USA Olympic Swimmer Dara Torres Reveals Her Battle with Psoriasis: An Interview with Steven R. Feldman, M.D., Ph.D.
Published by Daniel Lewis on July 26, 2017.
Christinne Muschi/Reuters
In a one-on-one interview with Steven R. Feldman, M.D., Ph.D., Professor of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine, Dr. Feldman and sports journalist Daniel Lewis recount USA Olympic swimmer Dara Torres’ 25-year battle with psoriasis and discuss exciting new developments in the treatment of psoriasis.
Twelve-time USA Olympic swimming medalist Dara Torres has spent the majority of her life in a swimming pool, with much of her skin exposed for the world to see.
But for years, she felt uncomfortable in her own skin after developing unusual red patches and plaques shortly before participating in the 1992 Summer Olympics in Barcelona, Spain.
“I still remember it so clearly,” Torres reflects. “It was the early ‘90s, and I was at the pool… when I finished my workout and got out of the water, I felt like something was off. I suddenly noticed red, flaky patches on my elbow. I headed to the locker room and looked at my discolored elbow in the mirror. ‘What is that?’ I thought. ‘Why am I itching?’”
“I figured it was just a rash, so I brushed it off and tried not to think about it,” Torres explains. “But the red, flaky patches kept coming back.”
At that point, Torres realized something was wrong with her skin.
“Then the patches started cropping up in other places, like my back and even my shins. And to make matters worse, I got into the habit of scratching them, and as I did, they kept getting redder and redder. I knew I needed to figure out what was going on.”
“I didn’t understand what was happening to my body. I was mortified, scared, and didn’t know what to do. My instinct was to hide it from everyone.”
Then came a diagnosis of psoriasis from her dermatologist.
“Could you spell that for me?” Torres asked, unfamiliar with the disease.
Twelve-time USA Olympic swimming medalist Dara Torres has spent the majority of her life in a swimming pool, with much of her skin exposed for the world to see.
But for years, she felt uncomfortable in her own skin after developing unusual red patches and plaques shortly before participating in the 1992 Summer Olympics in Barcelona, Spain.
“I still remember it so clearly,” Torres reflects. “It was the early ‘90s, and I was at the pool… when I finished my workout and got out of the water, I felt like something was off. I suddenly noticed red, flaky patches on my elbow. I headed to the locker room and looked at my discolored elbow in the mirror. ‘What is that?’ I thought. ‘Why am I itching?’”
“I figured it was just a rash, so I brushed it off and tried not to think about it,” Torres explains. “But the red, flaky patches kept coming back.”
At that point, Torres realized something was wrong with her skin.
“Then the patches started cropping up in other places, like my back and even my shins. And to make matters worse, I got into the habit of scratching them, and as I did, they kept getting redder and redder. I knew I needed to figure out what was going on.”
“I didn’t understand what was happening to my body. I was mortified, scared, and didn’t know what to do. My instinct was to hide it from everyone.”
Then came a diagnosis of psoriasis from her dermatologist.
“Could you spell that for me?” Torres asked, unfamiliar with the disease.
Steven R. Feldman, M.D., Ph.D.
Psoriasis is a chronic skin disorder in which skin cells mature seven times faster than normal. Skin cells grow from deep within the skin, slowly rise to the surface, where they are later shed. The typical life cycle of a skin cell is one month; in psoriasis, this process occurs in four days.
The immune system normally deploys white blood cells to attack invading microorganisms and fight infection. However, psoriasis is an autoinflammatory condition, in which two types of white blood cells—T lymphocytes and neutrophils—migrate to the skin without an identifiable intruder. These cells produce inflammation, causing skin cell production to go into overdrive.
“Psoriasis is a disease characterized by an overactive immune system,” explains Steven R. Feldman, M.D., Ph.D., Professor of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine. “It involves the same immune pathway as does athlete’s foot or other fungal infections. But as far as we know, there is no fungus or other microbes, so the body is producing inflammation even when there is no invader.”
This rapid overproduction of skin cells pushes them to the surface, where they congregate to produce raised, red plaques with overlying silvery scale. These lesions commonly appear on the elbows, knees, and scalp but can also occur on the trunk, buttocks, and palms and soles.
“At first, I was horribly embarrassed by my symptoms, especially since I couldn’t really hide them. After all, my work suit is my swimsuit! My body is completely exposed, except for whatever that little piece of clothing covers…I felt especially self-conscious whenever I had to jump in the pool—which was pretty much every day.”
Affecting 7.5 million people or 2% of the U.S. population, psoriasis is a very common disorder. It affects men and women equally and can occur at any age, though it most commonly develops during adolescence to young adulthood (ages 15 to 35) or in adults in their early 50s.
Although its exact cause remains unknown, its etiology is believed to be multifactorial—genetic, environmental, and immunologic factors all likely contribute to development of the disease.
Psoriasis can also be accompanied by psoriatic arthritis, which occurs in an estimated 10-30% of cases and manifests as joint pain, swelling, and stiffness. Individuals with psoriasis also face an elevated risk of developing cardiovascular disease and inflammatory bowel disease.
More than a physical condition, psoriasis can also affect emotional health and even lead to depression. Studies have demonstrated that the psychosocial effects of psoriasis can equal those experienced with debilitating conditions such as cancer or congestive heart failure.
“Like many people who deal with psoriasis, I found that the condition really started to take a toll on me emotionally,” Torres admits. “My biggest fear was that people would look at me and think if they came close to me or touched me they would catch it. Every time I dove in the water, I’d see the other swimmers stare at me, and I’d think they must be scared they would get the flaky patches too…People mistakenly thought the condition might be contagious—as if it were poison ivy or chickenpox. And sadly, that stigma still hasn’t totally gone away.”
“Psoriasis has an enormous impact on pretty much every dimension of people’s lives,” Feldman emphasizes. “Our research has shown that a high percentage of our psoriasis patients are depressed. A significant number of them had thought about committing suicide because of their disease.”
“It can be a socially disabling disease,” adds Feldman. “It may affect how you perceive yourself, how others perceive you, and how you think others perceive you.”
In fighting to overcome the emotional hurdles of psoriasis, Torres finally decided she would not let the disease affect her life any further.
“Despite my insecurities, eventually I realized: ‘Who cares if I have these flaky patches on my skin?’ It doesn’t define who I am, and I don’t want it to hold me back from showing my true self or pursuing my dreams. Whether my goal is competing in the Olympics or just being a good mom, I finally realized I can’t achieve anything if I sit around and think: ‘I’m not going out because I have psoriasis on my elbows or back.’”
Psoriasis can be difficult to treat since the lesions regularly come and go, exhibiting cycles of remissions and flares that occur over a lifetime. While the number of medications in our armamentarium to clear the red, scaly plaques is continually growing, no cure has been found.
Instead of focusing on her appearance, Torres smartly concentrated on controlling her disease.
“I’m the kind of person who doesn’t shy away from challenges; psoriasis is just another challenge in my life. So instead of dwelling on self-consciousness, I shifted my energy towards figuring out a way to manage my symptoms.”
Treatments for psoriasis aim to curb inflammation, remove scale, and slow the development of skin cells. The mainstay of therapy is topical steroids, which decrease inflammation, relieve itching, and thin out psoriatic plaques. Topical steroids can effectively treat mild-to-moderate psoriasis. Regular doses of ultraviolet light—yes, even sunlight—can also improve psoriasis.
“If a patient has few enough spots that they can apply topical agents to each spot individually, then we can treat him or her with creams, ointments, or other therapies delivered directly to the skin lesions,” Feldman describes. “But if he or she has many spots distributed throughout the body, then we can try internal treatments that treat all the lesions at once.”
Indeed, when topical agents and phototherapy fail or when the disease becomes more widespread, patients can turn to systemic therapy. Oral retinoids, compounds with vitamin A-like properties, can help relieve the thickened skin inherent to psoriatic plaques. Moreover, methotrexate, considered a chemotherapy drug, can produce dramatic clearing by controlling the white blood cells that contribute to the overactive inflammatory cascade in psoriasis.
A newer class of medications known as “biologics” have grown popular and are named as such because they consist of animal or human proteins. They represent a form of “targeted therapy” in that they inhibit the action of specific immune signals implicated in psoriasis: tumor necrosis factor-alpha, interleukin-12, interleukin-17, and interleukin-23. However, because they downregulate components of the immune system, they can result in immunosuppression. As such, they are generally reserved for cases of moderate-to-severe psoriasis or psoriatic arthritis.
“If you watch any television, you will see a host of advertisements on these biologics, which are extraordinarily effective and very safe for the treatment of psoriasis,” states Feldman.
Commonly advertised on television, biologics include older agents such as etanercept (Enbrel®), infliximab (Remicaide®), and adalimumab (Humira®). In recent years, biologics with more refined targeted activity, including ustekinumab (Stelara®), secukinumab (Cosentyx®), ixekizumab (Taltz®), brodalumab (Siliq®), and guselkumab (Tremfya®), have been introduced.
These biologics have transformed the way dermatologists treat severe psoriasis.
“In the past, for individuals with really severe psoriasis, the drugs we used previously were fairly toxic, and so we had to limit the dosing and could only get their psoriasis under reasonable enough control,” Feldman says. “Rarely did we ever make patients completely clear.”
“Now, with these biologics, we can improve their psoriasis much better and more safely than we could before,” Feldman contrasts. “Nowadays it is conceivable to get people completely cleared of their psoriasis or get them to the point where it does not bother them anymore.”
Another newer treatment is apremilast (Otezla®), an oral medication that decreases inflammatory signals upregulated in psoriasis without suppressing the immune system, unlike biologics.
“Every one of these new medications is another advance that can benefit my patients,” voices Feldman.
In an effort to empower others, Torres has teamed up with Celgene, the producer of Otezla®, to develop her “Show More of You” initiative. The campaign is designed to increase awareness of psoriasis and encourage those with psoriasis to overcome the stigma of their disease.
“I decided I wanted to use my story and my position in the public eye to help other people,” Torres conveys. “People can post pictures and inspirational messages, plus tell stories about what they’ve been through. It is meant to help educate the public on the condition and help destigmatize it once and for all.”
After breaking a world record at age 14 and coming out of retirement to win three Olympic silver medals at age 41, it is hardly surprising that, now 25 years after being diagnosed with psoriasis, Torres has learned to conquer her disease.
“It definitely wasn’t easy, but overcoming the challenges of living with the condition has made me stronger,” Torres declares.
“Nothing keeps me from training or competing. Nothing. Not even psoriasis.”
Steven R. Feldman, M.D., Ph.D., is Professor of Dermatology, Pathology and Public Health Sciences at the Wake Forest University School of Medicine in Winston-Salem, North Carolina. His work has been published in over 800 articles in books and peer-reviewed journals, and he has been a principal investigator or co-investigator on numerous industry, foundation, and federally-funded research grants. Since 1997, he has served as Director of the Center for Dermatology Research, the leading center for health services research in dermatology.
Dr. Feldman is neither involved in the medical care of Dara Torres nor has access to her personal medical records. His analysis represents general information about the care of patients with psoriasis.
The immune system normally deploys white blood cells to attack invading microorganisms and fight infection. However, psoriasis is an autoinflammatory condition, in which two types of white blood cells—T lymphocytes and neutrophils—migrate to the skin without an identifiable intruder. These cells produce inflammation, causing skin cell production to go into overdrive.
“Psoriasis is a disease characterized by an overactive immune system,” explains Steven R. Feldman, M.D., Ph.D., Professor of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine. “It involves the same immune pathway as does athlete’s foot or other fungal infections. But as far as we know, there is no fungus or other microbes, so the body is producing inflammation even when there is no invader.”
This rapid overproduction of skin cells pushes them to the surface, where they congregate to produce raised, red plaques with overlying silvery scale. These lesions commonly appear on the elbows, knees, and scalp but can also occur on the trunk, buttocks, and palms and soles.
“At first, I was horribly embarrassed by my symptoms, especially since I couldn’t really hide them. After all, my work suit is my swimsuit! My body is completely exposed, except for whatever that little piece of clothing covers…I felt especially self-conscious whenever I had to jump in the pool—which was pretty much every day.”
Affecting 7.5 million people or 2% of the U.S. population, psoriasis is a very common disorder. It affects men and women equally and can occur at any age, though it most commonly develops during adolescence to young adulthood (ages 15 to 35) or in adults in their early 50s.
Although its exact cause remains unknown, its etiology is believed to be multifactorial—genetic, environmental, and immunologic factors all likely contribute to development of the disease.
Psoriasis can also be accompanied by psoriatic arthritis, which occurs in an estimated 10-30% of cases and manifests as joint pain, swelling, and stiffness. Individuals with psoriasis also face an elevated risk of developing cardiovascular disease and inflammatory bowel disease.
More than a physical condition, psoriasis can also affect emotional health and even lead to depression. Studies have demonstrated that the psychosocial effects of psoriasis can equal those experienced with debilitating conditions such as cancer or congestive heart failure.
“Like many people who deal with psoriasis, I found that the condition really started to take a toll on me emotionally,” Torres admits. “My biggest fear was that people would look at me and think if they came close to me or touched me they would catch it. Every time I dove in the water, I’d see the other swimmers stare at me, and I’d think they must be scared they would get the flaky patches too…People mistakenly thought the condition might be contagious—as if it were poison ivy or chickenpox. And sadly, that stigma still hasn’t totally gone away.”
“Psoriasis has an enormous impact on pretty much every dimension of people’s lives,” Feldman emphasizes. “Our research has shown that a high percentage of our psoriasis patients are depressed. A significant number of them had thought about committing suicide because of their disease.”
“It can be a socially disabling disease,” adds Feldman. “It may affect how you perceive yourself, how others perceive you, and how you think others perceive you.”
In fighting to overcome the emotional hurdles of psoriasis, Torres finally decided she would not let the disease affect her life any further.
“Despite my insecurities, eventually I realized: ‘Who cares if I have these flaky patches on my skin?’ It doesn’t define who I am, and I don’t want it to hold me back from showing my true self or pursuing my dreams. Whether my goal is competing in the Olympics or just being a good mom, I finally realized I can’t achieve anything if I sit around and think: ‘I’m not going out because I have psoriasis on my elbows or back.’”
Psoriasis can be difficult to treat since the lesions regularly come and go, exhibiting cycles of remissions and flares that occur over a lifetime. While the number of medications in our armamentarium to clear the red, scaly plaques is continually growing, no cure has been found.
Instead of focusing on her appearance, Torres smartly concentrated on controlling her disease.
“I’m the kind of person who doesn’t shy away from challenges; psoriasis is just another challenge in my life. So instead of dwelling on self-consciousness, I shifted my energy towards figuring out a way to manage my symptoms.”
Treatments for psoriasis aim to curb inflammation, remove scale, and slow the development of skin cells. The mainstay of therapy is topical steroids, which decrease inflammation, relieve itching, and thin out psoriatic plaques. Topical steroids can effectively treat mild-to-moderate psoriasis. Regular doses of ultraviolet light—yes, even sunlight—can also improve psoriasis.
“If a patient has few enough spots that they can apply topical agents to each spot individually, then we can treat him or her with creams, ointments, or other therapies delivered directly to the skin lesions,” Feldman describes. “But if he or she has many spots distributed throughout the body, then we can try internal treatments that treat all the lesions at once.”
Indeed, when topical agents and phototherapy fail or when the disease becomes more widespread, patients can turn to systemic therapy. Oral retinoids, compounds with vitamin A-like properties, can help relieve the thickened skin inherent to psoriatic plaques. Moreover, methotrexate, considered a chemotherapy drug, can produce dramatic clearing by controlling the white blood cells that contribute to the overactive inflammatory cascade in psoriasis.
A newer class of medications known as “biologics” have grown popular and are named as such because they consist of animal or human proteins. They represent a form of “targeted therapy” in that they inhibit the action of specific immune signals implicated in psoriasis: tumor necrosis factor-alpha, interleukin-12, interleukin-17, and interleukin-23. However, because they downregulate components of the immune system, they can result in immunosuppression. As such, they are generally reserved for cases of moderate-to-severe psoriasis or psoriatic arthritis.
“If you watch any television, you will see a host of advertisements on these biologics, which are extraordinarily effective and very safe for the treatment of psoriasis,” states Feldman.
Commonly advertised on television, biologics include older agents such as etanercept (Enbrel®), infliximab (Remicaide®), and adalimumab (Humira®). In recent years, biologics with more refined targeted activity, including ustekinumab (Stelara®), secukinumab (Cosentyx®), ixekizumab (Taltz®), brodalumab (Siliq®), and guselkumab (Tremfya®), have been introduced.
These biologics have transformed the way dermatologists treat severe psoriasis.
“In the past, for individuals with really severe psoriasis, the drugs we used previously were fairly toxic, and so we had to limit the dosing and could only get their psoriasis under reasonable enough control,” Feldman says. “Rarely did we ever make patients completely clear.”
“Now, with these biologics, we can improve their psoriasis much better and more safely than we could before,” Feldman contrasts. “Nowadays it is conceivable to get people completely cleared of their psoriasis or get them to the point where it does not bother them anymore.”
Another newer treatment is apremilast (Otezla®), an oral medication that decreases inflammatory signals upregulated in psoriasis without suppressing the immune system, unlike biologics.
“Every one of these new medications is another advance that can benefit my patients,” voices Feldman.
In an effort to empower others, Torres has teamed up with Celgene, the producer of Otezla®, to develop her “Show More of You” initiative. The campaign is designed to increase awareness of psoriasis and encourage those with psoriasis to overcome the stigma of their disease.
“I decided I wanted to use my story and my position in the public eye to help other people,” Torres conveys. “People can post pictures and inspirational messages, plus tell stories about what they’ve been through. It is meant to help educate the public on the condition and help destigmatize it once and for all.”
After breaking a world record at age 14 and coming out of retirement to win three Olympic silver medals at age 41, it is hardly surprising that, now 25 years after being diagnosed with psoriasis, Torres has learned to conquer her disease.
“It definitely wasn’t easy, but overcoming the challenges of living with the condition has made me stronger,” Torres declares.
“Nothing keeps me from training or competing. Nothing. Not even psoriasis.”
Steven R. Feldman, M.D., Ph.D., is Professor of Dermatology, Pathology and Public Health Sciences at the Wake Forest University School of Medicine in Winston-Salem, North Carolina. His work has been published in over 800 articles in books and peer-reviewed journals, and he has been a principal investigator or co-investigator on numerous industry, foundation, and federally-funded research grants. Since 1997, he has served as Director of the Center for Dermatology Research, the leading center for health services research in dermatology.
Dr. Feldman is neither involved in the medical care of Dara Torres nor has access to her personal medical records. His analysis represents general information about the care of patients with psoriasis.