77357_FMxx_FINAL.QXP 11/4/09 10:29 AM Page i More Praise for 100 Questions & Answers About Psoriasis,Second Edition “[If] you are a person who is educated and informed about psoriasis, you will be more satisfied with your treatment and your doctor, and will have greater confidence in your future. We are grateful to Drs. Alexa Kimball and Kendra Bergstrom for helping to generate awareness and understanding about this chronic,lifelong disease.” Gail Zimmerman Former President and CEO,National Psoriasis Foundation “Psoriasis is a common skin disease that affects millions of people around the world.In recent years,a revolution has occurred in treat- ment options available for psoriasis. Drs. Bergstrom and Kimball have given us a clearly written guide to help psoriasis patients under- stand these options and select the appropriate treatment for this life-crippling disease.” Fred F.Castrow II,MD Past President,American Academy ofDermatology 77357_FMxx_FINAL.QXP 11/4/09 10:29 AM Page ii 77357_FMxx_FINAL.QXP 11/4/09 10:29 AM Page iii 100 Questions & Answers About Psoriasis Second Edition Kendra Gail Bergstrom, MD Pacific Medical Centers Seattle, Washington Alexa Boer Kimball, MD, MPH Vice Chair, Department of Dermatology Massachusetts General Hospital Boston, Massachusetts 77357_FMxx_FINAL.QXP 11/4/09 10:29 AM Page iv World Headquarters Jones and Bartlett Publishers Jones and Bartlett Publishers Jones and Bartlett Publishers 40 Tall Pine Drive Canada International Sudbury, MA 01776 6339 Ormindale Way Barb House, Barb Mews 978-443-5000 Mississauga, Ontario L5V 1J2 London W6 7PA [email protected] Canada United Kingdom www.jbpub.com Jones and Bartlett’s books and products are available through most bookstores and online book- sellers. To contact Jones and Bartlett Publishers directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jbpub.com. Substantial discounts on bulk quantities of Jones and Bartlett’s publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones and Bartlett via the above contact information or send an email to [email protected]. Copyright © 2011 by Jones and Bartlett Publishers, LLC All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. The authors, editor, and publisher have made every effort to provide accurate information. However, they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of this book and take no responsibility for the use of the products and procedures described. Treatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice, and government regulations often change the accepted standard in this field. When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determin- ing FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindications, and determining the appropriate usage for the product. This is especially important in the case of drugs that are new or seldom used. Dr. Kimball was an investigator and consultant for Galderma, Centocor, Amgen, Neostrata, and Abbott and an investigator for Stiefel within the year that this edition was revised. Production Credits Publisher: Christopher Davis Composition: Glyph International Editorial Assistant: Sara Cameron Cover Design: Carolyn Downer Associate Production Editor: Sarah Bayle Cover Image: © William Casey/Shutterstock, Senior Marketing Manager: Barb Bartoszek Inc.; © Yori Arcurs, Shutterstock, Inc. Manufacturing and Inventory Control Supervisor: Printing and Binding: Malloy, Inc. Amy Bacus Cover Printing: Malloy, Inc. Library of Congress Cataloging-in-Publication Data Bergstrom, Kendra Gail. 100 questions & answers about psoriasis / Kendra Gail Bergstrom, Alexa Boer Kimball. p. cm. Includes index. ISBN 978-0-7637-7735-7 (alk. paper) 1. Psoriasis—Popular works. 2. Psoriasis—Miscellanea. I. Kimball, Alexa Boer. II. Title. III. Title: One hundred questions & answers about psoriasis. IV. Title: 100 questions and answers about psoriasis. RL321.B468 2010 616.5'26—dc22 2009039588 6048 2008047289 Printed in the United States of America 13 12 11 10 09 10 9 8 7 6 5 4 3 2 1 77357_FMxx_FINAL.QXP 11/4/09 10:29 AM Page v Contents Introduction vii Foreword ix Part 1:The Basics 1 Questions 1–15cover basic information about the skin and psoriasis, including: • What is skin? • What is psoriasis? • How common is psoriasis? Part 2:Diagnosis 27 Questions 16–23describe how psoriasis and related conditions are diagnosed: • How does someone know whether he or she has psoriasis? • If I have psoriasis, am I at risk for other diseases as well? • What are the different types of psoriatic arthritis? Part 3:Risk,Prevention,and Epidemiology 39 Questions 24–33discuss factors contributing to psoriasis, including: • Are there different types of psoriasis? • Will psoriasis go away? • Why do some people have mild psoriasis and others have severe disease? Part 4:Treatment 59 Questions 34–81detail treatment options for psoriasis, such as: • What options do I have to treat my psoriasis, and do I need to treat it to keep it from getting worse? • Are there different treatments for different kinds of psoriasis? • Does health insurance cover psoriasis treatment? 77357_FMxx_FINAL.QXP 11/4/09 10:29 AM Page vi 1 0 0 Q U E S T I O N S & A N S W E R S A B O U T P S O R I A S I S Part 5:Social Effects ofPsoriasis 135 Questions 82–100describe common problems affecting the day-to-day life of people with psoriasis: • I don’t have health insurance. How can I get care for my psoriasis? • What are common problems faced by people with psoriasis? • What are some of the ways people deal with their psoriasis? How do I cope with knowing I have psoriasis? Appendix 161 Glossary 167 Index 177 vi 77357_FMxx_FINAL.QXP 11/4/09 10:29 AM Page vii Introduction Psoriasis is one of the most common skin diseases in the United States. As many as 7.5 million people are affected by psoriasis and psoriatic arthritis in the United States alone. Approximately 1 out of every 50 adults will be affected by this disease at some point,and of these people, 1.5 million will suffer from moderate or severe psoriasis. Every year, approximately 200,000 new cases of psoriasis are diagnosed. Psoriasis is not simply a disease of the skin. Although psoriasis does not cause life-threatening problems for the majority of patients, the effect on people’s lives can be substantial and is often underestimated.This very visible disease can cause patients to feel self-conscious and ashamed about their appearance,which can lead to social isolation,psychological stress,or depression. At present, psoriasis is a lifelong illness without a permanent cure. However, new therapies are being developed and innovative research continues in hopes of finding a cure. With an arsenal of topical steroids, topical and systemic immunosuppressants, novel biologics,and other treatments,patients now have a wider range of options than ever before. Even in the 5 years since the publication of our first edition, new therapies have been approved worldwide, and others have entered the pipeline. Many of these treatments are highly effective in controlling psoriasis and psoriatic arthritis and can alleviate the suffering often associated with this immune-mediated disease. Substantial progress has been made in understanding the complicated genetics and immunology that drive this disease, as well as identifying the other medical conditions that may be rele- vant for patients. This book is designed to provide you with answers to many of the common questions we have found patients and their families ask about psoriasis. Although patients may feel overwhelmed at 77357_FMxx_FINAL.QXP 11/4/09 10:29 AM Page viii 1 0 0 Q U E S T I O N S & A N S W E R S A B O U T P S O R I A S I S first by the experience of psoriasis,we hope that this book will offer information to alleviate some of that frustration.The most power- ful weapon in the battle against any disease is understanding it,and we hope that this book will provide an initial step toward gaining knowledge. Kendra Gail Bergstrom,MD Alexa Boer Kimball,MD,MPH viii 77357_FMxx_FINAL.QXP 11/4/09 10:29 AM Page ix Foreword Psoriasis is unpredictable.The person with psoriasis does not know when his disease will worsen or improve. He searches for patterns, but the stress of not being able to control his health can lead to anger and even hopelessness. Psoriasis often carries a social stigma.The psoriasis patient may hide her skin to avoid stares and comments, wearing long sleeves and pants to summer picnics, and avoid photographs. Sometimes even family and friends make thoughtless comments. Psoriasis is mysterious.Although it is the most common autoim- mune disease,few people know about psoriasis and even fewer under- stand that it is a genetic,noncontagious disease affecting 7.5 million Americans. Psoriasis and psoriatic arthritis are often undertreated. Research shows that more than 55% of people with psoriasis do not receive any treatment or their treatment does not do enough to relieve their symptoms.Many do not know that their psoriasis is also asso- ciated with increased risk of heart disease, hypertension, diabetes, and other serious conditions. Psoriasis and psoriatic arthritis are serious and often debilitat- ing diseases. The people who deal with them day in and day out need information,support,and action. The National Psoriasis Foundation is a volunteer-driven non- profit organization dedicated to improving the lives of people with psoriasis and psoriatic arthritis.In 2009,we created a new strategic plan outlining five major ways we will work to meet our mission. Our highest priority is to find a cure for psoriasis.Hundreds of thousands of members, their families, and doctors are joining our community and working toward this goal. Over the next 5 years we will increase the foundation’s role as a catalyst in scientific discovery by investing in and encouraging