Your Health

Dealing with psoriasis

New treatments help battle dry skin

Dealing with psoriasis

Winnipeg Health Region
Wave, November / December 2010

What is psoriasis?

Psoriasis is a common skin problem. It causes a thick, rough, dry buildup of the outer layer of skin. The thick areas of skin are called plaques. They usually occur on the scalp, elbows, knees, and buttocks, but they can develop anywhere on the skin. People of all ages can have psoriasis. It is not contagious.

How does it occur?

When you have psoriasis, your outer layer of skin makes new cells more rapidly than normal. The extra cells become thick plaques. No one knows exactly what causes psoriasis, but most researchers believe it is an immune system disorder. You are more likely to have psoriasis if members of your family have it.

What are the symptoms?

The symptoms are rough, dry, thick areas of skin. Often the skin under the plaques is slightly red. The skin may or may not itch. Most psoriasis occurs in patches. Sometimes, however, it appears as many small, droplike, scaly areas. This is called guttate or raindrop psoriasis and it often occurs on the back. Psoriasis can affect your fingernails and toenails, causing them to have pits or dents in them. In severe cases, the nails become thick and misshapen.

A few people also have arthritis or joint pain with psoriasis. The symptoms of psoriasis can vary from mild to severe. They may worsen when you are upset, sick, or injured. Flare-ups of the problem may also occur when:

  • You have a skin injury, such as a cut, burn, rash, or insect bite.
  • You drink a lot of alcohol (more than one drink a day for women, more than two drinks for men).
  • You have either very little exposure to sunlight or you have a severe sunburn.
  • Your skin is exposed to constant friction, for example, from clothing.

The severity of the symptoms may change with the seasons. Psoriasis usually gets better when you spend more time out in the sun.

How is it diagnosed?

Your health-care provider will examine your skin and nails. For more information, your provider may do a skin biopsy. The biopsy is done by removing a small sample of your skin after the area has been numbed with an anesthetic.

How is it treated?

Your treatment depends on your symptoms. The goal is to ease discomfort and slow the production of skin cells to prevent or reduce the buildup of plaque. Your health-care provider will recommend or prescribe a cream or ointment to rub on your skin. A variety of medicines are available, such as:

  • Steroid cream or ointment
  • Salicylic acid cream or ointment
  • Tar preparation (commonly ointment or shampoo)
  • Anthralin cream or ointment
  • Vitamin-D-like cream or ointment (calcipotriene)

A group of medicines called retinoids have been used to treat severe psoriasis. One of these, tazarotene, is a very potent gel used on the skin. This medicine may cause birth defects if it is used just before or during pregnancy. Another drug in this category is an oral medicine called acitretin, which is also very likely to cause birth defects.

More severe psoriasis may require medicines to suppress your body's immune response. Examples of such medicines are methotrexate and cyclosporin, which are usually taken by mouth. Another example is a medicine called Amevive (alefacept). It prevents your immune system from overreacting and so helps stop the buildup of extra skin cells. It is given as a shot once a week for 12 weeks. You will need some monitoring with blood tests while you are using these medicines.

Your health-care provider may want you to use more than one type of medicine. If you are using a combination of psoriasis medicines, it is helpful to keep a record of when you use each medicine and review it with your provider at your checkups. Your health-care provider may prescribe ultraviolet (UV) light therapy in addition to your medicines.

Two new prescription treatments are also available in Canada. They are:

Dovobet (calcipotriol/betamethasone diproprionate), a new product that combines the two gold-standard medicines, corticosteroid and the vitamin D derivative calcipotriol. Appropriate for patients with mild to moderate disease, this once-daily at bedtime topical treatment is steroidsparing and works quickly to reduce the signs and symptoms of psoriasis, usually providing noticeable results within one to four weeks.

Dovobet is cost-effective in comparison to other topical treatments. The cost per dose is higher than conventional topical treatment, however comparatively less medicine is used in order to resolve a flare.

Tazorac (tazarotene), a retinoid made from Vitamin A, can be used with emollient creams, once daily in the evening. Patients with mild to moderate psoriasis who have had success with the gel product may be interested in the new cream since it is generally better tolerated. Cost for the new cream formulation of Tazorac is comparable to that of the gel product.

How long will the effects last?

Psoriasis is a chronic disease, which means you will likely have it all of your life. The extent and severity of the disease vary widely. Early treatment of the plaques may help stop the problem from becoming more severe.

How can I help take care of myself?

To help reduce flare-ups:

  • Try to avoid skin injuries. When you do injure your skin, protect your skin from infection.
  • Avoid stress.
  • Exercise daily according to your healthcare provider's recommendation, and maintain a healthy weight.
  • Avoid drinking too much alcohol.
  • Follow your provider's recommendations for keeping your skin soft. Ask your provider to suggest soaps, lotions, and cosmetics.

Linda Coote is a clinical consultant to Health Links - Info Santé, the Winnipeg Health Region's telephone health information service.


About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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