Psoriasis is a skin condition that affects about 2% of the population. It features red, thickened areas with silvery scales, most often on the scalp, elbows, knees, and lower back. Some cases of psoriasis are so mild that people don’t know they have it (e.g. they think they just have dandruff). More moderate or severe psoriasis can cover large areas of the body. Psoriasis is not contagious and cannot be passed from one person to another, but it is most likely to occur in members of the same family. Up to 25% of patients with psoriasis also have associated psoriatic arthritis, most commonly of the small joints of the hands and feet.
The goal of psoriasis treatment is to reduce inflammation and to control shedding of the skin. Treatment is based on a patient’s health, age, lifestyle, and the severity of the psoriasis. Moisturizing creams loosen scales and help control itching. Steroid preparations are often the mainstay of psoriasis treatment as they help to reduce inflammation, redness and scales of the skin, and itching. Patients with thick body and scalp psoriasis plaques often require treatment with strong topical steroids to gain quick results. E.g. Clobex spray formulation of clobetasol steroid can lead to high compliance and better outcomes as it has fast-onset of action and dries quickly, as well as being versatile enough to use on the scalp and body. Weaker preparations are typically used on more sensitive areas of the body such as the genitals and face. Non-steroid anti-inflammatory creams such as Protopic or vitamin-D related creams such as Silkis can be quite helpful in the groin, armpits, and face as well.
Specialized light therapy (called phototherapy) is an effective and safe treatment modality, especially for more widespread psoriasis. It is covered by OHIP and is available at the Toronto Dermatology Centre. Systemic treatment options for psoriasis are divided into older systemic therapies (e.g. Soriatane, Methotrexate) and currently widely used biologic therapies, such as Enbrel, Humira, Remicade, and Stelara. Apremilast is a new effective and safe pill medication for psoriasis that is just around the corner from being on the market in Canada. As well, psoriasis is a very active area of research, with many ongoing therapeutic clinical trials including at our clinic. As a result of the constant developments in treatment and understanding of psoriasis, make sure to speak with your dermatologist as to the best option for you.