May 13, 2013

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

The camera pans in on darkened hospital room. A worried looking young doctor puts away his stethoscope. He stands over a middle aged lady in the hospital bed. From camera left, a nurse enters the room and asks, Doctor has Mrs. Smith regained consciousness? The doctor turns to the nurse gravely and says, No, she is touch and go. In this tension filled fictions medical drama touch and go means we arent sure if the patient is going to get better or not. What I didnt realize is touch and go has a more nautical origin. In the British Royal Navy, touch and go meant a sailing ship just barely ran aground, but then freed herself again. Im sure the sailing ship in question was also tension filled as everyone on board wondered if they were going to drown or not.


Psoriasis almost never puts the patient in danger for their life. However, that doesnt means the life of someone with psoriasis is not tension filled. 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. 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 cant cure psoriasis, but we 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. 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 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 families. Psoriasis usually starts in a persons twenties or thirties. It can also start in a persons 50s or 60s but that is less common. Psoriasis isnt 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.


Touch and go implies a life or death struggle or tension. Not all tension from medical conditions is life or death, though. A hair stylist with psoriasis on her hands may wonder if her clients will come back. A life guard with psoriasis on his elbow may wonder if anyone will take swimming lessons from him. Quality of life should be a top concern as the medical professions try to remember psoriasis is more than just a rash.



Psoriasis Info

Psoriasis Treatment Guidelines - Canadian Dermatology Association

US National Psoriasis Foundation



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

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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.


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