Recently, musician and activist Cyndi Lauper revealed that she is a longtime sufferer of psoriasis.1 Like 7.5 million other Americans, Ms. Lauper has struggled in silence with red, itchy patches and scales on her skin. She hid her condition under layers of clothing and heavy makeup, both of which made her sweat, worsening her psoriasis and causing even more physical and emotional trauma. Her long-term search for remedies that were effective, and stayed effective, prompted her to join a national initiative aimed at educating the public about the many challenges of living with psoriasis. “My psoriasis made me want to hide,” she said.
With dermatology compounding, she and millions of others may not have to.
What Causes Psoriasis and How Can It Be Cured?
Psoriasis is a chronic disease of the immune system that presents itself more as a skin condition than a disease. In fact, many people often think they have a skin allergy, and try to cure themselves in vain without realizing they have a chronic, systemic condition that needs a completely different type of treatment, one dermatology compounding can offer.
There are five different types of psoriasis:
- Plaque psoriasis, which is the most common type and usually presents as red patches of skin with white scales on the elbows, knees and lower back, as well as the scalp;
- Guttate psoriasis, the second most common type, appears as small red dots on the face, torso, limbs and also the scalp;
- Pustular psoriasis, which results in pus-filled blisters anywhere across the body;
- Erythrodermic psoriasis, which is related to the pustular type and shows up as big red sheets on the body, and
- Inverse psoriasis, which presents as red lesions in skin folds like under the breasts or in the groin area.
Scientists don’t know what causes psoriasis and there are many possible triggers (such as infection, stress, and even some medications), making developing a cure very difficult. Besides causing a lot of itchiness, and pain, psoriasis also correlates strongly with social embarrassment and anxiety, and can cause depression. Without a cure in development, or better knowledge about triggers, physicians must treat the symptoms. Pharmacists with dermatology compounding strategies are at an advantage because we can attack the disease on multiple fronts at once.
The Advantages of Dermatology Compounding
Since psoriasis presents as a serious skin condition, one of the easiest routes to management is topical preparation applied directly to the rash sites. It is difficult to know ahead of time what preparation works for a given patient and what has no effect at all. Psoriasis presents all over the body; thus different treatments need to be developed for different locations based on the sensitivity and accessibility of the skin at those locations. Patient-specific dermatology compounding offers flexibility and efficacy.
Any effective treatment strategy follows the path of softening the skin, soothing the pain, and then removing any scales before applying medications to treat other lesions 3. There are many options that may work for a time, or maybe have side effects that increase with exposure. Patients can easily be overwhelmed by the number of OTC options and natural supplements out there.
- Coal tar is a common treatment that slows psoriatic growth at the cellular level. The patient wears a salve of coal tar for a couple of hours, then rinses it off. The treatment can also reduce inflammation and itchiness but can make skin dry and sensitive to light. Patients can also be put off by the smell and stain of the tar.
- Salicylic acid compounded in high dosages and then tapered down helps to soften and remove psoriatic scales. Long-term exposure to salicylic acid irritates the skin, however, and can cause hair loss in the underlying follicles.
- Topical steroids reduce inflammation, relieve itching, and reducing the cellular overgrowth of psoriasis. The side effects can be severe, however, including irritation and burning, and even thinning of the skin.
- Calcipotriene, a form of vitamin D, also reduces cellular growth but can worsen the psoriasis and cause redness and irritation of the underlying skin.
The list is daunting, and can be exhausting for a patient who has seen psoriasis come and go in episodes that can’t be predicted or contained. Effective treatment regimens are usually found through combination therapy, and each option presents significant side effects.
Pharmacists are a key resource for the patient, in terms of discussing the pros and cons of different treatments, what combinations are best suited to the type of location of the outbreaks, and what methods of delivery works best for that patient. Coal tar may work on the patient’s scalp, for example but is too severe for treating skin folds.
Understanding the options for treating psoriasis can be difficult for patients and physicians don’t have the time to design a unique treatment that needs to be tweaked for each patient. Pharmacists have the expertise to offer their patients the treatment and care they badly need, physically and emotionally. Treating psoriasis is not an easy task but living with it is far worse.