One million Canadians are living with psoriasis, a skin disorder characterized by skin cells multiplying at a rate 10 times faster than normal. It causes raised, scaly red patches on the skin. It’s perplexing and often misunderstood, with no known cure. Fortunately, a new generation of drug therapies offers new options to treat this immune disease.

That’s a cause for hope. Those with the condition suffer both physically and emotionally. They may feel ashamed, embarrassed, or ostracized due to a common misconception that psoriasis can be spread to others. There are comorbidities as well, as individuals with the disease are at greater risk of developing depression and cardiovascular disease.

There’s no need to endure the negative impact the condition can have on one’s life. Yet 78 percent of psoriasis patients throughout North America and Europe report having never seen a dermatologist to address their disease. There’s also an extremely high proportion of patients (87 to 89 percent) who have had no treatment at all or topical therapy only.

New therapies for psoriasis

Over the years, treatments have evolved significantly. “It started with topical steroids,” says Dr. Melinda Gooderham, a dermatologist based in Peterborough, ON. “Then they’d put on sticky, smelly coal tar and use phototherapy to get improvement. That’s back when psoriasis was thought to be a disorder of the keratinocytes [the predominant cells on the outermost layer of the skin]. Over time, the thinking changed and we began to understand that
psoriasis is a disease originating with the immune system. Skin involvement is secondary.”

That knowledge came as a result of some patients taking immune suppressants for other conditions, which led to their psoriasis clearing up. “Physicians used available immune suppressants to help people, but these drugs had side effects,” says Dr. Gooderham.

Targeted therapies including certain oral systemics and injectable biologic treatments are the latest options. They zero in on specific cytokines (proteins secreted by cells to signal behaviour in other cells), instead of the entire immune system. “They work better and are more easily tolerated by patients,” notes Dr. Gooderham. “Overall, they have made a huge impact on patients and their quality of life. We are now able to take a patient who is covered in psoriasis and clear them up entirely.”

Patients find new hope

Over his 28-year career, dermatologist Dr. Kim Papp, based in Waterloo, ON, has been interested in clinical research and the development of therapies for cutaneous disorders. “The new therapies given orally or by injection are effective and safe,” he says. “They have revolutionized the way we treat psoriasis. Almost on a daily basis, I have a patient who says, ‘You’ve given me my life back.’”

He’s seen patients who had withdrawn from life for fear of being treated like a leper come out of their shells when using new targeted therapies as prescribed. “They’re good for patients who don’t respond to topical preparations or phototherapy, which can be time-consuming and expensive, and for those who may be affected by psoriasis in difficult-to-treat areas,” Dr. Papp explains. “When we see something that works, it’s gratifying.”