The prevalence of psoriasis—which affects up to 4.7% of the population in the US and Canada and 2% of the world’s population—has shown there is a greater need for treatment. Perhaps more than the symptoms of the condition itself, the psychosocial effect of psoriasis can take a toll on a patient’s quality of life.2 It is then essential to alleviate the emotional burden of psoriasis by decreasing triggering factors and developing appropriate drug therapy combinations to induce longer bouts of remission.
Psoriasis lesions are caused by the immune system mistakenly reacting to internal or external triggers, producing abnormally high levels of T-cells, thus increasing the rate of cell proliferation. This chronic condition can be exacerbated by a variety of triggers ranging from trauma or infections to outside medications and psychological stress. Psoriasis, a systemic disease process, can even progress to psoriatic arthritis in up to 20-30% of patients.1
The disease progresses in two main phases, which include the initiation phase and plaque progression, and involve various classes of T-cells and their interactions with dendritic cells, neutrophils, and keratinocytes, which are also involved in innate immunity.
Psoriatic lesions, or plaques, have clearly defined edges and are made up of red, scaly areas which occur frequently on the scalp, elbows, and knees, and less frequently on the hands, nails, feet, and trunk of the body including the inter-gluteal fold. Occasionally, pustules can form.
Onset of psoriasis is shown to peak at 20-30 and 50-60 years of age but can appear for those at any stage of life—from infants to the elderly. Women typically experience symptoms at an earlier age than men,3-4 though both genders experience chronic symptoms and intermittent remissions. Psoriasis has shown to worsen other simultaneously occurring conditions, which makes the need for treatment and remission all the more urgent. Conditions compounded by psoriasis (and consequently leading to decreased quality of life) include autoimmune diseases (Crohn’s disease and ulcerative colitis), cardiovascular disease, metabolic syndrome, decreased 25-hydroxyvitamin D levels, depression/suicide, psychologic and emotional burden of disease.5
Below is a list of several triggering factors (both externally and systemic) that can exacerbate disease progression in genetically-predisposed individuals.
|Koebner Phenomenon and Local skin Triggers||An externally triggering factor, the Koebner phenomenon has shown that injury to the skin barrier can elicit a psoriatic lesion. This local triggering can deem someone “Koebner-positive”. Other injuries such as sunburn, morbilliform drug eruption, and viral exanthem can elicit a response. Typically, the time from the point of trauma and appearance of skin lesion(s) is 2-6 weeks.|
|Infection||The most common offenders of the induction of psoriasis are bacterial injections, namely Streptococcal infections of the pharyngitis type. In up to 45% of psoriatic patients, a provoking infection has been observed.
HIV infections are also known to aggravate psoriasis.
|Endocrine Factors||Hypocalcemia and pregnancy can be triggering factors for pustular psoriasis.|
|Psychogenic Stress||In times of stress, elevated levels of cortisol are associated with initial and flares of those with existing psoriasis. In another study, worry and scratching also showed disease progression.|
|Drugs||Drugs such as lithium, beta-blocking agents, antimalarials, and systemic steroids which are rapidly tapered or discontinued have evidence of worsening psoriasis.|
|Alcohol consumption, smoking, and obesity||Decreasing alcohol consumption, smoking cessation, and weight loss have been shown to revert psoriasis prevalence in individuals back down to baseline levels versus those who partake.|
Compounded Treatment Options
Because psoriasis is a chronic disease, treatment options tend toward longterm care. With this in mind, it is important to be aware of potential longterm side effects and compliance with medication regimens. Remission is the goal when treating psoriasis, often with strategies that break down into “clearing” and “maintenance” phases.
|Patients with psoriasis covering more than 5% of their body need special treatment programs such as UVB and narrow-band UV-B light, oral retinoids and calcineurin inhibitors, TNF inhibitors and monoclonal antibodies.6|
Besides avoiding triggering factors, reducing inflammation and slowing down excessive cell growth will involve the use of prescription topical medication (as long as the psoriasis does not cover more than 5% of the body). Topical corticosteroids like clobetasol or betamethasone, zinc, cyanocobalamin, retinoids, immune system modulators, antimetabolites, and coal tar are some of the ingredients that can be compounded into products to combat psoriasis. Ask an Innovation Compounding pharmacisthow compounded products can help you manage your psoriasis!
- Nestlé FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med 2009;361:496–509.
- Lebwohl MG, Bachelez H, Barker J, et al. Patient perspectives in the management of psoriasis: Results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis Survey. J Am Acad Dermatol 2014;70:871–81.
- Raychaudhuri SP, Gross J. A comparative study of pediatric onset psoriasis with adult onset psoriasis. Pediatr Dermatol 2000;17:174–8.
- Farber EM, Nall ML. The natural history of 5600 patients. Dermatologica 1974;148:1–18.
- Van de Kerhof PCM, Nestle FO. Psoriasis. Dermatology: Papulosquamous and Eczematous Dermatoses. Chapter 8. Pp;138-160
- Dermatology: Psoriasis and Other Papulosquamous Diseases. Chapter 8: pp 263-328