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March 2020
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MARCH TABLE OF CONTENTS
 

Considerations During the Pandemic

As the COVID-19 situation in Canada continues to evolve, we are thinking about our community members and wishing everyone well during this challenging time. 

We remind our community to be attentive to reputable sources of health information such as the Public Health Agency of Canada as well as your provincial/territorial government for current recommendations and precautions.
 
We also encourage psoriasis / psoriatic arthritis patients to call their dermatologist / rheumatologist or other physicians with any concerns, or for information about their specific circumstances. Your health care team is the most appropriate resource for any specific questions or concerns you may have.  
 
To date, general information is that unless symptomatic, medications should be continued. We encourage psoriatic patients who develop symptoms or who have been diagnosed with COVID-19 to follow recommendations from their jurisdiction and to discuss their concerns and treatment plans with their prescribing physician. 
 
We further remind members of our community with exacerbated anxiety and depression symptoms of how to manage their mental wellness at this time of uncertainty. Check out the Canadian Mental Health Association for their suggestions if you are feeling elevated distress.

For general information for skin patients, the Canadian Skin Patient Alliance, of which CPN is an affiliate, has created an FAQ page.
 
If you are interested to know about clinical trials underway globally for COVID-19, check out this article
 
Please keep in touch with us on our website cpn-rcp.com and through Twitter @PsoriasisCanada and Facebook @Cdnpsoriasisnetwork where we will continue to link to sources of information. As always, please contact us at info@cpn-rcp.com with questions or comments.
 
We are including regular content in this e-newsletter with the hope that it will offer some informative distraction.
 
However, we plan to reissue articles in later e-newsletters in case you miss them this time around.

Psoriasis in Springtime

Though changes in psoriasis symptoms can happen anytime, changes in seasonal weather and temperature can commonly affect people. Dr. Sam Hanna is the Medical Director at Dermatology on Bloor in Toronto. We connected with him recently to talk about psoriasis in springtime. 
 
We are all practicing social distancing at this time, but people may be inclined to go for walks, runs or bike rides outdoors, especially as the weather warms up.
 
Dr. Hanna encourages people to “remember that although sunshine feels good and exposure can help relieve psoriasis symptoms, too much exposure can cause a sunburn, which can aggravate the skin and cause psoriasis to flare.”
 
Remember the importance of wearing sunscreen as we head outdoors with our skin exposed. “It’s very important to protect your skin with sunscreen, but at the same time you have to ensure the product isn’t irritating your skin,” explained Dr. Hanna. “Find a sunscreen that works well for you, or else it could worsen your psoriasis symptoms.”
 
For anyone who hasn’t been receiving regular treatment over the winter, or generally doesn’t feel ready yet to wear spring and summer clothing, Dr. Hanna says it’s definitely not too late. For example, according to the Canadian Skin Patient Alliance’s general FAQ regarding COVID-19, the decision to continue delivering phototherapy will be up to the individual physician, so you would need to contact your treatment provider to learn about their approach.

Rising temperatures themselves this time of year may pose a problem for
 
Dr. Sam Hanna, Medical Director, Dermatology on Bloor in Toronto

some. As Dr. Hanna explained, “people with inverse psoriasis – in the folds of their skin – may have problems as we progress into spring and summer, because overheating can cause them to flare.”
 
Another constant issue for anyone with psoriasis is social stigma, and this too flares as people naturally expose more of their skin to public scrutiny. “Most people have a general understanding of psoriasis, but the misconceptions are still broad,” shared Dr. Hanna. “We want everyone to understand that someone’s psoriasis does not put anyone else at risk; it is not contagious. Let’s continue to raise awareness to limit these awkward social interactions, because it shouldn’t be the job of psoriasis sufferers to continue explaining these details.”

For these and other reasons, depression and anxiety are common among people with psoriasis – especially now as we are just out of winter and amidst the current COVID-19 context. “This is not just a skin issue,” said Dr. Hanna.
 
Anyone whose  depression and anxiety symptoms are exacerbated this spring by COVID-19 can find helpful resources from organizations such as the Canadian Mental Health Association.

Women and Psoriasis

It is important to acknowledge that women with psoriasis face unique challenges with self-image, stigma, mental health, and treatment decisions.
 

“It makes sense to treat men’s and women’s health differently – each has different needs,” said Renita Ahluwalia, Lead Dermatologist with the Canadian Dermatology Centre and Lecturer with the University of Toronto. 
 
These are the reasons behind the Canadian Psoriasis Network’s (CPN) new female-focused resource, featured on CPN’s website: Women’s Health and Psoriasis. More than 100 women-identified Canadians with psoriasis and psoriatic arthritis were surveyed to gather common questions and considerations about living with the conditions.

The resource includes information about what the research says about women and psoriasis, questions for women to ask their dermatologist, and ideas for living well with the condition.

“My female patients want to know the implications with psoriasis treatment, and what [they] can and cannot do safely,” explained Dr. Ahluwalia.

“Family planning is something I discuss with all of my women patients of child-bearing age.” The doctor added that
Dr. Renita Ahluwalia, Lead Dermatologist with the Canadian Dermatology Centre and Lecturer with the University of Toronto.

there are now biologic treatment options that are safe for women and pregnancy.

Moreover, mental health and depression are common co-morbidities with psoriasis. “I see it a lot in my female patients who are in the workforce, trying to get ahead and feel their psoriasis is holding them back,” shared Dr. Ahluwalia. “This adds to the insecurities people already have, and it can push some close to the edge without proper support and treatment.”
 
Please note: in light of COVID-19, like many medical clinics across the country, the Canadian Dermatology Centre is offering virtual consults during this period of uncertainty, and patients can call or email to book an appointment.

A Look at the Treatment Landscape

We find ourselves at a good point in time for options available to treat psoriasis and psoriatic arthritis patients. This is the opinion of Dr. Wayne Gulliver, Professor of Medicine and Dermatology with Memorial University of Newfoundland.
 
“I’ve been practicing for 30 years and this gives me a unique perspective,” Dr. Gulliver shared recently. “I was there when all we had to offer patients was phototherapy, tar baths, methotrexate and cyclosporin.”
 
“In the past when I’d see a psoriasis patient, I’d say ‘if I get you better.’ Now it’s ‘when I get you better.’”
 
A common tool for classifying the severity of psoriasis is the Psoriasis Area and Severity Index (PASI), ranging from 0 for patients with no disease to 72 for the most severe disease. Patients with moderate to severe psoriasis usually have a PASI of 12 or higher.
 
“I’ve seen the evolution of biologics from their starting point of providing a PASI 75 in 17% of patients,” explained Dr. Gulliver. “Now, Anti IL-17s and the 23s have a PASI of 75 in over 90% of patients. Things have come a long way in the past 15 years." In this last context, a PASI 75 means a 75% improvement in PASI scores from baseline, in over 90% of patients.
 
In addition to biologics, there are now three other major categories of treatment options available to dermatologists and their patients.

These are: topical therapies, effective for mild-to-moderate psoriasis; phototherapy, which is used for moderate to severe, and sometimes mild symptoms; and, oral agents, such

Dr. Wayne Gulliver, Professor of Medicine and Dermatology with Memorial University of Newfoundland.
 
as methotrexate and cyclosporin, with one new oral agent on the market and others on the horizon.

“The beauty of the drugs we have now is they work for fingernails, they work for scalp and inverse lesions,” said Dr. Gulliver. “Before, we found methotrexate and cyclosporin for some reason didn’t work quite so well on the scalp, but now we can treat all aspects, including the arthritis. We see less side effects with biologics as compared to methotrexate and cyclosporine, and also with phototherapy.”
 
“In general, people with psoriasis have an easier time living with the disease nowadays than 15 or 20 years ago,” Dr. Gulliver said. “We will find a drug that’s safe for pretty well every patient. We’re doing very well right now. Again, it’s not ‘if I get you better,’ it’s ‘when I get you better.’”
 
Check out CPN’s treatment portal for information on treatments currently available in Canada to treat psoriasis and psoriatic arthritis.

What's New in Canada

Easy access to a range of treatment options is essential for people living with psoriasis and psoriatic arthritis. Here are some updates since our last email about what's happening in Canada.

SKYRIZI™ (risankizumab) has been added to public drug plans in all provinces and territories, except British Columbia, Newfoundland-Labrador and Prince Edward Island, for the treatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy.

This is an important step in ensuring new treatment options are available to all Canadians.

From the Community

The Canadian Pain Task Force is leading a national consultation to help the Government of Canada better understand and address the needs of the millions of Canadians who live with pain.
 
We know that pain is a major problem for many people who live with psoriatic disease.
 
For this reason, CPN is sharing information about the consultation to encourage members to share your feedback directly or to contact CPN to share your experience to inform our organization’s submission.
 
The consultation is seeking your input on:
  • How has pain affected your life?
  • Please describe the pain you have experienced and/or are experiencing. 
  • What challenges have you faced?
  • What has helped you the most?
The task force is interested in hearing from everyone, including people living with pain, health care providers, caregivers, family and friends, and others interested in this area.

This consultation will be open online from February 27 to April 17, 2020. Share your input directly online by April 17, 2020.

If you would like to share your input with CPN, please email executivedirector@cpn-rcp.com by April 15th.
 
*** 
Our friends at the Canadian Spondylitis Association are hosting a FREE webinar on nutrition and chronic inflammatory diseases tonight, March 31st at 7:30PM.
 
There is still time to register at http://events.spondylitis.ca.
 
N.B. This is an information post only. This is not a CPN-led initiative.
 
***
Interested in sharing your story with psoriasis through photography and art?

 
Check out this University of Toronto medical student-led magazine project to capture diverse stories about living with psoriasis through images. 
 
The magazine will be used to educate medical students and practicing physicians about what it is like to live with psoriasis for patients from diverse backgrounds.
 
Though photo shoots are on pause as we deal with the COVID-19 pandemic, recruitment for this project is open!
 
To express your interest and to get more information email: skinpatient@gmail.com.
N.B. This is an information post only. This is not a CPN-led initiative.
If you would like to share your story about living with psoriasis or
psoriatic arthritis, let's chat!

Send us a message at:


executivedirector@cpn-rcp.com
 Cdnpsoriasisnetwork
 PsoriasisCanada

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March Links: *These are links to external news sites, for your interest. The Canadian Psoriasis Network does not necessarily support all views expressed in these external resources.
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