Living with psoriasis

Having to live with any chronic disease is difficult, but having to come to terms with one as visible as psoriasis can be be especially hard at times. Often, the psychological effects of coping with the disease can be worse than the disease itself. In this article, J.P. tells us how he has grown to live with the condition over the past 20 years.


Diagnosis and acceptance

"I have had to live with psoriasis on and off for the past 20 years. I first developed the condition shortly after my 18th birthday. At this age, I was already self-conscious about my image and having this condition thrust upon me definitely had a detrimental effect on my life, both physically (the plaques were very sore and itchy and often bled) and psychologically (constant questioning, funny looks and even rejection from other people, etc...). However, as the years have gone by, I have learned to cope with the condition, which is not always easy. "

Seeking medical help straight away

"When psoriasis appears, it can be very easy to go into ostrich mode and bury one's head in the sand. However, ignoring it will not make it go away as if by magic (I know this from first-hand experience). The faster you seek medical help, the more likely you will be able to successfully manage the condition. Blitzing affected areas with topical steroids as soon as they appear will very often clear it up. However, if you leave small plaques untreated, they will invariably increase in size and thickness and become much harder to treat. You may think that you are troubling your GP unnecessarily, but psoriasis is no less important than a chest infection or any other illness or disease... Leaving the disease untreated will have a negative impact on your quality of life."

Triggers

"To say that psoriasis is unpredictable is an understatement. There is no single trigger for the disease. My own triggers include streptococcal throat infections (followed by episodes of guttate psoriasis), stress (scalp psoriasis, with some temporary hair loss) and even allergic reactions. Genetics are also a key factor in the development of the disease. In my case, there is a strong history of psoriasis in my family. Discovering what triggers off your psoriasis may take time, but is an essential step in helping you to manage the disease."

Finding the right treatment for you

"Over the years, I have tried several topical treatments, which usually are steroid-based creams and coal tar-based shampoos. Some of these have had varying degrees of success; some have had no effect whatsoever and, in one particular case, the cream prescribed even managed to strip of layers of healthy skin. It is not recommended to use these creams over a prolonged period of time, as they may damage the skin and, in some cases, they may lose effectiveness as your skin becomes used to them."

"I have also tried both UVB and PUVA phototherapy. These treatments - for me, at least - are particularly effective forms of treating psoriasis. That said, they can have some notable side-effects, namely sunburn, increased light sensitivity, folliculitis (infection of hair follicles) and nausea. For this reason, phototherapy courses (normally 30 sessions) are normally only prescribed in more severe or "stubborn" cases of psoriasis. I must stress that phototherapy is not the same as going to a tanning salon. The sessions are carried out in a controlled environment, usually in a hospital, with the dosage of UVB or PUVA light being increased very gradually with each new session by qualified professionals."

"I have not tried (and hope that I will never have to try) systemic treatments. This form of treatment is being used in the most severe cases of psoriasis and also where psoriasis has not responded to topical treatments and phototherapy. Drugs that slow the production of skin cells and suppress the immune system are administered and can have some serious side-effects."

Learning to help yourself

"There are a number of things you can do to make your psoriasis more manageable. My advice is as follows:"

• Learn more about the disease: The greater your understanding, the easier it will be to manage.
• Look at all options when it comes to treating and managing the disease: there is some evidence that nutrition may play an important role.
• Good personal hygiene: This is key so as to prevent plaques from becoming infected.
• Daily moisturising: This will stop plaques from becoming itchy and flaky. My dermatologist prescribed me parrafin-based moisturisers (Cetraben and Double Base) and these are very effective, albeit a tad messy. However, unscented everyday moisturisers such as Nivea Creme can also be just as good.
• Consult your GP as soon as you notice any plaques developing.
• Seek a referral to a specialist if your condition doesn't improve, (word of warning, this will generally be a slow process).
• Do not be afraid to question your GP about your treatment.
• Be patient: Unnecessary worrying or stress may worsen your psoriasis, as well as having other detrimental effects on your physical and psychological health.
• Try some kind of relaxation activity, such as yoga or Tai Chi. Your body will also appreciate the rewards that exercise has to offer.
• Do not feel embarrassed by your condition: This is easier said than done, but a more proactive and positive frame of mind will help you answer awkward questions and social situations.
• Sunbathe (without overdoing it and using protection): Sunlight works in the same way as phototherapy. Don't be afraid or ashamed to expose affected areas in public.
• If your psoriasis has affected your self-esteem or self-image, try contacting a support group or a life coach. Sharing how you feel in a non-judgmental environment will help you.
• Do not fall for "guaranteed cure" sales gimmicks. At present, there is no cure for psoriasis, so you would just be wasting your money.
• Dead Sea mud and salts: There is no proof that these actually work. You may be better off saving your money and making a trip to the actual Dead Sea in Israel (the increased exposure to sunlight and drop in stress from everyday life are probably more effective).

The burden of psoriasis

People with psoriasis and psoriatic arthritis experience significant challenges every day that heavily impact their quality of life.

Physical burden 

 

• Psoriasis is itchy, painful and comfortable.
• Psoriasis can negatively impact most daily normal activities, such as those using the hands or walking, and physical activities, such as swimming or playing sports.
• Psoriasis itching and pain can interfere with periods of rest and sleeping.

Social and psychological burden 

 

• Psoriasis is often labelled a "common" or "cosmetic" skin disease, minimizing the importance it has for individuals, and increasing their frustration when disease management is difficult.
• A common misperception by the public continues to be that psoriasis is contagious, leading to discrimination and social isolation of people with psoriasis.
• Social stigma of psoriasis often renders it a "hidden disease".
• Psoriasis sufferers often feel ashamed, cover their symptoms and will not tell friends that they suffer with the condition, thus making the disease and the impact it has on their lives completely unknown.
• Embarrassment from psoriasis interferes with socialising and sexual activities.
• Heavy psychological toll of low self-esteem, humiliation and depression.
• Psoriasis can limit employment opportunities and can impose a serious barrier in the job market.

The burden of managing psoriasis 

 

• Physicians may misdiagnose psoriasis, mistaking it for a common rash, atopic dermatitis or eczema.
• Managing psoriasis can be challenging for both patients and physicians: some physicians may not understand the full impact psoriasis has on a patient's quality of life, and sometimes patients may not be able to communicate this adequately to their physician.
• Healthcare system fails to recognise psoriasis as a chronic inflammatory disease that requires consistent monitoring and treatment.
• Recent studies show that, if left unrecognised and untreated, psoriasis will be more likely to experience comorbid complications, such as cardiovascular disease, liver disease, depression and obesity, that further burden the patient and healthcare system.
• Effective and long-term treatment is limited for many patients due to the lack of access to healthcare and phototherapy facilities, high cost of treatments and health insurance issues, low efficacy of available treatment, or treatment risk factors.

Detox and revitalise your body workshop: Saturday 21 June, 1-4pm

 

Detox and revitalise your body workshop

 

Saturday 21st June 2014, 1-4pm

Yoga teacher, Cherie Lathey, and Nutritionist, Fleur Borrelli, will be holding an afternoon detox workshop on Saturday 21st June from 1-4pm.

A detox awakens the body’s powerful cleansing and healing abilities, helping to cure and prevent disease, restore health, balance emotions and prolong life.

A juice detox with yoga helps eliminate toxins by producing internal heat and massaging the internal organs, whilst boosting the immune system, restoring the body’s natural healing power. It is a great kick-start to a healthier, more positive, lifestyle.


The afternoon will include:

• "Why detox" with Fleur Borrelli: Understanding why the mind and body benefits from gentle detoxifying.
• Vinyasa flow yoga with Cherie Lathey: Focusing on breath, movement, twisting, and heat producing poses.
• Refreshing detoxifying fresh juices / smoothies prepared by Fleur.
• Discussion and recipes on superfoods & smoothies. Learn how to prepare for the best detox results.

Both Fleur and Cherie believe in a gentle and safe detox approach.

Cost: £45

Early bird offer: £40 (if booked before 15 June)

 

More information and booking 

For more information or to book your place on this course, please call The Putney Clinic of Physical Therapy reception on 020 8789 3881 or send an email to info@putneyclinic.co.uk, quoting Detox and revitalise your body workshop as the subject.

Psoriasis: what treatments are currently available

There is no cure for psoriasis, but a range of treatments can improve symptoms and the appearance of the affected skin patches. In most cases, the first treatment used will be a topical treatment, such as vitamin D analogues or topical corticosteroids. Topical treatments are creams and ointments applied to the skin.

If these are ineffective or your condition is more severe, a treatment called phototherapy may be used. Phototherapy involves exposing your skin to certain types of ultraviolet light. In the most severe cases where other treatments are ineffective, systemic treatments may be used. These are oral or injected medicines that work throughout the whole body.

Treatments are determined by the type and severity of your psoriasis and the area of skin affected. Your doctor will probably start with a mild treatment, such as topical creams (which are applied to the skin), and then move on to stronger treatments if necessary.

A wide range of treatments are available for psoriasis, but identifying which treatment is most effective can be difficult. Talk to your doctor if you feel a treatment is not working or you have uncomfortable side effects.

Topical treatments

Topical treatments are usually the first treatments used for mild to moderate psoriasis. These are creams and ointments you apply to affected areas. They are all that some people need to control their condition. If you have scalp psoriasis, a combination of shampoo and ointment may be recommended.

Topical corticosteroids

Topical corticosteroids are commonly used to treat mild to moderate psoriasis in most areas of the body. The treatment works by reducing inflammation. This slows the production of skin cells and reduces the symptoms of itching. Topical corticosteroids range in strength from mild to very strong. Only use topical corticosteroids when recommended by your doctor. Stronger topical corticosteroids can be prescribed by your GP and should only be used on small areas of skin or on particularly thick patches. Overusing topical corticosteroids can lead to skin thinning.

Vitamin D analogues

Vitamin D analogue creams are commonly used along with, or instead of, topical corticosteroids for mild to moderate psoriasis affecting areas such as the limbs, trunk or scalp. They work by slowing the production of skin cells. They also have an anti-inflammatory effect. Types of vitamin D analogues include calcipotriol, calcitriol and tacalcitol. There are very few side effects, as long as you do not use more than the recommended amount.

Calineurin inhibitors

Calcineurin inhibitors, such as tacrolimus and pimecrolimus, are medicines that reduce the activity of the immune system and help to reduce inflammation. They are sometimes used to treat psoriasis affecting sensitive areas (such as the scalp, the genitals and folds in the skin) if topical corticosteroids are ineffective.

These medications can cause skin irritation or a burning and itching sensation when they are started, but this will usually improve within a week.

Coal tar

Coal tar is a thick, heavy oil and is probably the oldest treatment for psoriasis. How it works is not exactly known, but it can reduce scales, inflammation and itchiness. It may be used to treat psoriasis affecting the limbs, trunk or scalp if other topical treatments are ineffective. Coal tar can stain clothes and bedding and has a strong smell. It can be used in combination with phototherapy (see below).

Dithranol

Dithranol has been used for over 50 years to treat psoriasis. It has been shown to be effective in suppressing production of skin cells and has few side effects. However, it can burn if too concentrated.

It is typically used as a short-term treatment for psoriasis affecting the limbs or trunk under hospital supervision as it stains everything it comes into contact with, including skin, clothes and bathroom fittings. It is applied to your skin (while wearing gloves) and left for 10 to 60 minutes before being washed off. Dithranol can be used in combination with phototherapy.

Phototherapy

Phototherapy uses natural and artificial light to treat psoriasis. Artificial light therapy can be given in hospitals and some specialist centres, usually under the care of a dermatologist. These treatments are not the same as using a sunbed.

UVB phototherapy

Ultraviolet B (UVB) phototherapy uses a wavelength of light invisible to human eyes. The light slows down the production of skin cells and is an effective treatment for some types of psoriasis that have not responded to topical treatment. Prior to treatment starting, you will have a short test to ascertain your skin type. Treatments are generally administered twice a week over a period of 15 weeks (maximum 30 sessions), with the dosage being gradually increased with each session. Goggles must be worn while in the UVB chamber in order to protect your eyes. The nurse in charge of your treatment will check for any moles and will apply total sunblock to them.

This treatment may be used in cases in which psoriasis has not responded to topical treatments. You may continue to use topical steroid creams throughout your treatment, but you must not apply them on your treatment days (before entering the light chamber). Possible side effects of the treatment include burning, itchy or dry skin, increased light sensitivity, cold sores and folliculitis (inflammation of hair follicles).

Psoralen plus ultraviolet A (PUVA)

For this treatment, you will first be given a tablet containing compounds called psoralens, or psoralen may be applied directly to the skin. This makes your skin more sensitive to light. Your skin is then exposed to a wavelength of light called ultraviolet A (UVA). This light penetrates your skin more deeply than ultraviolet B light.

This treatment may be used if you have severe psoriasis that has not responded to other treatment. Side effects of the treatment include nausea, headaches, burning and itchiness. You may need to wear special glasses for 24 hours after taking the tablet to prevent the development of cataracts. Long-term use of this treatment is not encouraged as it can increase your risk of developing skin cancer.

Combination light therapy

Combining phototherapy with other treatments often increases its effectiveness. Some doctors use UVB phototherapy in combination with coal tar, as the coal tar makes the skin more receptive to light. Combining UVB phototherapy with dithranol cream may also be effective (this is known as Ingram treatment).

Systemic treatments

If your psoriasis is severe or other treatments have not worked, you may be prescribed systemic treatments by a specialist. Systemic treatments are treatments that work throughout the entire body. These medications can be very effective in treating psoriasis but they all have potentially serious side effects. All the systemic treatments for psoriasis have benefits and risks. Before starting treatment, talk to your doctor about your treatment options and any risks associated with them.

There are two main types of systemic treatment, called non-biological (usually given as tablets or capsules) and biological (usually given as injections). These are described in more detail below.

Non-biological medications

Methotrexate

Methotrexate can help control psoriasis by slowing down the production of skin cells and suppressing inflammation. It is usually taken once a week. Methotrexate can cause nausea and may affect production of blood cells. Long-term use can cause liver damage. People who have liver disease should not take methotrexate and you should not drink alcohol when taking it. Methotrexate can be very harmful to a developing baby, so it is important that women use contraception and do not become pregnant while they take this drug and for three months after they stop. Methotrexate can also affect the development of sperm cells, so men should not father a child during treatment and for three weeks afterwards.

Ciclosporin

Ciclosporin is a medicine that suppresses your immune system (immunosuppressant). It was originally used to prevent transplant rejection but has proved effective in treating all types of psoriasis. It is usually taken daily. Ciclosporin increases your chances of kidney disease and high blood pressure, which will need to be monitored.

Acitretin

Acitretin is an oral retinoid that reduces production of skin cells. It is used to treat severe psoriasis that has not responded to other non-biological systemic treatments. It is usually taken daily. Acitretin has a wide range of side effects, including dryness and cracking of the lips, dryness of the nasal passages and, in rarer cases, hepatitis. Acitretin can be very harmful to a developing baby, so it is important that women use contraception and do not become pregnant while they take this drug and for two years after they stop taking it. However, it is safe for a man taking acitretin to father a baby.

Biological treatments

Biological treatments reduce inflammation by targeting overactive cells in the immune system. These treatments are usually used if you have severe psoriasis that has not responded to other treatments, or if you cannot use other treatments.

Etanercept

Etanercept is injected twice a week and you will be shown how to do this. If there is no improvement in your psoriasis after 12 weeks, the treatment will be stopped. The main side effect of etanercept is a rash where the injection is given. However, as etanercept affects the whole immune system, there is a risk of serious side effects including severe infection. If you had tuberculosis in the past, there is a risk it may return. You will be monitored for side effects during your treatment.

Adalimumab

Adalimumab is injected once every two weeks and you will be shown how to do this. If there is no improvement in your psoriasis after 16 weeks, the treatment will be stopped. Adalimumab can be harmful to a developing baby, so it is important that women use contraception and do not become pregnant while they take this drug and for five months after the treatment finishes. The main side effects of adalimumab include headaches, a rash at the injection site and nausea. However, as adalimumab affects the whole immune system, there is a risk of serious side effects including severe infections. You will be monitored for side effects during your treatment.

Infliximab

Infliximab is given as a drip (infusion) into your vein at the hospital. You will have three infusions in the first six weeks, then one infusion every eight weeks. If there is no improvement in your psoriasis after 10 weeks, the treatment will be stopped. The main side effect of infliximab is a headache. However, as infliximab affects the whole immune system, there is a risk of serious side effects including severe infections. You will be monitored for side effects during your treatment.

Ustekinumab

Ustekinumab is injected at the beginning of treatment, then again four weeks later. After this, injections are every 12 weeks. If there is no improvement in your psoriasis after 16 weeks, the treatment will be stopped. The main side effects of ustekinumab are a throat infection and a rash at the injection site. However, as ustekinumab affects the whole immune system, there is a risk of serious side effects including severe infections. You will be monitored for side effects during your treatment.

Why we need to help our detoxification systems

by Fleur Borrelli, Nutritionist at The Putney Clinic of Physical Therapy

It is a relatively unknown fact that our body produces its own toxins as part of our normal metabolism. Our intestinal bacteria may also release by-products from metabolism that can be damaging to our health. This is before we even consider the toxins that come in from the environment.

Fortunately we have evolved a complex network of systems to get rid of toxins that have been created internally. The antioxidant system cleverly destroys free radicals during chemical reactions in our cells before they can damage the cell itself.

The liver, amongst its multitude of tasks, will take a toxic molecule which is generally fat soluble and transforms it into a water soluble molecule to be excreted out of the body in urine via the kidneys. Even fat soluble molecules can be shifted into bile which is then squirted into the intestine and ejected from the body in faeces. Sweating can lose any heavy metals lurking about, not to mention the shedding of toxins via skin, hair and nails.

This is what happens when all is working well... But we now live in a modern environment where we are being overloaded with toxins We have plastics in our toothpaste, heavy metals in our deodorant, herbicides in the air we breathe, additives in our foods, synthetic hormones in our drinking water, harmful electromagnetic radiation in our homes and the list goes on.

We may reach a point where we have adapted to this environment of chemicals that are foreign to our body but we haven’t got there yet. We are succumbing more and more to symptoms produced by compromised detoxification systems such as poor digestion, headaches, depression and chronic fatigue.

'Tired all the time' (TATT) is one of the major reasons why people visit their doctor... We need to help our detoxification systems. We can do that by consciously reducing our toxin exposure, being mindful of everything we put into our mouth or on our skin. Indeed a good rule of thumb would be not to put anything onto our skin that we are not prepared to put into our mouth! Nourishing the body as well will provide those systems with the raw materials they need to perform their tasks. Food is our medicine.

Fleur will holding a detox and revitalise your body workshop along with Cherie Lathey of Yoga Mama on Saturday 21 June, from 1-4pm. Early bird offer of £40, if booked before 15 June (normal price £45).


For appointments with Fleur at The Putney Clinic of Physical Therapy, call  020 8789 3881 or send an email to info@putneyclinic.co.uk.



Fleur Borrelli (Nutritionist)
W:Nutrition and superfood
N: Nutrition and superfood newsletters
T: 07766 88 35 22
E: fleur@nutritionandsuperfood.co.uk