I never imagined I would ever get rid of my psoriasis
David Chappell has regained control of his skin
Supplied
In his 20s David Chappell suddenly found himself living
with an unwanted companion. It was with him day and night and wouldn't
budge.
It was an unsightly skin condition which, when it poked out from under his shirt cuffs or his collar, made others look twice.
What surprised Chappell was that his psoriasis arrived out of the blue and then spread intermittently.
At
its height, it covered 70 per cent of his body and no matter how many
specialists he consulted and how many treatments he tried, the disease
seemed intractable.
with an unwanted companion. It was with him day and night and wouldn't
budge.
It was an unsightly skin condition which, when it poked out from under his shirt cuffs or his collar, made others look twice.
What surprised Chappell was that his psoriasis arrived out of the blue and then spread intermittently.
At
its height, it covered 70 per cent of his body and no matter how many
specialists he consulted and how many treatments he tried, the disease
seemed intractable.
"The Singing Detective", played by Michael Gambon, is
hospitalised with severe psoriasis. The author of the British television
series, Dennis Potter, suffered severely from the disease.
Supplied
Tired of being
investigated, prodded and asked the same old questions, he lowered his
expectations and resigned himself to living with psoriasis for ever.
investigated, prodded and asked the same old questions, he lowered his
expectations and resigned himself to living with psoriasis for ever.
Today, at the age of
37, Chappell has changed his position and has a message for the half a
million Australians who are silently living with psoriasis too: "Don't
give up!"
He's been on a trial of a drug that people are now describing as "life changing".
With
its red, thick and scaly plaques, psoriasis looks like a chronic
inflammatory skin disease but it is actually a systemic immune disease
that can alter and shorten a person's life.
Chappell had never
heard of it and when it first appeared as a few red spots on his ankle
he had no idea how preoccupying and almost disabling it would become.
37, Chappell has changed his position and has a message for the half a
million Australians who are silently living with psoriasis too: "Don't
give up!"
He's been on a trial of a drug that people are now describing as "life changing".
With
its red, thick and scaly plaques, psoriasis looks like a chronic
inflammatory skin disease but it is actually a systemic immune disease
that can alter and shorten a person's life.
Chappell had never
heard of it and when it first appeared as a few red spots on his ankle
he had no idea how preoccupying and almost disabling it would become.
Wearing shorts in
summer or stripping off at the beach was aesthetically out of the
question. Coming home after a good time and falling into bed was no
longer possible either.
If he didn't apply his ointments and
creams – and then wait patiently for them to dry – he'd be punished in
the morning with cracked and painful skin.
This
"companion" demanded endless care and often didn't even respond to it.
Figuring out what triggered it to flare from time to time was near
impossible.
Doctors told Chappell that triggers could include
stress, alcohol, obesity, smoking and some medications. There were also
triggers he couldn't protect against such as common upper respiratory
infections like a "strep throat", scratches, insect bites and any injury
to the skin.
summer or stripping off at the beach was aesthetically out of the
question. Coming home after a good time and falling into bed was no
longer possible either.
If he didn't apply his ointments and
creams – and then wait patiently for them to dry – he'd be punished in
the morning with cracked and painful skin.
This
"companion" demanded endless care and often didn't even respond to it.
Figuring out what triggered it to flare from time to time was near
impossible.
Doctors told Chappell that triggers could include
stress, alcohol, obesity, smoking and some medications. There were also
triggers he couldn't protect against such as common upper respiratory
infections like a "strep throat", scratches, insect bites and any injury
to the skin.
The spots first
appeared when he was abroad working in media and communications for the
controversial mayor of London, Ken Livingstone.
By the time he
shifted to HSBC's London headquarters, to lead a global team of
communicators responsible for supporting HR across 85 countries, the
disease was firmly established and he was battling to keep it under
control.
It forced him to mature much earlier than his mates. "I
knew I had to create a life balance, eating well, drinking enough water
and resting. This was going to be with me for life and I had to learn to
manage it daily."
Psoriasis is genetic. Although Chappell's
mother sometimes had red patches with silvery scales on her hands, these
were always attributed to her work as a nurse, which required constant
hand washing with abrasive disinfectants.
appeared when he was abroad working in media and communications for the
controversial mayor of London, Ken Livingstone.
By the time he
shifted to HSBC's London headquarters, to lead a global team of
communicators responsible for supporting HR across 85 countries, the
disease was firmly established and he was battling to keep it under
control.
It forced him to mature much earlier than his mates. "I
knew I had to create a life balance, eating well, drinking enough water
and resting. This was going to be with me for life and I had to learn to
manage it daily."
Psoriasis is genetic. Although Chappell's
mother sometimes had red patches with silvery scales on her hands, these
were always attributed to her work as a nurse, which required constant
hand washing with abrasive disinfectants.
As in her case, the
disease can be mild – defined as affecting less than 3 per cent of the
body – but it can also be so bad it affects fingernails, toenails, the
soft tissues of the genitals, the inside of the mouth and joints.
In severe cases people need to be hospitalised as happened in the celebrated '80s television series, The Singing Detective,
in which the main character was covered with psoriasis and so disabled
he could managed to write only with a pen tied to his fist.
Dennis
Potter, who created the story, suffered intensely from the disease
himself and knew about the lack of control, depression and desperation
it can bring.
World-class American golfer Phil Mickelson suffered from psoriatic arthritis that was so extreme he couldn't get out of bed.
disease can be mild – defined as affecting less than 3 per cent of the
body – but it can also be so bad it affects fingernails, toenails, the
soft tissues of the genitals, the inside of the mouth and joints.
In severe cases people need to be hospitalised as happened in the celebrated '80s television series, The Singing Detective,
in which the main character was covered with psoriasis and so disabled
he could managed to write only with a pen tied to his fist.
Dennis
Potter, who created the story, suffered intensely from the disease
himself and knew about the lack of control, depression and desperation
it can bring.
World-class American golfer Phil Mickelson suffered from psoriatic arthritis that was so extreme he couldn't get out of bed.
Although Kim Kardashian
spoke openly about her psoriasis, it's relatively rare for celebrities
to champion the cause and consequently there has not been much awareness
of it in the public mind.
There is now a concerted effort to lift
its profile. This is driven by a growing understanding that psoriasis
is a systemic disease with potential long-term consequences for the rest
of the body and by the fact that treatment has significantly improved.
There
is also increasing research into the psychosocial impact it has on
quality of life and on productivity. When people have severe untreated
psoriasis their work productivity suffers.
This disease can drive
people to the edge. For many it is a heavy social burden and it is not
unusual for suffers to anticipate rejection and feel ashamed.
In
2010, a multicentre study conducted in Australian adults with psoriasis
showed 73 per cent reported hiding their condition because of
embarrassment and fear of stigma.
"It certainly turned me into a
nervous person," says Chappell, who is back in Sydney working as a
change and communications manager for Suncorp.
He is grateful his
psoriasis never reached his hands or face, but it was on his scalp and
at times could be plainly seen, prompting questions about whether it was
contagious.
Eventually he avoided routine activities like going
to the gym where he couldn't cover up because it would look odd and he
would sweat even more.
spoke openly about her psoriasis, it's relatively rare for celebrities
to champion the cause and consequently there has not been much awareness
of it in the public mind.
There is now a concerted effort to lift
its profile. This is driven by a growing understanding that psoriasis
is a systemic disease with potential long-term consequences for the rest
of the body and by the fact that treatment has significantly improved.
There
is also increasing research into the psychosocial impact it has on
quality of life and on productivity. When people have severe untreated
psoriasis their work productivity suffers.
This disease can drive
people to the edge. For many it is a heavy social burden and it is not
unusual for suffers to anticipate rejection and feel ashamed.
In
2010, a multicentre study conducted in Australian adults with psoriasis
showed 73 per cent reported hiding their condition because of
embarrassment and fear of stigma.
"It certainly turned me into a
nervous person," says Chappell, who is back in Sydney working as a
change and communications manager for Suncorp.
He is grateful his
psoriasis never reached his hands or face, but it was on his scalp and
at times could be plainly seen, prompting questions about whether it was
contagious.
Eventually he avoided routine activities like going
to the gym where he couldn't cover up because it would look odd and he
would sweat even more.
Eight months ago he was
persuaded to join a trial for a treatment using "biologics". While
regular drugs are made from plants or chemicals, biologics are derived
from living cells cultured in a laboratory.
Designed to inhibit specific components of the immune system, they are usually given by injection or intravenous infusion.
First-generation
biologics, such as vaccines and insulin, have been around for many
years. In terms of psoriasis, biologics have been available in Australia
for a decade and are now in their third generation.
Until last
September there were four biologic drugs that could be expected to clear
or almost clear the skin of one-third to over 70 per cent of people
with psoriasis.
In September a new, more targeted biologic,
secukinumab, became available with the expectation of clearing or almost
clearing the skin of more than 80 per cent of the disease.
Now approval is being sought for a similar drug, ixekizumab, in Australia.
"The
level of response we see with these two new drugs is unprecedented,"
says Peter Foley, associate professor of dermatology at the University
of Melbourne.
While ixekizumab "may work in more people and may
work more completely", Foley says patients describe both drugs as life
changing because they have regained control of their skin.
persuaded to join a trial for a treatment using "biologics". While
regular drugs are made from plants or chemicals, biologics are derived
from living cells cultured in a laboratory.
Designed to inhibit specific components of the immune system, they are usually given by injection or intravenous infusion.
First-generation
biologics, such as vaccines and insulin, have been around for many
years. In terms of psoriasis, biologics have been available in Australia
for a decade and are now in their third generation.
Until last
September there were four biologic drugs that could be expected to clear
or almost clear the skin of one-third to over 70 per cent of people
with psoriasis.
In September a new, more targeted biologic,
secukinumab, became available with the expectation of clearing or almost
clearing the skin of more than 80 per cent of the disease.
Now approval is being sought for a similar drug, ixekizumab, in Australia.
"The
level of response we see with these two new drugs is unprecedented,"
says Peter Foley, associate professor of dermatology at the University
of Melbourne.
While ixekizumab "may work in more people and may
work more completely", Foley says patients describe both drugs as life
changing because they have regained control of their skin.
Foley, who is also
research director at the Skin and Cancer Foundation in Melbourne, says
as biologics work by suppressing immunity, they always carry a risk of
infection or cancer.
As these latest two are more targeted, they
are probably safer than their broader spectrum predecessors, but they
still carry risk.
Chappell has been injected every fortnight with ixekizumab and says he's experienced not even a mild after-effect.
After
the first month his disease had noticeably retracted and has now
virtually disappeared. He's regained the freedom of normality and if he
feels hot at work can enjoy the ordinary pleasure of rolling up his
sleeves.
"Now that it's gone, I realise just how much head space
it took. I have much more mental energy." Chappell is hoping with all
his heart that the treatment keeps working for him.
In June this year, The New England Journal of Medicine reported high rates of clearance of disease in people with moderate to severe psoriasis treated with ixekizumab at 60 weeks.
Side effects included slightly raised rates of low white blood cell counts, yeast infections and inflammatory bowel disease.
As
there is always the chance of serious infections with longer use or in
vulnerable patients, safety beyond 60 weeks will need to be monitored.
The drug has since been approved by the US Food and Drug Administration.
A retrospective study on biologic drugs for psoriasis, published in the Journal of the American Academy of Dermatology, found those who respond rapidly are more likely to enjoy long-term remission.
research director at the Skin and Cancer Foundation in Melbourne, says
as biologics work by suppressing immunity, they always carry a risk of
infection or cancer.
As these latest two are more targeted, they
are probably safer than their broader spectrum predecessors, but they
still carry risk.
Chappell has been injected every fortnight with ixekizumab and says he's experienced not even a mild after-effect.
After
the first month his disease had noticeably retracted and has now
virtually disappeared. He's regained the freedom of normality and if he
feels hot at work can enjoy the ordinary pleasure of rolling up his
sleeves.
"Now that it's gone, I realise just how much head space
it took. I have much more mental energy." Chappell is hoping with all
his heart that the treatment keeps working for him.
In June this year, The New England Journal of Medicine reported high rates of clearance of disease in people with moderate to severe psoriasis treated with ixekizumab at 60 weeks.
Side effects included slightly raised rates of low white blood cell counts, yeast infections and inflammatory bowel disease.
As
there is always the chance of serious infections with longer use or in
vulnerable patients, safety beyond 60 weeks will need to be monitored.
The drug has since been approved by the US Food and Drug Administration.
A retrospective study on biologic drugs for psoriasis, published in the Journal of the American Academy of Dermatology, found those who respond rapidly are more likely to enjoy long-term remission.
