Nurse Maureen‘s Health Show
Welcome to Nurse Maureen's Health Show Podcast where we dive deep into all things health, sex, menopause, relationships, parenting, communication and more! Hosted by a passionate nurse with years of frontline experience, we bring you expert interviews, real-life stories, and the latest insights on staying healthy aging. Nothing is off limits as we delve into overall health, sexual health, mental health, and sexual health. Whether we’re breaking down medical myths, discussing cutting-edge treatments, or chatting with top health professionals, this show is your go-to for practical advice and inspiring conversations.
Nurse Maureen‘s Health Show
New Medication For Atopic Dermatitis and Vitiligo
Joining me is Dr. Harvey Lui, prominent dermatologist and Professor in the Department of Dermatology & Skin Science at the University of British Columbia. Together we unlock the secrets to healthier skin and improved with insights from Dr. Harvey Lui for those individuals suffering from the effects of Atopic Dermatitis and Vitiligo. Discover how the skin, our body's largest organ, can profoundly impact our quality of life when plagued by the pain, itch and embarrassment of Atopic Dermatitis. Dr. Lui sheds light on the distinct challenges faced by those with atopic dermatitis and vitiligo, both from a medical and psychological perspective, including the societal stigma surrounding visible skin differences. Learn how those with Vitiligo may suffer emotionally with isolation, anxiety or depression. We have exciting news however! Opzelura, an exciting new topical treatment approved by Health targets these immune-related skin ailments. Tune in to learn more!
Good evening and welcome to the podcast. Thanks so much for tuning in. I'm Maureen McGrath, a registered nurse, nurse, continence advisor, sexual health educator, and what I'm talking about tonight is more than skin deep we're talking your skin. Did you know that your skin makes up about 15% of your total body weight and it's the largest organ in your body? The average adult has nearly six meters of skin that covers over 17 kilometers of blood vessels. There are about 300 sweat glands in about a two centimeter area of your skin and the thickest skin is found on your feet and the thinnest area of skin is your eyelids. Your skin protects your body from germs and regulates body temperature. Nerves in the skin help you feel sensations like hot and cold, and it's the first thing quite often that people notice about you, which is why tonight's discussion is so important.
Speaker 1:I am talking about atopic dermatitis. It's an inflammatory skin condition. It's the most common form of eczema and it's estimated to impact 17% of Canadians at some point in their lives. It's characterized by itching, inflamed skin and is usually found behind the knees, the inside of the elbows, face, neck and the hands. Well, I've got some exciting news tonight, and my guest is going to announce that news about what medication that Health Canada has recently approved. Dr Harvey Louis, professor Department of Dermatology and Skin Science at the University of British Columbia, is a leading dermatologist and expert on atopic dermatitis and vitiligo, one of the forms of atopic dermatitis, and he joins me on the line. I'm delighted to have him. Good evening, dr Louie. How are you? Hi Maureen, thanks for having me. Thanks so much for joining me. This impacts so many Canadians at some point in their lives and you can just imagine you're just trying to live and yet you're itchy, you have redness. It's affecting your work, it's affecting your relationship, your sleep. Tell me a little bit more about what atopic dermatitis is.
Speaker 2:Sure. So atopic dermatitis is a chronic skin condition. Unfortunately, it's not curable, but it's definitely treatable. It's not curable, but it's definitely treatable. And in atopic dermatitis, the skin becomes inflamed and so it goes red and it also becomes very itchy. So that means that in order to deal with the inflammation, you're distracted by the itch, and the itch will just drive you crazy. And the reason I know this is because I'm one of those 17% of Canadians who have had this, is because I'm one of those 17% of Canadians who have had or still have atopic dermatitis.
Speaker 2:The itch is incredible, it's distracting, and then you scratch, you break your skin down more and then you get the potential for having infection on your skin. Or, you know, you break the surface of the skin. It becomes dry and scaly, so it's super uncomfortable and it affects your ability to interact with all the things you need to do in your daily life. You know, because you can't live outside of your skin once you're itchy. You know you think about it. You know, when you're itchy, all you're concentrating on is the surface of your skin where you're scratching like crazy and you can't interact with the outside world because you're too damn distracted.
Speaker 1:I can't even imagine I'm one of the more fortunate ones that has not had this, but I mean it would drive me crazy. I mean you just think mosquito bite, which is, you know, temporary short-lived, but you can scratch away at that and it would just be awful. Now Health Canada has approved a new medication called Opsalura and it's the first topical treatment for atopic dermatitis, and also vitiligo, which I thought was really interesting, because vitiligo is really a very different skin condition.
Speaker 2:Tell me about that, yeah so vitiligo is just as you say. It's very different from atopic dermatitis. In vitiligo, what happens is that the body's immune system will actually attack the pigment cells of your skin, you know, the cells that make melanin, which is what gives you skin color. Or to make melanin, your skin turns white and you get these uneven patches of whiteness all over your skin and it's very disfiguring and it's very noticeable, so you can't hide it. If it's on your face, you know people will notice it. It causes a lot of distress for people because, you know, humans aren't really meant to be spotted necessarily. And it's disfigurement. And the reason there's a link between atopic dermatitis and vitiligo is because both skin conditions are actually triggered by the immune system being out of balance, being overactive in the skin. In one case it causes redness and itch and in the other case vitiligo it causes the skin to lose its natural color, but in a very patchy distribution. So you get these uneven, discolored patches all over your skin.
Speaker 1:Is that the condition that Michael Jackson is thought to have had?
Speaker 2:That's what we believe Michael Jackson had. When you develop this condition, it is quite noticeable and that's what causes so much distress for people, because we always like to put our best face forward, so to speak. Right, you get up in the morning, you get ready for the know, you want to look your best and when you have these patches of discolored skin, you know it really affects your self-esteem, affects your self-confidence. It actually affects the way people interact with you, because people don't understand what this is. They think it's contagious, they think it's infectious. Sometimes people are scared of you because there are these historical beliefs in the past. It even goes to ancient times, where people with vitiligo were thought to be persons who were infectious. Or even, you know, they thought, oh my goodness, you look like you are someone with leprosy, so people with vitiligo would be shunned. And these kinds of cultural beliefs are still with us today, unfortunately.
Speaker 1:That is so interesting. You know people with vitiligo I can understand and atopic dermatitis may experience substantial psychological and a psychosocial burden. Really, they may not feel like themselves, they might be embarrassed. This can you know. It's almost as though your identity is being taken away from you and it can really impact your mental health in terms of anxiety and depression, I would imagine. Is that correct?
Speaker 2:Oh, that's definitely true. We know many studies have been done that demonstrate that people with vitiligo, and also people with atopic dermatitis, will have a much higher rate of mental health conditions than the average person. As I say the minute you have difficulties with your skin, there are physical factors that are at play, you know itch or discoloration of the skin or even, in vitiligo, an easier tendency to sunburn. So there's these physical issues, and then there's these psychological and emotional issues, and the two kind of both are affecting your ability to live life and get on with the day in the way that you wish to.
Speaker 1:I can't even imagine it. It must just be an awful condition to live with. I do remember a patient that I had and she said she had met this new boyfriend and she kept him because of her eczema and he was willing to slather moisturizer all over her. He had the patience to do that and the persistence, I guess, and so she decided to keep him at least around for a little while anyway. First, what is the current treatment for atopic dermatitis?
Speaker 2:Okay. So for atopic dermatitis, the current treatments are either topical treatment, meaning you rub something on the skin, or if that's not enough, then the next thing you could do is something called phototherapy, light therapy and then the third option if the topical doesn't work and the light treatment doesn't work, then we go to what's called systemic therapy, where you take medicine either by pill or by injection, that has an effect on the inside of your body as well as the outside. Our usual preference when we're treating patients is to start by treating patients from the outside, meaning we start with topical, put the medication directly on the surface of the skin, where the problem is mainly showing up, and that's where topical and light treatment come in right, because you're treating from the outside, you're treating the skin very directly. In more difficult cases, then we have to kind of go inside the body by using oral medications or even injections in order to rebalance that abnormal immune system internally. So it depends on the severity of the atopic dermatitis, but usually we start with topicals first.
Speaker 1:And I just want to mention again for the listeners that the atopic dermatitis is the most common form of eczema A lot of people might refer to, say eczema or eczema, and you know it sounds like it can be resistant to medications. That it's not necessarily that if you're going to put something topical on or light therapy that they may not work effectively for everybody. Is that correct?
Speaker 2:That's absolutely correct. So atopic dermatitis is a? It's a difficult condition for us to understand scientifically, in the sense that there are many different things that are happening in your skin at the same time. So we know that in atopic dermatitis, the barrier of the skin, meaning the top layer of the skin, which is what protects you. It protects you from having irritants and infectious agents get inside the body. It also protects you by sealing the moisture in your body and preventing you from, you know, leaking out, so to speak.
Speaker 2:Right, so there are these two things, major things that are happening in your skin. One is this barrier, abnormality. And then the second thing that happens is your immune system is overactive. It just gets turned on somehow and that combination of a barrier that's not protecting you, you know, from the surface, and then this immune system that is overactive will combine to cause the inflammation. It will also cause dryness of the skin, cracks and breaks in the skin. So it becomes a really vicious cycle when you have atopic dermatitis and there are many things that are happening at the same time.
Speaker 2:So it means that when we're treating patients, unfortunately patients have to deal with each of these different aspects in order to correct their skin, so the barrier. It means that you have to add a moisturizer or a lubricant to seal the surface of your skin. A moisturizer or a lubricant to seal the surface of your skin In terms of the immune reactions that are over, producing inflammation and itch. You need to do something to control that inflammation, and that's usually in the form of a topical medication that will rebalance the immune system. So traditionally, we've used topical corticosteroids and they work, but they've got limitations. So that's why we still need better technology, better treatments, in order to restore the barrier of the skin and also to deal with that overactive immune system that's driving that inflammation.
Speaker 1:And those steroids can thin the skin. So, dr Louis, very interesting and, I'm certain, so frustrating for people who have atopic dermatitis or vitiligo. What gap or need does Opsalura fill as it relates to atopic dermatitis and vitiligo?
Speaker 2:Yeah, so the gap that Opsalura fills for atopic dermatitis is I've explained that when we're managing atopic dermatitis, there are many abnormalities that are going on in the skin and it means that we have to do many things for the patient, or the patient has to do many things to restore their skin and feel better and deal with that inflammation. So in essence, it means that the treatments that we need to make available to the patient need to have a large variety of different effects, and so we know that in atopic dermatitis there are many aspects of the immune system that are imbalanced, and, you know, topical corticosteroids can work, but they don't necessarily help with all of those reactions. There are other topical medications called topical calcineurin inhibitors, and they work as well, but again, there are ways that the body's immune system can still remain activated. So that's why Opsalura, or also known as topical ruxolitinib, is a newer treatment that actually targets the rebalancing of the immune system in a different way than the other products that have been available up to now. So it's there to help for patients where the existing topical therapies are not enough. Then that's the time to turn to topical Opsalura to try to, you know, further improve the skin when the other medications don't work.
Speaker 2:Now, that's a little bit different from vitiligo, vitiligo. We know what's abnormal with the skin, but the sad reality for vitiligo is that up to now, we have not had a single drug approved in Canada that is designed and tested to rebalance the immune system in order to cause the skin to repigment. Because what you want to do in vitiligo you've lost this color in your skin. You have these white patches all over your body. You need to restore those pigment cells. You need to restore that pigment in order to become normal again, and so up to now there's been no officially approved product in Canada that's actually been custom designed to work in vitiligo. So that's where the gap for Opsalura fits in with vitiligo. It's the first of its kind in this country. In atopic dermatitis, opsalura is being used or needs to be used in those cases where the existing treatments and we have many existing treatments, but they're not perfect those existing treatments if they don't work in atopic dermatitis, we use Opsalura In vitiligo. It's actually the only product that we now officially have available for treatment.
Speaker 1:And that would be first-line treatment for vitiligo.
Speaker 2:Then that definitely would be considered first line treatment in my opinion If you enjoy the show.
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Speaker 1:I mean, that is amazing. That is a huge advancement in medicine, and I just want to remind the listeners that Opsalura is a non-steroidal topical JAK Janus Kinase inhibitor that allows spot treatment for problem skin areas. So this is not a pill that you're having to take every day. This is a cream that you're putting on which is just so fantastic and just life altering and life changing for people living with these conditions atopic dermatitis and vitiligo and I mentioned a couple because the fact that it is a cream. But are there any other benefits that this cream provides, that the medication in the form of a cream provides?
Speaker 2:I should say the advantage of using a cream is that you apply the medication directly to where the action, directly to where the abnormality is occurring. So that's why we prefer, as dermatologists, if we can, to have our patients using topical medications. You know you get the treatment, you hit it where it's happening right, and the other advantage is that you're limiting the systemic exposure right, because if you don't need the top, if you don't need ruxolitinib in your liver, well, you don't need to, you know, have that part exposed, that part of your body exposed, when you're applying it topically. So the advantage of topical therapy is its direct action where it's needed. The limitation of topical tends to be that if you have a very large area then it can be a bit time consuming for application. But it's effective, it works and you know we have better tools now based on really fundamental understanding of the immune system and the way that the immune system can be unbalanced and cause conditions such as atopic dermatitis and vitiligo.
Speaker 1:It's really just so amazing and I'm delighted for people who suffer with these conditions, especially people who suffer with vitiligo. I know that atopic dermatitis or eczema can be debilitating for people as well, but vitiligo is really embarrassing with. They're trying to cover it and it spreads correct. It just doesn't. You know you can. Maybe it starts on your face, but it'll spread to your arms and legs and eventually, you know, cover a lot of your body. Is that right?
Speaker 2:That's correct. So vitiligo, it can involve multiple sites of the body, so it can start in certain locations and for the patient, as you start developing more spots, it can seem as if it's spreading in a sense. And so that's why some people think, oh well, it must be contagious if it's spreading. But it's not so much that the condition is spreading like an infection, it is extending to larger areas of the body because the immune system has decided that it's going to activate in multiple sites of the body. And so the thing that I'm very heartened as a practitioner, as a dermatologist and someone who has tried for the last 30 years to help patients with vitiligo.
Speaker 2:It's really been a shame that you know science and medicine haven't given this condition enough attention and enough understanding. You know, because you're not having itch and you're not having something that will result in skin cancer or something that will result in what others perceive as being a major disability, even though you know having abnormal discoloration of the skin is a huge disability. It's long overdue that you know the drug companies and the researchers and dermatologists, and now, finally, the government has recognized the plight of people with vitiligo, is now making effective treatment available to them. It's you know it shouldn't have taken this long, but you know that it is what it is. Thank goodness we now have something available to help our patients.
Speaker 1:Thank goodness we do, because another thing that I didn't bring up was that it can affect body image as well. Just really how you feel about yourself and how you present yourself to the world. What are some of the greatest chronic skincare needs Canadians face today, dr Louis?
Speaker 2:Well, there's many of them, right? So we've talked about two of the major ones, in the sense that when the immune system goes imbalanced, you can have things like atopic dermatitis or vitiligo. There's also other chronic immune conditions, like psoriasis, that affect a huge portion of the population. A growing area, or an area that we still struggle with, is skin cancer. We know that. You know, one in five Canadians are destined to develop skin cancer sometime in their life. So you know, the reason why skin disease is so prevalent is because the skin is how we interact with the environment. The skin is always, on a daily basis, being exposed to environmental factors. You know climate change, right? Okay, if climate change is going to affect us, it's definitely going to affect the skin, because the skin is directly interacting with the environment. So there's a lot of treatments we now have available. There's more work to be done, but I think Canadians need to understand that taking care of their skin is all about taking care of themselves.
Speaker 2:You mentioned about how the way we look influences the way we feel. Listeners that you know, if you get a bad haircut, you probably think your life is ruined, right? Can you imagine if you have something like vitiligo, where it's not easy to restore the way you want to look. You know a haircut event. Your hair will eventually grow back right, but can you imagine having something that just doesn't make you feel good and look good and not being able to do much about that? That's what the feeling is like on a day-to-day basis for people who suffer with these kinds of conditions.
Speaker 1:Well, thank goodness that Opsalura is now available, the non-steroidal cream for atopic dermatitis and vitiligo. And the skin is the largest organ in the body. It's so important. It accounts for 10 to 15% of one's body weight and it has its own metabolism and it's on the clock, and so it's very important that we take care of our skin. Is there anything else, dr Louis, you'd like listeners to know about Opsalura, atopic dermatitis or vitiligo, or vitiligo.
Speaker 2:I think what listeners need to be aware about is it's one of the options available. There are many things that we can do to help people. I know that some patients have gotten so frustrated that they've given up hope and they've sought, you know, alternative forms of therapy, but you know, if you're suffering from these conditions, there is more than we can do now, than we've ever been able to do. So consult with your healthcare professional, see your doctor, your nurse practitioner, because these treatments, they work, they're available and it's worth taking care of your skin and yourself.
Speaker 1:Thank you so much, Dr Louie. I really appreciate you coming on the program.
Speaker 2:My pleasure and thanks for helping us get this information out to Canadians.
Speaker 1:Well, it's very, very important and I hope people who are experiencing atopic dermatitis or vitiligo or know somebody who is experiencing either of those conditions share this very important episode with them, because it could be life altering for them. My guest was Dr Harvey Louie, professor department of dermatology and skin science at the university of British Columbia. He's a leading dermatologist and expert on atopic dermatitis and vitiligo. Thanks so much for tuning in everybody, and this is nurse Maureen's health show podcast. Thanks so much for tuning in. I'm Maureen McGrath and you have been listening to the Sunday Night Health Show podcast. If you want to hear this podcast or any other segment again, feel free to go to iTunes, spotify or Google Play or wherever you listen to your favorite podcasts. You can always email me, nursetalk at hotmailcom or text the show 604-765-9287. That's 604-765-9287. Or head on over to my website for more information. Maureenmcgrathcom, it's been my pleasure to spend this time with you.
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