(LifeWire) - It has been more than five years since Ninfa Cantu began self-injecting medicine to control her psoriasis, but she can still vividly recall how she felt at the start.
"I was scared -- very scared," says Cantu, 52, a San Antonio resident who developed the skin disorder nearly 30 years ago. "I didn't know what it was going to feel like, but you fear the worst."
Only about 70,000 of the roughly 6 million people with psoriasis have outbreaks severe enough to require injected medications -- known as biologics -- to quiet their skin. But for these patients, the injections can make allow them to function normally, rather than be debilitated by red plaques that can even appear on the palms of the hands, soles of the feet or the eyelids, lips or genitals.
Psoriasis results from an immune system malfunction that causes skin cells to turn over far more rapidly than normal, creating patches of thick silver-scaled skin that can itch and bleed. About one-third of individuals with psoriasis (called "psoriatics") have a severe form of the disease, covering anywhere from 30% to 100% of their bodies.
Additionally, approximately 10% of psoriatics have a related condition known as psoriatic arthritis, which affects the joints and causes the same sort of pain and stiffness that characterizes most forms of arthritis.
For patients whose skin or joints are acutely affected, the development of biologics over the past decade has been a major step, replacing or augmenting their past therapeutic strategies of topical creams, phototherapy or pills. Biologics -- which include compounds such as Amevive (alefacept), and Enbrel (etanercept) -- work by hindering the overproduction and inflammation of skin cells by the immune system.
However, for some psoriatics, the self-injections required to administer these medications are a major downside. An estimated 7% to 22% of the general population has "injection phobia," which, understandably, limits the attractiveness of this treatment method.
On the other hand, because biologics are generally pre-dosed in small syringes that deliver the medicine with a quick click of a finger, psoriatics often find that the anticipation of self-injecting is far worse than the reality.
The syringes, which resemble ballpoint pens, hide the needle from sight and inject the compound just under the skin of the thigh. Since the medicines are systemic, patients need to be monitored by a doctor and are at risk of increased infections and other immune system side effects resulting from the medication.
"It's painless and fast," says Doris J. Day, MD, clinical assistant professor of dermatology at New York University Medical Center, who noted that injections need only be done once or twice a week. "It doesn't look like a needle or syringe. And it's very liberating to people who have been applying (prescription) creams to so many spots for so long. They can be clear for months."
Leah Bird, 55 -- a Newton, MA, native who has extensive experience with psoriasis -- injects herself once a week with a biologic and finds that it clears her skin and significantly tames her psoriatic arthritis.
"For me, it's the difference between walking and not walking," Bird says. "The shots definitely sting, but there's no debate for me about it being worth it."
Dermatologists say they make sure patients are comfortable with the injection procedure before they have to tackle it on their own. But for those who are still anxious about self-injecting, there are a variety of strategies that may be helpful. For example, you can try:
- Applying ice to the injection site first. Ice helps numb the area to deaden the sting of the shot.
- Deep breathing. Doing so with your eyes closed for a few minutes before injecting can be helpful.
- Cognitive reframing. This involves examining your thoughts about self-injecting, deciding which ones are not accurate or helpful and modifying them. For example, thoughts such as "these injections are just another source of discomfort" can be re-framed into "injections help keep me healthy."
- Cognitive behavioral therapy (CBT). Working with a therapist familiar with CBT can help provide additional strategies for overcoming your discomfort with self-injection.
Sources:
Ninfa Cantu. Telephone interview, 24 April 2008.
Doris J. Day, MD, clinical assistant professor of dermatology, New York University Medical Center. Telephone interview, 21 April 2008.
Leah Bird. Telephone interview, 15 April 2008.
"Psoriasis." National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse. May 2003. National Institutes of Health. 11 Apr 2008 <http://www.niams.nih.gov/Health_Info/Psoriasis/default.asp>.
Cox, Darcy. "Managing Self-Injection Difficulties in Patients with Relapsing-Remitting Multiple Sclerosis." Journal of Neuroscience Nursing 38. 3 Dec. 2006. 167-171. 27 Apr. 2008. <http://www.medscape.com/viewarticle/548016>. (subscription)
LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Maureen Salamon is a New-Jersey based freelance writer who has written for newspaper, website and hospital clients. She has suffered from psoriasis for nearly three decades.
