(October 6, 2008 - Insidermedicine) At the recent Annual Conference of the Canadian Dermatology Association in Montreal, we caught up with Dr. Richard Langley MD, FCPC, an Associate Professor of Medicine in Dermatology, and the director of Dermatology Research at Dalhousie University.
If I had scaly plaques on my elbows …
The first consideration is that in people who have psoriasis it’s important that they recognize that this is not a life threatening condition and that it is not contagious – many times people are concerned about that aspect of it. When it was first described it was thought to be a form of leprosy, and so there was a tremendous amount of societal implications to having psoriasis. In fact, it is a chronic condition that isn’t curable, but is easily and well controlled, and there are new therapies that are providing even better control over time.
What is Psoriasis?
Psoriasis is a chronic, long-term incurable condition which is characterized by skin turning over excessively, causing red scaly and occasionally itchy skin. The skin turning over quickly is caused by an abnormality of the immune system. There are associations with psoriasis that are increasingly being recognized such as psoriatic arthritis, as well as other medical conditions such as diabetes, hypertension, even obesity are being found higher rates amongst psoriasis patients. It does run in families, it depends on the region how frequently psoriasis will occur, but generally it occurs in 1-3% of the population, although some areas are less, such as in Japan, and some areas are higher, such as in eastern Canada, particularly in Newfoundland.
Does psoriasis affect quality of life?
Psoriasis is a visible condition, it’s one of the conditions that can affect anywhere on the body, including the face, and when we think about how it impacts patients, it’s important to recognize that it can have a profound negative impact on quality of life. We often hear people say that it’s just a skin disease, but the reality is if it’s affecting your hands and you can’t work, if it’s affecting your feet and you can’t walk, it’s going to have a significant impact. However, even if it is not affecting those areas and perhaps not causing a lot of symptoms, you have to remember that if it is involving visible skin that it can affect patients’ self-esteem, in turn causing increased rates of depression, or in the case of children, being teased, and shyness from going swimming or doing activity, so it can really impact children as well as adults in their psycho-social development.
How is psoriasis treated?
When we talk about treatment, it is helpful to categorize the types of treatment according to the type of psoriasis. In general if we look at more localized psoriasis, say, involving a few large areas we call plaques on the knees and the elbows, topical therapy is often all that is ever needed, and the majority of patients do have relatively milder disease, and that may be all they’re using: topical steroids, topical vitamin D for example. As patients have more extensive disease or if they have localized disease but it involves perhaps a critical area like the hands and feet, or if they have coexisting arthritis called psoriatic arthritis, in those patients we will consider other therapies. Now if you have purely skin disease the nest standard approach is to consider phototherapy, or conventional agents such as methotrexate, or newer agents called biologic therapies. If you have arthiritis involved, we use specific drugs often, such as methatrexate often, or one of the biologic agents.
So if I had chronic psoriasis I think I would have a tremendous amount of optimism and hope right now. There have been tremendous advances in the understanding of this disease and with that has come increasing understanding and development of new therapies. These new therapies are able to control the disease, are able to provide long term benefit, and the safety profile to this point has looked really favorable. So if I had localized disease I’d feel quite comfortable, I know it can be controlled with topical therapies, and if I had more severe disease, I think that the future is promising, and the future is actually here (we now have some new agents available) and we are increasingly seeing improvements in the agents that are coming down the pipeline.