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Easing the Stigma of Psoriasis

A dermatologist’s insight

By Jason Santerre

Dry, red skin covered with silverywhite scales. Rashes, itching, and swelling. Pitted and discoloured nails. How horrific. How debilitating. If you’re one of 500,000 Canadians living with psoriasis, you feel like a pariah. According to the National Psoriasis Foundation, many sufferers feel mental anguish due to their afflicted skin, even if it’s not contagious.

And psoriasis is not curable. Now the good news. Many treatments are available now as opposed to even five years ago. Referral to a dermatologist might be needed if the diagnosis of psoriasis is uncertain, if the initial treatment does not improve symptoms, or if the disease is widespread or severe.

We recently spoke with Dr. Yves Poulin, a dermatological researcher, for his take on the disease and any advice he could impart.

Montréal enSanté: Are we any closer to understanding exactly what causes plaque psoriasis?

Dr. Yves Poulin: Of all immune-mediated inflammatory diseases, the knowledge on psoriasis is the highest. The importance of a very specific pathway of the immune system was recently identified and confirmed as the specific one for psoriasis. This is the Th17 pathway.

MES: Is it genetic?

Dr. Poulin: Psoriasis has a genetic basis. It is a polygenic disease with more than 45 genes associated. Triggers are multiple, streptococcal infection of the throat being the best identified trigger. But psoriasis is NOT an immune deficiency disorder; rather, it’s an excessive response of the immune system. I would say that psoriasis is an immune PROFICIENCY disorder.

MES: That’s interesting. What do you mean by that?

Dr. Poulin: The immune system is overreacting to proliferation signals that we all have. Our immune system is there to protect us from external aggression. In psoriasis, the skin is overreacting. For example, skin-cell turnover is normally 28 days. For psoriasis sufferers, it’s four days.

MES: Do you think a cure will be found in your lifetime?

Dr. Poulin: Good question. You know that we can control the disease with the new treatments, achieving total or almost total clearance of skin lesions. As for all chronic diseases, like hypertension, diabetes, and a lot of others, we bring the disease state to normal with continuous therapy, without curing the disease. For psoriasis it is the same: we can clear psoriasis with medication. There is no drug that can change the genetics.

MES: What sort of remedies can patients use to lessen the severity of their symptoms?

Dr. Poulin: Emollients are great to decrease the itch and the scales that are so bothersome. Many different emollients are available over the counter

MES: Are there daily tasks patients can perform or avoid in order to delay or ease symptoms?

Dr. Poulin: Psoriasis is an IMID (Immune- Mediated Inflammatory Disorder). Those having psoriasis did not do anything special to get the disease. It is a disease that you cannot avoid if your genetics are programmed to get the disease. The literature suggests that psoriasis is more frequent among smokers, among who exercise less, among obese people. But the patient that I see in my office is not a statistic. He has the disease.

 

Fall 2016, Vol 8 N°4

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