Psoriasis: More than just a skin condition
Imagine a sizeable portion of your body covered with bright red spots and thick scaly patches. Imagine being so itchy and uncomfortable that you hardly ever get a decent night's sleep. Imagine being continually on the receiving end of glares and stares, such that on many days you just don't even feel like leaving your home.
This is the reality for many people who suffer from psoriasis -- a life-long autoimmune disease affecting about one million Canadians. Not all cases of psoriasis are so severe, but some are. Many living with the condition have struggled for years without much improvement.
While psoriasis appears as a skin condition, its impact goes well beyond the skin. The disease can have a major effect on a person's quality of life and increase their risk for other chronic diseases such as heart disease and diabetes. The emotional and social impact can significantly effect a person's well-being and contribute to low self-esteem, anxiety and depression. Given that psoriasis is such a visible disease, people often want to cover it up and feel embarrassed and stigmatized when out in public.
Nurses: With you every step of the way
I see myself as more than a nurse who treats patients -- I also take on the role of counsellor, motivator and advocate at a time when they need support most.
Dermatology nurses like me play an important role in helping people living with psoriasis manage their chronic condition. Each day, I provide ongoing education, support and treatment to those patients who need it. I often meet with patients who are uncomfortable talking about what they're going through, even with loved ones. As dermatology nurses, we work to help each patient feel less alone in their journey. That's why the theme for this year's National Nursing Week couldn't be more fitting, Nurses: With you every step of the way.
Patients today want more information about their disease and to actively participate when it comes to making decisions about their care. An important first step is getting to know each patient by learning about their unique needs, preferences and treatment goals. This helps the patient better understand their disease and how to best manage it. There are many options available that can be very effective in treating people with moderate to severe symptoms including ointments, specialized light therapy and medicines taken by mouth or given by injection. Patients are encouraged to speak to a health-care professional to figure out what works best for them.
Expressing empathy is also key in empowering and motivating patients to take control of their disease management. Research informs us that when patients feel involved in decision making about their own care, they do better. I see myself as more than a nurse who treats patients -- I also take on the role of counsellor, motivator and advocate at a time when they need support most.
Hear from other Canadians treating and living with psoriasis
Nurses are always looking for new ways to reach out and communicate with patients, their families and society. Together with doctors and patients, I recently contributed to a podcast series called "Layer by Layer" which provides a glimpse into what it's like to live with psoriasis. Canadians living with or affected by psoriasis can hear the experiences of others who treat and have the disease and understand that there is help available and, most of all, that they are not alone in their journey.
As dermatology nurses, we're dedicated to helping and supporting patients as we want to help ensure their experiences are positive ones and that everything is being done to improve their condition.
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Approved by the U.S. Food and Drug Administration (FDA) to treat psoriasis, "sal acid," as it's commonly called, is available in a variety of products, including shampoos, ointments, lotions, creams, soaps, and pastes. Salicylic acid helps to soften scales and exfoliate or lift them off your skin. Sal acid can be helpful as long as you use it according to directions. Too much salicylic acid, or salicylic acid left on the skin (or scalp) for too long, can cause irritation or stinging. If your shampoo has salicylic acid, focus it on your scalp rather than your hair, because it can weaken shafts, leading to breakage and hair loss (hair should return to normal once you stop using it).
Most shampoos contain sulfates to create a rich, foamy lather -- without the froth, it seems, people don't think their shampoo is working. However, sulfates can irritate the scalp. If you have a sensitive scalp and psoriasis, look for sulfate-free shampoos. Sulfates may be listed under ingredients as sodium laureth (or lauryl) sulfate or ammonium lauryl sulfate.
Coal tar is another ingredient approved by the FDA to treat psoriasis, including scalp psoriasis. However, you might want to test coal tar on a small area of your skin to be sure it doesn't cause irritation or redness. Because coal tar can make your skin more sensitive to the sun's ultraviolet rays, be sure to apply sunscreen to treated areas if you're going to be outside for any length of time. "Coal tar can be messy, so some people don't like to use it," says Stefan Weiss, MD, of the Weiss Skin Institute in Boca Raton, Fla. Refined coal tars such as liquor carbonis detergens (LCD) have less odor and cause less staining, but they're also less effective and can be harder to find.
"At one time, tea tree oil was seen as the panacea for psoriasis," Dr. Weiss says of the oil that's extracted from the leaves of a tree native to Australia. "Now, not so much." Some people report that tea tree oil helps relieve symptoms of their scalp psoriasis, and others find they're allergic to it.
The trace element zinc is found in many topical psoriasis treatments and some shampoos. A study from the Skin Disease and Cutaneous Leishmaniasis Research Center in Mashhad, Iran, found that a topical emollient containing zinc pyrithione proved to be an effective treatment for localized psoriasis.
Extracted from the nuts of the argan tree of southwestern Morocco, argan oil is rich in antioxidants and has been popularized as a food, a health treatment, and a beauty ingredient. However, according to a recent review in the Journal of Pharmacy and Pharmacology, there's a lack of clinical studies to definitively support its effectiveness.
Shea butter is full of moisture, which can make it an effective ingredient in skin care products. When you have psoriasis, it's important to keep your skin moisturized, Weiss says. Skin creams made with shea butter tend to be thicker, he says, and when it comes to moisturizer, the thicker, the better. Heavy moisturizers for psoriasis help lock in the skin's natural moisture.
Several ingredients have been approved by the FDA for treating itch: calamine, hydrocortisone (a weak steroid), camphor, diphenhydramine hydrochloride (HCl), benzocaine, and menthol. Try them with caution, however, because some of them can increase skin irritation and dryness.
If you have sensitive skin, look for fragrance-free skin care products and shampoos. Scents added to make products smell good or just to neutralize their odor can be irritating ("unscented" might not be fragrance-free). Also, Weiss advises avoiding products that contain alcohol, because it is drying.
This medical video will look into different ways and treatments to stop psoriasis.