Patients battle tough skin diseases

Diana Stevens has had psoriasis for more than 40 years. It has affected her health, destroyed her marriage, and stolen her peace of mind.
It all began when she woke up one morning, to find the characteristic thick skin and sores on her knees. Since then, the condition has spread to most of her body.

She has tried ointments, creams and prescriptions. She also tried light therapy, sitting under a special light in a doctor’s office for exposure to ultraviolet-A radiation.
Never goes away

Some of these treatments worked for a while, but the psoriasis never goes away entirely, and the treatments eventually lost their effectiveness. Then, she would try something else.

The nuisance of the disease itself is compounded by the embarrassment from such a visible condition. The misunderstanding and even fear of psoriasis by the general public has taken its toll as well.

” I’m 62 now, getting older. So many of my years are gone, wasted,” says Stevens. She says she spent many of those years holed up in her house, afraid to show herself outside.

Although her case is severe, her feelings are not uncommon for people with skin conditions, according to rmatologist Dr. Harvey Lui.

” There are significant psychological, emotional and social impacts of this disorder,” he says.

One million sufferers
Lui is head of dermatology at the University of British Columbia, and director of the Psoriasis and Phototherapy Clinic at the Vancouver General Hospital. He says his patients tell him that one of their biggest concerns about having psoriasis is the embarrassment.

“With skin diseases, because these things are visible, the whole world knows that something is wrong with you,” he says.

Many of his patients say they are often treated as if they are contagious, or unclean. One of his patients was once asked to leave a swimming pool for fear of infecting other people.

Next page: No known cure

No known cure
There is no known cure for psoriasis, and doctors don’t know why one million people in Canada have the condition. None of the available treatments eliminate the condition entirely. But the creams, medication and light therapy can work in combination, or in rotation.

For people with severe psoriasis, however, the treatment can be more dangerous than the condition. There are several highly effective pills, but they may cause liver or kidney damage.

New research also links the combination of drugs and light therapy with an increased risk of skin cancer.

Overactive immune cells
Lui says one of the biggest advances in psoriasis research in the past decade is a better understanding of the process of the disease. Even 15 years ago, doctors thought it was simply skin that was growing too fast.

But newer research has determined that the rapid growth is the result of overactive immune cells. Their activity causes the skin to get inflamed and regenerate at a faster rate than normal.

Armed with this information, researchers have been able to target treatment more effectively.

Eczema less disfiguring
Similar advances are happening in the treatment of eczema. Eczema is also known for causing itchiness and redness on the skin, but is generally easier to control. It’s also not as disfiguring as psoriasis.

Eczema patients often have a family history of asthma or allergies as risk factors. But the itchiness can drive people to distraction. Research has revealed that this condition is also the result of overactive immune cells.

Dr. Kevin Smith sees many eczema sufferers at his clinic in Niagara Falls. The first thing he tells patients is to stop trying to be so clean. He says cutting out soaps, washcloths and body washes is the first step in giving skin a break.

Next page: Use water, moisturizer

Use water, moisturizer
Smith says plain water will get you clean enough, and much more gently. If you insist on soap for those tougher areas such as feet and armpits, Smith recommends ‘non-soap’ such as Dove.

And use moisturizer. Begin with an over-the-counter moisturizer, such as Cliniderm. Put your cream on immediately after washing, and always after washing.

More persistent cases are usually treated with hydrocortisone cream, which Smith says is mild enough to be used long-term without fear of side effects.

For more severe eczema, the most common treatment is steroid creams. Studies show many people have negative reactions to using medications containing steroids. Some stronger ones can cause thinning of the skin when used repeatedly over a long term. But most are very well tolerated and by and large very safe, according to Smith.

New research, drugs
However, there is a new treatment Smith calls ” a major advance in dermatology.” It’s a new class of drugs called immune modulators. These drugs tackle the problem at the cellular level.

” It takes the cells in your skin that are misbehaving,” he says, ” and makes them settle down and go back to what they are supposed to do.”

Smith says he is prescribing ” large quantities” of topical immunomodulators (TIMs) because they are ” so safe, and so effective.”

For many patients, the bonus is they do not contain steroids. They don’t cause the thinning of the skin that can lead to sun damage. So far, just one of these immunomodulator creams has been approved for use in Canada. The drug is tacrolimus. Fujisawa Canada markets it as Protopic.

Don’t give up
Despite advances, different things will work for different people, says Smith, so don’t expect a magic bullet. There is still no cure.

” There is no special health food or vitamin, or 1-800 rip-off or internet rip-off that’s going to help,” says Smith.

Dr. Lui of Vancouver says people who have had skin conditions for years, and have given up on finding effective treatments, should head back to their doctors.

” We’re getting really close to the cause,” he says. And once that is nailed down, a cure should follow.

” I’m willing to say within ten years,” he predicts, ” there’s really a lot to be hopeful for.”