Dealing with psoriasis

Hello from Jennifer, one of your Pharmacy chicks. I had just returned from an annual visit with the in-laws in Kansas in mid January of 2013. It was unseasonably warm in Kansas that year; temperatures were literally in the seventies one day with little to no humidity then dropped to the twenties the following day! I felt a sore throat coming on and knew that the change in weather was about to trigger my annual bout of strep throat.  As my husband, son, and I flew back to Nashville I began itching on my legs. After landing, I went to the bathroom and saw little red bumps all over my legs. It looked like I had a dozen or more bug bites all over my lower extremities. Immediately I thought that I had to have gotten into something in Kansas that was infested with bugs of some sort and I followed up with a Doctor visit the following week. He prescribed a steroid pack, an antibiotic for my strep infection and some anti itch cream which helped a little but as soon as I stopped the oral steroids the bumps came right back. I was referred to a dermatologist and fought this breakout for nine long, agonizing months! It was incorrectly diagnosed at first as a type of epithelial cancer, then dermatitis, then eczema, and finally the “aha” moment came when I found out that a close family relative had psoriasis. I had psoriasis. It eventually faded away with strong topical steroids, oral immunomodulators, and daily coal tar scrubs. Luckily I haven’t had any flare ups since, but I would’ve given anything to stop the itch during those trying months! I had a type of psoriasis known as guttate psoriasis that was triggered by stress, cold weather, and a recent strep infection. Whoever said, “Visiting the in laws isn’t stressful?” So my article today isn’t going to be about not visiting the in laws, but about psoriasis and how to manage flare ups.

Psoriasis is an autoimmune disease that typically causes plaques which are itchy or sore patches of thick, dry, discolored skin. The plaques most often develop on the elbows, knees, scalp, back, face, palms and feet but can occur anywhere on the skin. Psoriasis is an auto inflammatory disease and occurs when your immune system begins to attack healthy cells. Psoriasis is a genetic condition and symptoms usually develop between ages 15 and 35 with men equally as affected as females. There are five types of psoriasis with plaque psoriasis being the most common. Other types are as follows: Guttate Psoriasis, Inverse Psoriasis, Pustular Psoriasis, and Erythrodermic Psoriasis.

While psoriasis is primarily inherited some things can cause flare ups such as upper respiratory infections, smoking, diet, alcohol, dry skin, certain medications, stress, and cold weather. It is best if you have psoriasis to stop smoking, limit alcohol intake to one or two drinks weekly, avoid “trigger” foods (for example many psoriasis patients also have a gluten allergy), keep your skin moisturized with a fragrance free moisturizer, and try to expose your skin to the sun for no more than ten minutes daily as that has been shown to “turn” off the skin’s immune system which is overactive in psoriasis. Some medications that can treat high blood pressure called beta blockers can actually make psoriasis worse, so it is wise to talk to your Doctor about changing these medications. Lithium, which is used for mood disorders can also worsen psoriasis.

Unfortunately there is no way to prevent psoriasis but you can reduce the number of flare ups you may experience by practicing the above mentioned methods (avoiding triggers, moisturizing skin, small amounts of sunlight daily, etc.). Complications of psoriasis include high blood pressure, obesity, high cholesterol, diabetes, osteoporosis, liver disease, kidney disease, cancer, crohn’s disease and depression. Most of these complications are due to the medications used to treat psoriasis, primarily oral steroids. Topical steroids remain a first line therapy in the treatment of psoriasis and can be purchased over the counter (Cortaid or Hydrocortisone 1%). Ointments or oils tend to work better than lotions or creams for psoriasis flare ups. Other topical medications that are available without a prescription are coal tar, scale softeners such as lactic acid or urea and moisturizers.  Prescription medications include oral steroids, immunomodulators like cyclosporine or methotrexate, Otezla, a once daily pill that suppresses an enzyme involved in inflammation, and a whole host of nauseating commercialized biologics. I refer to the commercials as nauseating because I can’t watch television without seeing an ad for at least one of these medications that cost the price of a well appointed midsized sedan. These biologics are given as an injection and alter the immune system and include Enbrel, Remicade, Humira, Stelara, Simponi, Cosentyx, and Taltz. While these medications are effective in treating psoriasis, they are quite expensive and have several side effects that should be discussed with a dermatologist or physician before beginning. As always, your friendly Pharmacy Chicks will be happy to discuss any specific questions or concerns you may have. This is Jennifer signing off for this week, have a great weekend!