When I was just 11 years old, I asked my mom to look at my scalp. “It feels strange,” I worried. It was mildly itchy and had a tingly, almost burning sensation. Additionally, I had felt quite a few bumpy patches that I couldn’t keep my hands off. “Have you been picking?” she asked, knowing that I tended to scrape and pick at scabs. “Yes,” I admitted. “It’s very itchy!”
(That was only partially true. Have you ever seen the payoff from psoriasis scabs? They’re like the size of cornflakes and I found them so satisfying to peel! Disclaimer: Don’t do this!)
My mom marched me to our family doctor who a) diagnosed me with psoriasis and b) suggested a coal tar shampoo of which I can still recall the smell to this day. Faithfully, once a week, I tipped my head over in the bathtub while my mom massaged the shampoo into my hair and scalp. When I was older, I took over the duties myself, and weaned myself off the regimen when my psoriasis improved – though it never completely went away.
While I tried not to let my psoriasis get me down, it nevertheless affected me psychologically throughout my teens and twenties. I rarely wore my hair up, concerned that the scales and scabs would be more visible if I pulled my locks away from my scalp. I panicked when my hairdresser went on vacation, knowing I’d be too embarrassed to have a new stylist do my hair. When I dated, I freely disclosed my condition out of fear that a man would nonchalantly run his fingers through my hair – and draw back in surprise.
It’s obvious that while I thought I was “managing” my psoriasis, I was still allowing it to control my day-to-day. Fast forward to 2014, when, after decades of letting my psoriasis symptoms wax and wane, my joints flared to the point where I was disabled with swelling and pain for over six months. The diagnosis: psoriatic arthritis (PsA).
Today, I have mild flares of psoriasis on my scalp, lips and elbows, but I’m considered to be in clinical remission thanks to the medications I take for my psoriatic arthritis (which have the added benefit of keeping my psoriasis in check). I regularly see both a dermatologist and rheumatologist for my conditions, making sure to advocate for myself when I need to. Recently, I had a chance to sit down with Dr. Geeta Yadav, a dermatologist based in Toronto at Skin Science Dermatology.
In the days leading up to the interview, an idea started to form – I wanted to share with you some things I wish I knew about psoriasis decades ago (that I know now). Dr. Yadav was knowledgeable and thoroughly answered my questions, which in turn allowed me to create the following list for you!
1. Psoriasis is a lifelong condition.
If I had clearly understood that my psoriasis would likely be with me for the rest of my life, I would have taken more definitive steps sooner to get my condition under control (and certainly before it progressed to PsA).
“Psoriasis is a lifelong condition because it is primarily influenced by genetics, and exacerbated by the environment,” says Dr. Yadav. “It can have periods where it waxes and wanes, and there are certainly things that can make it flare, but ultimately, people are born with a predisposition to this condition.”
2. There are common, basic triggers for flares.
Of course, everyone is different. However, with 1 million Canadians battling psoriasis, there are similarities that can be identified when it comes to triggers.
Dr. Yadav says: “Common triggers include stress, infection, (sometimes) pregnancy, a response to certain medications, or environmental – such as dry weather.” She also noted that some triggers are within the patient’s control, such as smoking, obesity and swimming in chlorinated water, while other triggers are obviously not.
Keep in mind that no two individuals are the same; that’s why it’s important to seek the help of a health care professional to create a personalized approach to managing psoriasis.
3. OTC remedies are a good first start, but psoriasis often requires more specialized care.
“By the time that patients come to see me,” says Dr. Yadav, “they’ve usually ‘lotioned’ and ‘potioned’ themselves to try to do whatever they can to manage the condition. The first line is always going to be moisturization, because it’s all about repairing the skin barrier and keeping the skin integrity.
Then you move into the therapeutics that are prescription. For local, mild disease we usually use anti-inflammatories like a topical steroid, or a non-steroid anti-inflammatory cream for more sensitive areas such as the face. These are more effective than OTC moisturizers of course, and patients usually see good results.”
4. When topical meds aren’t effective, your dermatologist can suggest other therapies.
For years I thought that psoriasis treatments were limited to topical creams or phototherapy (exposing the skin to UV light). This is because I had only consulted my family doctor about my condition; I mistakenly believed that my skin getting “better” was the best result I could achieve. It was only when I began seeing a dermatologist that I learned there are systemic therapies and targeted biological treatments that can effectively put patients in remission.
“The reality is, for psoriasis, the systemic therapies are really actually quite safe; they’re quite targeted,” affirms Dr. Yadav. “The landscape for psoriasis and the standard of care is so high… I really do think that it’s a collaborative approach between the patient, their physician and pharmaceutical companies to get the patient onto the medication that they need and support them throughout the process. I have many, many patients on all biologics and as a provider, it’s so great to be able to treat diseases that have great therapeutic results.”
5. Don’t ignore the symptoms of psoriatic arthritis.
The fact is, 1 out of 3 people who have psoriasis will go on to develop psoriatic arthritis. Some of the warning signs are:
– a history of psoriasis
– swollen and stiff joints, especially the fingers and toes
– back and shoulder pain
– unexplained fatigue
Not everyone with psoriasis develops psoriatic arthritis, but it’s important to be aware of its symptoms – especially if you have psoriasis. Treating psoriatic arthritis early can help you avoid further joint damage, so make sure to bring up any new or unusual symptoms to your doctor or dermatologist.
While I can’t turn back the clock, I know I can move forward with positivity and purpose. Having access to specialists, the correct, targeted therapies, and learning to advocate for myself, has proven to be the right prescription (pun intended) for staying in remission! Here’s to clear days ahead!