Psoriasis: More than just skin deep
By Dr. Richard G.B. Langley
Psoriasis affects approximately one million Canadians and 125 million people worldwide, but it’s by no means just a skin disease. While this condition’s uncomfortable and often unsightly symptoms – such as scaling and raw skin lesions that can itch or burn – are its most visible impacts, research now shows that psoriasis can affect the whole body.
Serious Health Links
The effects of psoriasis can extend far beyond what you can see. Up to one-third of people with the condition have arthritis or go on to develop it. According to the National Psoriasis Foundation, psoriasis has also been linked to depression in about one-quarter of psoriasis sufferers, mainly because of its effects on mood and self-esteem. Psoriasis also negatively affects patients’ quality of life in other ways, such as limiting one’s ability to move or walk (if it affects feet) and even to work, thanks to flare-ups and sick days that result.
Other chronic and life-threatening diseases, such as diabetes, cardiovascular disease, obesity and cancer, are also associated with psoriasis.
Study findings are showing, for example, that psoriasis can increase the risk of heart attack and stroke. Researchers have also found connections with diabetes and high blood pressure. Another recent study suggests a link between psoriasis and kidney disease.
While it’s not clear how they are linked, psoriasis may play a contributing role to these and other diseases. Or it could be just a matter of bad company – skin lesions may signal some shared underlying glitch in the body that contributes to various diseases.
Whatever links may emerge, some psoriasis drugs may improve not only psoriasis but these underlying conditions. A paper published in the Journal of the American Academy of Dermatology reported that the psoriasis drug methotrexate, as well as some biologics (drugs that work by blocking specific proteins in the immune system), may reduce the risk of heart attack, stroke and other cardiovascular events. Some scientists also believe that treating psoriasis may help to reduce the risk and complications of other systemic diseases.
A Personalized Treatment Plan
Choosing the right treatment can be tricky – the goal is to maximize symptom relief while minimizing side effects. Usually a dermatologist assesses the type of psoriasis (plaque psoriasis makes up 90 per cent of cases), its severity or how large an area of skin is affected, and how a patient responds to treatment. A growing number of treatment options exist, including the recent addition of biologics to our armamentarium, which have shown increased efficacy. For mild to moderate psoriasis, topical treatments (creams and ointments applied to skin), such as corticosteroids, vitamin D or vitamin A derivatives and coal tar, offer relief. Topical agents reduce inflammation, slow down skin cell turnover and dampen the immune system, as well as moisturizing skin. Light therapy, or phototherapy, uses ultraviolet (UV) light to treat lesions. ™
For moderate to severe psoriasis (or more widespread disease affecting areas that have a significant impact on quality of life, such as lesions on the hands and/or feet), drugs are given orally, by injection or by infusion.
Oral medications include methotrexate, acitretin and cyclosporine. Biologics such as etanercept and adalimumab, which block cytokines called tumor necrosis factor-alpha (TNF-a), are injected at home; whereas another biologic, infliximab, is given by infusion at a clinic. Other biologics that can be injected at home, including the antibody ustekinumab, block chemical messengers in the immune system known as interleukin 12 and 23. Meanwhile, exciting ongoing research is expected to soon result in new oral medications, which may include two called apremilast and tofacitanib, respectively, as well as novel biologics, including brodalumab, ixekizumab and secukinumab, that block interleukin 17.
Winter-Proofing your skin
From holiday stress to dry indoor air and frigid temperatures, skin affected by psoriasis doesn’t enjoy winter. What’s worse is that during cold and flu season, infections can aggravate psoriasis symptoms. The reason is viruses and bacteria can upset the immune system as the body tries to fight off a seasonal bug, leading to infections that cause skin flare-ups. Meanwhile, some medications used to treat psoriasis suppress the immune system, which may increase your chances of getting the flu by lowering your body’s defenses. One form of the skin disease called guttate psoriasis can be triggered by an infection such as strep throat. A number of factors can trigger or worsen symptoms – here’s what to be mindful of in winter time:
Avoid temperature extremes. Cold weather can cause skin dryness and cracking, so don’t stay outside long in very low temperatures. Hot and dry indoor air may not be much better for skin, so turn down the heat and don’t plant yourself right in front of the fireplace.
Moisturize. With lower humidity levels in winter time, skin can succumb to dryness and chafing. For skin affected by psoriasis, any injury to the skin can trigger symptoms, so keep skin hydrated and protected. Drink more water, use a humidifier to put moisture back into your home, and use a moisturizing lotion or cream daily. Find a product you like to use, or ask your dermatologist or pharmacist to suggest one.
Manage your stress. Stress is associated with many diseases, and psoriasis is no exception. Periods of stress can trigger a flare-up of symptoms, so steal some quiet time, meditate, listen to soothing music or sounds or go for a walk.
Keep moving. Exercise is a healthy lifestyle habit that can reduce stress, improve sleep, control your weight and guard your health overall. But many of us slack off an exercise routine in the winter. It’s important to keep moving whether inside or outside.
Protect against skin injury. A scrape, cut or bruise can be a ripe opportunity for psoriasis to set up camp. Treat your skin like fine porcelain, protecting it from scratches or bumps, so you don’t provoke symptoms.
Dr. Richard G.B. Langley is President of the Canadian Dermatology Association, a professor and Director of Research at the Di- vision of Dermatology, Department of Medi- cine, Dalhousie University. He has received numerous awards for teaching, research, clinical practice and volunteer activities.
HOW BAD IS IT?
As shown below, psoriasis severity is generally classified by how much of the body it covers. however, we now know that even “mild” psoriasis, or disease that affects limited areas of skin, can actually be severe depending on what areas it affects, such as hands and feet, and how much it impacts a patient’s ability to function.
MILD PSORIASIS AFFECTS LESS THAN 3 PER CENT OF THE SKIN
MODERATE PSORIASIS AFFECTS 3 TO 10 PER CENT OF THE SKIN
SEVERE PSORIASIS AFFECTS MORE THAN 10 PER CENT OF THE SKIN
Baby, it’s cold outside!
Winter weather and cold temperatures can be tough on a baby’s delicate skin. here are some simple tips for avoiding irritations and problems.
Warm clothes are a must for taking infants outside on a chilly day. As cold wind can cause frostnip, a milder ver- sion of frostbite, it’s important to keep babies out of direct wind. And don’t forget a hat, mittens and booties.
Dressing babies in breathable layers that can be easily removed helps to keep them comfortable when bringing them inside or to warmer areas. It also reduces the risk of heat rash.
over-wet bottoms are a prime breed- ing ground for painful diaper rashes that can be avoided through diligence about diaper duty.
Generally, a baby’s bath time should be no longer than 10 to 12 minutes. Use a mild soap, gently pat skin dry and ap- ply a moisturizer to slightly damp skin.
Dry indoor air and frigid outdoor temperatures can steal moisture from a baby’s skin. Using a humidifier may help.
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