<![CDATA[Psoriasis - Health.com]]> en daily 1 Subscribe with My Yahoo!Subscribe with NewsGatorSubscribe with My AOLSubscribe with BloglinesSubscribe with NetvibesSubscribe with GoogleSubscribe with PageflakesSubscribe with PlusmoSubscribe with The Free DictionarySubscribe with Bitty BrowserSubscribe with Live.comSubscribe with Excite MIXSubscribe with WebwagSubscribe with Podcast ReadySubscribe with WikioSubscribe with Daily RotationPsoriasis is a skin condition that is often misunderstood; people who have psoriasis can face prejudice and discrimination. Psoriasis is characterized by raised red, white, or silvery skin patches. The good news is that many medications can control psoriasis, and lifestyle changes such as getting short periods of sun exposure and quitting smoking can help too.Subscribe with My Yahoo!Subscribe with NewsGatorSubscribe with My AOLSubscribe with BloglinesSubscribe with NetvibesSubscribe with GoogleSubscribe with PageflakesSubscribe with PlusmoSubscribe with The Free DictionarySubscribe with Bitty BrowserSubscribe with Live.comSubscribe with Excite MIXSubscribe with WebwagSubscribe with Podcast ReadySubscribe with WikioSubscribe with Daily RotationPsoriasis is a skin condition that is often misunderstood; people who have psoriasis can face prejudice and discrimination. Psoriasis is characterized by raised red, white, or silvery skin patches. The good news is that many medications can control psoriasis, and lifestyle changes such as getting short periods of sun exposure and quitting smoking can help too. <![CDATA[Stelara: A New Drug for Psoriasis]]>

Then, in 2006, the 32-year-old from Jersey City enrolled in a clinical trial for ustekinumab, a then-experimental biologic medication for psoriasis that has since been approved by the U.S. Food and Drug Administration (FDA) under the name Stelara. Her skin cleared within a month, but after two-and-a-half years on the injectable drug, she learned that she was pregnant with her second daughter and had to quit the study. (Like most biologics used for psoriasis, Stelara has not been tested in pregnant women and therefore the risks to the fetus are unknown.) Her psoriasis returned “full blown,” she says.

In September 2009, two months after her baby was born, Stelara was approved by the FDA, and in November Navani began using it again.

“I took my first shot and I started feeling relief in a week,” says Navani, the founder of NewYorkMother.com. Her skin is now 95% clear.

Stelara, the newest biologic for psoriasis, is a powerful drug that is approved only for moderate to severe cases of plaque psoriasis, an immune system disorder that causes red, inflamed skin lesions, often covered with silvery scales.

Stelara gives hope to hard-to-treat patients like Navani, and because it has a different mechanism of action, it’s especially promising for patients who haven’t responded, or have stopped responding, to other biologics.

“This is a drug where you give a shot and four weeks later the patients know they’re getting better, almost to a person,” says the chairman of the medical board of the National Psoriasis Foundation, Mark G. Lebwohl, MD, who helped recruit patients for many of the clinical trials of Stelara. “It is so uniformly effective and so dramatically effective that the results are quite spectacular.”

Despite the positive early reviews, experts caution that Stelara, like all biologics, has the potential to bring harm as well as relief. The drug carries a small risk of serious side effects, and, because it’s new, its safety in the long term is still unclear.

A new weapon to fight psoriasis
Biologics are the newest generation of psoriasis medications. Unlike older prescription drugs for psoriasis, which are made from synthetic chemicals and are taken orally, biologics are made from bioengineered human or animal proteins and are delivered via injection or IV. They work by blocking the action of certain immune cells or chemical messengers that play a role in psoriasis.

Before Stelara, there were two classes of biologics. The first class, known as TNF blockers (or inhibitors), targets proteins in the immune system and includes drugs such as Enbrel (etanercept) and Humira (adalimumab). The second contains just one drug, Amevive (alefacept), which works by blocking the white blood cells known as T cells.

One of Stelara’s main selling points is that it has a different mechanism of action than the other biologics on the market. “The TNF inhibitors were a huge step forward but yet there were even some people who didn’t get better with those drugs,” says Steven R. Feldman, MD, PhD, a professor of dermatology at Wake Forest University Health Sciences, in Winston-Salem, N.C. “[With Stelara] we have yet one more tool.”


Next Page: Less frequent injections
In some psoriasis patients, biologics gradually (and sometimes suddenly) stop working. Stelara’s unique mechanism of action makes it a good alternative for these patients, as switching to another biologic is often successful in such cases.

“If a patient comes in and they’ve never been on a biologic before, I’m prescribing a TNF [inhibitor] for them,” says Craig Leonardi, MD, a clinical assistant professor of dermatology at St. Louis University and private practice dermatologist in St. Louis. ”But if they’ve failed [on] Enbrel? Aren’t doing well on Humira? That’s a Stelara kind of patient, absolutely. They’ve done their hard time. There’s a reason to be using the drug.”

Another major difference between Stelara and older biologics is that the drug needs to be injected less frequently. Patients on Stelara receive a pair of initial shots four weeks apart, then an additional shot every 12 weeks. Other biologics are given as often as every other week, weekly, or twice a week.

Is Stelara safe?
Patients can achieve dramatic results with biologics, but the drugs have been hounded by safety concerns. Biologics work by suppressing the immune system, which can make patients more susceptible to infections, ranging from the flu to tuberculosis. As with other biologics, patients should undergo testing for tuberculosis before starting Stelara, and while taking the drug they should be tested for TB once a year.

Despite the potential for serious complications inherent to biologics, the side effects of Stelara generally include little more than upper respiratory tract infections (such as the common cold), fatigue, and minor body aches. “So far it’s been well tolerated,” says Dr. Leonardi.

The long-term safety of the drug remains unknown, however.

“Stelara is new, it’s high performance, it looks good, and it serves most well, but it’s not a first-line drug for me yet,” says Dr. Leonardi. “What’s missing right now is experience.” While TNF blockers have been used for more than a decade to treat arthritis (like psoriasis, an inflammatory condition), Stelara has been widely tested in clinical trials for just a few years, he says.

Biologics, moreover, have been linked to some scary side effects, even after FDA approval. In the spring of 2009, the maker of a biologic known as Raptiva voluntarily withdrew the drug from the market following reports of a rare but deadly brain infection. Then, in August, the FDA announced that it would require all TNF blockers to carry a so-called black-box warning stating that the drugs cause an increased risk of lymphoma and other cancers in children and adolescents.

Dr. Feldman tends to err on the side of safety. “If it were me, I would probably choose one of the drugs where we have a longer safety experience,” he says. But because “different people put their risks in different barrels,” he urges his patients to be involved in the decision-making process.

“Some people, you know, they smoke, they drive fast, and they want their psoriasis gone right away. They want the most powerful thing. They’re not so worried about safety risk,” he says. “Other people are just the opposite. They’re like, ‘I don’t care how long it takes; I just want to be safe in how we treat this.’”

Navani was aware of the potential cancer and immune system risks when she began taking Stelara, and although she says that “you never want to give up one problem for another,” she decided that alleviating the pain and embarrassment of her condition was worth the risk.

Will my insurance cover it?
Like many high-powered drugs, Stelara is expensive. The list price for one 45-milligram dose is $4,663, which has given some insurance companies pause.

A few dermatologists say insurers are requiring patients to try (and fail) an oral medication such as methotrexate and an older biologic before they will agree to cover a Stelara prescription. “Stelara’s a little bit more expensive than the other biologics, and that may be the reason that they’re requiring that they fail one of the older ones,” says Dr. Lebwohl, who is also the chairman of the department of dermatology at the Mount Sinai School of Medicine, in New York City.

Brian Kenney, a spokesman for the drug’s manufacturer, Centocor Ortho Biotech, says that few insurers have decided how to cover Stelara because it’s still so new. In the meantime, he says, the company is helping eligible patients who have commercial insurance with their out-of-pocket costs and will also provide referrals to those who may qualify for various patient-assistance programs.
]]> <![CDATA[Can Homegrown Aloe Help Treat Psoriasis?]]>
Sara Altshul

I was reflecting on the virtues of aloe vera when a new study popped up in my inbox. Aloe, in case you’ve never met one, is the spiky, cactus-like succulent and popular houseplant whose stalky leaves contain a clear gel that’s used in countless personal care products and cosmetics.

Used for healing skin problems since the days of the pharaohs, aloe was a go-to treatment for poisoned arrow wounds and was favored by African medics way back when.

I can’t vouch for its effectiveness against arrow wounds, but I can tell you that aloe might be worth a try if you have psoriasis, the chronic autoimmune disease that causes scaly, reddened skin eruptions.

Better than steroids?
According to a recent study, treatment with aloe led to a greater reduction in psoriasis severity when compared with a topical steroid cream.

The study, which was presented at the International Congress of Dermatology in May 2009, involved 80 patients, and has yet to be published in a peer-reviewed journal. Still, say the researchers, “Aloe vera can be considered a safe alternative treatment for mild to moderate chronic plaque psoriasis,” which is the most prevalent form of this bedeviling skin condition.

In the study, the volunteers all had scores of about 11 on a scale called the Psoriasis Area and Severity Index (PASI), which is considered the gold standard for assessing extensive psoriasis. The index measures the average redness, thickness, and scaliness of the lesions on a 0 to 4 scale.

Volunteers were randomly assigned to two groups. One group’s lesions were treated with a 70% aloe vera cream, while the other group got topical steroid treatment (0.1% triamcinolone acetonide). After eight weeks, the PASI scores for the aloe group decreased by an average of 7.7 points and by 6.6 points in the steroid group.

Where to find aloe
You can buy 70% aloe vera creams and gels in health-food stores, or you can simply use aloe vera goo straight from the plant. To do so, just break off a leaf, split it open with a knife, and scrape off the gel.

Buy aloe plants practically anywhere live plants are sold. They’re a terrifically hardy houseplant, and from personal experience, I can tell you that even gardeners with black thumbs have a hard time killing them. They just need sandy soil, a sunny window, and an occasional spritz of water. Be careful not to overwater your aloe; it’s a desert plant and appreciates dry conditions.

Good to know: Aloe isn’t just for psoriasis. Use the gel to soothe minor burns and sunburn, insect bites, scrapes, and cuts. You can get more information about topical aloe vera in our A–Z Health Library.

Continue reading about psoriasis diagnosis and treatment, or return to Sara Altshul's herbs and alternatives blog.
]]> (ISTOCKPHOTO) <![CDATA[A Guide to Oral Medications]]>

One of the main advantages of oral medications is how long the drugs have been around. “Most doctors are going to start you off with the medication that has the fewest side effects and the least chance of causing harm,” says Kathy Kavlick, RN, community outreach nurse for the Murdough Family Center for Psoriasis in Cleveland. In comparison to some of the newer psoriasis drugs on the market, Kavlick says, “these systemics have been around a lot longer, so we know a lot more about their long-term effects and what to watch for.”

If your psoriasis causes significant discomfort or pain or covers a sizable part of your body, your dermatologist is likely to discuss the possibility of using a systemic. Some insurance companies also require psoriasis patients to try an oral medication before starting a biologic, since biologics are far more expensive. The primary oral medications prescribed for psoriasis are methotrexate, cyclosporine, and acitretin.

Here’s what you should know about the different systemic medications:

Methotrexate
What it is: Methotrexate belongs to a class of drugs known as antimetabolites, and it works by interfering with the overproduction of skin cells that causes psoriatic plaques to develop. Methotrexate is usually taken once a week in a single dose of up to 30 mg, although it is sometimes broken up into three smaller doses spread out over a 24-hour period.

Efficacy: Studies have shown that methotrexate is effective in 70% to 80% of psoriasis patients. In a 2003 study of oral medications published in the New England Journal of Medicine, 60% of the patients who received methotrexate experienced partial remission; of those patients, 65% saw near-complete remission. Patients usually start to see results after two to three months.

Side effects: The most common side effect is nausea, which is usually alleviated by supplementing the drug with folic acid. Other side effects are more serious. Liver damage is a primary concern with methotrexate, especially for people who drink alcohol or who are diabetic or obese. (The risk of liver damage is high enough that, after taking the drug for a year or more, patients often require a liver biopsy to test for toxins in the organ.) Methotrexate can also cause birth defects and cannot be used during pregnancy.


Next Page: Cyclosporine
Cyclosporine
What it is: Cyclosporine is an immunosuppressant drug that fights psoriasis by suppressing the faulty immune cells that signal skin cells to grow too quickly. It is usually taken once a day as a capsule or in liquid form.

Efficacy: In more than a dozen studies, cyclosporine has been shown to produce significant improvement in psoriasis in up to 90% of the patients who take it. One of its main benefits is that it works quickly, usually in as little as two weeks.

In the New England Journal of Medicine study mentioned above, cyclosporine slightly outperformed methotrexate. More than 70% of the patients who received cyclosporine experienced a partial remission, although less than half of them experienced near-complete remission. In a more recent study comparing three-month treatments of cyclosporine and methotrexate, patients saw their psoriasis symptoms decrease by 72% and 58%, respectively.

Side effects: Cyclosporine reduces the flow of blood through the kidneys, which impairs their function and can cause serious damage over time. Cyclosporine can also cause high blood pressure, although limiting the course of treatment to a few months appears to mitigate this side effect. Other relatively minor side effects include nausea, joint pain, headache, and fatigue. (Cyclosporine has also been shown to raise the risk of non-melanoma skin cancer six-fold, but only in patients who have previously undergone a type of phototherapy known as PUVA.)

Acitretin
What it is: Acitretin is a retinoid, a type of synthetic vitamin A. Usually known by its brand name, Soriatane, acitretin is taken as a once-a-day pill and is the only oral systemic not available as a generic. It is often combined with phototherapy.

Efficacy: What little research exists on the use of Soriatane alone has shown that it can produce mild to moderate clearance. Soriatane seems to be most effective and useful as an addition to phototherapy, however. A pair of studies that compared the combination of UVB phototherapy and Soriatane with the phototherapy alone found that adding Soriatane more than doubled the number of patients who experienced improvement or clearing of their psoriasis.

Side effects: Most of the side effects associated with Soriatane are minor. They include lip inflammation, dry mouth, skin thinning and fragility, joint and muscle pain, and hair loss (alopecia). Potentially more serious side effects include liver damage, skeletal abnormalities, and an elevation of cholesterol and triglycerides. Soriatane is also known to cause birth defects, so it is not an option for women who may become pregnant.

How are they used?
Each systemic medication has its own advantages and potential complications. Although patients sometimes stay on one medication for months (or even years), dermatologists have found that they may be able to maximize the advantages and minimize the complications of these drugs by prescribing them in sequence.

Methotrexate and cyclosporine clear psoriasis more quickly than Soriatane, for instance, but are less appropriate for long-term “maintenance” therapy due to the potential for liver and kidney damage. Cyclosporine, for instance, cannot be taken continuously for more than a year. Some dermatologists will therefore prescribe an initial dose of methotrexate or cyclosporine, add Soriatane after a month or two, and then gradually taper off the more powerful systemic.

In other cases, dermatologists will simply rotate through the various systemic medications to lessen the risk of side effects. Systemic drugs are also frequently prescribed in combination. This appears to enhance their efficacy, and it also allows each drug to be given in lower doses, which minimizes the potential for any one long-term side effect.
]]> (VEER) <![CDATA[A Head-to-Toe Guide to Treating Psoriasis]]>

“The skin of the eyelid is completely different than the skin on the palm or the sole of the foot,” Dr. Feldman says. Because the skin in these areas will absorb medications differently, you need a tailored approach.

“When dealing with the sensitive skin of the face, you don’t need high potency. But when dealing with the palms or sole of the foot, you have to use the stronger stuff to get the adequate anti-inflammatory effects,” Dr. Feldman says. If your psoriasis is all over your body, systemic oral medications or biologics might be your best bet.

Here’s a rundown of common areas affected by psoriasis—and what you should know about treating them.

Scalp
Treat the scalp topically with medicated liquids, mousse, shampoo, sprays, gels, tar products, and soaps made especially for this difficult area. “Scalp psoriasis can be among the most recalcitrant,” says Neil Korman, MD, PhD, clinical director of the Murdough Family Center for Psoriasis in Cleveland. “Systemic therapy—pills or shots—may be necessary if a patient does not improve with an aggressive topical regimen.” Not only is psoriasis on the scalp stubborn, but treating it “can be incredibly time consuming and difficult to do,” Dr. Feldman says. It’s time consuming to get medication directly onto the scalp while avoiding the hair; tar products, while effective, can be smelly and stain light hair; and some scalp treatments must be left on overnight, which can be a messy proposition.

To make scalp treatments easier and more effective, the National Psoriasis Foundation recommends first removing any scales on the scalp so the medication can seep in more easily. Loosen them by soaking the scalp in warm water. The foundation also recommends rubbing some heated olive oil onto the scalp, wrapping your head in a towel and leaving it on for several hours, or using a hair dryer. Remove the scales carefully with a fine-tooth comb or brush before applying the treatment. If you need to leave the medicine on overnight, invest in a good, comfortable shower cap for less mess.

It’s common to use these treatments for about two months; once the psoriasis has cleared you can maintain this by using a medicated shampoo several times a week. Steroid creams and injections are also used for the scalp, although ideally in moderation. Other topical medications derived from vitamin D and A are also sometimes used.


Next Page: Face
Face
According to the National Psoriasis Foundation, the most common areas for facial psoriasis to appear are the forehead, upper lip, around the eyebrows, the upper forehead, and the hairline. Dermatologists try to avoid aggressive topical steroids in these highly delicate areas because they absorb medication readily and are prone to side effects such as skin thinning. Medications can also irritate the eyes.

Dermatologists usually start with mild topical steroids or topical immunomodulators, Dr. Korman says. If the patient doesn’t respond to these treatments, phototherapy or other systemic treatments might be appropriate. “If psoriasis on the face is causing major social-interaction problems, we need to be more aggressive,” Dr. Korman says.

Elbows and knees
These thick-skinned spots are ideal for topical steroids, salicylic acid, and coal tar. “In stubborn places such as the elbows and knees, I tend to use stronger topical steroid products or combinations of topical steroids and vitamin D analogues. I often tell patients to use topical medicine every day for a couple of weeks, and then taper off to once or twice a week,” says Robert E. Kalb, MD, clinical associate professor of dermatology at the University at Buffalo School of Medicine in Buffalo, N.Y.

Hands and feet
The first step in treating psoriasis on the hands and feet is to try moisturizers and mild soaps. If this doesn’t work, then a vitamin D derivative such as Dovonex and/or topical steroids should be next. If the psoriasis is severe, oral medications or a biologic might be the best course of action.

Genitals and skin folds
Psoriasis appearing in less visible parts of the body, such as the perineum, armpits, under the breasts, and around the genitals and buttocks, is known as inverse psoriasis. These sensitive areas can be breeding grounds for yeast or fungal infections, so your doctor might recommend adding an antifungal and yeast cream to your regular treatment to avoid such infections. Although topical steroids can be effective in these areas, Dr. Kalb tries to avoid using them here, opting instead for vitamin D analogues or topical calcineurin inhibitors. If the psoriasis is severe, he might prescribe topical steroids for a short period of time before switching over.

Psoriasis treatment usually proceeds by trial and error. Experts recommend using mild creams and phototherapy on affected areas at first. If your psoriasis is resistant or severe, your doctor might switch to systemic solutions, which include oral medications and biologics, either alone or in conjunction with some of the above treatments. The good news is that with so many options available, you and your doctor can take the time to find one that works best for you.
]]> (VEER/HEALTH.COM) <![CDATA[The Different Types of Psoriasis]]>

Plaque psoriasis
The most common type of psoriasis is plaque psoriasis. Nearly 90% of the people who live with psoriasis have this kind. Plaque psoriasis shows up as dry, red, raised lesions covered in silvery white scales that may shed. It usually appears on the elbows, knees, scalp, or lower back, although it can crop up anywhere, including the genitals and inside the mouth.

Guttate psoriasis
Up to 10% of people with psoriasis have guttate, the second most common type of the disease, which usually affects people under 30. In this form, the plaques are smaller and resemble water drops, and typically develop suddenly, often following a cold or upper respiratory tract infection. One of the major triggers of guttate psoriasis is strep throat. The plaques usually appear on the trunk, arms, legs, and scalp, and may be covered in a finer scale than those in plaque psoriasis.

Inverse psoriasis (also called seborrheic psoriasis)
Inverse psoriasis develops in skin folds such as the armpits, groin, under the breasts, around the genitals and buttocks, and sometimes behind the ears. It is exacerbated by friction and sweating. Most common in people who are overweight, it often starts out very red without much scale, and may appear shiny.

Pustular psoriasis
White blisters surrounded by red skin are the hallmarks of pustular psoriasis. The skin generally turns red first and then quickly develops noncontagious pustules filled with white blood cells. It usually covers a large swatch of skin and is sometimes accompanied by fever, chills, and severe itching. The blisters may clear quickly but reappear often.

This type of psoriasis has several triggers, including pregnancy and medications such as systemic steroids. Flares may also occur after stopping the use of certain medications, such as strong topical steroid creams.

Erythrodermic psoriasis
The least common form of psoriasis results in inflammation, itching, and a painful red rash that may peel and often covers the entire body. Sometimes accompanied by chills and unregulated body temperature, it can result from severe sunburn, withdrawal from systemic treatment, or another form of psoriasis that is not well controlled. People with erythrodermic psoriasis should seek immediate medical attention because it can lead to dangerous protein and fluid loss, swelling, infection, or pneumonia, and can require hospitalization.

Psoriatic arthritis
Up to 30% of people with psoriasis also have psoriatic arthritis, which usually develops five to 10 years after the original psoriasis diagnosis (although it can show up before a skin diagnosis). The primary symptoms are pain and stiffness in a joint or joints. Morning stiffness, which can take 45 minutes to loosen up, and tendinitis are two other signs.

If a person with psoriasis develops joint symptoms that last more than a few weeks, they should be evaluated to see if they have developed psoriatic arthritis. People with mild psoriasis might be just as likely to develop arthritis as someone with a severe form of the disease. Although psoriatic arthritis is not as debilitating as other forms of arthritis, it should be controlled to minimize pain and maximize joint function.

]]> (PHOTOTAKEUSA.COM) <![CDATA[How Topical Treatments Can Help Your Psoriasis]]>

If your condition is isolated to a few areas, topicals are the first line of defense, says Steven Feldman, MD, PhD, professor of dermatology at the Wake Forest University School of Medicine in Winston-Salem, N.C. “I divide patients into two groups: Those with a few spots where I use topicals, and those with so many spots that you can’t possibly put topicals on all of them.” For those with psoriasis that covers many areas, oral medications and biologics might be a better fit.

Your dermatologist may also decide to use topicals in combination with other medications. Make sure to apply them only to the part of the body directed by your doctor to avoid unwanted side effects.

Your topical tool kit
  • Moisturizing creams. A key to treating psoriasis is keeping your skin moisturized. Patients recommend ointments such as Vaseline and lotions to minimize itching and redness; finding the right product is a process of trial and error. Whatever you choose, slather the affected parts of your body immediately after a bath or shower.
  • Coal tar. How this age-old remedy helps psoriasis sufferers remains something of a mystery. “We have no idea how it works,” says Robert E. Kalb, MD, clinical associate professor of dermatology at the University at Buffalo School of Medicine in Buffalo, N.Y. Doctors presume that it reduces the overproduction of skin cells. The upside to tar products is that they don’t cause side effects. The downside is that they’re smelly and messy, and can stain fabric.
  • Topical steroids. “Steroids are the mainstay of topical treatments,” says Dr. Kalb. Also known as topical corticosteroids, topical steroids are one of the most popular topical solutions and come in a wide range of potencies, from mild formulas available over the counter to heavy-duty prescriptions. Steroids decrease inflammation, relieve itching, and slow the development of new psoriasis patches. Although effective, aggressive topical steroids can cause skin thinning (which can lead to stretch marks), so many dermatologists recommend using them only for a short period of time. “The challenge is to maintain the benefits without using them too much,” says Dr. Kalb.
  • Vitamin D analogues. Synthetic versions of vitamin D, these medications control the overproduction of skin cells, decreasing scaling and itching. They are not as fast acting as topical steroid products, but the upside is that they don’t have the skin-thinning side effects of steroids. Many doctors use them as a complement to steroids; once the psoriasis is under control with steroids, Dr. Kalb often switches his patients to a popular vitamin D derivative called Dovonex (also known by its generic name calcipotriene), or uses it in conjunction with lower doses of steroids. Another product called Taclonex combines calcipotriene with a steroid. “Of the patients that I treat who are candidates for topicals, 90% are treated with topical steroids or vitamin D derivatives,” says Neil Korman, MD, PhD, clinical director of the Murdough Family Center for Psoriasis in Cleveland.
  • Vitamin A derivatives. Vitamin A derivatives such as Tazorac (also known as tazarotene) slow down the growth of skin cells and reduce inflammation. They are commonly used on areas such as the face, scalp, and nails, although they sometimes can cause skin irritation.
  • Salicylic acid. This treatment, often used in conjunction with other topical remedies, reduces inflammation and helps remove scales that appear on psoriasis patches. Salicylic acid is available both over the counter and by prescription in lotions, soaps, shampoos, and other forms.

Next Page: Finding a topical that works
Finding one that works: It’s personal
Choosing the right treatment is a process of trial and error. You and your doctor should consider factors such as side effects, lifestyle choices, and cosmetic preferences to help you decide where to start. Once you begin experimenting, you will find out which approaches work best for you.

Researchers are not sure why success is so variable, but they speculate that some people respond better to certain treatments because of the genetic side to psoriasis. If this is true, says Dr. Kalb, understanding how different people react could greatly advance treatment options someday. “In the future, we might be able to do a blood or skin test to predict what will help them,” he says.

Until then, patients should work closely with their doctors to monitor and switch treatments when necessary. “If you use a topical medication for three to four weeks you should definitely see an improvement,” says Dr. Kalb. If not, your dermatologist will probably try something else.

Although topicals can be very effective, doctors say there is a high rate of noncompliance when it comes to applying them. “It’s a chronic disease, and sometimes people just use them for awhile, get tired of them, and then stop using them,” says Dr. Korman. For the best results, follow the directions from your doctor on how often to apply and, even though it can be bothersome, stick with it.
]]> (GETTY IMAGES) <![CDATA[Your Guide to Biologics]]>

Psoriasis is an autoimmune disorder in which faulty immune cells produce inflammation. This inflammation causes skin cells to grow too quickly, which in turn causes the red and flaky lesions characteristic of the disorder. Biologics work by suppressing the immune cells at the heart of this process. One group of biologics, which target a type of white blood cell, are known as the T-cell modulators; the other main group, which target a protein involved in inflammation, are known as the tumor necrosis factor (TNF) inhibitors.

There are currently five biologics approved for psoriasis patients in the United States:

  • Humira (adalimumab). Originally used to treat psoriatic and rheumatoid arthritis, Humira was approved for psoriasis in 2008. In long-term controlled trials, between 55% and 70% of the patients taking Humira experienced a 75% reduction in their plaques (a common measure of clearance known as “PASI 75”).
  • Remicade (infliximab). Administered via IV in a dermatologist’s office every eight weeks, Remicade is perhaps the most powerful biologic. The two trials that have studied the long-term efficacy of Remicade report PASI 75 response rates of around 80%.
  • Enbrel (etanercept) One of the earliest biologics approved for psoriasis, Enbrel is considered to be relatively safe and well tolerated, although it is less powerful than Humira. Studies report PASI 75 rates ranging from about 45% to 60%.
  • Amevive (alefacept). Amevive is the only biologic designed to be used intermittently, in 12-week intervals. Although one study reported PASI 75 rates of nearly 30% at 12 weeks and more than 50% at 60 weeks, the evidence suggests that Amevive may be the least effective biologic in the long term.
  • Stelara (ustekinumab). Stelara, which was approved by the U.S. Food and Drug Administration (FDA) in September 2009, is the newest biologic. It is injected just once every three months (after a pair of initial doses four weeks apart). And because it isn't a T-cell modulator or TNF inhibitor, it provides an alternative for patients who haven't responded to other biologics. In clinical trials, Stelara has achieved PASI 75 response rates between roughly 65% and 80%.
A sixth biologic, Raptiva (efalizumab), which was approved for the treatment of psoriasis in 2003, has been phased out. In April 2009, the manufacturer announced a voluntary withdrawal of the drug after the FDA reported that three people taking the drug had died from a rare brain infection.


Next Page: Risk vs. reward
Risk vs. reward
Biologics can be extremely effective at clearing psoriasis, but their immunosuppressive effect also produces a slightly increased risk of infection, including the flu, serious fungal infections, and even tuberculosis. Patients (and dermatologists) should therefore be on the lookout for any warning signs of infection, such as a fever. Some patients taking biologics report a greater susceptibility to colds and other upper respiratory tract infections, but there is some disagreement about whether that can be attributed to the drug itself or merely to patient perception.

Given the impact psoriasis can have on everyday life and happiness, many patients with moderate to severe psoriasis have decided that the prospect of clear skin is worth the small infection risk. And those who have experienced good results with a biologic tend to describe the drugs as something of a miracle cure.

About 25 years ago, Allison Duncan, 48, of Palm Coast, Fla., started to experience psoriasis symptoms that eventually grew more severe. At its worst, 50% to 60% of her body was covered, and in the late 1990s she finally consulted a dermatologist. “I tried treating it with topicals, I tried natural remedies—I tried everything in the book,” she says. She even tried bathing in a tub filled with freshly grated ginger, which didn’t help her psoriasis but did clog up the pipes.

Six years ago, Duncan was invited to take part in a clinical study for a biologic. Her skin didn’t respond for nearly 10 weeks, and she almost quit the study. And then, “literally overnight,” she says, her skin started to clear. Two weeks later she was 100% clear. “I’ve never had a spot come back,” she says.

Although Duncan’s results are exceptional, other psoriasis patients describe similar night-and-day experiences. Nikki Woistman, 21, of St. Petersburg, Fla., started taking a biologic in 2003 after her psoriasis had grown to cover 30% of her body. After two weeks her skin started to clear, and within two months she was 99% psoriasis-free. “I was in heaven,” she says.

Biologics’ effectiveness can wear out
The incredible relief patients feel when their skin clears is sometimes quickly deflated. Biologics sometimes stop working after several months or a year (or more). The efficacy of the drug often wears down gradually, but this process can also happen quite suddenly.

Experts aren’t certain why—and for whom—biologics become ineffective. “This phenomenon is definitely known, but it’s not well studied,” says Craig Leonardi, MD, a clinical professor of dermatology at Saint Louis University who has participated in numerous clinical trials for biologics. “No company really wants to fund any research to explain why their drug stops working.”

The likely explanation is the makeup of the drugs, Dr. Leonardi says. Because biologics are made from natural proteins, the body’s immune system can reject the proteins when they are injected; it develops antibodies to the drug and clears the drug from your system before it has time to work.

If a biologic does stop working, dermatologists will often switch the patient to another biologic, which is often successful. Alternatively, dermatologists sometimes supplement a biologic with low doses of older systemic drugs, such as Soriatane or, most often, methotrexate. Although there has been no research done specifically in psoriasis patients to support this practice, studies conducted in the field of gastroenterology show that adding a low dose of methotrexate may prolong the effectiveness of biologics.

Once a drug stops working in any individual patient, however, it’s done for good. “If a patient develops an immunologic response, that’s it—the drug is pretty much done,” says Dr. Leonardi.

There is hope, however, for patients who have come to the end of the line with biologics. Several new biologics currently in the pipeline for FDA approval could prove to be significant additions to the dermatologist’s arsenal.

]]> (GETTY IMAGES) <![CDATA[Psoriasis News Roundup]]>
Women with Psoriasis at Risk for Other Chronic Conditions – (April 20, 2009)
A study published in the April issue of the Archives of Dermatology shows that women with the skin condition psoriasis are at increased risk of developing diabetes and high blood pressure. The researchers suspect that inflammation, which plays a role in all three conditions, is likely the cause and suggest ways that women with psoriasis can lower their risk. Read more

New Drug Approved for Psoriatic Arthritis – (April 9, 2009)
A drug approved in April to treat patients with rheumatoid and psoriatic arthritis appears to help patients who have not responded to anti-rheumatic drugs or nonsteroidal anti-inflammatory drugs. The new medication, golimumab, is marketed under the name Simponi and is injected once monthly. Read more

Psoriasis Drug Raptiva Pulled From the Market – (March 17, 2009)
After three patients died from brain infections linked to the biologic drug Raptiva and the FDA issued a safety advisory, the drug’s maker, Genentech, ordered doctors to stop prescribing the psoriasis medication and announced that it would be gone from the market by June 8. Read more

Psoriasis Drug Also Effective for Nail Psoriasis – (March 17, 2009)
For most people living with psoriasis, the condition affects their nails as well, leaving them discolored and disfigured. A study from Italy published in the Archives of Dermatology in March showed that the psoriasis drug acitretin helped 25% of patients clear their nail psoriasis entirely, while another 25% experienced “moderate improvement.” Read more

New Biologic May Help Psoriatic Arthritis – (February 12, 2009)
A new study showed that ustekinumab, a biologic drug currently undergoing clinical testing for approval to treat psoriatic arthritis and multiple sclerosis, may significantly improve psoriatic arthritis and psoriasis. Read more

New Vitamin D Ointment Approved for Psoriasis – (February 4, 2009)
The Food and Drug Administration approved Vectical ointment, derived from vitamin D3, for the treatment of mild to moderate plaque psoriasis in adults. Read more

]]> (ISTOCKPHOTO) <![CDATA[A Guide to Using Light Therapy for Psoriasis]]>

“When ultraviolet light hits skin, it does all kinds of things,” says Steven Feldman, MD, PhD, a professor of dermatology at the Wake Forest University School of Medicine in Winston-Salem, N.C. Ultraviolet light kills the immune cells in the skin that contribute to psoriasis, and research suggests that UV light may also disrupt the faulty signals between immune cells and skin cells that lead to psoriasis lesions.

With relatively few side effects, phototherapy is an effective—yet underused—treatment, experts say. “Phototherapy is a great treatment to start with,” recommends Kathy Kavlick, RN, community outreach nurse for the Murdough Family Center for Psoriasis in Cleveland. “Some people get really good results from it.”

Types of phototherapy
Phototherapy is usually administered on an outpatient basis in a dermatologist’s office two to three times a week, using a walk-in light booth that looks like a tanning bed stood on end. Light boxes for home use are also available.

There are two main types of phototherapy:

  • Ultraviolet B light (UVB), one of the components of sunlight, is especially effective for treating psoriasis. During the treatment patients are exposed to the light for just a few seconds at first, and the exposure time is gradually increased to several minutes per treatment. UVB treatment is sometimes administered with topical treatments such as coal tar, anthralin, or just mineral oil. A form of UVB light known as narrow-band (NB-UVB) has been shown to be even more effective than UVB, and is increasingly being used by dermatologists.

  • Although not as potent as UVB, ultraviolet A light (UVA) is also used to treat psoriasis. UVA treatment generally takes longer than UVB—exposure times can reach 15 to 20 minutes—but at these higher doses it is also effective in clearing lesions. UVA light is often combined with an oral medication known as psoralen (a treatment known as PUVA).
A newer variation of phototherapy uses excimer or pulsed-dye lasers to target individual plaques. Research suggests that laser therapy may require fewer treatments and produce longer remissions, but since this technique is so focused it is not very practical for people with widespread lesions. As Dr. Feldman notes, however, roughly eight out of 10 people with psoriasis have lesions only in small, isolated spots, and laser therapy may grow more popular as the technology becomes faster and more effective.


Next Page: What works best
What works best
Patients generally require about 20 phototherapy sessions before they see an improvement in their skin. Although response rates vary, studies suggest that 65% of the patients who receive UVB treatment and 75% of the patients who receive NB-UVB will experience significant skin clearance. Although UVB treatments are more widely used, PUVA may actually be more effective.

In a 2006 study in the Archives of Dermatology that compared PUVA and NB-UVB therapy in patients with chronic plaque psoriasis, the patients who underwent PUVA therapy had a significantly higher clearance rate (84%) than those who received NB-UVB (65%). The former group also required fewer treatment sessions, and the effects lasted longer.

PUVA does have some potentially serious side effects, however. Nearly one-third of patients experience nausea after treatment—and, more important, PUVA carries a long-term risk of skin cancer, especially in patients with fair skin.

The psoralen molecule used in PUVA is believed to be largely responsible for the increased risk. Psoralen, which is ingested orally or applied topically, enters the body’s cells and, when activated by UV light, changes their DNA. This process kills off immune cells close to the skin and helps control psoriasis, but it also leads to collateral damage that can cause skin cancer in the long run.

Because of the risk of skin cancer, PUVA is typically reserved for the most severe and stubborn psoriasis cases. “PUVA is a very, very effective treatment,” says Dr. Feldman. “It’s at least as effective as narrowband UVB, but it causes an increased risk of skin cancer, so we tend to avoid using it.”

UVB light is known to cause skin cancer as well, but studies have not shown any increased risk of skin cancer among psoriasis patients who have undergone UVB phototherapy.

If it’s so effective, why isn’t phototherapy used more?
Although phototherapy is considered a first-line treatment for psoriasis, patients and dermatologists alike report that it is often impractical.

Convenience is a factor, since patients need to visit their doctor’s office several times a week during business hours. But it can also be expensive; for each treatment, most insurance companies charge an office-visit co-pay, which tends to be higher than drug co-pays.

Nikki Woistman, 21, of St. Petersburg, Fla., considered phototherapy several years ago when psoriasis covered about 30% of her body. She was surprised to learn, however, that phototherapy would actually be more expensive than the new generation of biologic medications.

“Phototherapy was going to be $30 to $45 three times a week—and that adds up,” she says. “And it was a 30- to 45-minute ride [to get there], which didn’t really work with my schedule.” Woistman was interested in a home unit, but insurance didn’t cover it and her family couldn’t afford to pay out of pocket (some units cost several thousand dollars).

“Some dermatologists say phototherapy is threatened,” says Sheila Rittenberg, senior director of advocacy and external affairs for the National Psoriasis Foundation. “They can’t keep the equipment up if patients aren’t using it, and some patients are being bumped up to more expensive treatments.”


Next Page: Tanning beds
Tanning beds
Many psoriasis patients use commercial tanning beds to manage their lesions, and the anecdotal evidence suggests that they can be effective. Tanning beds emit both UVA and UVB light, and the percentage of UVB varies widely by machine, from less than 1% to nearly 10%. Whatever benefit patients experience likely comes from the UVB.

Many dermatologists believe that tanning beds are ineffective and potentially risky, since excessive use can cause skin damage and an increased risk of cancer. But if used responsibly, Dr. Feldman says, commercial tanning centers may be a “reasonable alternative” to phototherapy for patients without easy access to affordable office- or home-based treatments. (Consult a dermatologist before starting a tanning regimen, and review this list of precautions from the National Psoriasis Foundation.)

Good old sun
As people have known for thousands of years, natural sunlight is an effective treatment for psoriasis, although the effects may take several weeks to materialize. To avoid sunburn and overexposure, the National Psoriasis Foundation recommends multiple short sunbathing sessions. (Sunburns can actually exacerbate psoriasis.) Psoriasis patients should use sunscreen of SPF 15 or more on the parts of their bodies that aren’t affected by lesions, reapplying frequently.
]]> (PHOTOTAKEUSA.COM) <![CDATA[Your Guide to Getting the Help You Need for Your Psoriasis]]>

Education
One common misperception about psoriasis, says Nicora Gardner, health education manager at the National Psoriasis Foundation, is that it’s merely a skin disease. “It’s a systemic disease of the immune system that can affect more than your skin,” she says. Psoriasis can increase your risk for “heart disease, depression, obesity, and diabetes,” says Gardner, which is why she says it’s important to educate yourself about the disease and the treatment options.

  • The National Psoriasis Foundation. The website of the country’s leading psoriasis education and advocacy group is the mother lode for information about psoriasis and psoriatic arthritis. Learn about the types of psoriasis, treatment options, advocacy opportunities, locating a doctor, resources for managing the disease, and ways to navigate your health care options.
  • PsoriasisNet. This site from the American Academy of Dermatology covers everything you need to know about psoriasis and includes sections on causes, treatments, triggers, minimizing flare-ups, and finding a dermatologist in your area.

Support
Because it is a visible and chronic illness, psoriasis affects more than how you feel physically. “The mental-health aspect is huge,” says Gardner. “It’s easy to become isolated and depressed. Building a support team beyond your physicians is invaluable. It helps with self-esteem and isolation, and provides a feeling of acceptance for people who have a very visible disease.”

  • WeArePsoriasis.org. Share photos and treatment experiences, join communities based on mutual interests, and connect with people around the world at this active social-networking site for people living with psoriasis.
  • Psoriasis Patients. People with psoriasis share tips, treatment advice, and feelings about living with the disease on this social-networking site, which also includes blogs and information about upcoming events.

Next Page: Affording health care
Affording health care
Navigating the confusing world of health care can be a challenge, which is why the National Psoriasis Foundation offers several resources to help make the process smoother. Download the foundation’s Access Action Guide, in which the insured can learn how to decipher their health plan and the uninsured can find out how to get low-cost or free care. On the foundation’s website you can also learn about financial aid and patient assistance programs for purchasing medications, how to appeal a denied claim, and how to choose a health plan.

Research
There is hope for the millions of people living with psoriasis in the United States. New medications, treatments, and studies are shedding light on this chronic disease. Visit these websites to stay up to date on the latest research and to find out about clinical trials:

  • The Murdough Family Center for Psoriasis. Find out about cutting-edge news, research, and clinical trials on the website of this innovative research and clinical center, based at Case Western Reserve University in Cleveland.
  • Journal of Investigative Dermatology. Read the latest news, sign up for email alerts, and search the archives and current issues of this journal, which publishes research on biology and skin disease.
Educate Others
“After people have gone through the information-gathering phase, the most empowering thing people can do to fight the stigma is to do something about changing the stigma and changing the public perception of psoriasis,” says Gardner.

Visit the National Psoriasis Foundation's “Act” section to find events you can join, including the Walk for Awareness, the foundation’s annual Capitol Hill Day, educational events around the country, the foundation’s national conference, and Psoriasis Awareness Month each August.
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