Speak Clearly: Perspectives on Psoriasis

Psoriasis treatments have come a long way since the term dermatology was coined in the early nineteenth century. From the days of seemingly farfetched treatments, small advances in knowledge and innovation have brought us to a place where achieving clear skin is now possible for many people living with psoriasis.1 So, how did we get here?

A Look at Early Treatments 

The nineteenth century was a turning point in the field of dermatology when physicians like Jean-Louis Ailbert and Robert Willan, pioneers in dermatology, began classifying and describing skin diseases.1 In 1809, Robert Willan recorded the first, accurate depiction of psoriasis during a period in time when psoriasis and other skin conditions were largely misunderstood.1

Historically, psoriasis management included covering affected areas in lubricated cloth or applying substances like oil or tar to the skin.1 Common treatments in the nineteenth century look different from treatments today, but the notion of applying a product to the skin to treat psoriasis evolved from here.

Topical Treatments 

In the twentieth century treatment tactics became more sophisticated, including topical steroids applied directly to the skin. These are considered a first-line treatment for mild-to-moderate psoriasis and work to hinder excessive skin cell growth.2,3 Around this time is also when dermatologists began to discover that treatment plans should be individualized for each patient.1

In the last decade, topical treatments for psoriasis have focused on combination therapies to further decrease skin cell growth and the inflammation caused by psoriasis.3,4 While topical treatments are often effective, over time the effects of may diminish.5 If this happens, it’s important to talk with your doctor about additional treatment options. Not sure where to start? Use this customizable discussion guide.

Phototherapy and UV Light 

For thousands of years, sunlight has been considered beneficial as a treatment for skin conditions.6 That is no different for psoriasis. Today, phototherapy is considered a safe and effective treatment for mild psoriasis.6 Like topical treatments, phototherapy targets one area of the skin and often requires in-office sessions with your doctor.5

Psoriasis and the Immune System

In the mid-twentieth century, researchers made a discovery that revolutionized the treatment of psoriasis. They learned psoriasis is not just a skin disease but is actually caused by a malfunction of the immune system leading to inflammation that causes psoriasis. 3,4

This discovery shifted the focus of research into treatment options that work from the inside out.

Oral Systemic Treatments 

Oral systemic treatments work inside the body to treat psoriasis, instead of just one localized area. 5,7 Different oral medications work in different ways such as suppressing the immune system or acting as an anti-inflammatory to reduce the rapid growth of skin cells similar to the way topical treatments and phototherapy work.7

Biologics 

The latest innovations in the psoriasis treatment landscape are biologic treatments, which are a type of systemic treatment.3,7 Working inside the body to prevent inflammation, biologics are often prescribed to people who have not responded well to other treatment options.

The development of biologics is considered a major milestone in psoriasis treatment as these targeted therapies are proven to be effective.8 They continue to evolve as we learn more about chronic immune-mediated diseases and how psoriasis interacts with the body.

What’s Next?

Research continues to evolve to help psoriasis patients achieve clear skin as soon as possible, with the goal of avoiding the increasingly negative impacts a person with unmanaged psoriasis experiences. One concept, cumulative life course impairment (CLCI), has helped physicians better assess the life-long physical and mental burden of chronic diseases, like psoriasis.9 In dermatology, CLCI is used to evaluate how not achieving completely clear skin early in their journey can negatively impact a patient’s life over time and to ignite a sense of urgency among the dermatology community to treat to clear.9

We’ve come a long way with treatment options, researchers continue to strive to improve outcomes for all people living with psoriasis. Newer, innovative research is focused on the role of genetics in psoriasis, how combination therapies can improve out comes and addressing common comorbidities of psoriasis patients.8 Experts predict the next wave of psoriasis treatment could bring more individualized treatment plans.1,8

To pick the best treatment plan for you, it’s important to openly discuss your goals with your doctor and all of the ways psoriasis is impacting your life. Not sure how to start the discussion? Use this guide to help.

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References:

  1. National Psoriasis Foundation. The History of Psoriasis. September 2015. https://www.psoriasis.org/advance/history-psoriasis. Accessed on May 15, 2020.
  2. National Psoriasis Foundation. Topical Treatments. June 2016. Available at https://www.psoriasis.org/about-psoriasis/treatments/topicals. Accessed on May 15, 2020  
  3. Armstrong, A., et al. The Evolving Landscape of Psoriasis Treatment. Seminars in Cutaneous Medicine and Surgery. March 2018. 37(2S)S40-S44.
  4. Gerb, J., et al. Psoriasis. Nat Rev Dis Primers. November 2016. 2(16082).
  5. Mayo Clinic. Psoriasis. May 2020. Available at:  https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845. Accessed on May 15, 2020.
  6. Lapolla, W., et al. A review of phototherapy protocols for psoriasis treatment. J Am Acad Dermatol. May 2011. 64(5):936-49.
  7. National Psoriasis Foundation. About Psoriasis. Available at: www.psoriasis.org. Accessed June 2019.
  8. Ronholt, K., et al. Old and New Biological Therapies for Psoriasis. International Journal of Molecular Sciences. November 2017. 1811).
  9. Ros S, Puig L, Carrascosa JM. Cumulative Life Course Impairment: The Imprint of Psoriasis on the Patient’s Life. Actas Dermosifiliogr. 2014;105:128–134.

Get clear with your doctor

You deserve to feel confident in your skin, but how do you have a clear conversation with your doctor? Sometimes speaking up can be the hardest part. 

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Your voice makes a difference

Be clear about your goals. The power to speak up, feel confident and demand the best care is within you. Sharing your story could be your next step to feeling free from psoriasis—and possibly inspire others to do the same.

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