Psoriasis is a chronic autoimmune disease that can start at any age, most commonly in young adulthood; once it appears, it often means a lifetime of flaking and itching skin, sometimes to the extent that people feel imprisoned in their own body. Up to a million Canadians are struggling with the condition’60 percent of them under age 50. (Men and women are equally at risk.)
The red patches of psoriasis, covered in silvery flakes or scales, are often maddeningly itchy. They can be cracked and sore, and they can bleed. Psoriasis can interfere with sleep and cause stress. And while the condition is not contagious, its appearance can cause sufferers to be embarrassed, or even to withdraw from social interactions.
While many people with psoriasis may commonly get the scaly patches on their knees, elbows or torso, skin changes can appear even on the scalp or fingernails. This can mean it is harder to identify, or that it will be misidentified as dry skin or some other skin problem.
New discoveries suggest that the inflammation of severe psoriasis may also be associated with other harmful effects throughout the body, including heart disease and diabetes. That alone makes a compelling argument for getting treatment.
What causes it?
Psoriasis is an immune response gone wrong. A type of white blood cell that normally fights foreign invaders instead starts attacking healthy skin cells, speeding up their growth cycles. The result is a buildup of dead cells in thick patches. Although psoriasis is genetic, it is often triggered by some outside factor, such as a cut in the skin, illness or medication.
Perhaps three quarters of people with psoriasis have a mild form of the disease, affecting a small percentage of their skin area’less than the size of three handprints. But even a minor patch can be frustrating if it embarrasses you or constantly itches. In other sufferers, the condition covers more body surface and severely interferes with quality of life. ‘It imprisons you,’ says Andrew Gosse, 43, a realtor near St. John’s, Nfld., who has dealt with severe psoriasis over more than 40 percent of his body since he was in his teens. ‘You withdraw from society and work.’ He says that before he got the right medication, psoriasis used to torture him with itching and the pain of cracking and bleeding skin. ‘When I took off my clothes, I looked like I had been whipped mercilessly. Taking a shower was excruciating.’ Gosse recalls being at work and handing a couple a pen to sign a contract: ‘They pulled their hands back. I had psoriasis under my fingernails and red patches on my hands, and it looked awful.’
Conventional approaches include prescription topical corticosteroids; vitamin D analogues (medications based on vitamin D); and controlled UV therapies that are performed in the dermatologist’s office and covered under provincial health plans (these may be effective for people with milder psoriasis).
But the real advances in treatment are for more challenging cases. ‘We used to be happy when we could get people 50 percent better,’ says Dr. Kirk Barber, a dermatologist in Calgary. ‘But the thinking now is that we can actually get people clear of the disease.’ Biological therapies (medications that are derived from living materials, such as vaccines, hormones and stem cells) have been available only within the past eight or nine years, and more are being developed. These injections or IV infusions affect the immune system, not just the scaly patches. ‘Psoriasis is increasingly believed to be a systemic disease. We know that it’s not localized only in the skin,‘ says Dr. Joel Gelfand, associate professor of dermatology and epidemiology at the University of Pennsylvania’s Perelman School of Medicine. Psoriasis is now known to affect the entire body, perhaps due to the demands on the metabolism when new skin is constantly produced, or to the substances released and circulated by chronically inflamed skin.
Gelfand and other researchers have pinpointed links between the severity of psoriasis and an increased risk of other health problems such as diabetes, cardiovascular disease, and liver and kidney disease. In fact, the lifespan of those with severe psoriasis is shorter by as much as five years. But epidemiologists are still working out whether life expectancy improves when psoriasis is controlled. ‘We don’t know for certain if untreated psoriasis ultimately causes health problems that could have been prevented by controlling the disease,’ Gelfand says.
In the meantime, scientists are refining drugs that can control the parts of the immune system that have gone haywire. Others are working on matching treatments to genetic profiles.
Despite these advances, high numbers of people do not seek treatment. ‘People who have psoriasis are simply tired of getting their hopes up with treatments that weren’t effective in preventing symptoms,’ says Gosse, who founded the non-profit Canadian Psoriasis Network in 2011 to educate people and encourage sufferers to access help. Plus, patients may not be interested in a new drug if it is expensive (not all medications are covered in all provinces); if it carries health risks; and if it requires weekly, monthly or quarterly injections.
But Gosse and others are reaping the benefits of the newer therapies. His psoriasis has been under control for seven years. ‘To say it’s been liberating doesn’t do it justice,’ he says. ‘Ideally, I’d love to see a cure for psoriasis. But while we’re waiting, I would like to see easy access to the most effective treatments for everyone across the country.’
Huge progress has been made in controlling the autoimmune disease, but there is no cure yet. Until there is, dermatologists recommend that anyone with psoriasis’especially a moderate to severe form’take good care of their general health and be on the lookout for early signs of other chronic diseases. If you are not sure if you have psoriasis, see your doctor.