Psoriasis

About Psoriasis

For you or a loved one with psoriasis, this section goes into the medical treatment methods and alternative therapies available. Perhaps most importantly, though, it emphasizes the importance of a support network and empowers people with practical things they can do to make it easier to live with the condition.

What is psoriasis?

top

Psoriasis is a disease that causes the skin cells to grow too quickly. Skin lesions or plaques — patches of dead skin — can appear to be rough, dry and thick as dead skin builds up, red and irritated with silvery scales and a distinct border between the plaque and normal skin. Sometimes the lesions itch, burn, or bleed. Patches are most often seen on the elbows, knees, and torso, but can appear anywhere, including the scalp. Fingernails and toenails can also be affected — nails become thickened, lift up from the skin or become pitted (small holes form in them).

Psoriasis is a chronic disease, meaning once it starts, it likely persists life-long. We don’t yet know what triggers psoriasis or how to cure it, but we do know about the types of psoriasis symptoms, how to treat symptoms, and how the disease progresses.

What causes psoriasis?

top

Psoriasis is not contagious — you can’t catch it from someone who has it. The lesions you see on your skin are the result of an overactive immune system which mistakenly attacks your own healthy skin cells. Scientists are not sure why this happens. But the nature of psoriasis puts it in the category of “autoimmune diseases”.

Scientists are studying the potential causes:

  • Genetics: some people have genes that set them up to develop psoriasis — although carrying these genes is enough to develop the disease
  • Triggering event: external factors are usually needed to set off psoriasis
  • Triggers are not universal, but there some that are common to many people:
    • Stress
    • Damage or injury to the skin, like scratches, scrapes, bug bites, cuts, sunburns and vaccinations
    • Use of certain medications, or certain infections, like strep throat
    • Smoking
    • Heavy alcohol consumption
    • Cold weather
  • Other risk factors: someone who smokes, is overweight, or has a relative with psoriasis is also at higher risk of developing the disease

What are the effects of psoriasis?

top

Inflammation is a natural process that your body normally uses to protect itself from harm. Inflammation is behind the pain and swelling you feel from:

  • Bumping your knee
  • An infection in your throat
  • Burning your hand while cooking
  • A sunburn
  • A paper cut
  • Etc. 

When a portion of skin is affected, it becomes red, swollen and painful, and feels hot or warm to the touch: this is called inflammation.

A normal skin cell takes 28 to 30 days to form at the bottom layer of your skin, then makes its way to the surface, falling off without you noticing. When your immune system malfunctions and produces inflammation in an area of your skin, it only takes three to four days for the skin cells to mature and reach the surface. The skin cells don’t have time to fall off, and build up with other skin cells instead, creating inflamed skin scales and skin plaques.

The severity of psoriasis is measured by the percentage of body surface affected (BSA). Your palm is usually the reference point to represent 1% of the total body surface.
Mild psoriasis: less than 5% BSA
Moderate psoriasis: 5 to 10% BSA
Severe psoriasis: more than 10% BSA

However, severity can also be measured by how psoriasis affects your quality of life. For example, even a mild case affecting only a small area in the palms or soles of the feet can have a significant impact on your life.

Psoriasis symptoms tend to change over time, appearing differently in each person. People with psoriasis often suffer from a cycle of periods of active disease — flares — followed by periods when symptoms disappear, called remissions. The triggers, which can set off psoriasis in the first place, often worsen symptoms or cause a flare after a period of remission.

If inflammation from psoriasis is left untreated, it can eventually lead to thickened skin, scarring, disfigurement and bacterial skin infections caused by scratching and touching plaques. Fortunately, there are many ways to treat psoriasis and prevent complications before they happen.

Which body parts are affected?

Psoriasis patches can range from a few pinhead-sized spots to major eruptions that cover large areas of the body.

Are there other complications?

If you have psoriasis, you’re at greater risk of developing other diseases, such as:

  • Psoriatic arthritis (in 10% and 30% of people with psoriasis)
  • Depression (in about a third of people with psoriasis)
  • Anxiety
  • Crohn's disease, a type of inflammatory bowel disease
  • Diabetes
  • Hypertension
  • Cardiovascular disease

Many psoriasis patients also feel embarrassed by their appearance, avoiding social situations or other daily activities, and intimacy with their partners.

Support is everything

top

No man is an island: in other words, it is not helpful to try to live with psoriasis by yourself. Your friends and family can help, along with your treatment team of health care professionals.
Living with any chronic disease can make you feel isolated — especially when you have to adapt or change your daily routine, see many health care practitioners, and learn medical terms. But you don’t need to do it alone.

When you’re living with psoriasis, it’s invaluable to keep the lines of communication open with your family, friends and coworkers: they can’t understand what it’s like to live with psoriasis if you don’t talk openly about it.

Here are some tips and helpful insights we’ve learned from psoriasis patients:

  • Ask those closest to you to learn about your condition. This way they’ll understand your symptoms, or even go with you to your appointments. They can read this or other web sites, or consult reliable sources like libraries, or the Canadian Psoriasis Foundation. 
  • Let them know you need their support. This could be just a sympathetic ear when you need to talk. Be sure to tell them that inflammatory diseases always have good and bad days. 
  • Always be open and honest about your psoriasis. It’s the only way people can help you. Remember, if you’ve ever said to a friend or family member, “You don’t know what it’s like”, that’s maybe because you haven’t told them.

When we stop doing the things we love, our mood drops, symptoms seem worse, and it becomes even harder to get motivated. Keeping fun in your life is absolutely essential — make it a top priority. It boosts your mood, your relationships, and your energy level. Find one activity you love — even a small one — that you can add to each week without fail, and one you can add to each day. Once they become routine, you'll start feeling better and will want to add more.

Psoriasis is different for every patient, and treatment must be tailored for each individual case. The key is to communicate regularly with your doctor about your progress and the effects of your treatment, and to follow your treatment instructions every day, as medication can take time to work. If you feel there’s a problem with your regimen, or are experiencing any side effects, talk to your doctor right away about trying alternative methods. Don't hesitate to ask questions and get involved in decision-making regarding your health. And keep in mind there are many options available to you, so if one approach isn’t working, another one might.

Lifestyle options

top

If you have psoriasis, there are things you can do; soothing skin care routines, healthy eating and relaxation techniques are important factors in keeping your skin healthy. Talk to your health care professional for more guidance. While there’s no cure yet for psoriasis, a healthy lifestyle certainly supports overall health. 

Proper skincare will help you manage some psoriasis symptoms. To soothe your skin:

  • Soak up a little sun: moderate exposure to sunlight usually helps by slowing the growth of skin cells. However, too much sun damages your skin, so always use sunscreen. Be aware that in rare cases, UV exposure makes some types of psoriasis worse
  • Control air humidity: use a humidifier to prevent dry air, which can aggravate psoriasis, especially in winter
  • Moisturize: keep your skin moist with topical creams and lotions that contain cocoa butter, lanolin, petroleum jelly, light mineral oil or baby oil
  • Avoid irritating products: don’t use strong soaps and moisturizers that contain perfumes or chemicals
  • Take daily baths: gently washing your skin every day helps to remove dead skin and calm inflammation
  • Use medicated creams and ointments: your pharmacy has non-prescription products that can help reduce itching and scaling. For scalp psoriasis, try a medicated shampoo. Always follow label directions and your doctor’s advice 

If you have psoriasis, maintaining a healthy weight is the main reason to exercise and watch what you eat. It helps reduce the severity of your psoriasis, and can minimize your risk of developing related conditions like diabetes and heart disease.

First identify the triggers that bring about your flares or make your symptoms worse, and then try to avoid them. For example:

  • Stay healthy to ward off infections
  • Avoid alcohol. It’s a potential trigger, and may decrease the effectiveness of some psoriasis treatments
  • Choose not to smoke
  • Keep away from unnecessary stressful situations
  • Opt out of activities or situations that could injure your skin
  • Keep a food diary. While science hasn’t proven that certain foods either improve or aggravate psoriasis, you can track whether certain foods affect your symptoms
  • Avoid staying in the sun for prolonged periods to prevent sunburns

Stress can lead to an increase blood pressure, interrupt sleep, and play a role in the intensity of psoriasis symptoms. The first step is identifying stress triggers — then developing relaxation and coping skills to improve your overall wellbeing and give you a greater sense of control over your psoriasis. 

On days when you might feel particularly self-conscious about the appearance of your skin, you can cover the affected areas with clothing, or use makeup or concealer to mask redness and plaques. However, never cover open sores or unhealed lesions — it could irritate skin even more.

Complementary therapy options

top

For some people with psoriasis, complementary and alternative therapies — treatments that fall outside the scope of traditional western medicine — can sometimes work very well for symptom relief. Ask your health care professional about alternative therapies. 

Omega-3 fatty acids (fish oil) supplements may reduce inflammation associated with psoriasis. Vitamin E is also thought to benefit skin and nails. Talk to your health care professional for more guidance.

Some people add natural relief therapies to their medical psoriasis treatments, such as acupuncture, acupressure, massage therapy, or biofeedback (with or without hypnosis). Always first discuss these treatment options with your physician, and be sure to tell any alternative health specialist about your condition in order to avoid injury.

Medical treatment

top

Psoriasis medications relieve symptoms and inflammation, and interrupt the cycle of increased production of skin cells. Your doctor can explain the different medications, their benefits and side effects. You will likely try different therapies or combinations before finding the best prolonged symptom relief.

Applied directly to the affected area, topical corticosteroids are the most frequently prescribed for treating mild-to-moderate psoriasis. They slow cell turnover, which reduces inflammation and relieves itching. They should only be used for limited periods, because long-term use or overuse of strong corticosteroids can cause thinning of the skin and resistance to the treatment's benefits. 

Brief exposure to small amounts of sunlight, or to controlled doses of UVB light from an artificial source, may improve mild-to-moderate psoriasis symptoms. During UVB treatment, psoriasis may worsen temporarily before improving, and light therapy can cause short-term side effects such as redness, itching and dry skin. Moisturizers help lessen these side effects.

Combining UVB with other therapies may increase efficacy dramatically and allow for lower doses of medication.

Reserved for moderate-to-severe cases, PUVA (psoralen plus long-wave ultraviolet A light) can be used to clear psoriasis. PUVA uses a light-sensitive compound in addition to light therapy, and usually works in over 85% of people with chronic psoriasis lesions.

The short-term side effects with PUVA include nausea, headache, burning and itching. The long-term side effects can include dry and wrinkled skin, freckles, and increased risk of skin cancer (including melanoma, the most serious form of skin cancer).

If your psoriasis is severe and doesn't respond to other treatments, your doctor may recommend using a drug from the retinoid family. It’s not known exactly how retinoids work, but they reduce skin cell production and the speed at which they grow and shed. 

With retinoids, symptoms usually return once the therapy is stopped. Common side effects are dry skin and mucous membranes, itching, and hair loss. Women must avoid pregnancy for at least three years after taking retinoids since they can cause severe birth defects.

Disease-modifying anti-rheumatic drugs (DMARDs) are medications often prescribed to relieve skin inflammation and decrease skin cell production in people with moderate-to-severe psoriasis. DMARDs can take time to work - it may be weeks or months before you see a noticeable difference in your symptoms. During this time, your doctor may prescribe another medication, like a topical corticosteroid, to help control symptoms.

DMARDs are meant for long-term management and may be taken consistently for months or years in order to keep psoriasis in remission
Common side effects include nausea, diarrhea, upset stomach, dizziness, increased risk of infection, and liver problems. Regular blood work is needed for the monitoring of blood cell counts and liver function. 

Although they can be taken alone, DMARDS are sometimes prescribed with light therapy, other DMARDs or biologic medications. Your doctor will recommend the therapy best suited to your type and stage of psoriasis, other medical problems and medications.

Biologic response modifiers, or biologics for short, are medications specifically designed to target your body’s immune system. Like DMARDs, biologics are used to slow the production of skin cells, and ease the pain and swelling of psoriasis plaques and scales.

Biologics can take some time to work. Some people notice the effects of the medication quickly (within a week), while it takes others months to feel the effects. Biologics are often combined with other medications to treat psoriasis, such as DMARDs. They are also prescribed when other psoriasis therapies aren’t effective, and in people with moderate-to-severe cases.

Common side effects with biologics include mild skin reactions at the injection site, nausea, abdominal pain and headaches. Rarely, people who take biologics may develop serious infections, lupus-like reactions, nervous system diseases, and cancer. You should not take a biologic if you are pregnant or nursing, or have a history of multiple sclerosis or cancer. Inform your doctor if you have a history of tuberculosis, hepatitis B, or recurrent infections. 

Biologics are administered in two ways: infusion or injection. Your doctor can provide you with information and help make the right choice for you.

Understanding biologic and biosimilar medications

Most people are familiar with conventional medications such as pain relievers. These medications are made from chemicals (chemically synthesized).

Some of you may also have heard about biological or “biologic” medications which are used to treat serious illnesses, such as cancer, inflammatory bowel disease, psoriasis and rheumatoid arthritis. Biologics are special medications created using the biologic processes within living cells.

Conventional medicines and biologic medicines have important differences.

 

Conventional medicines Biologic medicines
Made from chemicals Created in living cells
Generally small molecules Complex large molecules

 

Some history on biologics…

  • In the 1970s and 1980s scientists started inserting selected genes into living cells to make specific proteins, or “biologics” that could be used as treatments for people.
  • The first biologic was human insulin, used to treat diabetes.

It is common knowledge that when the patent expires on a conventional medication, other companies are allowed to make copies called generics. Although the active ingredient in a generic is exactly the same as the active ingredient in the original conventional medication, non-medicinal ingredients, like fillers and colouring, may be different.

When the patent on a biologic medication expires, other companies are allowed to make copies. However, since it is impossible to make exact copies of biologic medications because of the way they are made, the copies are not called generics or even biogenerics. The correct term is biosimilar since it can only be similar and not identical to the original. In Canada, the official term for a biosimilar medication is Subsequent Entry Biologic or SEB.

Is a biosimilar a generic version of the original biologic drug?

No, biosimilars are similar to, but not identical to the original biologic drug. This is because the group of cells used to produce the drugs (the cell line), the actual drug molecule and the manufacturing process are different.

In Canada, manufacturers of biosimilars are required to show Health Canada that their product is similar to the original biologic and that the benefits of their product outweigh the risks. SEBs must have a label that is different from the original biologic medication.

Does the difference between a biosimilar and the original biologic matter to me and my care?

Yes, original biologics and biosimilars may act differently in your body and could have different side effects.

Since original biologics and the biosimilar versions are not identical, it’s important that you review your prescription with your doctor so you know which one is being prescribed.

Health Canada does not support automatic substitution of a biosimilar for an original biologic at the pharmacy.

For more information about biosimilar medicines, visit:

Health Canada
www.hc-sc.gc.ca/dhp-mps/brgtherap/applic-demande/guides/seb-pbu/01-2010-seb-pbu-qa-qr-eng.php

Alliance for Safe Biologic Medicines (USA)
www.safebiologics.org

Disclaimer 

Please note that the information on this Web site should not be used as a substitute for seeking medical advice or treatment from a physician. You should not use this information to diagnose or treat a medical condition or health problem. Speak to your health care provider if you have any questions about your medical condition, symptoms or treatment options. The information found on this Web site can be referenced at www.dermatology.ca