Psoriasis is a chronic autoimmune condition that affects the skin, causing the rapid buildup of skin cells that form thick, scaly patches.
These patches can appear anywhere on the body but are most commonly found on the elbows, knees, scalp, and lower back.
Psoriasis is not only a physical condition but also has emotional and social impacts, as the visible patches can lead to self-esteem issues and social stigma.
While there is no cure for psoriasis, there are effective treatments available to manage symptoms and improve quality of life.
Pharmacists play a key role in helping patients manage psoriasis by providing medication counseling, recommending skin care products, and offering support throughout the treatment process.
Understanding Psoriasis
Psoriasis is primarily driven by an overactive immune response that accelerates the growth of skin cells. In a typical individual, skin cells shed every 28-30 days. However, in someone with psoriasis, this process occurs in just 3-4 days, leading to the accumulation of skin cells on the surface.
The exact cause of psoriasis is unknown, but several factors contribute to its development:
• Genetics: A family history of psoriasis increases the likelihood of developing the condition.
• Immune system dysfunction: In psoriasis, the immune system mistakenly attacks healthy skin cells, triggering inflammation and the rapid production of new cells.
• Triggers: Environmental factors such as stress, infections, medications, and weather changes (cold weather, dry air) can worsen psoriasis or trigger flare-ups.
Types of psoriasis include:
• Plaque psoriasis: The most common form, characterized by raised, red patches with silvery-white scales.
• Guttate psoriasis: Small, drop-shaped lesions that often follow an infection, such as strep throat.
• Inverse psoriasis: Red, shiny lesions that develop in skin folds, such as under the arms or in the groin area.
• Pustular psoriasis: Characterized by white pustules surrounded by red skin.
• Erythrodermic psoriasis: A rare but severe form that causes widespread redness, shedding of skin, and pain.
Psoriasis can also affect the joints, a condition known as psoriatic arthritis, leading to pain and inflammation in the joints.
The Pharmacist’s Role in Managing Psoriasis
Pharmacists play a critical role in the management of psoriasis by providing advice on treatment options, offering patient education, and supporting adherence to therapy. Their responsibilities include:
1. Topical Treatments
Topical treatments are the first line of defense for most patients with psoriasis. Pharmacists help patients understand how to use these products effectively:
• Corticosteroids: Topical corticosteroids are the most commonly prescribed treatment for psoriasis. They help reduce inflammation and slow down the production of skin cells. Pharmacists guide patients on how to use these products safely, as long-term use can lead to side effects such as skin thinning and stretch marks. They also provide recommendations on the appropriate strength of corticosteroid to use, as different forms (creams, ointments, lotions) vary in potency.
• Vitamin D analogs (e.g., calcipotriene): These help regulate the growth of skin cells and can be used in combination with corticosteroids. Pharmacists assist in proper application to minimize irritation and maximize effectiveness.
• Topical retinoids (e.g., tazarotene): These vitamin A derivatives help normalize skin cell growth. Pharmacists educate patients about potential side effects, such as irritation or sun sensitivity, and provide guidance on how to use them correctly.
• Coal tar: Coal tar products help reduce scaling and inflammation, though they are less commonly used today due to their odor and messiness.
Pharmacists can recommend specific formulations for ease of use.
• Topical calcineurin inhibitors (e.g., tacrolimus, pimecrolimus): These non-steroidal medications reduce inflammation and are often used for psoriasis on sensitive areas such as the face and genitals. Pharmacists educate patients on their proper use and potential side effects.
2. Systemic Treatments
For moderate to severe psoriasis that does not respond to topical treatments, systemic therapies may be required. These treatments include:
• Oral medications:
o Methotrexate: An immunosuppressive drug that reduces the production of skin cells and inflammation. Pharmacists play a role in counseling on the proper dosing schedule, potential side effects, and monitoring requirements (e.g., liver function tests).
o Cyclosporine: An immunosuppressant that helps control severe psoriasis by inhibiting the immune response. Pharmacists assist in monitoring kidney function and blood pressure due to potential side effects.
o Acitretin: A systemic retinoid used for severe psoriasis that helps normalize skin cell production. Pharmacists guide patients on the potential for birth defects, requiring strict contraceptive measures.
• Biologic therapies (e.g., adalimumab, etanercept, ustekinumab): These are newer medications that target specific components of the immune system. Biologics are often administered by injection or infusion and are used for moderate to severe cases of psoriasis or psoriatic arthritis. Pharmacists play an essential role in educating patients on injection techniques, the importance of adherence, and monitoring for potential side effects, including infections and allergic reactions.
3. Patient Education and Support
Pharmacists provide valuable education and counseling to help patients manage their condition more effectively:
• Adherence counseling: Ensuring patients adhere to prescribed treatments is crucial for managing psoriasis. Pharmacists emphasize the importance of consistency with topical and systemic treatments and help patients understand how to apply topical medications properly.
• Skin care recommendations: Psoriasis can be exacerbated by dry skin. Pharmacists suggest using emollient-rich moisturizers to keep the skin hydrated and reduce flare-ups. They may recommend fragrance-free products to avoid irritation and advise on the use of bath oils or oatmeal baths to soothe the skin.
• Stress management: As stress can trigger psoriasis flare-ups, pharmacists can provide tips for stress management, such as relaxation techniques, exercise, and adequate sleep.
• Sun protection: Psoriasis can improve with moderate sun exposure; however, sunburn can make symptoms worse. Pharmacists recommend using sunscreen to protect the skin while managing psoriasis.
• Referral to specialists: In some cases, pharmacists may recommend that patients see a dermatologist or a rheumatologist if their psoriasis is not adequately controlled or if there are concerns about psoriatic arthritis.
4. Monitoring and Ongoing Care
Pharmacists help patients monitor the effectiveness of their treatment plans and make adjustments as needed. They assess for side effects from medications, such as gastrointestinal issues, liver toxicity, or increased risk of infections from immunosuppressive therapies. Regular follow-up is important to ensure that treatments are working and that patients are managing side effects appropriately.
Conclusion
Pharmacists play an indispensable role in managing psoriasis by offering expert advice on treatments, skincare routines, and lifestyle modifications. Whether recommending topical treatments, counseling on systemic therapies, or providing support for stress management and adherence, pharmacists help improve the quality of life for individuals living with psoriasis. If you or someone you know is struggling with psoriasis, consulting a pharmacist can be an important first step in achieving better symptom control and overall skin health.
