Having psoriasis and celiac disease together can cause trouble with your small intestines, skin, joints, and more. Is it just bad luck if you get both, or is something else at play?
Studies show that people with psoriasis have a greater chance of getting celiac disease and the opposite is true too, says Michele Green, MD, a dermatologist at Lenox Hill Hospital in New York.
Psoriasis and celiac disease are autoimmune diseases, which tend to run in families. In autoimmune diseases, your immune system targets healthy cells in your body by mistake because it thinks they’re foreign invaders.
One large study found that psoriasis is linked to 14 other autoimmune diseases, including celiac disease. In another one, researchers took a close look at four large studies and found that people with psoriasis were three times more likely to get celiac than people who didn’t have psoriasis.
Other research found the chance of getting psoriasis is high in people who already have celiac disease.
What’s the connection? Although questions remain, there’s growing evidence that psoriasis and celiac disease have similar genetic links and inflammatory pathways, Green says.
What Role Does Your Immune System Play?
When your immune system is switched on, it sends out white blood cells, proteins (antibodies), and other cells in response to an injury or infection. Your body sends out inflammatory cells to trap bacteria and viruses in hopes of destroying them. This creates swelling, redness, and pain. The inflammation goes away when you start to heal.
But when your immune system fights your own healthy tissue, inflammation doesn’t know when to stop. It’s like a Ferris wheel — once inflammation starts spinning, it’s hard to slow down, explains Danielle Kelvas, MD, a primary care doctor in Johnson City, TN.
In psoriasis, inflammation causes certain skin cells to grow too fast. In the most common type of the skin disease, cells pile up and form thick, itchy patches, called plaques. People with psoriasis can get other problems, including psoriatic arthritis, which can damage joints.
Celiac disease damages the lining of your small intestine. It can cause gut troubles, problems absorbing nutrients, and more. You can have celiac and not even know it. Some people don’t have any symptoms, but damage is still being done.
The inflammation and damage from celiac happens when your immune system reacts to gluten, a protein found in wheat, rye, and barley.
Do You Suspect Celiac Disease?
Celiac disease should be on your radar if you already have psoriasis. You’re at higher risk if a close family member (parent, sibling, child) has it. If you have moderate or severe psoriatic disease, you’re even more prone to getting other autoimmune diseases including celiac, Green says.
You can’t prevent it, but getting a correct diagnosis and treatment can lessen damage and help your gut heal. Call your doctor if you have:
- Stubborn bowel issues including pain, bloating, and diarrhea
- Unexplained weight loss
- Joint pain
- Tiredness
Your doctor may suggest a blood test for antibodies that could point to celiac disease. Don’t remove gluten from your diet before the test because that can cause a false negative.
Even if the blood test shows high levels of antibodies, it doesn’t mean you definitely have it. People with psoriasis often have positive results but don’t have celiac disease. Your doctor may suggest a procedure called an upper GI endoscopy to make a diagnosis. This test looks for damage in the small intestine.
Do You Suspect Psoriasis?
Skin problems are pretty common in people with celiac. So, see a skin doctor (dermatologist) to find out what’s wrong.
It could be psoriasis if:
- You have raised patches that itch or burn.
- Skin rashes come and go, but may be triggered by things like stress or alcohol.
- You notice changes in your nails or pain in your joints, too.
Psoriasis looks different depending on your skin tone. On light-skinned people, plaques may look red. On darker skin, they may be more purple or brown.
Also keep in mind that people with celiac are at risk of getting a skin problem called dermatitis herpetiformis. It’s a burning rash triggered by eating or drinking gluten. It’s more common in people of northern European descent than those of Asian or African descent.
How to Live With Psoriasis and Celiac Disease
There’s no cure for either celiac disease or psoriasis, so good management and treatment are essential, Green says.
Treatments for psoriasis include:
- Steroid creams and ointments you spread on your skin
- Pills like methotrexate to control inflammation from the inside out
- Injections called biologics
- Phototherapy which uses ultraviolet light
Try to lose weight if you need to. Extra pounds can make psoriasis worse and are also hard on your joints.
Treatment for celiac disease starts and ends with closely following a gluten-free diet for the rest of your life.
That means taking a pass on foods with wheat, rye, and barley, like:
- Bread
- Pizza and pasta
- Cakes and pastries
- Beer
Unprocessed meat, vegetables, and dairy foods are naturally gluten-free. Many baked goods, chips, pastas, and other products come in gluten-free options. Look for “gluten-free” on the labels. (The FDA has certain rules for gluten-free products.)
Be on the lookout for hidden sources of gluten, too. Many prepared foods and even vitamins and lipstick include it.
A registered dietitian can help you read food labels and craft a celiac-friendly meal plan based on your likes and dislikes. They also may be able to suggest smartphone apps to help you make safe choices at the grocery store and at restaurants.
Gluten Sensitive or Celiac?
As many as a quarter of people with psoriasis have a gluten sensitivity. What’s the difference between that and celiac? Gluten-sensitive people may have diarrhea and other symptoms when they eat gluten. But, it doesn’t damage the lining of the small intestine like celiac does.
“Even if you don’t have celiac disease but have psoriasis, you may benefit from trying a gluten-free diet to see if it will help some of the symptoms,” Green says.
One study found that people with positive celiac blood markers showed improvements in their skin after being gluten-free for 3 months.