Oct 19, 2010

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.

My daughter, Emily, had an assignment at school. They had to come up with four statements about themselves. Three of the statements were to be true and one statement was to be false. They were going to present these four statements to their class with a computer assisted Smart board. During the presentation, the class was going to guess which was true and which was false. Emily really liked this assignment because she typed words into the computer and picked pictures to go with the words. She was telling me the last two statements she had written. For my true one, she said I said our house was gray, and picked a picture of a gray house! For my fake one, I said you were from England, because I like how that flag looked. I giggled a bit, and broke the bad news. Unfortunately Emmie, I was born in England. That one is actually true. She was quite annoyed, rolled her eyes and said, There is soooo much about my family I dont know! Much like Emily, there is soooo much about the skin condition psoriasis I dont know. So I participated in an online webinar and learned a little.

Psoriasis is a skin disease, but it can effect more than the skin. The most common form of psoriasis is called chronic 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 cant cure psoriasis, but we have treatments that can treat the symptoms.

Psoriasis is not contagious. It is not causes by a bacteria or virus. You cant pass psoriasis onto another person by touching them. Psoriasis is an autoimmune disease. That means the bodys own immune system attacks itself by accident. This autoimmune attack causes inflammation. Healthy inflammation happens when the skin is cut or torn. The area 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 dont get any blood supply. These cells die off which forms that silver-white scaly crust that we get with psoriasis.

What causes psoriasis? We dont know. It probably has a genetic component because it does run in some families. Psoriasis usually starts in a persons twenties or thirties. It can start with a trigger like a serious illness, but often we dont know what triggered the original flare up. Psoriasis isnt just a disease of the skin. Up to 30% of patients with psoriasis have symptoms of arthritis. Psoriasis many increase the chance of getting diabetes and high blood pressure. 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 psoriasis. 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 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.

If you have psoriasis, do some reading and talk to your doctor. Maybe there will be sooo much you can learn about your condition too.

Psoriasis Info

Canadian Dermatology Association

US National Psoriasis Foundation

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