Psoriasis treatment in Calgary

Psoriasis diagnosisand treatment in Calgary.

Psoriasis is a chronic immune-mediated disease that affects about one million Canadians. At Rejuvenation Dermatology Calgary South, Dr. Paul Kuzel, a board-certified dermatologist, diagnoses and treats all forms of it, from topical therapy and phototherapy through to biologics, and monitors the joint and cardiovascular health that psoriasis affects.

Book a consultation Call (403) 286-6888

14Years of training FRCPCRoyal College certified VPAlberta Society of Dermatologists

What it is

An immune-mediated disease of the skin.

Psoriasis is not an infection, an allergy or a problem of hygiene. It is an overactive immune response that drives the skin to produce new cells far faster than it can shed them. Understanding that explains both why it behaves as it does and why the newest treatments work.

The immune signalIn psoriasis, immune cells in the skin release signalling proteins, chiefly interleukin 17 and interleukin 23, that tell the skin to inflame and multiply. The biologic treatments that have transformed psoriasis care block those specific proteins.

The turnoverSkin cells normally mature and shed over about a month. In a psoriasis plaque they do it in three to four days. The cells pile up before they can be lost, which produces the thick, raised, silvery plaque.

Genetics and triggersPsoriasis runs in families and involves dozens of known genes. It is then set off or worsened by triggers: streptococcal throat infection, skin injury, stress, certain medications, alcohol, smoking and, in Calgary, the dry winter air.

The types

Forms of psoriasis, and where they present.

Plaque psoriasis accounts for most cases. The other forms are distinguished by the pattern of the rash and the sites involved, and some of them change the treatment plan.

Most common

Plaque psoriasis

Well-defined, raised, red plaques with a silvery scale, most often on the elbows, knees, lower back and scalp. Accounts for roughly nine in ten cases.

Symmetrical, and stable over months rather than changing daily
Itch is common but usually less severe than in eczema
Pinpoint bleeding when the scale is removed is characteristic

After infection

Guttate psoriasis

Many small, drop-shaped spots across the trunk and limbs, appearing suddenly, often two to three weeks after a streptococcal throat infection. Most common in children and young adults.

Frequently clears within months, with or without treatment
A proportion of cases go on to develop plaque psoriasis
Phototherapy is particularly effective for this form

Specific sites

Inverse, scalp and nail psoriasis

Inverse psoriasis affects the skin folds, smooth and red without scale. Scalp psoriasis can be mistaken for dandruff for years. Nail psoriasis causes pitting, thickening and lifting of the nail plate.

Each needs a different formulation and strength of treatment
Nail involvement is associated with a higher risk of psoriatic arthritis

Uncommon, urgent

Pustular and erythrodermic psoriasis

Pustular psoriasis produces sterile pustules, on the palms and soles or across the body. Erythrodermic psoriasis is inflammation of most of the skin surface. Both are uncommon, and both require prompt specialist care.

Generalised forms can cause fever and fluid loss
Often triggered by abrupt withdrawal of oral steroids

Why a dermatologist

Psoriasis is a systemic disease that presents on the skin.

Treating the plaques is only part of the work. A dermatologist confirms the diagnosis, grades the severity, screens for the conditions that travel with psoriasis, and has access to the treatments that change its course.

DiagnosisEczema, fungal infection, seborrheic dermatitis and several rarer conditions can look like psoriasis. Dr. Kuzel confirms the diagnosis clinically and by biopsy where the picture is unclear, because the treatments differ.

Screening for what accompanies itUp to a third of people with psoriasis develop psoriatic arthritis, and psoriasis raises the risk of cardiovascular disease, diabetes and depression. Each visit includes a check for joint symptoms and a review of the risks that warrant attention from your family physician.

Access to the full range of treatmentPhototherapy, conventional oral agents, targeted oral agents and every class of biologic are prescribed and monitored here. Biologics in particular require a dermatologist's prescription and special authorisation, both handled in clinic.

Covered as medical careAssessment and treatment of psoriasis is medical dermatology, generally covered by Alberta Health Care with a referral from your family physician. Phototherapy is a covered service. Biologics are covered by Alberta's drug plans and most private insurers with special authorisation.

Beyond the skin

Joints, cardiovascular and metabolic health.

The inflammation that drives psoriasis is not confined to the skin. Recognising its other effects early is part of managing the disease properly.

Signs of psoriatic arthritis

Morning stiffness in the joints lasting more than thirty minutes
Swelling of an entire finger or toe
Pain at the heel or where tendons attach to bone
Low back or buttock pain that improves with activity
Nail pitting or lifting, which is associated with joint involvement
Joint symptoms can precede the rash, and untreated arthritis causes permanent damage

Associated conditions

Moderate to severe psoriasis is associated with a higher rate of cardiovascular disease, obesity, type 2 diabetes, fatty liver disease and inflammatory bowel disease, and with depression and anxiety. Controlling the skin inflammation may reduce some of these risks.

Dr. Kuzel reviews these at each visit and communicates with your family physician, who manages screening for blood pressure, lipids and blood sugar. Referral to rheumatology is arranged where joint disease is suspected.

Treatment

Treatment is matched to severity and extent.

Limited psoriasis is treated with topical agents. Widespread or severe psoriasis, or disease at sites that affect daily function, is treated with phototherapy, oral agents or biologics. The plan is stepped up until the skin is clear or nearly clear.

Limited disease

Topical treatment

Corticosteroids of appropriate strength, vitamin D analogues, and combination products that pair the two. Coal tar and salicylic acid preparations for thick scale, particularly on the scalp. Non-steroid agents for the face and skin folds.

Formulation matched to the site: foam or solution for scalp, ointment for thick plaques
Effective for most people with limited disease

Widespread disease

Phototherapy

Narrowband UVB delivered in a medical booth two or three times a week slows cell turnover and calms the immune activity in the skin. Well suited to guttate psoriasis and to widespread plaque disease, and to patients who prefer to avoid systemic medication.

A course of eight to twelve weeks, most patients clear or substantially improve
Covered by Alberta Health Care

UV therapy

Moderate to severe

Oral treatment

Methotrexate, acitretin and cyclosporine are established systemic agents, each with a defined monitoring schedule. Newer targeted oral agents, apremilast and deucravacitinib, act on specific inflammatory pathways with less monitoring.

Blood tests before and during treatment, arranged through the clinic
Selected according to your other health conditions and plans for pregnancy

Moderate to severe

Biologics

Injectable antibodies that block the specific proteins driving psoriasis: TNF, interleukin 17 or interleukin 23. Current agents clear or nearly clear the skin in most patients, with dosing as infrequent as every twelve weeks, and also treat psoriatic arthritis.

For psoriasis that has not responded adequately to topical treatment and phototherapy
Screening, special authorisation and monitoring are handled in clinic

Site specific

Scalp and nail psoriasis

Scalp disease responds to medicated solutions, foams and shampoos applied correctly. Nail psoriasis is slow to respond to topical treatment and, when significant, is an indication for systemic therapy in its own right.

All patients

Trigger management

Treatment of streptococcal infection, review of medications known to worsen psoriasis, moisturising through the Calgary winter, and support with weight, alcohol and smoking where relevant. Each reduces flares and improves the response to treatment.

Your visit

Assessment, treatment plan and monitoring.

Psoriasis is managed over years. The first visit establishes the diagnosis and severity; subsequent visits adjust treatment and monitor for the conditions associated with the disease.

HistoryOnset, family history, previous treatments, joint symptoms, and the medications and illnesses that affect treatment choice.

ExaminationThe full skin surface, scalp and nails. Severity is graded by extent and by impact on daily life.

InvestigationsBiopsy where the diagnosis is uncertain. Blood tests where systemic treatment is planned.

Treatment planWritten instructions for topical treatment, or a booking for phototherapy, or a prescription and authorisation for systemic therapy.

Follow-upEight to twelve weeks after starting, then at intervals set by the treatment, with joint and general health reviewed at each visit.

What to expect

Expected outcomes.

Psoriasis cannot at present be cured, but it can be controlled, and the standard of control has risen substantially in the last decade. For limited disease, topical treatment used correctly clears most plaques within six to eight weeks. For widespread disease, a course of phototherapy clears or substantially improves most patients.

For moderate to severe psoriasis, current biologics achieve clear or almost clear skin in the majority of patients, usually within twelve to sixteen weeks, and maintain it for as long as treatment continues. The same agents treat psoriatic arthritis where it is present.

Psoriasis does relapse when treatment stops, and it flares with triggers. The plan therefore includes maintenance, and a written approach to managing a flare when one occurs.

8 to 12Weeks, typical phototherapy course 12 to 16Weeks to full biologic response 1Physician managing the plan

Questions

Questions about psoriasis, answered.

Is psoriasis contagious?

No. Psoriasis is an immune-mediated condition and cannot be passed from one person to another by contact.

Can psoriasis be cured?

Not at present. It can be controlled, and with current treatment most patients can expect clear or nearly clear skin for as long as they remain on treatment. Some people, particularly after guttate psoriasis, have long periods of remission without treatment.

Is psoriasis treatment covered by Alberta Health Care?

Assessment and treatment of psoriasis is medical dermatology and is generally covered with a referral from your family physician. Phototherapy is a covered service. Prescriptions are covered by most drug plans, and biologics are covered by Alberta's plans and most private insurers with special authorisation, which Dr. Kuzel's office handles.

Do I need a referral?

For care billed to Alberta Health Care, a referral from a physician is the normal route, and it can be faxed to (403) 225-2914. If you do not have a family doctor or would rather not wait, call (403) 286-6888 and the team will tell you the quickest way to be seen.

Is phototherapy safe?

Narrowband UVB is a well-established treatment with a long safety record. Doses are measured and increased gradually, exposure is limited to minutes, and the eyes and genitals are shielded. It is not equivalent to tanning bed use, which delivers UVA at uncontrolled doses. Long-term risk is monitored, and regular skin checks are part of the care of any patient who has had phototherapy.

Are biologics safe?

Biologics have been used for psoriasis for two decades and their safety is well characterised. The principal concern is a modestly increased risk of infection, so screening for tuberculosis and hepatitis is done before starting and patients are advised on vaccination. Dr. Kuzel reviews the specific risks of each agent with you before prescribing.

What makes psoriasis worse?

Streptococcal throat infection, injury to the skin, stress, alcohol, smoking, obesity, and certain medications including beta blockers, lithium and antimalarials. Abruptly stopping oral corticosteroids can provoke a severe flare. Dry winter air worsens scaling, which is why many Calgary patients are worse from November to March.

Does diet affect psoriasis?

No specific diet treats psoriasis. Weight reduction in patients who are overweight improves psoriasis and the response to treatment, and reducing alcohol intake reduces flares. A small number of patients with coeliac disease improve on a gluten-free diet; for others there is no evidence of benefit.

Will my children get psoriasis?

Psoriasis has a strong genetic component. With one affected parent the risk to a child is roughly ten to fifteen percent; with two affected parents it is higher. Most children of affected parents do not develop the disease.

Who provides the care?

Dr. Paul Kuzel, MD FRCPC, a board-certified dermatologist and the founder and Medical Director of Rejuvenation Dermatology Calgary South. He sees patients in English and Czech.

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