Psoriasis is a chronic autoimmune condition that affects the skin, leading to the rapid growth 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 can be uncomfortable, itchy, and in some cases, it can also lead to social and emotional challenges.
While there is no cure for psoriasis, various treatments can help manage symptoms and reduce flare-ups.
Pharmacists play a vital role in the management of psoriasis by providing medication counseling, recommending suitable skincare products, and offering support to help patients manage their condition effectively.
Understanding Psoriasis
Psoriasis is caused by an overactive immune response that speeds up the skin cell turnover process. Normally, skin cells grow, mature, and are shed in about a month, but in individuals with psoriasis, this process occurs in just a few days. This rapid turnover leads to the accumulation of excess skin cells, forming scales and patches. The exact cause of psoriasis is still not fully understood, but both genetic and environmental factors play a role. Common triggers for psoriasis flare-ups include:
• Infections: Illnesses like strep throat or fungal infections can trigger psoriasis symptoms, particularly in children.
• Stress: High levels of stress are a common trigger for flare-ups.
• Injury to the skin: Cuts, scrapes, or even sunburn can cause psoriasis patches to form in the affected areas (a phenomenon known as the Koebner response).
• Medications: Certain drugs, such as beta-blockers, lithium, and antimalarial medications, can exacerbate psoriasis.
• Weather: Cold, dry weather can worsen psoriasis symptoms, while warmer, more humid conditions may help alleviate them.
There are several types of psoriasis, including:
• Plaque psoriasis: The most common form, characterized by raised, red, scaly patches.
• Guttate psoriasis: Small, drop-shaped lesions often triggered by bacterial infections like strep throat.
• Inverse psoriasis: Red, shiny lesions that appear in skin folds such as the armpits or groin.
• Pustular psoriasis: White pustules surrounded by red skin, often affecting the hands and feet.
• Erythrodermic psoriasis: A rare, severe form that causes widespread redness, shedding of the skin, and intense itching or burning.
The Pharmacist’s Role in Managing Psoriasis
Pharmacists play a key role in the management of psoriasis by helping patients understand their treatment options, ensuring safe use of medications, and providing practical advice for skincare. Below are some ways pharmacists contribute to psoriasis management:
1. Medication Counseling and Management
Pharmacists can help patients navigate a variety of topical and systemic treatments prescribed for psoriasis:
• Topical treatments: The first line of defense for managing mild to moderate psoriasis. Pharmacists can provide counseling on the proper use of the following:
o Topical corticosteroids: These are commonly prescribed to reduce inflammation and redness. Pharmacists help educate patients on how to apply these products safely, avoid side effects like skin thinning, and manage their use to control flare-ups.
o Topical vitamin D analogs (e.g., calcipotriene): These products help slow down skin cell growth and are often used in combination with corticosteroids. Pharmacists can help patients understand how to apply these treatments effectively and the importance of adhering to dosing schedules.
o Topical retinoids (e.g., tazarotene): Retinoids promote skin cell turnover and reduce inflammation. Pharmacists advise on their proper application, common side effects like skin irritation, and precautions, especially for pregnant women.
o Coal tar: This treatment can help slow skin cell turnover and reduce inflammation. Pharmacists provide guidance on its use, as well as recommendations for reducing the strong odor associated with coal tar products.
• Systemic treatments: For moderate to severe psoriasis, systemic treatments may be necessary. These treatments are often prescribed when topical therapies are not sufficient:
o Oral medications: Methotrexate, cyclosporine, and acitretin are oral medications that help control psoriasis symptoms by suppressing the immune system or slowing down skin cell turnover. Pharmacists educate patients on the potential side effects, such as liver damage, nausea, and increased risk of infections, and help monitor for any adverse effects.
o Biologics: These are advanced treatments that target specific parts of the immune system to reduce inflammation. Biologics are often administered via injection or infusion. Pharmacists play a critical role in helping patients understand how to administer their biologic medication, monitor for side effects (such as infections or allergic reactions), and manage the cost and insurance aspects of biologic treatments.
2. Skincare Recommendations
Proper skincare is essential for individuals with psoriasis, as it helps reduce dryness, irritation, and the likelihood of flare-ups. Pharmacists can recommend the following strategies:
• Moisturizers: Regular use of thick, emollient-rich moisturizers can help soothe dry, flaky skin and reduce itching. Pharmacists can guide patients in choosing non-irritating products free from alcohol, fragrances, and harsh chemicals, which can worsen symptoms.
• Bath treatments: Bathing in lukewarm water with added colloidal oatmeal or Epsom salts can help alleviate itching and inflammation. Pharmacists recommend avoiding hot water, as it can further dry out the skin.
• Sun protection: Exposure to sunlight may improve psoriasis symptoms for some people, but excessive sun exposure can trigger flare-ups or lead to skin damage. Pharmacists emphasize the importance of using broad-spectrum sunscreens (SPF 30 or higher) to protect the skin.
3. Lifestyle and Dietary Guidance
Pharmacists can help guide patients on lifestyle changes that may reduce the frequency and severity of psoriasis flare-ups:
• Stress management: Since stress is a common trigger for psoriasis, pharmacists may recommend relaxation techniques such as yoga, meditation, or deep breathing exercises.
• Dietary considerations: While no specific diet has been proven to cure psoriasis, some people find that certain foods exacerbate their condition. Pharmacists can advise on healthy eating habits and recommend an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids.
4. Monitoring and Referral to Specialists
Pharmacists monitor patients for any signs of adverse effects from treatments, ensuring safe and effective use of medications. If a patient’s psoriasis symptoms do not improve with current treatments or if they experience severe side effects, pharmacists may refer them to a dermatologist for more specialized care.
Conclusion
Pharmacists play an essential role in the management of psoriasis by providing medication counseling, recommending suitable skincare products, and offering advice on lifestyle modifications. While there is no cure for psoriasis, effective treatment options are available, and pharmacists can help patients navigate these choices to manage symptoms, improve quality of life, and reduce flare-ups. By working with a pharmacist, individuals with psoriasis can gain the knowledge and support they need to take control of their condition and maintain healthy, comfortable skin.
