Psoriasis

Apr 20, 2016

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

The ball was kicked high in the air. Eric got underneath it. Was he going to flinch or misjudge it? Was it going bounce over his head dangerously deep into our end of the pitch? Nope. He made contact for a decent header up the field to one of our strikers. Eric claimed afterward, he wasn't really trying to head the ball. He says it was more like he accidentally got hit in the head. But, from the sidelines it looked like he knew what he was doing. The really cool part was when his head made contact with the ball, his bright yellow left soccer boot went flying off his foot. It was just like those 5 steel ball bearing desk top clacking devices. You pull one ball bearing on a string, let it go, it clacks into the row of 4 other suspended ball bearings and the fifth one flies away from the group. It was just like that, the soccer ball hit Eric's head, somehow the energy transferred through his whole body and his soccer boot blew off.

I was surprised to see soccer ball to the head knock off a soccer boot. Most people are surprised a rash can cause social isolation. One study of 1300 people with moderate to severe psoriasis found 26% of them reported that in the last month someone made a conscious effort not to touch them and 19% of them had been asked to leave a social situation like a gym or swimming pool.

Psoriasis is a skin disease, but it can effect more than the skin. It is estimated that over 500,000 Canadians or 1.7% of the population have psoriasis. It occurs more often in the Northern Hemisphere and more often in Caucasian people. The most common form of psoriasis is called plaque psoriasis. Areas of the skin develop red patches. The red patches often have dry silvery scales on them. Psoriasis is a chronic disease like diabetes, or high blood pressure. That means we can't cure psoriasis, but we can treat the symptoms.

Psoriasis is not contagious. It is not causes by a bacteria or virus. You can't pass psoriasis onto another person by touching them. Psoriasis is an autoimmune disease. That means the body's own immune system attacks itself. This autoimmune attack causes inflammation. Healthy inflammation happens when the skin is cut or torn. The skin gets red and hot and swollen with blood. Part of the inflammatory cycle is for skin cells to reproduce rapidly. These rapidly reproducing cells help heal up and repair the wound. In psoriasis undamaged skin gets inflamed and the skin cells go into wound repair mode. The cells reproduce rapidly, but there is no wound to repair. So the extra cells are pushed to the surface. This causes a raised area. The cells at the top of this raised area don't get any blood supply. These cells die off which forms that silver-white scaly crust that we get with psoriasis.

What causes psoriasis? We don't know. It probably has a genetic component because it does run in families. Psoriasis usually starts in a person's twenties or thirties. It can also start in a person's 50's or 60's but that is less common. Psoriasis isn't just a disease of the skin. Many diseases like arthritis happen more often in people with psoriasis. Other comorbid conditions include diabetes, high blood pressure, heart disease, obesity, inflammatory bowel disease, liver disease, and stomach ulcers. Many psoriasis patients also experience low self-esteem, depression, stress, anxiety and feelings of helplessness.

How is psoriasis treated? It depends on the severity of the disease. About 80% of people with psoriasis have a mild condition. By that we mean less than 10% of their body is covered with lesions. For them usually a topical ointment or cream that you can rub directly onto the lesion can work well. Some common ingredients in topical psoriasis treatments include steroids, coal tar, Vitamin D analogues and Vitamin A products.

Steroids reduce inflammation. They are available from quite weak ones that can be bought without a prescription all the way to ones that are so strong that they could burn your face if used there. Coal tar can help slow the rapid growth of skin cells and restore the skin's appearance. In addition, coal tar can help reduce the inflammation, itching and scaling of psoriasis. Calcipotriol is a form of synthetic Vitamin D3 that can slow skin cell growth, flatten lesions and remove scale. The most common side effect of calcipotriol is skin irritation, stinging and burning. A form of Vitamin A called a retinoid can be applied to a psoriasis lesion to slow skin cell growth. It is normal for psoriasis plaques to become very red before clearing when using a retinoid. The redness is often intense in color, but it is generally not painful. The most common side effects from the Vitamin A products are skin irritation, dry skin and increased susceptibility to sunburn.

For more severe psoriasis, there are stronger therapies than topical creams. Phototherapy is when the skin is exposed to ultraviolet light under medical supervision. Not being a drug, it is outside my expertise, but I read that it can be done in a clinic or at home. There are oral pills which are similar to those used in rheumatoid arthritis. They have names like cyclosporin, methotrexate and acitretin. They are designed to suppress the immune system and so reduce flare ups. The newest treatments for psoriasis are the injectable biologics. They are very potent but very specific immune suppressors. They are designed to only suppress the parts of the immune system that causes the flare ups and so should work better with fewer side effects. But the biologics are very expensive. They have names like remicade, humira, enbrel and stelara. They can cost thousands of dollars a month. Before someone starts phototherapy, oral immune suppressors or injectable biologics, they should see a dermatologist.

We were lucky to get to play soccer in the early spring when there was still snow on the ground. We got to play in a beautiful indoor facility at the U of M in Winnipeg with artificial turf and high ceilings. I was surprised when we got there at 7:30 am that old timers like me had been playing soccer since 6 am. I'm not sure if I'd play rec hockey if I had to be at the rink at 6 am on a Saturday. But Eric's header shoe maneuver surprised me the most. He might not have been the most talented player on the pitch that weekend, but I don't think anyone else pulled off Eric's trick shot.

I'm Trevor Shewfelt from the Dauphin Clinic Pharmacy. The Pharmacy

Feature is heard every Tuesday here on 730 CKDM.

Psoriasis Info www.livingwellwithpsoriasis.com

Psoriasis Treatment Guidelines - Canadian Dermatology Association

www.dermatology.ca/wp-content/uploads/2012/01/cdnpsoriasisguidelines.pdf

US National Psoriasis Foundation www.psoriasis.org

As always if you have any questions or concerns about these products, ask your pharmacist.

 


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