Psoriasis is a chronic autoimmune condition that affects the skin, causing cells to grow too quickly, leading to the formation of thick, scaly patches.
These patches, commonly seen on the elbows, knees, scalp, and lower back, can cause discomfort and emotional distress.
While psoriasis is not curable, it can be managed effectively with the right treatment plan.
Pharmacists play a key role in helping patients manage psoriasis by recommending appropriate medications, providing guidance on topical treatments, and offering lifestyle advice to improve symptoms and overall quality of life.
Understanding Psoriasis
Psoriasis occurs when the immune system mistakenly accelerates the growth of skin cells, leading to an overproduction of cells that accumulate on the surface of the skin. The most common 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 appear after a bacterial infection such as strep throat.
• Inverse psoriasis: Smooth, red patches that appear in skin folds, such as under the arms, in the groin area, and around the genitals.
• Pustular psoriasis: White pustules (blisters of noninfectious pus) surrounded by red skin.
• Erythrodermic psoriasis: A severe form of psoriasis that can cause widespread redness and peeling of the skin, often accompanied by severe itching or pain.
Psoriasis can be triggered by various factors, including:
• Genetics: A family history of psoriasis increases the risk of developing the condition.
• Infections: Infections, especially throat infections caused by streptococcus bacteria, can trigger or worsen psoriasis.
• Stress: Emotional stress can exacerbate psoriasis flare-ups.
• Weather conditions: Cold, dry weather can lead to worsening of symptoms, while warm, moist climates may provide some relief.
• Medications: Certain drugs, such as lithium, antimalarials, and beta-blockers, can trigger or worsen psoriasis.
• Diet and lifestyle factors: Poor diet, smoking, and alcohol consumption can also be contributing factors.
The Pharmacist’s Role in Managing Psoriasis
Pharmacists are vital in managing psoriasis by helping patients choose the right treatments, providing education on how to use medications effectively, and offering lifestyle and skincare advice. Here are the key areas where pharmacists can make a significant impact:
1. Topical Treatments
Topical therapies are the first line of treatment for most patients with psoriasis. Pharmacists play a critical role in recommending and educating patients about the correct use of topical treatments, which include:
• Topical corticosteroids: These are the most commonly prescribed treatment for psoriasis. They reduce inflammation and help control the rapid turnover of skin cells. Pharmacists provide guidance on the proper application of topical steroids, including the potential side effects of prolonged use, such as thinning of the skin and delayed wound healing.
• Topical vitamin D analogs (e.g., calcipotriene): These medications help slow skin cell growth and are often used in combination with corticosteroids. Pharmacists ensure patients are aware of any potential irritation and the importance of proper application.
• Topical retinoids (e.g., tazarotene): Retinoids help to normalize skin cell growth and are used for more moderate cases of psoriasis. Pharmacists help with managing side effects such as skin irritation and redness.
• Coal tar: Available in shampoos, creams, and oils, coal tar reduces skin cell turnover and helps alleviate itching and inflammation. Pharmacists can advise on how to use coal tar products, which may have a strong odor and staining properties.
• Emollients and moisturizers: Regular use of moisturizers is crucial in managing psoriasis, as it helps soothe the skin and prevents dryness and cracking.
Pharmacists recommend non-irritating, fragrance-free products suitable for psoriasis-prone skin.
2. Systemic Treatments
For moderate to severe cases of psoriasis, topical treatments may not be sufficient, and systemic treatments are often required. Pharmacists assist in managing the use of oral or injectable medications, including:
• Oral retinoids (e.g., acitretin): These medications work by reducing skin cell growth. Pharmacists counsel patients on the potential side effects, such as dry skin, elevated liver enzymes, and teratogenicity (birth defects), and ensure that patients follow necessary precautions, such as using contraception during treatment.
• Methotrexate: This medication reduces inflammation and skin cell turnover. It can be effective for patients with severe psoriasis but may cause side effects, including liver toxicity and bone marrow suppression. Pharmacists help monitor patients for signs of these side effects and ensure they undergo necessary laboratory tests.
• Cyclosporine: An immunosuppressive drug that can be used for short-term management of severe psoriasis. Pharmacists help monitor kidney function and blood pressure, as these can be affected by cyclosporine use.
• Biologic therapies (e.g., adalimumab, etanercept, ustekinumab): Biologic medications are newer, targeted treatments that work by suppressing specific parts of the immune system responsible for psoriasis flare-ups. They are typically administered through injections or infusions and are used for moderate to severe cases. Pharmacists ensure patients understand how to properly use injectable biologics and monitor for any potential side effects, such as infection or allergic reactions.
3. Phototherapy
For some patients, phototherapy (light therapy) is an effective treatment option. This involves exposing the skin to ultraviolet (UV) light under medical supervision. Pharmacists can educate patients on the benefits and risks of phototherapy, including the potential for skin damage with excessive sun exposure and the importance of sun protection when using phototherapy.
4. Lifestyle and Skin Care Recommendations
In addition to medications, managing psoriasis involves taking care of the skin and adopting healthy lifestyle habits. Pharmacists can offer advice on:
• Avoiding triggers: Identifying and avoiding personal triggers, such as stress, smoking, alcohol, and certain medications, can help reduce flare-ups.
• Maintaining a healthy diet: A balanced diet rich in anti-inflammatory foods (e.g., fruits, vegetables, and omega-3 fatty acids) may help reduce psoriasis symptoms.
• Sun protection: Patients undergoing treatments like phototherapy or using medications like retinoids are more sensitive to sunlight. Pharmacists recommend using sunscreen and protective clothing to prevent sunburn and skin damage.
• Stress management: Since stress is a common trigger, pharmacists can suggest relaxation techniques such as yoga, meditation, or breathing exercises to help manage stress levels.
5. Education and Ongoing Support
Psoriasis is a chronic condition, and long-term management is essential. Pharmacists provide education about the nature of the disease, the importance of adherence to treatment regimens, and managing expectations. They also offer ongoing support by monitoring progress, adjusting treatments as needed, and helping with any side effects that may arise.
Conclusion
Pharmacists are an integral part of the care team for individuals with psoriasis. They provide valuable support through medication counseling, lifestyle recommendations, and education on effective skincare practices. With their expertise, pharmacists help patients manage psoriasis more effectively, improving quality of life and reducing the frequency and severity of flare-ups. If you have psoriasis, consulting a pharmacist can be an important step toward achieving better skin health and long-term management of the condition.
