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications – bleeding, infection, urethral stricture and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence. KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications.

Yet the reality is there are millions of men and boys in this world right now for whom it is too late. Having worked extensively with those who have undergone circumcision (both those who have and have not experienced noticeable negative effects), I believe the most healing approach is as follows:

If you are a parent who chose circumcision for your child:

  1. Acknowledge that it was a mistake.
  2. Be willing to communicate this openly with your child. This allows healing and creates safety for others to seek help when needed. Accept that wisdom is a combination of knowledge and experience, and not all experience is positive.
  3. Speak up as much as you comfortably can. Use the wisdom you have gained to help others. Apply this wisdom to future decisions you make for yourself and on the behalf of others. Healing mistakes requires that we recognize them and choose NOT to repeat them.

For adults:

  1. If you do not feel your circumcision interferes with your life, be grateful that you did not suffer a complication. Recognize that this is not the case for all men.
  2. Understand and acknowledge that the foreskin is made of sensitive tissue with a purpose and even though you may be functioning well, you are inherently lacking the functions that would have been provided by your foreskin.
  3. If you do have problems, seek support. Groups like Intact America can help put you in touch with others.
  4. As above, be open, honest, and share as much as you are comfortable. This helps others know they aren’t alone and will help reduce the incidence of non-therapeutic genital cutting of children.
  5. If you have specific issues with your scar and shaft mobility, consider whether foreskin restoration may be an option for you. If you believe you have a severe problem, consider having an exam by a urologist.

Above all else, recognize that we have been misled. Circumcision is absolutely not necessary for enjoying a healthy life and complications are many. Let the cycle of genital cutting stop with you.

Why Holistic Urology and Functional Medicine?

Some have suggested the reason home birth was a safe and good choice for me is because of my knowledge and experience as a physician.

Yet the only time I ever used this knowledge set was to convince my midwife to give me 24 hours before doing lab tests for the elevated blood pressure and protein in my urine she detected on routine screening 1 week before my son was born.

I knew I was ok. I reassured the midwife that the nurse who worked in my office would recheck my blood pressure and urine in the morning. Then I went to the local farm where I was a member, picked up my veggie order for the week, and ate a lot of fresh spring greens. The next day, my blood pressure and urine were normal, and I had a long, peaceful, and easy labor 6 days later.

There is a role for obstetrics. In the case of a diseased pregnancy, their skills can be life-saving. But the way I learned about my healthy pregnancy and how to have a healthy delivery was by learning what my body was capable of and how it worked. And I learned this from other women. Some of these women were health care professionals, some were not, and all were mothers.

I never used my skills as a surgeon when I gave birth. I used my skills as a woman–skills I was born with and that I knew I had because of other women’s examples and encouragement.

Ask Dr. Carmack: Pain After Cystoscopy

PJ from San Diego, California, asks:

I understand that many women have classic UTI symptoms of burning, abdominal and back pain yet test normal on urinalysis and culture. I was referred like many to a Urologist for an additional urinalysis and culture via catheter, CT scans, and Cystoscopy. It appears that many still have negative test results however now suffer from horrific spasms as result of the catheterization- a symptom they now have in addition to burning with urination. It seems unusual that specialists speak little about this adverse reaction given that the pain can be acute and need medication. You might think a patient already suffering from urinary burning might want to make an informed decision prior to having the test and having received a negative CT scan.

I would like to see more information on bladder spasm pain as a result of a routine cystoscopy. What homeopathic remedies are known to be beneficial for this acute pain and what natural therapies are known to help until it passes? There are over the counter and prescription medications used from different drug families some containing a myriad of side effects and chemicals. I, like others, have concerns in regards to adding a prescription or drug to others and prefer to explore either homeopathic or other alternative therapies.

Dear PJ,

Thank you for this excellent question! I’m sorry to hear that you are suffering more after having the cystoscopy.

For those who don’t know, a cystoscopy is a test done by a urologist. A camera that is basically shaped like a urinary catheter is inserted through the urethra and into the bladder. The doctor can see the inside of the urethra and bladder very well. This is basically like a colonoscopy of the bladder.

Cystoscopy is performed to evaluate for cancer of the bladder or urethra, urethral strictures (scar tissue of the urethra), and congenital abnormalities (such as malposition of the ureters, which connect the kidney to the bladders). It is also done to evaluate the prostate and to look for signs of urinary tract obstruction. If there is a stone in the bladder or urethra, this can often be seen on cystoscopy.

Unfortunately, the risk management and reimbursement driven culture of medicine often leads doctors to be more concerned with ruling out life-threatening problems such as cancer and less concerned with actually achieving resolution for the patient, even if the diagnosis is unclear. This is why, as PJ says, informed consent by patients is truly the best solution–the physician is able to tell the patient what he or she can do and why, and it is ultimately the patient’s responsibility to make an informed choice. The real problem is that providing true informed consent is quite time-consuming, and not paid for by most insurance companies.

Another challenge is the lack of awareness of how patients really feel after we perform tests on them. I must say that issues such as you report have rarely come to my attention. I don’t know if this means they are actually rare or that patients just don’t seek follow-up or tell their doctors about them. In any case, it sounds as if you may be one of many people suffering from inflammation of the urinary tract and/or pelvic floor muscles. These problems are common and unrecognized causes of pain and urinary symptoms such as the burning you describe.

The best way to calm inflammation of the urinary tract is with a multimodal approach. I am not an expert on homeopathy, but belladonna is likely to be a helpful remedy. The best herbal remedy I know of is marshmallow root tea, which can be brewed 1 tablespoon in a cup of water four times a day. As for pharmaceuticals, phenazopyridine (sold over-the-counter as Azo and via prescripton as Pyridium) may provide some relief of the symptoms, though it does not treat the underlying cause in any way.

Most patients with urinary tract inflammation will benefit from an elimination diet. I really love the work of Tom Malterre and Alissa Segersten on elimination diets. The Interstitial Cystitis Association also has a great webpage on this with a more specific focus on foods likely to be irritating to the urinary tract.

Whole body anti-inflammatory measures such as following a gluten- and dairy-free diet, achieving a healthy omega-3 to omega-6 ratio (for example, by avoiding trans-fats and taking fish oil), and supplementing with anti-inflammatory foods and herbs such as turmeric, ginger, and Boswellia, are also likely to be helpful.

And, if your symptoms are coming from inflammation of the pelvic floor muscles, I highly recommend you seek out a physical therapist trained in pelvic floor muscle rehabilitation. Your urologist may know one.

Please note that I don’t recommend these approaches without a careful evaluation first. As mentioned, some people have the symptoms you describe because of issues such as infections or cancers that benefit from early diagnosis and treatment.

As I mentioned, your experience is not, to my knowledge, a common one, but is is important! Cystoscopy is an extremely valuable tool and the technology really does allow us to help many people. Most people who I encounter report that the cystoscopy is uncomfortable but that it does not cause pain afterwards. Before reading your question, I probably would not have thought about mentioning the side effects you describe, so I cannot fault your urologist for not doing so either. I am really grateful for the opportunity the Internet provides for us to learn more from each other and share more widely! My deepest wish is that this article will help you and others find relief.

Thank you, PJ, for asking the right questions!

One Critical Lifestyle Change That Can Boost Male Testosterone: Sleep

Functional medicine doctors refer to the interplay of hormones throughout the body as the “hormone dance.” Having enough testosterone that works the way it is supposed to is not a simple formula of hormone in, function out. It is a much more complex interplay throughout our bodies.

Many men suffering signs of testosterone deficiency such as fatigue, lowered libido, loss of muscle mass, depression, and weak erections will find that numerous factors contribute to their hormonal dysfunctions.

How you live your life on a daily basis has a tremendous impact on how your hormones work. Sleep deprivation is a factor that is often overlooked because it isn’t easy to test for and treating it really requires comprehensive changes on the patient’s part. Knowing about these issues will help you put your health in your own hands!

The data on sleep and testosterone is extensive. At the severe end of the spectrum, men with obstructive sleep apnea have been found to have significant drops in testosterone levels throughout the day, as compared with those who do not have sleep apnea.[1]

But it is not just diseases like sleep apnea that cause problems. Both long-term (sleeping every night but not enough hours) and short-term (skipping an entire night of sleep) sleep deprivation bring down testosterone.

In a study of otherwise healthy men who missed just one night of sleep, the men had significant drops in their testosterone levels the very next day![2,3]

Men who only get 4 or 5 hours of sleep per night for just a few days also show drops in testosterone, even if they get 10 hours of sleep the night immediately before the period of sleep deprivation.[4] Testosterone levels drop by 10-15% in young healthy men after just one week of 5 hours of sleep, compared to the drop of 1-2% per year that is commonly seen with aging.[5]

In an attempt to make up for the missed sleep, researchers had subjects practice extended sleep (10 hours a night) versus regular sleep (8.5 hours a night) for 6 days before keeping them up for 24 hours. They found, as expected, significant drops in testosterone levels after being kept up for 24 hours and then getting a night of recovery sleep.[6] All the extra sleep before and after wasn’t enough to prevent the drop from just one night of sleep deprivation!

Another study has shown that in men with chronic sleep deprivation during the week, having 3 nights of “catch-up sleep” on the weekends (10 hours) did raise their testosterone levels.[7] Catch-up sleep is important if you are deprived of sleep, but continuing to not get enough sleep on a frequent basis will keep your testosterone levels far lower than you need for true well-being.

We can conclude from all of this data that one of the keys for producing healthy levels of testosterone every day is to get a good night’s sleep. If your lifestyle prevents this, look closely at what you can change. If you have medical issues keeping you from sleeping well, seek out a functional medicine practitioner or other health care provider who can help you sort this out!


  1. Ghiciuc CM, Dima-Cozma LC, Bercea RM, Lupusoru CE, Mihaescu T, Cozma S, Patacchioli FR. Braz J Otorhinolaryngol.Imbalance in the diurnal salivary testosterone/cortisol ratio in men with severe obstructive sleep apnea: an observational study. 2015 Dec 17. pii: S1808-8694(15)00241-4. doi: 10.1016/j.bjorl.2015.09.004. [Epub ahead of print]
  2. Jauch-Chara K, Schmid SM, Hallschmid M, Oltmanns KM, Schultes B. Pituitary-gonadal and pituitary-thyroid axis hormone concentrations before and during a hypoglycemic clamp after sleep deprivation in healthy men. PLoS One. 2013;8(1):e54209. doi: 10.1371/journal.pone.0054209. Epub 2013 Jan 10.
  3. Cote KA, McCormick CM, Geniole SN, Renn RP, MacAulay SD. Sleep deprivation lowers reactive aggression and testosterone in men. Biol Psychol. 2013 Feb;92(2):249-56. doi: 10.1016/j.biopsycho.2012.09.011. Epub 2012 Oct 6.
  4. Reynolds AC, Dorrian J, Liu PY, Van Dongen HP, Wittert GA, Harmer LJ, Banks S. Impact of five nights of sleep restriction on glucose metabolism, leptin and testosterone in young adult men. PLoS One. 2012;7(7):e41218. doi: 10.1371/journal.pone.0041218. Epub 2012 Jul 23.
  5. Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011 Jun 1;305(21):2173-4. doi: 10.1001/jama.2011.710.
  6. Arnal PJ, Drogou C, Sauvet F, Regnaud J, Dispersyn G, Faraut B, Millet GY, Leger D, Gomez-Merino D, Chennaoui M. Effect of sleep extension on the subsequent testosterone, cortisol and prolactin responses to total sleep deprivation and recovery. J Neuroendocrinol. 2015 Dec 9. doi: 10.1111/jne.12346. [Epub ahead of print]
  7. Killick R, Hoyos CM, Melehan KL, Dungan GC, Poh J, Liu PY. Metabolic and hormonal effects of ‘catch-up’ sleep in men with chronic, repetitive, lifestyle-driven sleep restriction. Clin Endocrinol (Oxf). 2015 Oct;83(4):498-507. doi: 10.1111/cen.12747. Epub 2015 Mar 6.

The Right Diet for Your Genes

I’ve been studying genetics for a long time. Working in a genetics research lab is how I put myself through college! But it wasn’t until recently that I found a way to really use this information in my daily health practices. In this article, I share with you a fantastic service for finding the right diet for your genes.

In this great video, the folks at GH HealthWatch illustrate how you can develop a personalized diet from knowing your genes.

My mother and I are both AA (also reported as TT, since these are the bases that join to form a pair). This is not surprising, since we are primarily of European descent. According to the video, this means we should be able to produce all of the fatty acids we need from plants. Interestingly, however, we both have some variants of genes that convert beta-carotene to vitamin A, which means it is better if we get our vitamin A from animal sources. (Knowing this, I make sure to include cod liver oil in my daily supplement regimen.)

We learned this about ourselves on the GB HealthWatch website, where you can upload raw genetic data from 23andme and get lots of useful information on how your body is likely to process the foods you eat. Best of all, you can do this for free. All you have to do is upload your raw genetic data from 23andme on their site. Once uploaded, read the article “Are Plant or Animal Fats Better for You?,” and select “Show Gene Info” on the upper left to see your FADS1 genotype.

Besides some guidance on the best foods for me, I’ve gotten even more health insights from this website. Before I went on a gluten-free and high nutrition whole foods diet, I suffered from canker sores. Well, GB HealthWatch tells me why—I have high risk genes in 2 major contributors to this problem! Fortunately, the dietary changes I have made have calmed my immune system down and provided the nutritional support I need to be well.

If you haven’t been genotyped on 23andme yet, check it out now! Then, upload your raw data, for free, at GB HealthWatch and learn more about which diet is best for your genes!

Regardless of your genes, remember, a whole foods diet is the healthiest—eating foods in as close to their natural state as possible helps you get the most nutrients in each bite. Be sure to consume a variety of fruits, vegetables, whole grains or meat, and eggs or fish, depending on your preferences and the foods that feel best in your body!