Prescription options available to treat psoriasis

Today I am going to give you a quick overview of some of the most common prescription treatments for psoriasis and links so you can access more information.

Whoa, Healthy Scratch! Why just prescription drugs?

Hey, I get it. There are lots of alternative treatments that people are using to attack this disease. I just needed to start somewhere. Check out future posts for more about these alternative ways to manage your P.

Yeah, but I know all this stuff. Old news, Scratch.

Ok, rockstar fine maybe you know it all. Good for you.

But what if you don’t?

Are there new drugs on the market since you last talked to your Dr or Derm? Are there new drugs to consider for safety or efficacy reasons? You’re happy with 50% clearance but what if you could do better?

Rookie and veteran members of team P should regularly check in here and elsewhere and take a minute and review what’s available. You might be surprised at what you learn!

 


 

Here are the most commonly prescribed classes of drugs in Canada:

  • Topicals
  • Phototherapy
  • Systemics
  • Biologics

 

Topicals

What are they?

  • These are drugs applied directly on the skin
  • Most common class of drugs prescribed for mild cases
  • Can be made into creams, ointments, gels, lotions or sprays

Available types of topicals include:

  • Corticosteroids
  • Vitamin D
  • Vitamin A
  • Coal tar

What’s new

  • Enstilar – an aerosol foam approved in October 2015 for once daily use up to 4 weeks. In 2 clinical trials of patients with primarily moderate or mild plaque psoriasis, 45% and 53.3% of patients achieved “Clear” or “Almost clear” skin at Week 4

Things to consider:

  • Long term use of corticosteroids is not generally recommended – ask your doctor. If used longer than recommended it can thin your skin, cause redness (erythema), acne, difficulty healing wounds and even something called Red Skin Syndrome or Steroid Addiction.
  • It is likely to be the cheapest of the prescription options

Phototherapy

  • This is usually performed in a doctor office but patients may obtain a unit to treat themselves at home
  • Depending on your skin type (how prone you are to sunburn) these treatments can be quite quick to start – as little as less than a minute

Available types of phototherapy include:

  • UVB – perhaps the most common
  • PUVA – Psoralen + UVA. Psoralen is a topical or oral light sensitizing medication to increase the effectiveness of UVA treatment

What’s new

  • Excimer laser – a high intensity UVB laser that targets specific plaques
  • Pulsed dye laser – a high intensity beam of yellow light that disrupts blood flow to affected areas

Things to consider

  • Suntan beds do not replace medical phototherapy treatments! The National Psoriasis Foundation says indoor tanning increases your risk of devloping melanoma by 59%
  • In order to be most effective you must receive consistent treatments throughout the week. This may pose a challenge with your work or school schedule
  • Phototherapy treatments can be progressive (increasing radiation each week or visit). Speak up if you begin to feel discomfort to avoid getting a minor burn.

Systemics

  • Typically prescribed when the previous treatment methods have not been effective to manage your psoriasis and when at least 5-10% of your body
  • They are called systemic because they treat your whole body, not just your skin.
  • Systemic medications are chemical formulations. Generic options may be available
  • Some systemic medications can have serious side effects so it is likely that your doctor will want regular blood tests and check ups
  • Systemic medications may cost more than topical treatment

Available types of systemics include:

  • Acitretin – sold under the brand name Soriatane. It’s made of vitamin A and has been effective in pustular psoriasis.
  • Cyclosporine – also works to suppress the immune system
  • Hydroxyurea – while not FDA approved as a psoriasis treatment, it has been prescribed by some doctors for many years. It is seen to have less side effects than some of the “stronger” systemics but is also less effective
  • Methotrexate – high doses have been used to treat cancer. For psoriasis patients, the dosage is much lower. It has been effective at treating both psoriasis and psoriatic arthritis

What’s new

  • Apremilast – sold under the brand name Otezla, this medication was FDA approved in 2014 and works to shut down an enzyme in the immune system to improve psoriasis symptoms

Things to consider:

  • Systemic medications may cost more than topical treatments
  • Some systemic medications can have serious side effects so it is likely that your doctor will want regular blood tests and check ups. Over time methotrexate can damage liver and blood cells. Cyclosporine can affect your kidneys, blood pressure and cholesterol. Hydroxyurea has been linked to skin cancer and bone marrow problems.
  • Many systemics pose pregnancy risks. For example, women and men both of must not intend to have children for at least 3 years after discontinuing Soriatane

Biologics

  • The newest form of psoriasis treatment
  • They are said to have “fewer side effects than traditional systemic therapy”

Available types of biologics include:

  • Adalimumab – Humira
  • Certolizumab –Cimzia
  • Etanercept – Enbrel
  • Golimumab – Simponi
  • Infliximab – Remicade 
  • Secukinumab – Cosentyx
  • Ustekinumab – Stelara
  • Ixekizumab – Taltz

Things to consider:

  • Typically biologics are very expensive treatments – as much as $20,000 or more per year.
  • It may be possible to participate in a clinical research trial and receive a biologic treatment for free, but the medication will be relatively unproven.
  • Biologics affect the immune system so infections may become more frequent
  • You will need to be tested for TB as that disease can be reactivated by certain biologic treatments

 


 

Links for more info:

 


 

If what you are doing to treat your psoriasis is working for you then keep it up!

If, on the other hand, your psoriasis or joints are not well maintained or worsening then I would suggest that you consider the options losted above and talk with your doctor or dermatologist to see if it’s time to make a change.

With psoriasis, ignorance is rarely bliss. Ignoring it doesn’t make it go away. You deserve to shoot for more than just getting by. Don’t give up hope. See a doctor.

Maybe you will ultimately decide to tackle this in a different way like through modifying your diet or some other means. But make sure that you have spoken with a professional who can help you make that call. It might change your life.

 

Mr Healthy Scratch

 

(PS – If you can’t wait for my series on alternative treatments I mentioned at the top of this post, check out this handy page from psoriasis.org which will lead you to more information. As always, make sure that you consult a real professional to determine what treatment is best for you.)

(PPS – Know of a treatment I missed? See a mistake? Please let me know! I want to continue to add to this post to keep it current and helpful. Thanks for participating in passing on your first hand knowledge and expertise)

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This week’s Starting Lineup and the first Healthy Lifestyle Challenge Update!

My Starting Lineup is a feature where I announce my upcoming blog posts as part incentive to check back later in the week and part motivational tool to keep me writing. Have an idea you’d like added to the Starting Lineup? Feel free to submit a suggestion below.

 


 

First up: Health Challenge Update #1!

So last week I proposed a Healthy Eating Challenge. I did so because I had just wrote about the importance of nutrition to…well everyone really, but especially those of us with psoriasis.

Within days I wished I had proposed a Healthy Lifestyle challenge and here’s why:

  1. I’ve recently been too inactive and wondered if that’s contributed to some health scares in the last year.
  2. Losing weight can help your P and to lose weight you should also include exercise in your plan.
  3. Our beautiful BC coast has been enjoying some amazing sunny summer like weather lately so why not get out and enjoy it more.

 

So, from this day forward it shall be known as the 8 Week Healthy Living Challenge (or HLC)!

If you missed last week’s post, I have been tracking everything I eat or drink to be accountable to you all.

For the HLC I am also tracking any additional activity added to my day. I don’t wear one of those step counters, I just Google map any walks or runs I take out and about instead of driving or taking a bus. Just back to basics stuff because I don’t have the time or money for gym memberships.

But you want to know… has it been working?

This morning I stepped on to the scales (nervously) and was surprised by the results. Here they are:

First here’s Day 1:

  • Weight – 207.6 lbs
  • Chest – 42.3 inches
  • Midsection – 43 inches
  • Blood pressure – 130 / 74
  • Pulse – 69 bpm

Then there’s This morning:

  • Weight – 202.0 lbs   (-5.6lbs Wow!)
  • Chest – 42.0″     (-0.3″)
  • Midsection – 42.5″     (-0.5″)
  • Blood pressure – 132 / 77     (+2/+3)
  • Pulse – 70 bpm     (+1)

 

That’s pretty sweet! A measurable improvement in weight and body dimensions in just 1 week. I mean that’s a 2.7% reduction in weight without ever feeling deprived!

I threw the BP and Heart rate numbers in there to see how the long term trends start to look but I am keeping in mind that they are highly variable. For instance, though I am using 132/77 as the official measurement a few minutes later it registered as 123/77.

(No, that’s not me being dyslexic, that is just an example of how much it can swing)

As promised, here is a page to view all of my food and fitness choices since Day 1 that have helped me reach these results. When you see the ways I did well in my commitment to health as well as the cheat foods…well, just be kind.

 


 

On with the Starting Lineup!

Uh…. Yeah, so about last week’s starting lineup, let’s review how I did:

  1. I want to research and share a summary of the main pharmaceutical treatment options for psoriasis. FAIL – But I’m close! I’m putting a lot of time into this one because I really want to do it justice.
  2. I want to pick one natural or alternative treatment method for psoriasis and share what I have learned and/or what others have said about it. FAIL – Have a few ideas, but still needs work.
  3. I want to try blogging either a new recipe or share an old favorite. I’m thinking Mexican but we’ll have to see. ACCOMPLISHED – Mmm! Guacamole!
  4. I’ve been toying around with a post about why it’s hard being a Canucks fan. Hopefully I can get that finished this week. FAIL – Honestly I just find myself a bit numb when it comes to the Canucks right now. Here’s hoping the (eventual) draft and free agency gets me jazzed up again…

 

So this week’s Starting Lineup… is to actually accomplish last week’s posts.

Let’s see what this week brings!

 

– Scratch

A tasty and healthy guacamole to serve tonight

Today I’m serving up one of my favourite recipes for hanging out with friends – guacamole!

Playoff hockey! Sunny night on the deck. Whatever the reason, if you’ve got people coming over keep, this recipe up your sleeve.

Five reasons why you need to try this guacamole :

  1. The taste is fresh and satisfying. I mean I get requests for this stuff all the time
  2. It’s so easy! Start to finish in 5 to 10 minutes if you’re handy with a knife.
  3. It’s cheaper than picking up a little tub from the grocery store as long as avocados are in season. 
  4. It’s healthy!  No added salt or preservatives. Full of healthy fats, potassium,  a source of protein as well as other vitamins and minerals.

Whoa, timeout! Did you say fat?

Yeah, fat. Listen, I’m not a nutritionist but here’s what I’ve read: the majority of the fat content in avocados are unsaturated fats. Those unsaturated fats could lower cholesterol levels and improve heart health.

My research did uncover one word of caution: go easy on the portion sizes! While heart healthy, avocados are rich in calories. Like all things, pace yourself.

Still if it’s heads up vs cheese dip I figure this guacamole is healthier! (and tastier too, but that’s just me)

 

Guacamole from Scratch

Here is what you need:

  • 4 avocados, ripe
  • 1/2 a lemon
  • 1/2 a lime
  • 1 medium tomato chopped
  • 1/4 cup finely chopped onion
  • 1 teaspoon garlic powder
  • Fresh ground pepper to taste

 

Here’s what you do:

Mash em together.

Basically it’s that simple. Heck, it’s not gourmet cooking but it tastes great!

 


 

When my buddies are over I try to serve salt free or reduced nachos. The dip is packed with flavor so you won’t miss it.

Or if your crew likes to go even healthier, try using this guac as a dip on fresh cut veggies!

The next day if you’ve got leftovers you can spread it on a burger or try making tacos or fajitas.

Hopefully you guys love it!

 

Mr Healthy Scratch

 

 

Get informed! And don’t lose hope in the fight against psoriasis

I am constantly reading about psoriasis these days and I am struck by how many types of treatment options are available and working for people like you and me. People around the world seem to be finding success with prescription drugs, over the counter medicine, elimination diets, nutritional supplements… The list goes on and on. I am more and more encouraged by the new advancements and options available to try. Now, more than ever before in my life, I have hope.

Go back a few years and you would meet a guy with a completely different outlook. I was resigned to living with out of control psoriasis. I had little hope that things could ever change. Other than a half-hearted attempt to change my diet (which I failed at regularly), I was doing nothing to improve my psoriasis even though it covered much of my body, made my itch and bleed, and made me feel terrible about the way I looked.

What took me from despair to hope?

My turning point was having kids. One day it just clicked. I didn’t want my kids to be teased in school because of their weird looking Dad. I didn’t want to tell them Daddy couldn’t play today because I was in too much pain. And in case one day they too developed this disease, I wanted to show them it’s better to treat their P than just give up.

So I scoured the internet, I spoke to my doctor, and I got a referral to a dermatologist. Together, we’ve tried a few different ways to manage my disease over the last couple of years. Some didn’t work. Old Healthy Scratch probably would have given up, but as a result of being armed with knowledge and having a bit more hope I stuck it out.

I am more clear today than I have been in at least 20 years. I could not be happier.

So, if what you are doing to treat your psoriasis is working then that’s awesome. Way to go! But if your psoriasis or joints are not well maintained or worsening then I would suggest that you review your options and talk with your doctor or dermatologist to see if it’s time to make a change.

If you haven’t seen a doctor in a long time and are living with out of control P then do yourself a favor: Take the first step and get an appointment. I let myself settle for getting by for too long because I gave up hope.

I can’t guarantee that your psoriasis will be completely cleared – mine isn’t. But man is it better!

So my encouragement to you is to get informed about the latest develoments in treating this disease. If you don’t know what options are available to you and all you know is “chronic incurable disease” then it is easy to settle.

I hope that by reading up and talking to real professionals that you will find the tools you need to allow you to manage your psoriasis and live well.

Take the first step today towards a healthier tomorrow.

 

Mr Healthy Scratch

Starting Lineup and Healthy Eating Challenge

My Starting Lineup is a feature where I announce my upcoming blog posts as part incentive to check back later in the week and part motivational tool to keep me writing. Have an idea you’d like added to the Starting Lineup? Feel free to submit a suggestion below.

 


 

So, this week here is what I’m planning to write about:

  1. I want to research and share a summary of the main pharmaceutical treatment options for psoriasis
  2. I want to pick one natural or alternative treatment method for psoriasis and share what I have learned and/or what others have said about it
  3. I want to try blogging either a new recipe or share an old favorite. I’m thinking Mexican but we’ll have to see
  4. I’ve been toying around with a post about why it’s hard being a Canucks fan. Hopefully I can get that finished this week.

 


 

As I promised yesterday in my post explaining the importance of healthy eating, here is my Day 1 weigh in for my 8 week Healthy Eating Challenge

  • Weight – 207.6 lbs
  • Chest – 42.3 inches
  • Midsection – 43 inches
  • Blood pressure – 130 / 74
  • Pulse – 69 bpm

 

In yesterday’s post I said I was going to track my food habits for the next 8 weeks, but to push myself I have decided to also include physical activity info too. Look for my first update next weekend.

 

I feel like I should emphasize something: I am not engaging in this challenge as some kind of a diet or weight loss scheme. That’s not the point.

Let me be clear: my first priority with this challenge is to improve my health. I also hope to inspire others to take steps to improve their health as well by sharing my journey here.

Speaking of journeys, Ernest Hemingway wrote this about journeying:

 

It is good to have an end to journey toward; but it is the journey that matters, in the end

 

Are you journeying well? If not, then commit to making a change and take the first step today.

Right now this health challenge is my first step.

What will be yours?

 

Mr Healthy Scratch

Why I’m making a healthy eating challenge

I’ve said it before and I’ll say it again…

I am not a professional of any sort – medical, psychological or otherwise.

I’m just a guy with spots. Lots of spots. If you’re reading this, I’m guessing you can relate.

I’m on a mission to learn more about psoriasis and share with you. What I’ve learned – even just in the last year – about a condition I thought I knew like the back of my hand…and my face, neck, chest, and everywhere else I’ve been scratching all this time.

So I’m planning to get you up to speed on everything you maybe didn’t know about psoriasis so you can live healthy and happy.

First up?

Food!

Now I don’t do as well as I would like with healthy eating. I’ll eat really well and then pig out on junk food. Sometimes I get fast food because I haven’t planned ahead or feel too busy to cook. So I get that eating well consistently is hard. But I’m going to share about why I think it is so important

4 reasons why members of team P should watch what they eat:

 

1. Eating well could improve your skin

You are what you eat.

This saying is more true for my fellow scratchers than you may know. In fact, some members of team P report full clearance of their skin symptoms by changing their diet!

2. Eating well could help your weight

There are strong links between psoriasis and carrying extra weight. It’s possible we are predisposed to it, but as a guy who has seen his waist size grow over the last few years, here is a pattern that I’ve seen develop in my life:

  • Have a major breakout of psoriasis
  • Get down about how I look and feel crappy from the breakout.
  • Eat crappy because I feel crappy
  • Pack on a few pounds because I’m eating crappy and not active enough
  • Psoriasis flares even worse because I’m eating poorly, inactive, heavier than normal, and stressing over all of the above.

If it sounds like a downward cycle, that’s because it can be. But by eating healthy I believe you can take control of that cycle!

3. Eating well could reduce your risk of other diseases

Diabetes, high blood pressure and cholesterol are all diseases that experts say are impacted by our dietary choices amongst others.

4. Eating well could help you feel great

There is no “food hangover” from healthy fruits and veggies. When you’re eating right, you don’t pay for it the next day. I find when I eat well I feel great both physically and emotionally.

And if eating well also helps control your psoriasis and your weight, that seems like a win-win situation!

 


 

Is there a miracle diet?

My answer?

Maybe.

Some people say add “this” to your diet or avoid “that”. They say it “cured” their symptoms. I am going to write future posts on many of these dietary plans to let you decide, but I must say there are 2 main reasons that I am not going to advocate for any one of them right now:

  1. Lack of personal success
  2. Lack of conclusive evidence

Let’s address those 2 concerns:

1. Lack of personal success

Perhaps it seems strange that I have written this epic post about eating healthy when it “hasn’t cured” me. To that, I would say eating healthy with the sole purpose of healing your skin is missing the point! I am beginning to learn that improved skin clearance shouldn’t be the only goal – maybe not even a main goal.

Eating well to improve your overall health can help control weight and contribute to your overall sense of happiness and well-being as I wrote above. There are many other benefits including helping the environment and even your wallet. Make these benefits your main goal. And absolutely, celebrate if you see improvement in your skin at the same time but don’t give up if you don’t.

2. Lack of conclusive evidence

Look, if science proved that eating 10 cucumbers each day was a healthy and 100% effective way to see complete clearance of psoriasis I’d be down at the supermarket filling up a cart of the stuff. Every week. Wouldn’t you?

More research is still needed – both to show what methods are effective and to prove that they are safe for long term use. Smarter people than I are on the case however, so don’t lose hope.

(By the way, don’t Google that cucumber thing, I just made it up as a random example. To my knowledge, a diet consisting solely of cucumber would not help and would probably be unhealthy.)

 


 

So then, what do you mean by Healthy eating?

For me, it’s simple. I plan to limit the foods that I know to be less healthy and eat more of the ones I know to be good.

There is no “food hangover” from healthy fruits and veggies. When you’re eating right, you don’t pay for it the next day.

Looking for more expert opinion and being a patriotic Canadian, I went searching for what the government had to say. I found a funny cartoon commercial (my tax dollars at work???) and some helpful information.

Some key take aways?

  • Eat more healthy things like veggies, fish and lean meats and reduce or eliminate unhealthy things like candy, doughnuts, french fries, alcohol and soft drinks. (Common sense, right?)
  • Be careful with portion sizes and the proportions of the different types of food on your plate (the largest portion on your plate should be fruits and veggies).
  • The government even has Eat Well recipes to try to give you quick and healthy options to try.

 


 

My 8 week Mr Healthy Scratch food challenge

For the next 8 weeks, I commit to doing the following:

  • I will limit cheat foods like candy and chocolate as much as possible
  • I will keep a journal of everything I eat whether it’s good or bad
  • I will take weekly measurements to track if food impacts my weight
  • I will try to learn and share healthy meal ideas – cooking from scratch when possible

I believe by focusing on healthy eating that I will notice better energy, better mood, maybe even better skin (but that might be hard to distinguish from the treatment I’m receiving – more on that in the future too).

Point is, I feel that this is a good and necessary journey for me to go on. I hope by sharing it with you that you to will feel like you can take steps to change your health too.

Tomorrow will be the official starting “weigh in.”

Ugh… I’m off to eat a Snickers while I still can.

I’m kidding, I’m kidding…

 

Mr Healthy Scratch

Finding motivation to focus on healthy living

There is no cure for psoriasis but that doesn’t mean you should give up hope. The choices we make (healthy and unhealthy) have a huge impact on the quality of our lives – possibly more so than for people without psoriasis. That’s because getting active and eating well may help reduce or even eliminate some of your symptoms.

First, let me share some of the health challenges I have experienced to showyou what can happen when you neglect your health.

 

Not long ago I was a reasonably fit dude. I had an active job, I’d walk most places and I had friends who would call me up like this:

Hit the gym tonight?     Sure!

Let’s go run a 5k?      Definitely!

Wanna hike for a week or two this summer?     Absolutely! 

My health and healthy living never crossed my mind.

A few years go by and now the picture is completely different. I’m a grown-up guy with grown-up stress. I traded the active job for a grown-up desk job. My friends are living the grown-up life now too. I’ve got kids. They’ve got kids. Young kids.

This is what “hanging out” with a buddy looks like lately: walking the kids to a park and pushing the younger ones on the swings while watching the older ones play soccer or run around.

I feel like I need to stop for a moment and talk to the guys. Men, it’s not all bad having kids. I don’t mean to make it sound like that it sucks. It totally changes your life but it’s awesomeOk, back to the story.

The main way I get exercise now is working in the yard. I live on a big property with a big slope from front down to the back. Lots of grass, gardens and trees. We’ll come back to that in a minute.

So, why am I telling you all this? I needed to paint a picture of my life: a guy who has been active in the past but now is definitely not. But no big deal right? I’m only 34…

Maybe not.

I ended up in the emergency room last summer. I was hauling bags of yard waste uphill from the back of the property up to the street. At the same time my 3 year old is grabbing at garden shears or something so I’m yelling at her to stop. And I’m thinking I need a break cause work’s been stressful and our third kid is on the way and…

All of a sudden there’s chest pains, dizziness and trouble catching my breath. Ultimately I was fine, but it should have been a clue that things needed to change.

Well…

Yeah, I totally didn’t change.

Fast forward to the winter. It’s been a hard week, I’ve been sick and I just need a relaxing weekend. I pop in a new action movie and I’m really getting into it. Like really into it. My adrenaline is really going.

When the movie finishes I realize something: my heart is still pumpin. And it won’t quit. I start measuring my heart rate and it’s up over 110 beats a minute. It stayed there for over an hour.

I now get regular ECG tests.

 

This is the point…and it might be tough to hear if this is news to you: psoriasis is linked with other diseases.

What I mean by that is that if you have psoriasis you are at increased risk of developing other health issues as well. (And note that it is only a risk, not a guarantee.)

So what do you do when you know you have an increased risk of cardiovascular disease?

Here are 3 ideas:

1. Talk to a real medical professional about treatment.

  • If you aren’t seeing a GP, start. If you haven’t seen a dermatologist for a while (or ever), get an appointment. Why? Knowledge about psoriasis is evolving regularly. New treatment options are coming up. According to psoriasis.org, one study suggests some methods of treating your disease reduce you risk of cardiac events and strokes.

2. When you check in with your doctor, talk about your exercise options.

  • My uneducated mind figures that exercise – done safely – will help. Ask your doctor for advice. And check out this WebMD article that suggests exercise to reduce weight, fight inflammation, decrease cardiac risks and improve the effectiveness of psoriasis meds.

3. Make healthy lifestyle changes

  • Smoke? Take steps to stop. Now. Stressed? Hit a trail with some friends, take some time in the garden, read a book, try some yoga, have a bath… Whatever it is for you that brings you peace and joy. Strive to work a bit of that into every day. The science is less conclusive but evidence suggests it could really help.

 

At the end of the day, some things are out of our control. But some aren’t. You have the chance to improve your health starting today.

Which brings me to my last piece of advice.

Find your motivation. Mine? A great wife and 3 young kids I want to see grown with families of their own. What’s yours?

Make one healthy change today. I’m going to try to.

Mr Healthy Scratch