Dr. Melinda Gooderham
Dermatologist & Medical Director, SKiN Centre for Dermatology
Chronic inflammatory autoimmune disease can affect quality of life and mental health, but new targeted therapies are bringing hope to sufferers.
When she was 11, Deva Murthy broke out in an itchy, uncomfortable rash all over her body. At age 12, she was diagnosed with severe plaque psoriasis and spent a year in hospital receiving UV light therapy and coal tar baths. The treatments would help, but after a few weeks, her plaques would return.
She remembers her mom applying ointment to her skin and wrapping her body in plastic wrap. “That was very difficult for my mom, and for me, especially being a teenager. I remember trying to cover up with makeup and clothes when my body was covered in sores,” says Murthy, 48, who lives in Long Harbour, NL. “My parents missed a lot of work taking me to doctor appointments. I missed a lot of school. Even when I did go, I couldn’t do any physical activity. It was just too uncomfortable.”
Psoriasis affects one million Canadians
Psoriasis is a chronic inflammatory autoimmune condition that affects the regeneration of skin cells. Skin cells usually grow, mature, and are shed over 28 to 30 days. With psoriasis, faulty signals in the body’s immune system trigger new skin cells to form in just three to four days. Because the skin cells grow so fast, they aren’t shed normally and pile up on the skin, creating sores, often called plaques. Thick, silvery scales form on top of these itchy and sometimes painful red patches.
Psoriasis can also cause inflammation in other areas of the body, such as the joints or blood vessels. In about one third of cases, patients develop psoriatic arthritis, which can lead to joint pain and stiffness and if untreated, can cause deformity in the joints.
According to the Canadian Dermatology Association, psoriasis affects about one million Canadians. It can be mild, moderate, or severe, depending on how much of the body it covers, the location of the plaques, and the effects on the patient’s overall quality of life.
Shame and depression are common
Psoriasis also carries a large emotional impact. “On its own, systemic inflammation can be associated with anxiety and depression. On top of that, you have the stigmatization of living with a visible skin disease. People who don’t understand it may think you’re contagious or withdraw from you. That exacerbates the mental burden of the condition,” says Dr. Melinda Gooderham, a dermatologist and Medical Director at the SKiN Centre for Dermatology in Peterborough, ON.
Murthy knows this all too well. “The shame of it all digs into every portion of your life. The trauma of psoriasis is very real,” she says. “I suffered from depression when I couldn’t go to school or work.”
During high school, Murthy took traditional immunosuppressants like methotrexate, which can cause harsh side effects. She and her parents were desperate for her to get some relief. In her 20s, newer medications gave her hope. Then about 13 years ago, she started biologics and has been virtually rash-free since. “My life has completely changed. The new medications are amazing,” she says.
On its own, systemic inflammation can be associated with anxiety and depression. On top of that, you have the stigmatization of living with a visible skin disease.Dr. Melinda Gooderham
Targeted therapies are safer and more effective
Biologics are made from proteins that are similar or the same as proteins naturally occurring in the body. They target specific parts of the immune system that are responsible for inflammation. These targeted therapies regulate the faulty signals that occur with psoriasis and are safer than medications that broadly suppress the immune system.
Dr. Gooderham says that some people may worry about receiving treatments that affect the immune system during the COVID-19 pandemic. “These newer biologic treatments are very targeted, so they aren’t suppressing the other parts of your immune system,” she says, adding that patients shouldn’t be afraid to visit their health care provider during the pandemic. She stresses that stringent safety protocols are in place in medical offices and hospitals, that there are also virtual care options, and that it’s important for patients to seek diagnosis and treatment.
Murthy wants people with moderate to severe plaque psoriasis to know that they don’t have to suffer. “You may need to try a few treatments until you find the right one for you, but there are so many options now and they’re so fabulous,” she says. “It’s easy to get depressed. It can be a dehumanizing disease. You suffer in silence for so long because you’re embarrassed. It’s important to have faith and hope and to talk about it. If you shed light on it, then the darkness goes away.”
Talk to your dermatologist or your health care professional for a referral to a dermatologist who treats psoriasis.
Navigating Access to Care During COVID-19
To better understand the impacts of the COVID-19 pandemic on people living with psoriasis, three patient advocacy groups — the Canadian Association of Psoriasis Patients (CAPP), the Canadian Psoriasis Network, and Unmasking Psoriasis — surveyed 830 patients, 96% of whom had psoriasis.
Almost half of respondents avoided seeking care with a doctor or at a hospital
had a virtual appointment
Average rating was 3.6/5
Changes to Access to Treatments During COVID-19
I had to change my treatment in order to manage new flares
My treatment plan was disrupted because of the impacts of COVID-19
I decided to change or stop my treatment because of the impacts
My doctor changed my treatment plan because of risks related to COVID-19
Impact of COVID-19 on the Psoriasis and Psoriatic Arthritis Community in Canada, Canadian Association of Psoriasis Patients.
The key message from Rachael Manion, Executive Director of CAPP, is for patients to know that they’re not alone. There are resources available online and it’s important to continue to work with your health care team to find a plan that works for you.
If you’ve been considering seeking professional help from a dermatologist, you’ll need a referral from a general physician first. Here’s a list of tips and questions to help you discuss this with health care provider.
Before your visit:
- Write down the symptoms you’ve been experiencing and think about the ways these symptoms are impacting your daily life.
- Consider when you started experiencing symptoms and whether they have worsened or improved, and bring a list of all your medications.
- Be sure to bring a pen and paper so you can take down what the doctor says.
Questions for your doctor:
- What could be causing my symptoms?
- What’s the most important thing (or few things) I should know about this condition?
- How can I easily explain to people what psoriasis is? Do you have any suggestions or strategies for how to manage people’s responses and reactions to psoriasis?
- Now that you’ve seen my psoriasis and understood how this disease is affecting my life, how would you qualify my psoriasis in terms of severity? Mild, moderate, or severe?
- (If you’ve been diagnosed with moderate to severe psoriasis:) Can you recommend a dermatologist that specifically treats psoriasis or uses advanced therapies to treat psoriasis?
Questions for your doctor and dermatologist about treatments:
- What’s the stepwise approach you’d take to treat my psoriasis? How can we make a tailored treatment plan for me?
- What treatment goal would we set together in regard to my psoriasis?
- What treatment are you proposing? What should I expect from this treatment?
- What are the normal side effects and what should I be sure to notify you about? Are these side effects permanent?
- What plans should we make in case symptoms worsen?
- Are there things I should do (or avoid) that would maximize the impact or efficacy of the treatment?
How quickly will I see results? How will I know when it’s successful? Will my skin completely clear up?
- What timeline do we set to evaluate the success of this treatment and move on if it’s not successful? Can I book an appointment now for that timeline?
- Is there anything else I should be screened for if I have psoriasis?
This article was made possible with support from a research-based pharmaceutical company and IMC member.