The many faces of psoriasis
Dr. Gary Sibbald discusses the different subtypes of psoriasis and the various modalities of treatment (750 words, 4 min)
Skin Spectrum Weekly is proud to announce the first dermatology conference of its kind. The Indigenous Skin Spectrum Summit is a special session of Skin Spectrum Summit held on March 18 and 20, addressing Canada's Indigenous community's specific treatment needs. Click here to learn more and register.
A recent study found that the known dermoscopic criteria for psoriasis subtypes, including guttate psoriasis, pityriasis rosea, and pityriasis lichenoides chronica also apply to dark skin phototypes.
In his presentation at Skin Spectrum Summit in Toronto, Dr. Gary Sibbald discussed the “many faces of psoriasis,” including the subtypes, the different treatment modalities, and the common areas where psoriasis tends to manifest.
Psoriasis subtypes include plaque psoriasis, guttate psoriasis, pustular psoriasis and erythrodermic psoriasis, said Dr. Sibbald. He went on to point out that there is “‘A’ evidence for most of what we do in psoriasis,” referring to randomized controlled trials.
He said that for any patient with 5 per cent or less psoriasis coverage, he would recommend starting with topical corticosteroids. They only work for a very short period of time,” said Dr. Sibbald. Salicylic acid increases penetration, and he even recommended using petrolatum, which he said has an antipsoriatic effect.
He also suggested that additional supplemental treatments should include local physical modalities, ultraviolet light, biologics and systemic agents.
In his list of treatments, he also mentioned methotrexate, although he noted it has B rather than A evidence.
Dr. Sibbald described the differences between the various topical treatment vehicles for psoriasis: lotions, creams, ointments, patches, pastes and gels.
He described the differences between the various topical treatment vehicles for psoriasis: lotions, creams, ointments, patches, pastes and gels.
“We always talk about these terms, but do we really know what they mean?” he asked the audience.
A lotion is a powder in water, a cream is composed of oil in a continuous water base, an ointment is water with a continuous oil base, a patch is occlusive delivery, a paste is a powder in an ointment, and a gel is a powder in a lattice, said Dr. Sibbald.
Ointment vehicles do have an antipsoriatic effect, he noted. He also warned against compounding a gel.
“A gel is an unstable modality that must not be compounded,” he said.
The takeaway: Common sites where psoriasis manifests or “areas of trauma,” said Dr. Sibbald, include the elbows, knees, scalp and torso. Less common sites include the genitals and the nails. If the nails are involved, he said, be aware that this could point to psoriatic arthritis.
FROM THE LITERATURE ON PSORIASIS
Dermoscopic characterization of guttate psoriasis, pityriasis rosea, and pityriasis lichenoides chronica in dark skin phototypes: An observational study
A recent study found that the known dermoscopic criteria for psoriasis subtypes, including guttate psoriasis, pityriasis rosea, and pityriasis lichenoides chronica, also apply to dark skin phototypes.
Racial and ethnic disparities in access to emerging and frontline therapies in common dermatological conditions: A cross-sectional study
Black patients with psoriasis were found to have a lower likelihood of receiving frontline therapies such as cyclosporine and etanercept, according to a recent study. The study also looked at prescribing disparities for frontline therapies for several other skin conditions.
Secukinumab demonstrates high efficacy and a favourable safety profile over 52 weeks in Chinese patients with moderate to severe plaque psoriasis
A phase 3 trial found that Secukinumab is highly effective and well-tolerated in Chinese patients with moderate to severe plaque psoriasis. The study looked at 441 Chinese patients over a 52-week period.
VIDEO: Gender and aged-based modifications in psoriasis treatments may be needed
AT THE INTERSECTION OF SKIN AND SOCIETY
In a recent article published by Global News, Black leaders in Toronto’s medical community discussed racial inequality in the field and how to tackle it head-on. “I believe that there's definitely some discrimination in the medical field when we talk about attitude between peers, between doctors, nurses, hospital staff to patient, patients to hospital staff as well,” said Dr. Alexandra Bastiany (pictured below), a 33-year-old interventional cardiologist. She is Canada’s first Black female specialist in that field, according to the report. The article also includes comments by Dr. Upton Allen, chief of infectious diseases at The Hospital for Sick Children and Akwatu Khenti, an expert in anti-Black racism. Read the full article here.
This Week
March is Colorectal Cancer Awareness Month
Saturday, March 6 is World Lymphedema Day
Monday, March 8 is International Women’s Day
Something to think about during the week ahead…
Next Week
Education and open dialogue are crucial for doctors helping their patients manage rosacea symptoms, according to Dr. Maha Dutil, who discusses treatment options and things to avoid.
Thank you to our panellists and delegates for making Skin Spectrum Summit 2020 a great success. Conference highlights will soon be posted to the Skin Spectrum website. As always, we welcome your questions and comments on topics in Ethnodermatology.