RSS
Rate this Site
Welcome to Psoriasis Support Canada’s most frequently asked question and answer section. This section will be updated regularly to reflect the latest changes in psoriasis information and treatment.
Click on the question of your choice and you will be directed to the answer!
If you don't find the answer to your question, let us know. Submit a question and we will do our best to include the answer in this section.
Frequently Asked Questions
Printer Friendly
Send to a FriendThe Basics
Frequently Asked Questions
What is psoriasis?
When do people get psoriasis?
What is the most common kind of psoriasis?
Are there different types of psoriasis?
What is psoriatic arthritis?
What causes psoriasis?
What role does the immune system play?
What are common symptoms of psoriasis?
What can trigger psoriasis?
How is psoriasis treated?
Can I treat psoriasis with moisturizers?
What are light treatments?
What is systemic therapy?
When a treatment is “remittive”, what does that mean?
What are biologic agents and how do they work?
What kind of biologic treatments are available in Canada?
Why is consulting with a dermatologist important?
How do I get an appointment with a dermatologist?
What kinds of questions should I ask my dermatologist in considering my treatment options?
What is psoriasis?
Psoriasis is a chronic (ongoing and often recurring) diseaseDisease - [di-zeez]
An impairment of health or a condition of abnormal functioning. characterized by patches of red and usually scaly skin. Affecting about one million Canadians, psoriasis can range in severity and affect any part of the body. Psoriasis usually occurs on the scalp, elbows, knees, lower back and genitals, often in the same place on both sides of the body. It can also appear in the fingernails or toenails.
When do people get psoriasis?
Psoriasis usually begins in early adulthood but may develop at any age. It can heal temporarily but come back throughout a person’s life. People with psoriasis may suffer discomfort, including pain, itching and emotional distress. It is not a contagious Contagious - [kuh n-tey-juh s]
Capable of being transmitted by bodily contact with an infected person or object. skin condition - it cannot be spread from one person to another or from one part of the body to another.
What is the most common kind of psoriasis?
The most common type of psoriasis is plaque psoriasis. Dermatologists may also refer to this as plaques: raised patches of thick, inflamed red skin covered with silvery-white flakes or scales Scale - [skeyl]
Any thin, plate-like piece, lamina, or flake that peels off from a surface, as from the skin..
Are there different types of psoriasis?
Plaque psoriasis is the most common form of psoriasis – appearing as raised patches of thick, inflamed red skin with silvery flakes or scales. Scalp psoriasis occurs when thick, crusted plaques appear on the scalp. It is noticeable around the ears and hairline. Scalp psoriasis is difficult to treat because of the hair protecting the scalp. The flaking and shedding of dead skin cells give the appearance of severe dandruff.
Guttate psoriasis, the second most common type, is characterized by small, scaly, pink teardrop patches. It usually appears on the trunk (or torso of the body), arms and legs, but can sometimes cover the entire body. Guttate psoriasis often appears suddenly following a common bacterial infection, such as strep throat.
Pustular psoriasis is characterized by small pus-filled blisters that often occur on the hands and feet, or spread over large areas of the body. This type can be painful, cause fever and may require antibioticAntibiotic [an-ti-bahy-ot-ik]
A substance, such as penicillin or streptomycin, produced by or derived from certain fungi, bacteria, and other organisms, that can destroy or inhibit the growth of other microorganisms. treatment.
Erythrodermic psoriasis, the least common form, is characterized by widespread reddening and scaling of the skin. It is often accompanied by painful inflammation, and may require hospitalization. This is not a complete list of all the different types of psoriasis, but rather some of the different varieties that do exist.
What is psoriatic arthritis?
- Psoriatic (pronounced sore-ee-at-ick) arthritis causes swelling and pain in joints. This is called inflammation. It also causes a scaly rash on the skin.
- It usually affects the wrists, knees, ankles, fingers and toes. It can also affect the back.
- Psoriasis (pronounced sore-eye-a-sis) is a skin disease that is linked with psoriatic arthritis.
- Psoriasis causes a scaly skin rash on the elbows, knees and scalp.
Psoriatic arthritis is a condition that causes swelling and pain in and around the joints. It can affect a number of joints including the fingers, wrists, toes, knees, ankles, elbows and shoulder joints, the spine and joints in the lower back (called sacroiliac joints). Psoriatic arthritis also affects tissues surrounding the joints including tendons and ligaments. It may cause a swelling of the whole digit called “sausage” finger or toe. There is also skin inflammation, particularly on the elbows, knees and scalp. Psoriatic arthritis is linked to psoriasis, a disorder causing areas of the skin to become inflamed and be covered with silvery or grey scales.
For more information on psoriatic arthritis, visit The Arthritis Society web site http://www.arthritis.ca/
What causes psoriasis?
While the exact cause of psoriasis is not known, current research indicates that a disorder in the body’s immune system Immune System
A that protects the body from foreign substances and pathogenic organisms by producing the immune response., the system that protects one’s body from infection, may be involved in the development of psoriasis. In people with psoriasis, a malfunction of the immune system causes skin cells to reproduce faster than normal. Because of their rapid growth, and the lack of time for the cells to shed, skin cells accumulate forming plaques. For example, a normal skin cell grows to maturity in 28-30 days. It then sheds from the skin’s surface. A psoriatic skin cell on the other hand takes only 3-4 days to mature. It then moves to the surface of the skin where it builds up with other cells, forming the thick scaly patches called plaques.
What role does the immune system play?
Psoriasis has been linked with abnormal functioning of the immune system. This means that the immune system that normally protects your body sends abnormal signals to the cells and tissues of your own body. These abnormal signals cause the skin cells to grow more quickly than normal. The immune system is comprised of T-cells T-Cells
A class of lymphocytes, so called because they are derived from the thymus and have been through thymic processing. The T-cells coordinate the immune system by secreting lymphokine hormones. and other cells that help protect the body against disease and infection. It is believed that in psoriasis, abnormal activity of T-cells causes inflammation and excessive skin reproduction in the top layers of the skin. We don’t know exactly what causes these T-cells to behave in this way, but we know that if we can stop their abnormal activity we can help to treat psoriasis.
What are common symptoms of psoriasis?
- Dry and cracked skin
- Itching
- Skin swelling
- Skin pain
- Pitted, cracked, crumbly or loose nails
What can trigger psoriasis?
Certain factors are thought to trigger the disease; however psoriasis can also flare without any clear cause. Many people with psoriasis may notice that their symptoms can get worse temporarily (flare-ups). Possible causes for flare-up may include:
Skin injury and irritation: Frequent rubbing and/or scratching of the skin can make psoriasis worse.
Climate: Moderate sun exposure can be very helpful. However, a hot humid environment or overexposure to the sun can make psoriasis worse. In winter, skin can become excessively dry as a result of the lower humidity in the air and the condition may worsen.
Diet: A healthy balanced diet is advisable for people with psoriasis or any other disease. If you find certain foods cause flare-ups, note them and avoid these foods as much as possible. For example, excessive alcohol consumption is a notorious cause of flare-ups.
Stress: Stress and tension seem to make psoriasis worse. Try to avoid stressful situations as much as possible.
Medications: Some medications can make psoriasis worse. These medications include: treatments for rheumatoid and osteo-arthritis including some anti-inflammatory medications; anti-malarialAnti-malarial – [ān'tē-mə-lâr'ē-əl, ān'tī-]
Preventing or relieving the symptoms of malaria (any of a group of diseases characterized by attacks of chills, fever, and, and sweating.) treatments as well as certain beta-blockersBeta-blocker – [bā'tə-blŏk'ər]
A drug that blocks the excitatory effects of epinephrine on the cardiovascular system by binding to cell-surface receptors (called beta-receptors). Beta-blockers are used to treat high blood pressure, angina, and certain abnormal heart rhythms. used to treat high blood pressure. It is important to let your dermatologist know what medications you are taking for other medical conditions.
Infections: Some throat and respiratory infections, particularly strep infections, can make psoriasis worse. This is most commonly seen in children and adolescents.
How is psoriasis treated?
There is a wide range of treatment options available for relieving and controlling psoriasis. A dermatologist will select a treatment plan based on the type of psoriasis, the affected skin areas, and the disease’s effects on a patient’s overall physical and emotional well-being. Treatment will also depend on the perception of the disease and the patient’s preferences for treatment. Treatment options are generally considered as being either suppressive or remittive. Suppressive treatments cause a response but symptoms may return soon after treatment is stopped. Remittive treatments cause a response that can last for a significant period of time after the treatment is stopped. The best treatment is one agreed upon by both the patient and doctor after full discussion of treatment options that fit your personal condition and lifestyle. Some common topical treatments are:
Topical steroids (applied to the skin): Also called corticosteroids [kor-ti-ko-stair-oids], steroids (such as Diprolene Glycol®, Cyclocort® or Kenalog®, among others) can have a positive effect. Short-term use of steroidsSteroid – [steer-oid, ster-]
Any of a large class of organic compounds having as a basis 17 carbon atoms arranged in four rings fused together. Steroids include many biologically important compounds, including cholesterol and other sterols, the sex hormones, bile acids, adrenal hormones, plant alkaloids, and certain forms of vitamins. has proven to be effective, especially when psoriasis is inflamed or when it exists in the delicate areas of the skin. Over-usage of large quantities of topical steroids will cause a resistance to the medication and may result in the thinning or cracking of the skin.
Coal tar (Balnetar® or Estar®): One of the oldest therapies for psoriasis, coal tar is often used on small or large plaques. It can irritate unaffected skin, but this is usually temporary and mild. Coal tar is suitable for plaques that are widespread across the body; however it is not generally recommended for delicate areas. Many patients find that coal tar has an unpleasant odor and that it can stain clothing. Make sure to let the medication air dry before dressing.
Vitamin D derivatives: Products made from vitamin D3, such as Dovonex®, are used for mild to moderate psoriasis. This is not the same vitamin D found in commercial vitamin D supplements. It is a prescription medication that controls the excessive production of skin cells.
Vitamin A derivatives (Tazorac®): May prove useful in the treatment of psoriasis; however, they can be irritating to the skin. These medications may be prescribed for stable plaque psoriasis.
Can I treat psoriasis with moisturizers?
Moisturizers can help reduce inflammation and itching, while helping the skin retain more hydration (water). They also help reduce the chance of dryness, scaling, cracking and tenderness – symptoms often associated with psoriasis. Moisturizers allow other treatments (such as creams and ointments) to work more effectively after you apply your medicated cream, or at any other time during the day. The best moisturizer has a formulation that you find most pleasing and that you are comfortable using on a regular basis. There are many emollients that have been especially designed for sensitive skin. Your physician or pharmacist can advise you on specific brands.
What are light treatments?
Sunlight Daily, regular short doses of sunlight that do not produce sunburn can be helpful in clearing up or improving psoriasis. Ultraviolet radiation (UV) is made up of invisible rays the sun emits that can cause suntans, sunburns, and in some cases, skin cancer. UV rays are also responsible for the signs of premature aging such as wrinkles.
Phototherapy Ultraviolet (UV) light from the sun reduces inflammation and slows the overproduction of skin cells that causes scaling. Phototherapy is a controlled form of artificial light that may be prescribed for the treatment of psoriasis. This treatment uses special wavelengths of ultraviolet lights, either in the form of ultraviolet A (UVA) or ultraviolet B (UVB). This treatment is usually administered in a doctor’s office or a psoriasis day clinic.
PUVA: Long-wave ultraviolet light A (UVA) is used in combination with an oral or topical substance called psoralen to treat resistant psoriasis (PUVA – psoralen ultraviolet A). Making the skin more sensitive to UVA rays, psoralen promotes a deeper, more therapeutic effect. This treatment needs to be used with precaution and under the supervision of a dermatologist as it may be associated with the development of skin cancer.
UVB: This type of treatment involves exposing the skin to short-wave ultraviolet light B (UVB). By receiving properly controlled exposure, this can be an effective treatment for moderate to severe psoriasis. Psoriasis patients should be under the direction of a dermatologist when receiving any light therapy.
What is systemic therapy?
Some individuals develop widespread plaques that are not manageable by conventional topical treatment. Patients with moderate to severe psoriasis who are not effectively treated with topical therapies are considered for systemic medications (given by injection or by mouth (orally)). The most common medications are methotrexate, cyclosporine, and oral retinoids. There are side effects associated with most systemic agents and it is advisable to discuss this with your dermatologist prior to treatment.
Methotrexate is a medication that was first used in chemotherapy. It may be prescribed for people with moderate to severe psoriasis who do not respond well to other forms of therapy. Although effective in the treatment of moderate to severe psoriasis, regular blood monitoring is essential because of its side effects.
Cyclosporine (Neoral® or Sandimmune®) may be prescribed for the treatment of moderate to severe psoriasis sufferers who do not respond well to other forms of therapy. Like other medications, cyclosporine is a medication that can have side effects, so regular monitoring is recommended.
Retinoids, such as acitretin (Soriatane®) are Vitamin A derivatives that are effective when used in combination with light therapy - PUVA or UVB. Regular monitoring is important because of the possible side effects. Women who are planning a pregnancy or who are pregnant must consult their doctor before starting this treatment.
When a treatment is “remittive”, what does that mean?
Remittive treatments cause a response (i.e. reduction in symptoms) that can last for significant periods of time after the treatment has stopped.
What are biologic agents and how do they work?
Researchers now know that psoriasis is an immune-mediated disease involving T-cells. Scientific investigation on how to reduce these psoriasis-causing immune cells and stop the chemicals that the T-cells release represents one focus of current psoriasis research. Biologic agents are usually used for people who have failed to respond to (or cannot use) traditional therapies (such as vitamin D derivatives and steroids), older, systemic therapies or for people with associated psoriatic arthritis. These biological therapies use a specific, targeted approach to interrupt the underlying immune-mediated processes that drive psoriasis.
What kind of biologic treatments are available in Canada?
There are a number of biologic treatments that have been approved by Health Canada for patients with moderate to severe chronic plaque psoriasis including Amevive® (alefacept), Enbrel® (etanercept), Raptiva® (efalizumab) and Remicade® (infliximab). There are also other biologic therapies for psoriasis in various stages of development at this time.
One of the greatest prospects for biologic agents is that they provide new treatment options for patients with psoriasis. With the advent of biologic medicines, there is additional hope that people with psoriasis will benefit from safe and effective treatments. Biologic therapy, in some cases, can provide extended breaks from taking medication. In fact, some biologics can offer a break from therapy while the psoriasis remains in control.
There are more than 80 different biologics available in Canada today for the treatment of a variety of medical conditions, such as arthritis, cancer and kidney disease. The most commonly known biologic is insulin, which is used in the treatment of diabetes. Research into biologics originated in the mid-1970 when scientist Herbert Boyer, at the University of Southern California, used his knowledge of the amino acid sequence of insulin to manufacture a genetic copy of insulin. By manipulating the gene responsible for the production of insulin, he was able to produce man-made insulin – a revolutionary discovery for the treatment of diabetes. Biologics are also used in various vaccines.
Why is consulting with a dermatologist important?
A dermatologist is an expert in the diagnosis and treatment of diseases of the skin, hair and nails and is the best source of information about psoriasis. Psoriasis is a difficult disease to have and it is also often difficult to treat. Developing a solid partnership of consultation and communication with your dermatologist will help you and your physician to explore and decide on the best treatment.
How do I get an appointment with a dermatologist?
Your family physician can provide you with a referral to a dermatologist in your area.
What kinds of questions should I ask my dermatologist in considering my treatment options?
Because the time that you have with your doctor may be limited, preparing questions in advance will help you remember the most important points that you want to cover. Here are some questions you may want to ask:
- What treatment would be right for me based on the severity of my psoriasis and how would this choice affect my lifestyle?
- What are the key benefits of this treatment?
- What are the possible short-term and long-term side effects?
- Will I have to use this medication on a continuousContinuous – [kuh n-tin-yoo-uh s]
Uninterrupted in time; without cessation. or intermittentIntermittent – [in-ter-mit-nt]
Stopping or ceasing for a time; alternately ceasing and beginning again. basis? - Is there are chance of my disease worsening or rebounding with this medication?
Download practical tips on questions for your dermatologist
Didn't find what you were looking for? Submit your question and we will do our best to answer it for you.
