Supplementation with probiotics was shown to improve hyperuricemia and symptoms of gout, among other inflammatory diseases such as juvenile arthritis (JIA), osteoarthritis (OA), osteoporosis and osteopenia, inflammatory bowel disease (IBD), spondyloarthritis, rheumatoid arthritis (RA), and psoriasis (PsO). Investigators note that further randomized controlled trials (RCTs) are necessary to evaluate efficacy and optimal dosages of probiotics, according to a study published in Frontiers in Immunology.1

There is a need for new related target therapeutic approaches for drug development and treatment of joint inflammation, thereby reducing the disease burden of inflammatory arthritis, investigators stated. A study showed that gut microbial dysbiosis (in combination with environmental triggers) may contribute to inflammatory immune disturbances in inflammatory arthritis in combination with genetically predisposed individuals.

Information on the treatment of rheumatic diseases with probiotics was obtained via databases in this systematic review, including the China National Knowledge Infrastructure (CNKI), PubMed, Embase, and the Cochrane Library, until May 2022. RCTs of probiotics regarding treatment of hyperuricemia and gout were evaluated and the Cochrane risk assessment tool was used to determine quality evaluation. Controls were participants without probiotic preparation. Adverse events, disease efficacy indicators, and inflammatory indicators were the primary outcomes.

In total, 37 records included in the study, of which 34 were RCTs and 8 types of autoimmune disease were analyzed. Of the 10 RCTs (involving 632 participants), probiotic intervention reduced C-reactive protein (CRP). Of the psoriasis RCTs, probiotics reduced Psoriasis Area and Severity Index (PASI) scores. Patients with spondyloarthritis who received probiotics had improvements in disease-related symptoms. Bone mineral density was improved in patients with osteoporosis and osteopenia receiving probiotic intervention and symptoms were improved in patients with OA (433 participants). Symptoms were also improved in patients with JIA (72 participants) and IBD (120 participants). Lastly, serum uric acid was improved in those with hyperuricemia and gout in 4 RCTs (294 participants). Probiotics did not increase the incidence of adverse events in any of the RCTs included in the analysis.

While the study was strengthened by including 8 types of inflammatory arthritis, providing clinical references, the quality of the RCTs involved is hindered by the lack of detailed random sequence generation, blinding information, and allocation concealment. Further, certain RCTs used probiotic-rich foods in their analyses, which not include specific strains and doses, while others had uncertain dosages, which allowed for discrepancies among results. Additionally, the methods of recording efficacy indicators were different among RCTs. Adverse events were not reported in many RCTs evaluated. Lastly, only 8 types of inflammatory arthritis were observed, possibly due in part to the fact that probiotics have just recently emerged as a supplementation option in this patient population.

Probiotic supplements may improve hyperuricemia and gout, inflammatory bowel disease arthritis, JIA, OA, Osteoporosis and Osteopenia, psoriasis, RA, and spondyloarthritis, investigators emphasized. However, lack of evidence and heterogeneity of studies do not allow us to recommend them to patients with inflammatory arthritis to manage their disease. More randomized controlled trials are needed in the future to determine the efficacy and optimal dosing design of probiotics.

Reference:

Zeng L, Deng Y, He Q, et al. Safety and efficacy of probiotic supplementation in 8 types of inflammatory arthritis: A systematic review and meta-analysis of 34 randomized controlled trials.Front Immunol. 2022;13:961325. Published 2022 Sep 23. doi:10.3389/fimmu.2022.961325

Read more here:

Probiotics Supplementation may Improve Symptoms of Hyperuricemia and Gout - Rheumatology Network

Supermodel Cara Delevingne (29) has openly talked about her struggles with the autoimmune skin disease Psoriasis in the past. During Fashion Week in 2017, Kate Moss helped her by recommending a good doctor.

Recently in May, Delevingne made a Met Gala appearance where she was topless and she did not shy away from revealing her scabs. Fans and Netizens alike praised the supermodel for her confidence in showing off her skin condition rather than hiding them.

The Valerian actress has always been vocal and open about her skin condition. Cara Delevingne has shared her struggles with Psoriasis, a skin condition where the affected person gets rashes and scabs on the skin. It was not only a big inconvenience for her but also once left her questioning her profession. In an interview with The Times, Cara Delevingne shared about her struggle saying,

People would put on gloves and not want to touch me because they thought it was, like, leprosy or something.

Also during the 2017 fashion week, her Psoriasis condition worsened. The Paper Town actress shared with the W magazine what went down during that fashion week, she told,

It only happened during Fashion Week! Which is, of course, the worst time of the year for me to be covered in scabs. Psoriasis is an autoimmune disease, and Im sensitive. Kate [Moss] saw me before the Louis Vuitton show at 3 a.m., when I was being painted by people to cover the scabs. She said, This is horrible! Why is this happening? I need to help you. She got me a doctor that afternoon; Kate gives really good advice,

Around the same year at the peak of her career, the model was questioning herself and her profession due to the autoimmune disease she struggling with.

Also Read: Teenagers can be very, very cruel: Amber Heards Alleged Ex-Girlfriend Cara Delevingne Reveals Traumatic Childhood, Was Bullied For Being Flat-Chested Despite Being British Aristocrat

The Paper Town actress who suffers from chronic Psoriasis has opened up about it several times in the past. And recently in May 2022, she appeared at the met Gala topless with a gold color painted on her. The model refused to cover her Psoriasis flare-ups. Being topless, her skin condition was visible on the front and the back of her arms. This was appreciated and praised by fans and Netizens. One fan wrote,

If Cara Delevingne can go on the red carpet in front of millions and show her psoriasis flare-up, then I can go out in my small town and show my lupus scars. We are both still beautiful,

Another Twitter user reacted,

ok like I dont really care too much about celebrities but Cara Delevingne leaving her psoriasis visible in her met gala look is so validating to me (Ive been SO embarrassed by severe eczema I developed on my hands).

The Supermodel is working on an eco-thriller movie project at the moment. The film is based on true events concerning Environmental protection and is titled The Climb.

Also Read: Margot Robbie and Cara Delevingne Attacked By Paparazzi in Argentina, Left Harley Quinn Actress Nearly Hanging in the Car Clutching For Dear Life

Source: geo.tv

See the original post:

'Worst time of the year for me to be covered in scabs': Amber Heard's Alleged Ex Cara Delevingne Revealed Her Psoriasis Struggle Made Kate Moss Scream...

Cyclic AMP and psoriasis Science News, April 29, 1972

[A team of dermatologists] discovered that cyclic AMP levels in psoriasis lesions are significantly lower than in healthy skin. [The team] is now trying to find out if the cyclic AMP deficiency causes psoriasis and to develop a medication to increase cyclic AMP levels in psoriasis lesions.

Psoriasis, which affects 2 to 3 percent of the global population, is an inflammatory skin disease marked by red, scaly patches that itch or burn. Low levels of cyclic AMP a chemical messenger key to cellular communication havent been found to cause the disease. Psoriasis stems from an overactive immune response. Cyclic AMP is just one player alongside other chemical messengers and immune cells, and certain gene variants can make a person more susceptible. The choice among a range of treatment options today depends in part on the severity of the disease and the areas of the body affected. One drug, called apremilast, approved by the U.S. Food and Drug Administration in 2014, increases levels of cyclic AMP, among other actions.

The rest is here:

50 years ago, scientists were seeking the cause of psoriasis - Science News Magazine

Psoriatic arthritis (PsA) is an inflammatory disease of the joints. It causes stiffness, pain, and swelling in the joints. Most of the time, people with PsA have psoriasis, which causes red, scaly patches on the skin.

But the impact of PsA goes beyond the joints and skin.

In recent years, researchers and doctors have discovered that PsA is linked to a variety of metabolic issues.

Specifically, people with PsA are more likely to develop heart disease. This puts people with PsA at a higher risk of heart attack, stroke, and death.

Research has shown that chronic inflammation from psoriasis can lead to cardiovascular disease.

Inflammation is a primary driver for atherosclerosis, which is the buildup of fat and cholesterol in artery walls. Over time, this buildup can lead to high blood pressure, heart attack, and stroke.

A 2014 study found that arthritis in one joint has a significant impact on heart health. The researchers found that people with PsA who had sacroiliitis, or inflammation of the sacroiliac joints connecting the spine and pelvis, were more likely to have cardiovascular issues. Inflammation in these specific joints was linked to more inflammation in the heart.

A 2016 review of studies with more than 32,000 patients found that people with PsA were 43 percent more likely to develop cardiovascular diseases compared to the general population.

In addition to the increased likelihood of heart disease, one study found that people with PsA are more likely to have traditional risk factors for heart disease, including obesity and diabetes. Combined with chronic inflammation from PsA, these factors can lead to damage to the blood vessels and arteries.

Whats more, another review of studies found that people with PsA are significantly more likely to have metabolic syndrome. Metabolic syndrome includes conditions that increase the risk for cardiovascular disease, including:

These cardiovascular impacts are most significant in people with moderate and severe PsA, not mild.

Someone with heart disease may not experience symptoms until the disease is already severe and potentially fatal. One study found that cardiovascular disease was the leading cause of death in people with PsA.

Thats why people with PsA should work with their doctors to identify potential risks and symptoms of heart disease before they progress.

These symptoms may include:

If youre experiencing these symptoms, discuss them with your doctor. These symptoms are a sign that you could have heart disease or heart-related health issues.

Its hard to measure the impact of inflammation on the body until its caused significant damage. Inflammation is difficult, but not impossible, to detect.

Regular testing and physicals with your doctor can help you address the heart-related impacts of PsA early on. It is important to monitor key indicators of heart health.

Monitor your heart health by testing for:

Traditional risk assessments for cardiovascular disease look at a persons medical history and lifestyle to predict their risk of heart attack, stroke, and death. These assessments are not as useful for people with PsA because they do not factor in the impact of chronic inflammation.

In the future, more advanced testing to predict the risk of heart disease in people with PsA may be developed. Until then, people with PsA should make sure to regularly check on their heart health.

Newer research says treating PsA properly may help reduce the risk of cardiovascular disease.

One study found that people who had PsA and also took tumor necrosis factor (TNF) inhibitors, a type of treatment that targets specific inflammation markers, had a lower incidence of plaque buildup in their arteries.

In another study, patients with a low cardiovascular risk who were taking a biologic treatment had a 6 percent reduction in arterial plaque after 1 year of treatment. The researchers concluded this is likely the result of reduced inflammation.

Biologics are used to treat moderate or severe cases of PsA, and people with cases at this level are more likely to have greater indications of heart disease. Work with your doctor to find a treatment that both treats PsA and doesnt increase the risk of heart issues. Properly treating PsA may help manage cardiovascular risk.

Certain lifestyle changes may also help treat both heart disease and PsA. These changes include:

Psoriatic arthritis (PsA) doesnt only affect the skin and joints. It can cause heart health problems, too.

People with PsA should carefully monitor their heart health with their doctor and treat any issues like high blood pressure, high cholesterol, and high blood sugar.

Properly treating PsA may reduce your risk for cardiovascular issues. Many other risk factors for heart disease, including obesity and smoking, can be managed or improved. Its possible the same is true for PsA inflammation.

If you have PsA, work with your doctor to monitor for signs of heart health complications. Having PsA doesnt mean you will have heart disease, but being aware of the risk keeps you one step ahead of potential health issues.

Read more:

Psoriatic Arthritis and Heart Disease: What's the Link? - Healthline

Overview How psoriasis develops Open pop-up dialog box

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In psoriasis, the life cycle of your skin cells greatly accelerates, leading to a buildup of dead cells on the surface of the epidermis.

Psoriasis is a skin disease that causes red, itchy scaly patches, most commonly on the knees, elbows, trunk and scalp.

Psoriasis is a common, long-term (chronic) disease with no cure. It tends to go through cycles, flaring for a few weeks or months, then subsiding for a while or going into remission. Treatments are available to help you manage symptoms. And you can incorporate lifestyle habits and coping strategies to help you live better with psoriasis.

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Plaque psoriasis is the most common type of psoriasis. It usually causes dry, red skin lesions (plaques) covered with silvery scales.

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Guttate psoriasis, more common in children and adults younger than 30, appears as small, water-drop-shaped lesions on the trunk, arms, legs and scalp. The lesions are typically covered by a fine scale.

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Psoriasis causes red patches of skin covered with silvery scales and a thick crust on the scalp most often extending just past the hairline that may bleed when removed.

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Inverse psoriasis causes smooth patches of red, inflamed skin. It's more common in overweight people and is worsened by friction and sweating.

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Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration.

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Pustular psoriasis generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. It can occur in widespread patches or in smaller areas on your hands, feet or fingertips.

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The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely.

Psoriasis signs and symptoms can vary from person to person. Common signs and symptoms include:

Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. The most commonly affected areas are the lower back, elbows, knees, legs, soles of the feet, scalp, face and palms.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into remission.

There are several types of psoriasis, including:

If you suspect that you may have psoriasis, see your doctor. Also, talk to your doctor if your psoriasis:

Viven Williams: Your fingernails are clues to your overall health. Many people develop lines or ridges from the cuticle to the tip.

Rachel Miest, M.D.: Those are actually completely fine and just a part of normal aging.

Viven Williams: But Dr. Rachel Miest says there are other nail changes you should not ignore that may indicate

Rachel Miest, M.D.: liver problems, kidney problems, nutritional deficiencies ...

Viven Williams: and other issues. Here are six examples: No. 1 is pitting. This could be a sign of psoriasis. Two is clubbing. Clubbing happens when your oxygen is low and could be a sign of lung issues. Three is spooning. It can happen if you have iron-deficient anemia or liver disease. Four is called "a Beau's line." It's a horizontal line that indicates a previous injury or infection. Five is nail separation. This may happen as a result of injury, infection or a medication. And six is yellowing of the nails, which may be the result of chronic bronchitis.

For the Mayo Clinic News Network, I'm Vivien Williams.

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Psoriasis is thought to be an immune system problem that causes the skin to regenerate at faster than normal rates. In the most common type of psoriasis, known as plaque psoriasis, this rapid turnover of cells results in scales and red patches.

Just what causes the immune system to malfunction isn't entirely clear. Researchers believe both genetics and environmental factors play a role. The condition is not contagious.

Many people who are predisposed to psoriasis may be free of symptoms for years until the disease is triggered by some environmental factor. Common psoriasis triggers include:

Anyone can develop psoriasis. About a third of instances begin in the pediatric years. These factors can increase your risk:

If you have psoriasis, you're at greater risk of developing other conditions, including:

Read the rest here:

Psoriasis - Symptoms and causes - Mayo Clinic

The connection between psoriatic arthritis (PsA) and anxiety is a two-way street. Anxiety and stress can worsen PsA symptoms, but the reverse is also true: PsA can impact your mental health.

Research shows that joint pain and inflammation from PsA can impact your confidence and your quality of life.

There is also evidence that cytokines, a type of proteins released by your bodys cells, play a role in both PsA inflammation and symptoms of depression and anxiety. So theres a reason you might feel both anxious and inflamed.

Still, there are ways to manage social anxiety with PsA that create a positive feedback loop. Research in 2021 found that managing anxiety and depression made it possible to minimize the effects of PsA.

PsA and the resulting inflammation can cause a wide range of physical and psychological symptoms.

Some of the physical symptoms of PsA are:

Anxiety symptoms that may affect people with PsA include:

Symptoms of depression include:

Its a bit of a vicious cycle, because physical and mental symptoms can intensify each other. For example, some research suggests stress may cause PsA flares, which can create anxiety, which can feed into depression. In turn, depression can worsen the impression of pain, according to a 2003 research review.

Mood disorders are more common among people with PsA. A 2014 study found that rates of depression were higher among people with psoriasis than in the general population and that rates were even higher in people with PsA.

A 2020 review found that 51 percent of people living with PsA may experience depression.

Fatigue resulting from PsA sleep disturbance and pain is associated with anxiety and depression, according to research from 2020. Anxiety and depression can also contribute to fatigue.

Its no surprise that these complications can all impact your social functioning.

When PsA affects your ability to enjoy time with friends, social events, and travel, you can miss out on an important outlet. Social interaction is essential for your well-being. We are people who need other people! But sometimes other people can cause anxiety.

A 2017 study on PsAs close sibling, psoriasis, offers some insight into social triggers that likely apply to both conditions. The study found that the age of disease onset affected its influence on social anxiety.

For people diagnosed with psoriasis in adulthood, the primary cause of social anxiety was concern about their appearance. For people diagnosed before age 18, stigmatizing experiences mattered the most.

Regardless of which applies to you, PsA can increase social anxiety and make you self-conscious about your appearance.

How you feel about the way you look might not seem important until you consider the impact it has on your social support system.

Finding the confidence to get out there socially can make a huge difference, as you will see from these tricks of the trade.

There are things you can do to feel better emotionally, regardless of the physical effects of your PsA.

Fantastic, right? So lets look at some ideas.

Talk therapy can help you change the thought patterns that are undermining your confidence.

There are many different types of therapy, but cognitive behavioral therapy (CBT) has been found effective at helping to improve social anxiety. This goes for in-office visits and CBT appointments held online with therapists.

The CBT techniques you may use include reappraisal of your negative thoughts and exposure therapy.

Further, a 2020 study involving CBT looked at the connection between inflammation and psychiatric disorders. CBT didnt reduce the levels of inflammation-causing cytokines, but participants experienced improvements in their anxiety.

You can start by asking your doctor for advice or asking a friend who has already found an effective practice. There are also search tools, like the Anxiety & Depression Association of Americas therapist directory, that allow you to filter for people who specialize in chronic illness.

If youre taking medication to treat your PsA, you might feel reluctant to add another prescription to the mix. However, there could be a safe and effective option that helps you feel better if anxiety is interfering with your daily functioning.

A 2017 review found some evidence that selective serotonin reuptake inhibitors (SSRIs) helped with diagnosed social anxiety disorder. These meds alter chemicals in your brain, affecting mood and emotion.

SSRIs are typically prescribed by a primary care doctor or a psychiatrist. Often you start with a low dose. You should not stop taking the medication without talking with your doctor.

Exercise has been shown to reduce joint stiffness, pain, and fatigue in people with PsA. Its also a great way to improve your mood.

Low impact options to consider include:

Eating well and adjusting your diet may ease PsA symptoms and improve your mood, but the diet that works best for you might not work for everyone with PsA.

A 2018 review of studies on diet and PsA gave only weak recommendations for any given diet in helping with symptoms. The researchers warned that studies generally used low quality data.

In cases of obesity and overweight, the researchers recommended diets designed for weight loss.

A 2019 study of Swedish people with PsA found that short-term weight loss helped reduce symptoms. However, side effects included severe constipation, hair loss, and low blood pressure. The link between weight and PsA is not straightforward.

It can help to connect with other people who can listen to your story and issue a cathartic SAME!

The National Psoriasis Foundation has a peer support program called One to One for people living with psoriasis and psoriatic arthritis.

Healthline also has Bezzy PsA, a private forum where people with PsA can connect.

Research suggests that self-critical behaviors can make it harder to manage PsA.

Positive beliefs and determination are important parts of a successful mental health strategy for managing chronic pain, according to people interviewed for a 2018 study. So are support people like family, friends, and your medical team.

Being realistic about what you can accomplish can also help you put your condition in perspective and pace yourself.

So, there you have it how you feel matters with PsA. Symptom management is important not just for your physical health, but for your emotional well-being too.

Medication and therapy can help if social anxiety is interfering with your everyday life. Self-care techniques can help you adjust your expectations and perspective on living with the condition and connect with others. Social support and connection can, in turn, become an important piece of your PsA care plan.

More:

Managing Social Anxiety and Psoriatic Arthritis: What to Know - Greatist

If you have certain skin conditions, your doctor might suggest Ilumya as a treatment option for you. Its a prescription drug used to treat moderate to severe plaque psoriasis in adults.

The active ingredient in Ilumya is tildrakizumab-asmn. (The active ingredient is what makes the drug work.) Ilumya is a biologic medication (which means its made from living cells).

Ilumya is given as a subcutaneous injection (an injection under your skin). This is done by a healthcare professional in a doctors office.

For more information about Ilumya, including details about its uses, see this in-depth article.

Ilumya is usually a long-term treatment. Like other drugs, Ilumya can cause mild to serious side effects, also known as adverse effects. Like other biologics, this drug has effects on the immune system. Keep reading to learn more.

Some people may experience mild to serious side effects during their Ilumya treatment. Examples of Ilumyas commonly reported side effects include:

* To learn more about this side effect, see the Side effects explained section below.

The most common side effects are also the more mild ones. Examples of mild side effects that have been reported with Ilumya include:

* To learn more about this side effect, see the Side effects explained section below.

In most cases, these side effects should be temporary. And some may be easily managed. But if you have symptoms that are ongoing or bother you, talk with your doctor or pharmacist. And do not stop Ilumya treatment unless your doctor recommends it.

Ilumya may cause mild side effects other than the ones listed above. See the Ilumya prescribing information for details.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If youd like to notify the FDA about a side effect youve had with Ilumya, visit MedWatch.

You might experience serious side effects during Ilumya treatment, although these were rare in the drugs studies. Serious side effects that have been reported with this drug include:

* To learn more about this side effect, see the Side effects explained section below.

If you develop serious side effects during Ilumya treatment, call your doctor right away. If the side effects seem life threatening or you think youre having a medical emergency, immediately call 911 or your local emergency number.

Learn more about some of the side effects Ilumya may cause.

Injection site reactions are skin reactions that happen in the place where your doctor injects Ilumya. They can be mild to serious and were a common side effect in Ilumya studies.

Youll receive Ilumya as a subcutaneous injection (an injection under your skin). Unlike medications you take at home, your doctor will give you this injection. Theyll choose a site where your skin is healthy (meaning it doesnt have bruises, psoriasis plaques, or scars). This may be your belly, upper arm, or thigh. An injection-site reaction is possible in any of these places.

There were several kinds of injection side effects. The reactions were mild to serious and included:

Youll receive your Ilumya injection at a doctors office or other healthcare facility. Your doctor can talk with you about how to manage any injection site reactions you might have.

For a mild reaction, you can use a cool compress to help decrease the inflammation at the injection site. You can also take an over-the-counter pain reliever or antihistamine to help with pain or itching.

If the reaction is severe or doesnt go away in a few days, talk with your doctor. An injection site reaction can lead to a serious skin infection if not treated. Learn more about subcutaneous injections in this article.

An upper respiratory infection was a common side effect in studies of Ilumya, but severe infections were rare. This kind of infection is in your nose, ears, throat, or lungs. An example of an upper respiratory infection is the common cold. Because Ilumya weakens your immune system, youre more likely to get an infection while being treated with this drug. An upper respiratory infection could be caused by several different kinds of bacteria or viruses.

Symptoms of infection that you should watch out for include:

Infections will sometimes go away on their own with time, rest, and supportive care. Its important to drink plenty of fluids and get lots of rest to help your body heal from infection.

There are also over-the-counter medications* you can get to help with your symptoms:

* Be sure to talk with your doctor or pharmacist before taking over-the-counter medications.

For some infections, your doctor may prescribe an antibiotic for you. Be sure to take it exactly as directed and finish all the medication even if you start feeling better.

Talk with your doctor if you have symptoms that feel severe or dont go away. You should also tell them if you develop a cough that doesnt go away or a cough with blood. Rarely, Ilumya can cause severe infection, including tuberculosis (TB). If the infection is serious, your doctor may suggest that you temporarily stop Ilumya treatment. This will allow your immune system to clear the infection faster.

If you have a lot of infections while using Ilumya, your doctor may consider a different treatment for your condition.

Studies of Ilumya reported diarrhea, but most people who took the drug didnt report this side effect. Diarrhea is loose or watery bowel movements that may occur very often. You can have mild to severe diarrhea and may also have some of the following symptoms:

If you have diarrhea, keep track of your symptoms and how long they last. If its more than a few days, let your doctor know. It could be a sign of an infection. Other signs that diarrhea may be part of a serious condition are:

If you have diarrhea thats severe or lasts a long time, its important to figure out the cause. For serious diarrhea, this might involve a fecal test or a colonoscopy. The test results will help your doctor decide on the best treatment for your condition.

There are also ways to treat mild diarrhea symptoms. You can drink lots of fluids with electrolytes. For example, juice or some non-caffeinated sports drinks have electrolytes. This helps your body stay hydrated if youre losing too much fluid due to the diarrhea.

You can also eat plain foods that are easy to digest. For example, toast and applesauce are mild foods for most people. Stick to foods that you know are easy on your stomach. You can avoid foods and drinks that commonly make diarrhea worse, such as:

Be sure to wash your hands well after using the bathroom. This helps prevent the spread of infection.

If your doctor says its safe for you, you can take an over-the-counter medication such as Imodium. This medication can help your symptoms, but its not always the best choice if your diarrhea is caused by an infection.

Like most drugs, Ilumya can cause an allergic reaction in some people. Symptoms can be mild to serious and can include:

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms. This could include:

If your doctor confirms youve had a mild allergic reaction to Ilumya, theyll decide if you should continue using it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms youve had a serious allergic reaction to Ilumya, they may have you switch to a different treatment.

During your Ilumya treatment, consider taking notes on any side effects youre having. You can then share this information with your doctor. This is especially helpful when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things such as:

Keeping notes and sharing them with your doctor will help them learn more about how Ilumya affects you. They can then use this information to adjust your treatment plan if needed.

Get answers to some common questions about Ilumyas side effects.

You may be able to use Ilumya if you have an infection, it depends on whether its mild or serious. Infection was a common side effect in studies of Ilumya, especially upper respiratory infection.

Your doctor may have you wait until your infection clears up before having you start treatment. This is because Ilumya decreases your bodys ability to fight infections.

If you have a latent tuberculosis (TB) infection, your doctor may prescribe a TB treatment while you use Ilumya. Or they may choose a different medication for you. The manufacturer of Ilumya includes a specific warning about TB in the prescribing information.

If youre already using Ilumya and you develop a new infection, your doctor might stop your treatment temporarily.

Ilumya is a biologic medication (which means its made from living cells). Biologics, including Ilumya, are not necessarily more or less safe than creams or lotions used to treat psoriasis. The side effects are just different for each drug.

For example, one kind of psoriasis treatment is steroid cream. These creams often have side effects of thinning skin and sun sensitivity. Another kind of psoriasis treatment is vitamin D cream. These creams have a rare side effect of disrupting your bodys normal use of calcium.

There are many different kinds of psoriasis treatments, and each kind has side effects to consider. Read more about psoriasis treatments and side effects in this article.

Other biologic drugs used to treat psoriasis include Humira, Orencia, and Cosentyx. Although most biologic drug studies report decreased immune function, other side effects are different depending on the drug. Talk with your doctor about whether a biologic drug such as Ilumya is a good choice for you.

Yes, you might develop antibodies to Ilumya, though this was rare in studies of the drug.

Sometimes your immune system mistakes a biologic drug for a bacteria or virus it needs to kill. So your body may develop antibodies that stop Ilumya from being an effective treatment. Your doctor will do frequent blood tests to check for this. Even if your body makes some antibodies against Ilumya, the drug might still be effective. Talk with your doctor about how often you should get tested while using Ilumya.

There are several warnings to keep in mind when considering treatment with Ilumya. This drug may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before starting Ilumya. The list below includes factors to consider.

Frequent infections. Ilumya makes your body less able to fight infection. So if you already get frequent infections, Ilumya could make them worse. Your doctor can help you manage your infections before you start Ilumya.

Live vaccines. If youre planning to get a live attenuated vaccine soon, talk with your doctor about waiting to start Ilumya. Its a good idea to be up to date on your vaccinations before you begin treatment with this drug.

Tuberculosis. Ilumya may cause active disease in people who already have tuberculosis (TB). If you have TB, talk with your doctor about whether Ilumya is the right drug for you. If youve been in close contact with someone who has TB, be sure to get a TB test before you start Ilumya.

Allergic reaction. If youve had an allergic reaction to Ilumya or any of its ingredients, your doctor will likely not prescribe it for you. Ask them about other treatments that might be better options for you.

Alcohol and Ilumya dont interact directly, but a possible side effect of each is diarrhea. Because of this, consuming alcohol during treatment with Ilumya could increase your risk of this side effect.

Alcohol is a psoriasis trigger for some people. If you drink alcohol and it worsens your psoriasis, Ilumya may not work as well.

If you drink alcohol, talk with your doctor about how to limit your intake during your Ilumya treatment.

There are not enough studies yet to know whether Ilumya is safe for use during pregnancy and breastfeeding. Talk with your doctor about the risks and benefits of Ilumya in these situations.

Ilumya may cause side effects that your doctor can help treat. Here are a few possible questions for you to ask them:

For advice on managing your condition and news on treatments for it, sign up for Healthlines psoriasis newsletter.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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Ilumya: Side Effects and What to Do About Them - Healthline

Psoriatic disease is an autoimmune disorder that involves inflammation throughout your body. Its also an umbrella term for two conditions: psoriasis and psoriatic arthritis (PsA).

Psoriasis generally affects the skin and causes plaques or lesions to appear. PsA primarily affects the joints, causing pain and stiffness. People with psoriatic disease may also experience issues with other organs and tissues, and they have a higher chance of developing heart disease or diabetes.

About 30 percent of people living with psoriasis also develop PsA. You may develop PsA without having psoriasis, but its not common.

When treating PsA, a person will often have a team of doctors and specialists. This team typically includes a dermatologist and a rheumatologist. When these healthcare professionals work together, diagnosis and treatment practices may be more effective.

Dermatologists often work with people living with psoriasis. With around 30 percent of people living with psoriasis later developing PsA, dermatologists are often the first to recognize PsA symptoms in their patients.

If youre already living with psoriasis and working with a dermatologist, theyll likely ask you about symptoms related to PsA. If they identify PsA, they can start to administer treatment specifically for PsA.

Early treatment is important to help prevent arthritis from getting worse and causing joint damage. About 40 to 60 percent of people living with PsA will develop joint deformity, which leads to reduced quality of life.

Rheumatologists specialize in diseases that affect the joints and muscles. A rheumatologist can provide an initial diagnosis of PsA or develop a treatment plan following a dermatologists diagnosis.

A rheumatologist can help you develop a comprehensive treatment plan that works for your needs. They will often be the doctor you see for managing your medication, reporting any issues, and other aspects of your PsA care.

Diagnosing PsA can be difficult, but its important to diagnose the condition as soon as possible for more successful treatment outcomes. Early treatment can help prevent permanent joint damage.

The best results may occur when the rheumatologists and dermatologists work together to diagnose the condition. According to a 2021 study, close collaboration between the two doctors can help speed up the diagnosis of PsA.

Diagnosis typically involves ruling out other conditions, which can be difficult because PsA has overlapping symptoms with other types of arthritis. Currently, theres no standard practice for diagnosing PsA.

Symptoms a dermatologist or rheumatologist may look for when diagnosing PsA include:

According to a 2021 study conducted in China, one factor that affects a rheumatologists ability to diagnose PsA effectively is whether they work full time or part time. These findings may not apply the same way in the United States, but they provide helpful insight into the need for rheumatologists to have experience with and be involved in the diagnosis.

Psoriasis often presents before PsA. Due to the likelihood of comorbidity of the two conditions, your dermatologist may be more open to a PsA diagnosis if you have psoriasis and develop joint pain.

Treatment outcomes for PsA may also improve when a rheumatologist and dermatologist work together.

Often, treatments for psoriasis and PsA overlap. This means some of the systemic treatments used to treat one can also help treat the other. Systemic treatments can include biologics and oral medications.

When working with both doctors, a person with PsA will need to communicate which treatment each doctor provides. A dermatologist may work by prescribing skin care treatments, while the rheumatologist may work more on treating the overall disease and joint pain.

Treatments for psoriatic disease include:

Systemic medications often help for PsA, because they target overall inflammation. Your rheumatologist may recommend additional treatment, such as pain medications like nonsteroidal anti-inflammatory drugs (NSAIDs).

When a person with PsA seeks care from both a dermatologist and rheumatologist working together, a diagnosis may come earlier, and treatment outcomes may improve. Earlier diagnosis can help slow disease progression and help prevent joint damage.

Dermatologists often work with people living with psoriasis, and rheumatologists specialize in diseases affecting the joints and muscles. About 30 percent of people living with psoriasis develop PsA.

Speak with your doctors about whether working together would help in developing a comprehensive treatment plan and improving your PsA.

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Treating PsA: How a Rheumatologist and Dermatologist Work Together - Healthline

Introduction

Apremilast, a phosphodiesterase 4 (PDE-4) inhibitor, has demonstrated clinical benefits in the management of psoriasis not only in randomized controlled trials (RCTs), ESTEEM 1 and 2 but also in real-world studies.1,2 The inhibition of PDE-4 is associated with an increase in intracellular cAMP levels, and subsequently modulates inflammatory responses, and thus helps in maintaining a balanced immune system.35 While apremilast is proven to be safe and well tolerated, it may cause a few temporary and mild to moderate adverse events (AEs) such as gastrointestinal upset, nausea, muscle pain and headache during the initiation of the therapy.6 These side effects are linked to cAMP levels which are decreased in psoriasis. Because of higher incidence of AEs, dose titration of apremilast is recommended at the initiation of therapy over a period of one week. However, despite the initial dose titration many patients develop AEs, leading to discontinuation of therapy in real-world practice.7

Although several interventions are well demonstrated for the management of AEs, sometimes dose adjustment and discontinuation of the therapy may be required.7,8 Recently published Indian papers on apremilast also highlighted a slowdown of titration in the initial period.9,10 Owing to this, for reduction in AEs and better compliance by patients, many dermatologists in India further slow down titration therapy up to 24 weeks, but studies regarding the safety of apremilast in different titration methods are lacking. The objective of this clinical study is to evaluate the safety and effectiveness of different dose titration methods of apremilast as initiation therapy in the management of patients with plaque psoriasis.

Adult patients (18 years of age) of either gender and diagnosed with chronic plaque psoriasis were included in the study. Patients with history of anti-psoriatic medications in any form within 2 weeks and use of biologics within 1224 weeks were excluded. Additionally, patients with any significant medical illness such as diabetes or cardiac disease, immunocompromised conditions, sexually transmitted diseases, etc. that would have prevented study participation, and female patients who were pregnant or lactating were excluded from the study as per the investigators discretion.

The study was conducted in compliance with the protocol approved by the Ethics Committee (Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane). Written informed consent was obtained from all the patients prior to participation in the study. This study was registered with a clinical trial registry (CTRI/2020/04/024631). This study was performed in accordance with Good Clinical Practices and the Declaration of Helsinki 1996.

This was an open-label, randomized, prospective, comparative, three-arm, and single-center study. The objective of this study was to study the initial adverse effect profile associated with apremilast titration dose and its effectiveness in each group. Patients were randomized by simple randomization technique into three groups. Group I received apremilast 30 mg twice a day after standard titration for the first 6 days. Group II received all tablets in a starter pack as once a day (OD) for 13 days, followed by apremilast 30 mg twice a day. Group III received two starter packs as 8 tablets of apremilast 10 mg OD for 8 days, followed by 20 mg OD for the next 8 days, and 30 mg OD for the next 10 days; thus totaling 26 days followed by apremilast 30 mg twice a day (Figure 1). All the patients were prescribed moisturizer only along with apremilast with antihistamines if needed. The total duration of the therapy in all groups was 16 weeks.

Figure 1 Apremilast titration methods.

Abbreviation: mg; milligram.

The primary objective of the study was to compare the percentage of patients presenting with adverse events (AEs) and the number of patients discontinuing treatment due to AEs in each group. The secondary objective was to compare the effectiveness of apremilast in each group.

A safety analysis was performed on a full analysis set (SAF), (i.e., those patients who have received at least one dose of apremilast and completed at least one post-baseline follow-up visit). The effectiveness analyses were performed on the intent-to-treat set (ITT), (i.e., those patients who have received at least one dose of apremilast and had at least one post baseline efficacy assessment).

Results were presented as mean scores, and the groups were compared using one-way ANOVA with Tukey HSD test and Fishers exact test. The level of significance was set at p <0.05. The difference in the proportion of patients with a change in mean scores (based on improvement criteria), was analysed using the chi-square test. Data were analysed using the IBM SPSS (Statistical Package for Social Sciences) statistics version 20.

Of the 128 patients enrolled in this study, all (100%) were included in the SAF, and 95 patients (74.22%) were included in the ITT. Thirty-three patients (25.78%) were lost to follow-up before the first effectiveness assessment visit (Figure 2).

Figure 2 Study Design.

There were 38 patients in Group I, 46 patients in Group II and 44 patients in Group III. Male predominance was seen in all groups with a mean (SD) age of 43.58 (9.78) in Group I, 42.53 (10.73) in Group II and 38.7 (12.5) years in Group III, respectively (Table 1). All the baseline characteristics under SAF are noted in Table 1. Patient distribution was homogeneous in all groups.

Table 1 Baseline Demographic Characteristics for Full Analysis Set (SAF)

Safety outcomes in all groups are summarized in Table 2. In Group I, 50% reported AEs, 41.3% reported AEs in Group II whereas 25% reported AEs in Group III. There was statistical difference (p <0.05) between Group I and III but no statistical difference was noted between Groups II and III. Nausea was the most common AE reported in all groups, followed by gastrointestinal upset and headache. Though all the groups experienced AEs, the maximum number of AEs were seen in Group I in first week only (74.19%) compared with other groups whereas in Groups II and III, 24.32% and 42.85% patients reported AEs in first week. In subsequent weeks, there was reduction in occurrence of AEs in all groups, as shown in Table 2. Most of the AEs occurred at the dose of apremilast 30 mg. As a result, 4 patients (10.53%) of the patients discontinued the therapy in Group I, 3 patients (6.52%) in Group II and 1 patient (2.27%) in Group III (Table 2). There was no significant statistical difference between any groups in terms of discontinuation of apremilast.

Table 2 Details of Adverse Events in All Groups

All ITT patients were included in the treatment response group. There were 35 patients in Group I, 33 patients in Group II and 27 patients in Group III. All the baseline characteristics under ITT are noted in Table 3. Patient distribution was homogeneous in all groups.

Table 3 Baseline Demographic Characteristics for Intention to Treat (ITT)

At week 10, in Group I, 10 patients (28.5%) and 5 patients (14.5%) achieved Psoriasis Area and Severity Index (PASI) 50 and 75 respectively while in Group II, 12 (36.3%) and 6 patients (18.1%) achieved PASI 50 and 75 respectively. In Group III, PASI 50 was achieved in 8 patients (29.6%) and PASI 75 in 2 patients (7.4%). At week 16, 14 (40%), 6 (18.1%) and 7 (26%) patients achieved PASI 50 and 11 (31.43%), 14 (42.4%), 9 patients (33.3%) achieved PASI 75 in Groups I, II and III respectively (Figure 3). On intergroup comparison, there was no statistically significant difference between any groups.

Figure 3 Effectiveness evaluation in all groups for PASI.

Abbreviation: PASI; Psoriasis area and severity index.

There was a significant statistical difference between the baseline and the end of treatment in all groups in terms of improvement of all mean scores such as mean PASI, mean body surface area (BSA) and mean symptoms scores (p <0.05) as shown in Figures 4 and 5, but on intergroup comparison, there was no statistical significant difference, as shown in Table 4.

Table 4 Clinical Response at Week 10 and Week 16

Figure 4 Improvement in mean PASI and BSA scores at week 10 and week 16.

Abbreviations: PASI; Psoriasis area and severity index, BSA; body surface area.

Figure 5 Improvement in mean scores at week 10 and week 16.

All the landmark clinical trials1,2 and real-world studies11 have examined the safety and effectiveness of apremilast for a complete duration of therapy but this study has examined safety during the titration of therapy. Apremilast is a PDE-4 inhibitor and the inhibition of PDE-4 is associated with an increase in intracellular cAMP levels, which subsequently modulate the inflammatory responses, and thus help in maintaining balance of the immune system.35 It has been found that the cAMP-specific PDE-4 is highly expressed in some specific organs such as the gastrointestinal tract, the musculoskeletal system, the brain and the skin,1214 and hence adverse effects associated with these systems that are observed with apremilast are accredited to PDE-4 inhibition.13,15,16 Moreover, it has been found that patients with inflammatory diseases express higher levels of PDE-4 than healthy individuals.13,17 Hence, in such patients, more attention is required to minimize AEs with maintaining the balance of efficacy.

In earlier studies where apremilast dosing began at the full dose, more AEs were reported than Phase II studies, where apremilast titration was done over a period of 6 days. Hence initial dose titration is recommended to lower the AEs.18,19 But, despite titration, a high number of AEs were reported from landmark trials and real-world studies, leading to the discontinuation of the drug.11

In our study, 50%, 41.3% and 25% of the patients reported 1 AE in Groups I, II and III, respectively which was statistically significant. This is in line with recently published real-world studies on titration suggesting that a further slowdown of titration led to a lesser rate of AEs.10 Moreover, recently published papers on apremilast also pointed towards a slower titration in the initial period.9,20 Additionally, patients in Group I experienced the maximum number of AEs in the first week compared with other groups. The incidence of AEs in subsequent weeks was reduced in all groups. This suggests that further slowdown of titration helps in reducing the AEs associated with apremilast. Nausea was the most commonly reported AE in our study, unlike the other study on titration where GI upset was the most commonly reported. As reported by Giembycz et al., nausea and emesis were among the commonest adverse effects of PDE-4 inhibitors due to the expression of PDE-4 in the central nervous system.21

Additionally, the percentage of patients discontinuing apremilast was reported as lower compared with other studies, though this was not significant. This could be due to a smaller sample size. But the trend of lower AEs with a slowdown of titration was reported as significant. Additionally, though these AEs were mild to moderate in nature and resolved with the continuation of the drug, most of the AEs occurred in the initial 2 weeks of dosing.

In terms of effectiveness, 31.43%, 42.4% and 33.3% of the patients achieved PASI 75 at the end of 16 weeks in Groups I, II and III, respectively. This is in line with landmark clinical studies on apremilast.1,2 But as mentioned above, there was no statistical difference between any of the groups suggesting that even further slowdown of titration at the initiation of therapy did not affect the efficacy of apremilast. As per a recently published report from India, a minimum of 24 weeks of therapy was recommended by experts for better efficacy.9 Effectiveness was also statistically significant at week 16 from baseline in all groups in the mean score of PASI, BSA and symptoms score suggesting that all titration methods were equally effective.

To the best of our knowledge, the present study is the first prospective, randomized and comparative realworld experience of safety and effectiveness of apremilast with three different titration methods. This study provides evidence that in patients who are intolerant to apremilast titration in the initial period, further slowdown of titration is an effective strategy. This strategy will not only help in reducing adverse effects but also help in the reduction of the discontinuation of apremilast therapy. Moreover, this strategy may help in improving compliance by patients. Additionally, clinical efficacy was also well documented with the further slowdown of titration. The clinical implication is that apremilast should be titrated gradually and tailored according to the patients tolerance, especially in patients who do not tolerate standard dose titration. There were some limitations such as small sample size and only one center being involved in the study.

In conclusion, the slow titration of apremilast is associated with lesser occurrence of AEs, and hence, fewer chances of discontinuation of the treatment. Additionally, in terms of effectiveness, there was no statistical difference between any groups in terms of PASI and BSA improvement. Hence, it can be concluded that slower titration is a useful strategy for reducing AEs but at the same time maintaining the efficacy of apremilast.

The datasets are available only on request due to privacy/ ethical restrictions, and can be requested from [emailprotected]

Dr Dhiraj Dhoot, Dr Namrata Mahadkar and Dr Hanmant Barkate are employees of Glenmark Pharmaceuticals Ltd. The other authors report no conflicts of interest in this work.

1. Papp K, Reich K, Leonardi CL, et al. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: results of a Phase III, randomized, controlled trial (efficacy and safety trial evaluating the effects of apremilast in psoriasis [ESTEEM] 1). J Am Acad Dermatol. 2015;73(1):3749. doi:10.1016/j.jaad.2015.03.049

2. Paul C, Cather J, Gooderham M, et al. Efficacy and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with moderate-to-severe plaque psoriasis over 52 weeks: a phase III, randomized controlled trial (ESTEEM 2). Br J Dermatol. 2015;173(6):13871399. doi:10.1111/bjd.14164

3. Schafer P. Apremilast mechanism of action and application to psoriasis and psoriatic arthritis. Biochem Pharmacol. 2012;83(12):15831590. doi:10.1016/j.bcp.2012.01.001

4. Schafer PH, Parton A, Capone L, et al. Apremilast is a selective PDE4 inhibitor with regulatory effects on innate immunity. Cell Signal. 2014;26(9):20162029. doi:10.1016/j.cellsig.2014.05.014

5. Maurice DH, Ke H, Ahmad F, Wang Y, Chung J, Manganiello VC. Advances in targeting cyclic nucleotide phosphodiesterases. Nat Rev Drug Discov. 2014;13(4):290314. doi:10.1038/nrd4228

6. Dattola A, Del Duca E, Saraceno R, Gramiccia T, Bianchi L. Safety evaluation of apremilast for the treatment of psoriasis. Expert Opin Drug Saf. 2017;16(3):381385. doi:10.1080/14740338.2017.1288714

7. Daudn Tello E, Alonso Surez J, Beltrn Cataln E, et al. Multidisciplinary management of the adverse effects of apremilast. Manejo de los efectos adversos de apremilast desde un abordaje multidisciplinar. Actas Dermosifiliogr. 2021;112(2):134141. doi:10.1016/j.ad.2020.08.007

8. Langley A, Beecker J. Management of common side effects of apremilast. J Cutan Med Surg. 2018;22(4):415421. doi:10.1177/1203475417748886

9. Rajagopalan M, Dogra S, Saraswat A, Varma S, Banodkar P. the use of apremilast in psoriasis: an Indian perspective on real-world scenarios. Psoriasis. 2021;11:109122. doi:10.2147/PTT.S320810

10. De A, Sarda A, Dhoot D, Barkate H. Apremilast titration: real-world Indian experience. Clin Dermatol Rev. 2021;5(2):183186.

11. Parasramani S, Thomas J, Budamakuntla L, Dhoot D, Barkate H. Real-world experience on the effectiveness and tolerability of apremilast in patients with plaque psoriasis in India. Indian J Drugs Dermatol. 2019;5(2):8388.

12. Chiricozzi A, Caposiena D, Garofalo V, Cannizzaro MV, Chimenti S, Saraceno R. A new therapeutic for the treatment of moderate-to-severe plaque psoriasis: apremilast. Expert Rev Clin Immunol. 2016;12(3):237249. doi:10.1586/1744666X.2016.1134319

13. Li H, Zuo J, Tang W. Phosphodiesterase-4 inhibitors for the treatment of inflammatory diseases. Front Pharmacol. 2018;9:1048. doi:10.3389/fphar.2018.01048

14. Halpin DM. ABCD of the phosphodiesterase family: interaction and differential activity in COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(4):543561. doi:10.2147/COPD.S1761

15. Dyke HJ, Montana JG. Update on the therapeutic potential of PDE4 inhibitors. Expert Opin Investig Drugs. 2002;11(1):113. doi:10.1517/13543784.11.1.1

16. Dietsch GN, Dipalma CR, Eyre RJ, et al. Characterization of the inflammatory response to a highly selective PDE4 inhibitor in the rat and the identification of biomarkers that correlate with toxicity. Toxicol Pathol. 2006;34(1):3951. doi:10.1080/01926230500385549

17. Schafer PH, Truzzi F, Parton A, et al. Phosphodiesterase 4 in inflammatory diseases: effects of apremilast in psoriatic blood and in dermal myofibroblasts through the PDE4/CD271 complex. Cell Signal. 2016;28(7):753763. doi:10.1016/j.cellsig.2016.01.007

18. Busa S, Kavanaugh A. Drug safety evaluation of apremilast for treating psoriatic arthritis. Expert Opin Drug Saf. 2015;14(6):979985. doi:10.1517/14740338.2015.1031743

19. Young M, Roebuck HL. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor: a novel treatment option for nurse practitioners treating patients with psoriatic disease. J Am Assoc Nurse Pract. 2016;28(12):683695. doi:10.1002/2327-6924.12428

20. Carrascosa JM, Belinchn I, Rivera R, Ara M, Bustinduy M, Herranz P. The use of apremilast in psoriasis: a Delphi Study. Estudio Delphi para el uso de apremilast en la psoriasis. Actas Dermosifiliogr. 2020;111(2):115134. doi:10.1016/j.ad.2019.07.005

21. Giembycz MA. Phosphodiesterase 4 inhibitors and the treatment of asthma: where are we now and where do we go from here? Drugs. 2000;59(2):193212. doi:10.2165/00003495-200059020-00004

Excerpt from:

Safety and effectiveness of Apremilast in plaque psoriasis | PTT - Dove Medical Press

Rashes can be thought of as a dysfunctional community of skin cells. Your skin harbors dozens of distinct cell types, including those that form blood vessels, nerves and the local immune system of the skin. For decades, clinicians have largely been diagnosing rashes by eye. While examining the physical appearance of a skin sample under a microscope may work for more obvious skin conditions, many rashes can be difficult to distinguish from one another.

At the molecular level, however, the differences between rashes become more clear.

Scientists have long known that molecular abnormalities in skin cells cause the redness and scaliness seen in conditions like psoriasis and eczema. While almost all the various cell types in your skin can release chemicals that worsen inflammation, which ones leads to rash formation remains a mystery and may vary from patient to patient.

But molecular testing of skin rashes isnt a common practice because of technological limitations. Using a new approach, my colleagues and I were able to analyze the genetic profiles of skin rashes and quantitatively diagnose their root causes.

Traditional genetic analyses work by averaging out the activity of thousands of genes across millions of cells.

Genetically testing tissue samples is standard practice for conditions like cancer. Clinicians collect and analyze tumor biopsies from patients to determine a particular cancers unique molecular characteristics. This genetic fingerprint helps oncologists predict whether a cancer will spread or which treatments might work best. Cancer cells lend themselves to this form of testing because they often grow into recognizable masses that make them easy to isolate and analyze.

But skin is a complex mixture of cells. Collapsing these unique cell communities into a single group may obscure genetic signatures essential to diagnosis.

Recent technological advances called single-cell RNA sequencing, however, have enabled scientists to preserve the identity of each type of cell that lives in the skin. Instead of averaging the genetic signatures across all cell types in bulk, single-cell RNA sequencing analyses allow each cell to preserve its unique characteristics.

Using this approach, my colleagues and I isolated over 158,000 immune cells from the skin samples of 31 patients. We measured the activity of about 1,000 genes from each of those cells to create detailed molecular fingerprints for each patient. By analyzing these fingerprints, we were able to pinpoint the genetic abnormalities unique to the immune cells residing in each rash type. This allowed us to quantitatively diagnose otherwise visually ambiguous rashes.

We also observed that some patients had treatment responses consistent with what we expected with our predicted diagnoses. This suggests that our concept could viably be expanded for further testing.

To make our approach available to clinicians and scientists, we developed an open source web database called RashX that contains the genetic fingerprints of different rashes. This database will allow clinicians to compare the genetic profile of their patients rashes to similar profiles in our database. A closely matching genetic fingerprint might yield clues as to what caused their patients rash and lead to potential treatment avenues.

The rapid development of drugs that target the immune system in recent years has inundated doctors with difficult treatment decisions for individual patients. For example, while certain drugs that act on the immune system are known to work well for conditions like psoriasis or eczema, many patients have atypical rashes that cant be precisely diagnosed.

An open source database like ours could help enable clinicians to profile and diagnose these rashes, providing a stepping stone to choose a suitable treatment.

Furthermore, chronic inflammatory diseases that affect organs other than the skin share similar genetic abnormalities. Lab tests that can illuminate the root causes of skin diseases can likely be expanded to many other conditions.

Our RashX project initially focused on just two very common types of rashes, psoriasis and eczema. It is unknown whether other types of rashes will have similar genetic profiles to psoriasis and eczema or instead have their own unique fingerprints. It is also unclear which parts of the fingerprint would best predict drug response.

But RashX is a living web resource that will grow more useful as more scientists collaborate and contribute new data. Our lab is also working to simplify the process of developing genetic profiles of rashes to make participating in this area of research more accessible for clinics around the world. With more data, we believe that projects like RashX will make precision testing for rashes an essential next step in diagnosis and treatment.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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What is that rash? - ASBMB Today

Probiotic skin care involves using products that contain live microorganisms to improve the health of the skin. The idea behind this is that it helps maintain a beneficial balance of microbes, helping to reduce the symptoms of skin conditions.

Research on the effectiveness and safety of probiotics in skin care is very preliminary. Early studies indicate that oral probiotics may help with some health conditions, which has led scientists to study whether they may also be useful as a topical treatment.

However, some scientists argue that doctors do not yet understand the skin microbiome well enough to safely use topical probiotics as a skin treatment. The Food and Drug Administration (FDA) also does not regulate topical probiotics.

This article discusses probiotic skin care and the research supporting its use. It also examines potential risks and suggests other factors to consider when shopping for skin care products.

Probiotics are live microorganisms that are beneficial to human health. Probiotic skin care involves applying these microbes topically in the form of products such as creams or treatments.

The concept of probiotics dates back to 1900, when Louis Pasteur discovered them as the source of fermentation in foods such as yogurt. In the human body, probiotics make up part of the microbiome, which is the collection of microorganisms that naturally inhabit the digestive tract, skin, and other parts of the body.

The microbiome contains a huge variety of species. Some of these microbes are beneficial, while others can be pathogenic, or disease-causing. An imbalance in the amount of good and bad microbes is known as dysbiosis.

According to a 2019 study, the composition of the skin microbiome in healthy skin differs from the composition of the microbiome in diseased skin. Research from 2021 also reports that dysbiosis within the skin microbiome can result in the emergence and worsening of skin conditions.

Because of this, scientists and cosmetic companies have become increasingly interested in how probiotics might restore balance to the skin microbiome.

Some common species of probiotics that people may find in skin products include:

Almost any skin care product can contain them, including:

However, it is important to note that while many products may list microbes on their ingredients label, it is not always possible to know whether or not these microbes are alive.

Many companies use preservatives in their products to prolong their shelf life and ensure they are safe to use. Preservatives work by killing bacteria. This means that, in many cases, the probiotics may be inactivated.

A 2021 review looked at the body of research exploring the use of topical probiotics in skin care. Although some studies suggest these may have benefits, research is still in its early stages. Most research on probiotics focuses on oral probiotics.

People with atopic dermatitis (AD), or atopic eczema, have a higher amount of the bacteria Staphylococcus aureus in their skin microbiome, according to a 2017 study.

The authors of the study tested the effects of applying the probiotic Lactobacillus johnsonii to the skin of 31 participants with AD. Analysis of the data indicated that it reduced the number of S. aureus and decreased AD symptoms.

Older research from 2003 investigated the effect of S. thermophilus on AD. After a 2-week application period involving 11 participants, the results suggested that the probiotic reduced redness, scaling, and itching.

A 2016 study reviewed the effects of probiotics on the skin in clinical trials and animal experiments. The results indicated that their benefits include:

This may mean probiotics can reduce some of the visible signs of aging, such as sun damage. However, more research is necessary.

Some studies suggest that topical probiotics may promote wound healing, but the results vary significantly.

Older research from 2005 evaluated the effect of the probiotic Lactobacillus plantarum on preventing infections in wounds. After investigating it in test tubes and in mice, the authors concluded that it might inhibit infection development and improve tissue repair.

More large-scale human trials are necessary to see if it affects people the same way.

A 2020 paper states that topical probiotics may help address a loss of microbial diversity that previous research has found in people with acne. They may also reduce levels of Cutibacterium acnes on the skin, which is a type of bacteria that lives in hair follicles and is strongly associated with acne.

However, at the moment, this is only a theory. There are currently no randomized controlled trials that prove probiotic skin care targets C. acnes.

Data on probiotic treatment of psoriasis is limited, but studies investigating oral probiotics for the condition show promise. Authors of research from 2019 listed psoriasis as a skin condition that they believe oral and topical probiotics may help.

A 2019 review analyzed six clinical trials to explore the safety of topical probiotic treatment for AD. It found no significant side effects.

However, as with other types of skin care, there is always a risk that some people will have hypersensitivity or allergies to the ingredients. This may cause:

If this occurs, or the product burns or stings, a person should wash it off and stop using it.

Even though the probiotics in skin care may not be alive due to preservatives, it is difficult to know for sure. For this reason, people with compromised immune systems should avoid topical products that may contain live cultures, as well as probiotic foods and supplements.

It is important to note that experts are still learning about the skin microbiome. A 2021 paper argues that because scientists do not have sufficient knowledge, using topical probiotics could have unforeseen consequences.

Some species, or groups of species, may be capable of damaging the skin microbiome rather than helping it.

Microbes do not affect the body in isolation. Communities of microbes can have different effects when they coexist. Because this ecosystem is complex and differs from person to person, disruption can be potentially harmful.

The authors of a 2021 study urge scientists to conduct more research to understand how the microbiome as a whole interacts with human health, rather than only looking at individual microbes.

It is also difficult for cosmetic companies to create products that still contain live microbes due to the need to keep the product sanitary using preservatives.

An alternative approach could be to use prebiotics in skin care instead. These are ingredients that feed the beneficial bacteria that already live on the skin. This requires no live cultures to be present in the product and does not introduce new species.

If a person decides to try probiotic skin care, they can do so by following these tips:

Probiotic skin care involves using probiotic-containing products to try to alleviate certain skin conditions or improve its appearance. Some species of probiotics that people may find on skin product labels include S. thermophilus, Lactococcus, and Lactobacillus.

The FDA does not regulate probiotic skin care, so there is currently no recommendation on which types of probiotics are beneficial to the skin and little way of knowing if the probiotics in a product are alive.

Limited studies that examine specific species have suggested topical probiotics may be well-tolerated by many, but more research is necessary to fully understand if they could treat skin conditions and, if so, which species work best.

It is possible that probiotics could cause negative effects if they disrupt someones skin microbiome. People may want to ask a dermatologist for advice on the best products to suit their skin, particularly if they have a condition such as AD or acne.

Learn more about creating a dermatologist-recommended skin care routine here.

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Does probiotic skin care work? Products, uses, and more - Medical News Today

You have swollen, painful joints. It might be a sign of psoriatic arthritis. But you dont have the telltale skin rash that signals psoriasis. Could you have one condition without the other?

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Psoriasis and psoriatic arthritis are related conditions, but they dont always strike at the same time, says rheumatologist Ivana Parody, MD.

Heres what to know about psoriasis and psoriatic arthritis and how they fit together.

Psoriatic arthritis is an autoimmune disease. It occurs when your bodys immune system attacks its own tissues. The disease causes pain and swelling in your joints and the places where tendons and ligaments attach to bones. It can develop at any age, but most people experience their first symptoms between ages 35 and 55.

So, where does the skin come into play? Psoriasis is an autoimmune disease that affects your skin. It causes red, itchy, inflamed patches of skin that can be covered with silvery scales.

Psoriasis is common on the elbows, knees and scalp but can show up just about anywhere on your body. Most people with psoriasis never get psoriatic arthritis. But about 30% of people with psoriasis do develop the disease.

Its possible, but not very common, says Dr. Parody. Most people develop psoriasis first. Psoriatic arthritis typically emerges about seven to 10 years later.

Thats not always the case, however. A small number of people have joint pain first, and the skin disease appears later. Its even possible that a person with psoriatic arthritis will never have any skin symptoms. But that doesnt happen often. When it does, there is usually a family history of psoriasis, Dr. Parody says.

Psoriatic arthritis can cause different symptoms from person to person. But there are several common symptoms:

Experts arent sure what causes psoriatic arthritis. They suspect a combination of genes and environmental factors is to blame.

Unfortunately, no single test can identify psoriatic arthritis. Its usually easier for a doctor to diagnose you if you have psoriasis, as the two diseases often tag team.

Whether or not your skin is involved, your doctor will consider several factors to make a diagnosis. These include:

If you have painful, swollen joints and other symptoms, start with your primary care doctor, says Dr. Parody. They may refer you to a rheumatologist, who specializes in diagnosing and treating arthritis and other diseases that affect the joints, muscles and bones.

Some psoriatic arthritis treatments will also help calm skin symptoms. But if you have bothersome psoriasis symptoms, it can be helpful to see a dermatologist, too (an expert in skin conditions).

Some people with psoriatic arthritis have mild symptoms. They may be able to control pain and swelling with over-the-counter anti-inflammatory drugs.

People with advanced disease usually need prescription medications. These drugs can relieve symptoms and prevent permanent joint damage. They include:

Besides medications, there are things you can do to help relieve pain and protect your joints:

Theres no cure for psoriasis or psoriatic arthritis, but you can manage both with treatment. And new medications come out every year, says Dr. Parody. By working with your doctor, you can develop a plan to protect your joints and keep doing the things you love.

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Can You Have Psoriatic Arthritis Without Psoriasis? - Health Essentials from Cleveland Clinic

This article was originally published here

PLoS One. 2021 Dec 9;16(12):e0259852. doi: 10.1371/journal.pone.0259852. eCollection 2021.

ABSTRACT

This study aimed to investigate the perceived threat, mental health outcomes, behavior changes, and associated predictors among psoriasis patients during the COVID-19 pandemic. The COVID-19 has been known to increase the health risks of patients with psoriasis owing to patients immune dysregulation, comorbidities, and immunosuppressive drug use. A total of 423 psoriasis patients not infected with COVID-19 was recruited from the Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Chang Gung Memorial Hospital, and China Medical University Hospital from May 2020 to July 2020. A self-administered questionnaire was used to evaluate the perceived threat, mental health, and psychological impact on psoriasis patients using the Perceived COVID-19-Related Risk Scale score for Psoriasis (PCRSP), depression, anxiety, insomnia, and stress-associated symptoms (DAISS) scales, and Impact of Event Scale-Revised (IES-R), respectively. Over 94% of 423 patients with psoriasis perceived threat to be 1 due to COVID-19; 18% of the patients experienced psychological symptoms more frequently 1, and 22% perceived psychological impact during the pandemic to be 1. Multivariable linear regression showed that the higher psoriasis severity and comorbidities were significantly associated with higher PCRSP, DAISS, and IES-R scores. The requirement for a prolonged prescription and canceling or deferring clinic visits for psoriasis treatment among patients are the two most common healthcare-seeking behavior changes during the COVID-19 pandemic. Psoriasis patients who perceived a higher COVID-19 threat were more likely to require a prolonged prescription and have their clinic visits canceled or deferred. Surveillance of the psychological consequences in psoriasis patients due to COVID-19 must be implemented to avoid psychological consequences and inappropriate treatment delays or withdrawal.

PMID:34882690 | DOI:10.1371/journal.pone.0259852

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Perception of the threat, mental health burden, and healthcare-seeking behavior change among psoriasis patients during the COVID-19 pandemic - DocWire...

A method to shed unprecedented views into skin diseases: that was the goal when the INNODERM project was launched in 2016 under the leadership of the Technical University of Munich (TUM). It has yielded a novel imaging modality that can see deeper and with higher discrimination beneath the skin surface than any competing method today. The project has now been chosen as the winner of the European Commissions 2021 ECS Innovation Award, writes TUM in a press release.

Raster scan optoacoustic mesoscopy RSOM for short is the name of the pioneering imaging technology developed as part of the EU-funded INNODERM project. With an RSOM scanner, it becomes possible to capture very detailed vascular and cellular structures under the skin surface and precisely analyse changes of the skin. This is important, for example, in following the progression of diseases like psoriasis, eczema or melanoma. This was not possible with previous approaches like visual inspection, optical imaging or ultrasonography, as they do not provide sufficient contrast or depth penetration to obtain comparable information. The RSOM scanner has been used to image the extent of melanomas with unprecedented detail under the skin surface and quantify treatment efficacy associated with psoriasis, offering more objective and accurate observations that could enable doctors to determine if treatments are taking effect.

An international team headed by Vasilis Ntziachristos,Professor of Biological Imagingat TUM and Director of the Institute for Biological and Medical Imaging at Helmholtz Munich, spent five years refining and developing the technology. The project, which has involved research institutions as well as partners in industry, has generated more than 20 scientific papers. When INNODERM first began, the RSOM required a large laboratory installation to operate. In the meantime, however, the team has squeezed the technology into a portable scanner around the size of a medical ultrasound device. It is now being used for research purposes at several university hospitals around the world. Certification for use in physicians practices and hospital clinics is expected by the end of 2022.

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At the European Forum for Electronic Components and Systems (EFECS), a major congress of the European electronics industry, INNODERM received the ECS Innovation Award. The award is presented annually by the European Commission and the European Health and Digital Executive Agency (HaDEA) in recognition of innovative projects funded under the EU research and innovation program Horizon 2020. The jury praised the technological progress made by INNODERM and was impressed by the projects progress in developing the scanner into a commercial device by INNODERM partner iThera Medical GmbH. INNODERM received 3.8 million euros in funding through Horizon 2020.

Optoacoustic imaging, which fuels RSOM, is a modality that is intensively studied by Prof. Ntziachristos team in more than 15 years. Put simply, light pulses illuminate and are absorbed by tissue and converted to ultrasound waves, which are then detected by sensors and mathematically converted into images. Since each molecule absorbs and responds uniquely to different colors of light, the technique can be used to study anatomical and biochemical features of tissue. This makes RSOM capable of resolving details like microvascular, tissue oxygenation concentrations, endothelial function and other pathophysiological processes. This is all without the need to use contrast agents and ionizing radiation, making the method extremely safe and non-invasive for patients.

A follow-up project to INNODERM began in 2020. Also funded by the EU, the WINTHER project aims to improve RSOM technology while continuing to miniaturize the equipment. Along with skin diseases, the new scanner will be suitable for detecting and monitoring cardiovascular conditions and diabetes. OPTOMICS, an international EU project launched in 2021, also headed by Prof. Ntziachristos, is studying how RSOM data can be combined with multi-omics measurements to lead to a digital twin used for prognosis and treatment planning for type-2 diabetes.

Also interesting: Scientists search for the cause of your wrinkles with Chanel

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Seeing deeper through skin - Innovation Origins

Diagnosis

Your doctor will ask questions about your health and examine your skin, scalp and nails. Your doctor might take a small sample of skin (biopsy) for examination under a microscope. This helps determine the type of psoriasis and rule out other disorders.

Psoriasis treatments aim to stop skin cells from growing so quickly and to remove scales. Options include creams and ointments (topical therapy), light therapy (phototherapy), and oral or injected medication.

Which treatments you use depends on how severe the psoriasis is and how responsive it has been to previous treatment. You might need to try different drugs or a combination of treatments before you find an approach that works for you. Usually, however, the disease returns.

Corticosteroids. These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They are available as ointments, creams, lotions, gels, foams, sprays and shampoos. Mild corticosteroid ointments (hydrocortisone) are usually recommended for sensitive areas, such as your face or skin folds, and for treating widespread patches. Topical corticosteroids might be applied once a day during flares, and on alternate days or weekends only to maintain remission.

Your doctor may prescribe a stronger corticosteroid cream or ointment triamcinolone (Acetonide, Trianex), clobetasol (Temovate) for smaller, less-sensitive or tougher-to-treat areas.

Long-term use or overuse of strong corticosteroids can thin the skin. Over time, topical corticosteroids may stop working.

Retinoids. Tazarotene (Tazorac, Avage) is available as a gel and cream and applied once or twice daily. The most common side effects are skin irritation and increased sensitivity to light.

Tazarotene isn't recommended when you're pregnant or breast-feeding or if you intend to become pregnant.

Calcineurin inhibitors. Calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel) reduce inflammation and plaque buildup. They can be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.

Calcineurin inhibitors are not recommended when you're pregnant or breast-feeding or if you intend to become pregnant. This drug is also not intended for long-term use because of a potential increased risk of skin cancer and lymphoma.

Coal tar. Coal tar reduces scaling, itching and inflammation. It's available over-the-counter or by prescription in various forms, such as shampoo, cream and oil. These products can irritate the skin. They're also messy, stain clothing and bedding, and can have a strong odor.

Coal tar treatment isn't recommended for women who are pregnant or breast-feeding.

Light therapy is a first-line treatment for moderate to severe psoriasis, either alone or in combination with medications. It involves exposing the skin to controlled amounts of natural or artificial light. Repeated treatments are necessary. Talk with your doctor about whether home phototherapy is an option for you.

Psoralen plus ultraviolet A (PUVA). This treatment involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.

This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. Short-term side effects include nausea, headache, burning and itching. Long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma.

If you have moderate to severe psoriasis or other treatments haven't worked, your doctor may prescribe oral or injected (systemic) drugs. Because of the potential for severe side effects, some of these medications are used for only brief periods and might be alternated with other treatments.

Methotrexate. Usually administered weekly as a single oral dose, methotrexate (Trexall) decreases the production of skin cells and suppresses inflammation. It's less effective than adalimumab (Humira) and infliximab (Remicade). It might cause upset stomach, loss of appetite and fatigue. People taking methotrexate long term need ongoing testing to monitor their blood counts and liver function.

Men and women should stop taking methotrexate at least three months before attempting to conceive. This drug is not recommended when you're breast-feeding.

Cyclosporine. Taken orally for severe psoriasis, cyclosporine (Neoral) suppresses the immune system. It's similar to methotrexate in effectiveness but cannot be used continuously for more than a year. Like other immunosuppressant drugs, cyclosporine increases your risk of infection and other health problems, including cancer. People taking cyclosporine need ongoing monitoring of their blood pressure and kidney function.

These drugs are not recommended when you're pregnant, breast-feeding or if you intend to become pregnant.

Biologics. These drugs, usually administered by injection, alter the immune system in a way that disrupts the disease cycle and improves symptoms and signs of disease within weeks. Several of these drugs are approved for the treatment of moderate to severe psoriasis in people who haven't responded to first-line therapies. The therapeutic options are rapidly expanding. Examples include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), ustekinumab (Stelara), secukinumab (Cosentyx) and ixekizumab (Taltz). These types of drugs are expensive and may or may not be covered by health insurance plans.

Biologics must be used with caution because they carry the risk of suppressing your immune system in ways that increase your risk of serious infections. In particular, people taking these treatments must be screened for tuberculosis.

Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments topical creams and ultraviolet light therapy (phototherapy) in people with typical skin lesions (plaques) and then progress to stronger ones only if necessary. People with pustular or erythrodermic psoriasis or associated arthritis usually need systemic therapy from the beginning of treatment. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.

A number of alternative therapies claim to ease the symptoms of psoriasis, including special diets, creams, dietary supplements and herbs. None have definitively been proved effective. But some alternative therapies are deemed generally safe and might reduce itching and scaling in people with mild to moderate psoriasis. Other alternative therapies are useful in avoiding triggers, such as stress.

If you're considering dietary supplements or other alternative therapy to ease the symptoms of psoriasis, consult your doctor. He or she can help you weigh the pros and cons of specific alternative therapies.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Try these self-care measures to better manage your psoriasis and feel your best:

Coping with psoriasis can be a challenge, especially if the affected skin covers a large area of your body or is visible to other people. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden.

Here are some ways to help you cope and to feel more in control:

You'll likely first see your family doctor or a general practitioner. In some cases, you may be referred directly to a specialist in skin diseases (dermatologist).

Here's some information to help you prepare for your appointment and to know what to expect from your doctor.

Make a list of the following:

For psoriasis, some basic questions you might ask your doctor include:

Your doctor is likely to ask you several questions, such as:

Read more:

Psoriasis - Diagnosis and treatment - Mayo Clinic

Alwan, W., and F.O. Nestle. "Pathogenesis and Treatment of Psoriasis: Exploiting Pathophysiological Pathways for Precision Medicine." Clin Exp Rheumatol 33 (Suppl. 93): S2-S6.

Arndt, Kenneth A., eds., et al. "Topical Therapies for Psoriasis." Seminars in Cutaneous Medicine and Surgery 35.2S Mar. 2016: S35-S46.

Benhadou, Fairda, Dillon Mintoff, and Vronique del Marmol. "Psoriasis: Keratinocytes or Immune Cells -- Which Is the Trigger?" Dermatology Dec. 19, 2018.

Conrad, Curdin, Michel Gilliet. "Psoriasis: From Pathogenesis to Targeted Therapies." Clinical Reviews in Allergy & Immunology Jan. 18, 2015.

Dowlatshahi, E.A., E.A.M van der Voort, L.R. Arends, and T. Nijsten. "Markers of Systemic Inflammation in Psoriasis: A Systematic Review and Meta-Analysis." British Journal of Dermatology 169.2 Aug. 2013: 266-282.

Georgescu, Simona-Roxana, et al. "Advances in Understanding the Immunological Pathways in Psoriasis." International Journal of Molecular Sciences 20.739 Feb. 10, 2019: 2-17.

Greb, Jacqueline E., et al. "Psoriasis." Nature Reviews Disease Primers 2 (2016): 1-17.

Kaushik, Shivani B., and Mark G. Lebwohl. "Review of Safety and Efficacy of Approved Systemic Psoriasis Therapies." International Journal of Dermatology 2018.

National Psoriasis Foundation. "Systemic Treatments: Biologics and Oral Treatments." 1-25.

Ogawa, Eisaku, Yuki Sato, Akane Minagawa, and Ryuhei Okuyama. "Pathogenesis of Psoriasis and Development of Treatment." The Journal of Dermatology 2017: 1-9.

Stiff, Katherine M., Katelyn R. Glines, Caroline L. Porter, Abigail Cline & StevenR. Feldman. "Current pharmacological treatment guidelines for psoriasis and psoriaticarthritis." Expert Review of Clinical Pharmacology (2018).

Villaseor-Park, Jennifer, David Wheeler, and Lisa Grandinetti. "Psoriasis: Evolving Treatment for a Complex Disease." Cleveland Clinic Journal of Medicine 79.6 June 2012: 413-423.

Woo, Yu Ri, Dae Ho Cho, and Hyun Jeong Park. "Molecular Mechanisms and Management of a Cutaneous Inflammatory Disorder: Psoriasis." International Journal of Molecular Sciences 18 Dec. 11, 2017: 1-26.

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Psoriasis Treatment, Symptoms, Causes, Types & Diet

What is psoriasis?

Psoriasis is a chronic autoimmune condition that causes the rapid buildup of skin cells. This buildup of cells causes scaling on the skins surface.

Inflammation and redness around the scales is fairly common. Typical psoriatic scales are whitish-silver and develop in thick, red patches. Sometimes, these patches will crack and bleed.

Psoriasis is the result of a sped-up skin production process. Typically, skin cells grow deep in the skin and slowly rise to the surface. Eventually, they fall off. The typical life cycle of a skin cell is one month.

In people with psoriasis, this production process may occur in just a few days. Because of this, skin cells dont have time to fall off. This rapid overproduction leads to the buildup of skin cells.

Scales typically develop on joints, such elbows and knees. They may develop anywhere on the body, including the:

Less common types of psoriasis affect the nails, the mouth, and the area around genitals.

According to one study, around 7.4 million Americans have psoriasis. Its commonly associated with several other conditions, including:

There are five types of psoriasis:

Plaque psoriasis is the most common type of psoriasis.

The American Academy of Dermatology (AAD) estimates that about 80 percent of people with the condition have plaque psoriasis. It causes red, inflamed patches that cover areas of the skin. These patches are often covered with whitish-silver scales or plaques. These plaques are commonly found on the elbows, knees, and scalp.

Guttate psoriasis is common in childhood. This type of psoriasis causes small pink spots. The most common sites for guttate psoriasis include the torso, arms, and legs. These spots are rarely thick or raised like plaque psoriasis.

Pustular psoriasis is more common in adults. It causes white, pus-filled blisters and broad areas of red, inflamed skin. Pustular psoriasis is typically localized to smaller areas of the body, such as the hands or feet, but it can be widespread.

Inverse psoriasis causes bright areas of red, shiny, inflamed skin. Patches of inverse psoriasis develop under armpits or breasts, in the groin, or around skinfolds in the genitals.

Erythrodermic psoriasis is a severe and very rare type of psoriasis.

This form often covers large sections of the body at once. The skin almost appears sunburned. Scales that develop often slough off in large sections or sheets. Its not uncommon for a person with this type of psoriasis to run a fever or become very ill.

This type can be life-threatening, so individuals should see a doctor immediately.

Check out pictures of the different types of psoriasis.

Psoriasis symptoms differ from person to person and depend on the type of psoriasis. Areas of psoriasis can be as small as a few flakes on the scalp or elbow, or cover the majority of the body.

The most common symptoms of plaque psoriasis include:

Not every person will experience all of these symptoms. Some people will experience entirely different symptoms if they have a less common type of psoriasis.

Most people with psoriasis go through cycles of symptoms. The condition may cause severe symptoms for a few days or weeks, and then the symptoms may clear up and be almost unnoticeable. Then, in a few weeks or if made worse by a common psoriasis trigger, the condition may flare up again. Sometimes, symptoms of psoriasis disappear completely.

When you have no active signs of the condition, you may be in remission. That doesnt mean psoriasis wont come back, but for now youre symptom-free.

Doctors are unclear as to what causes psoriasis. However, thanks to decades of research, they have a general idea of two key factors: genetics and the immune system.

Psoriasis is an autoimmune condition. Autoimmune conditions are the result of the body attacking itself. In the case of psoriasis, white blood cells known as T cells mistakenly attack the skin cells.

In a typical body, white blood cells are deployed to attack and destroy invading bacteria and fight infections. This mistaken attack causes the skin cell production process to go into overdrive. The sped-up skin cell production causes new skin cells to develop too quickly. They are pushed to the skins surface, where they pile up.

This results in the plaques that are most commonly associated with psoriasis. The attacks on the skin cells also cause red, inflamed areas of skin to develop.

Some people inherit genes that make them more likely to develop psoriasis. If you have an immediate family member with the skin condition, your risk for developing psoriasis is higher. However, the percentage of people who have psoriasis and a genetic predisposition is small. Approximately 2 to 3 percent of people with the gene develop the condition, according to the National Psoriasis Foundation (NPF).

Read more about the causes of psoriasis.

Two tests or examinations may be necessary to diagnose psoriasis.

Most doctors are able to make a diagnosis with a simple physical exam. Symptoms of psoriasis are typically evident and easy to distinguish from other conditions that may cause similar symptoms.

During this exam, be sure to show your doctor all areas of concern. In addition, let your doctor know if any family members have the condition.

If the symptoms are unclear or if your doctor wants to confirm their suspected diagnosis, they may take a small sample of skin. This is known as a biopsy.

The skin will be sent to a lab, where itll be examined under a microscope. The examination can diagnose the type of psoriasis you have. It can also rule out other possible disorders or infections.

Most biopsies are done in your doctors office the day of your appointment. Your doctor will likely inject a local numbing medication to make the biopsy less painful. They will then send the biopsy to a lab for analysis.

When the results return, your doctor may request an appointment to discuss the findings and treatment options with you.

External triggers may start a new bout of psoriasis. These triggers arent the same for everyone. They may also change over time for you.

The most common triggers for psoriasis include:

Unusually high stress may trigger a flare-up. If you learn to reduce and manage your stress, you can reduce and possibly prevent flare-ups.

Heavy alcohol use can trigger psoriasis flare-ups. If you excessively use alcohol, psoriasis outbreaks may be more frequent. Reducing alcohol consumption is smart for more than just your skin too. Your doctor can help you form a plan to quit drinking if you need help.

An accident, cut, or scrape may trigger a flare-up. Shots, vaccines, and sunburns can also trigger a new outbreak.

Some medications are considered psoriasis triggers. These medications include:

Psoriasis is caused, at least in part, by the immune system mistakenly attacking healthy skin cells. If youre sick or battling an infection, your immune system will go into overdrive to fight the infection. This might start another psoriasis flare-up. Strep throat is a common trigger.

Here are 10 more psoriasis triggers you can avoid.

Psoriasis has no cure. Treatments aim to reduce inflammation and scales, slow the growth of skin cells, and remove plaques. Psoriasis treatments fall into three categories:

Creams and ointments applied directly to the skin can be helpful for reducing mild to moderate psoriasis.

Topical psoriasis treatments include:

People with moderate to severe psoriasis, and those who havent responded well to other treatment types, may need to use oral or injected medications. Many of these medications have severe side effects. Doctors usually prescribe them for short periods of time.

These medications include:

This psoriasis treatment uses ultraviolet (UV) or natural light. Sunlight kills the overactive white blood cells that are attacking healthy skin cells and causing the rapid cell growth. Both UVA and UVB light may be helpful in reducing symptoms of mild to moderate psoriasis.

Most people with moderate to severe psoriasis will benefit from a combination of treatments. This type of therapy uses more than one of the treatment types to reduce symptoms. Some people may use the same treatment their entire lives. Others may need to change treatments occasionally if their skin stops responding to what theyre using.

Learn more about your treatment options for psoriasis.

If you have moderate to severe psoriasis or if psoriasis stops responding to other treatments your doctor may consider an oral or injected medication.

The most common oral and injected medications used to treat psoriasis include:

This class of medications alters your immune system and prevents interactions between your immune system and inflammatory pathways. These medications are injected or given through intravenous (IV) infusion.

Retinoids reduce skin cell production. Once you stop using them, symptoms of psoriasis will likely return. Side effects include hair loss and lip inflammation.

People who are pregnant or may become pregnant within the next three years shouldnt take retinoids because of the risk of possible birth defects.

Cyclosporine (Sandimmune) prevents the immune systems response. This can ease symptoms of psoriasis. It also means you have a weakened immune system, so you may become sick more easily. Side effects include kidney problems and high blood pressure.

Like cyclosporine, methotrexate suppresses the immune system. It may cause fewer side effects when used in low doses. It can cause serious side effects in the long term. Serious side effects include liver damage and reduced production of red and white blood cells.

Learn more about the oral medications used to treat psoriasis.

Food cant cure or even treat psoriasis, but eating better might reduce your symptoms. These five lifestyle changes may help ease symptoms of psoriasis and reduce flare-ups:

If youre overweight, losing weight may reduce the conditions severity. Losing weight may also make treatments more effective. Its unclear how weight interacts with psoriasis, so even if your symptoms remain unchanged, losing weight is still good for your overall health.

Reduce your intake of saturated fats. These are found in animal products like meats and dairy. Increase your intake of lean proteins that contain omega-3 fatty acids, such as salmon, sardines, and shrimp. Plant sources of omega-3s include walnuts, flax seeds, and soybeans.

Psoriasis causes inflammation. Certain foods cause inflammation too. Avoiding those foods might improve symptoms. These foods include:

Alcohol consumption can increase your risks of a flare-up. Cut back or quit entirely. If you have a problem with your alcohol use, your doctor can help you form a treatment plan.

Some doctors prefer a vitamin-rich diet to vitamins in pill form. However, even the healthiest eater may need help getting adequate nutrients. Ask your doctor if you should be taking any vitamins as a supplement to your diet.

Learn more about your dietary options.

Life with psoriasis can be challenging, but with the right approach, you can reduce flare-ups and live a healthy, fulfilling life. These three areas will help you cope in the short- and long-term:

Losing weight and maintaining a healthy diet can go a long way toward helping ease and reduce symptoms of psoriasis. This includes eating a diet rich in omega-3 fatty acids, whole grains, and plants. You should also limit foods that may increase your inflammation. These foods include refined sugars, dairy products, and processed foods.

There is anecdotal evidence that eating nightshade fruits and vegetables can trigger psoriasis symptoms. Nightshade fruits and vegetables include tomatoes as well as white potatoes, eggplants, and pepper-derived foods like paprika and cayenne pepper (but not black pepper, which comes from a different plant altogether).

Stress is a well-established trigger for psoriasis. Learning to manage and cope with stress may help you reduce flare-ups and ease symptoms. Try the following to reduce your stress:

People with psoriasis are more likely to experience depression and self-esteem issues. You may feel less confident when new spots appear. Talking with family members about how psoriasis affects you may be difficult. The constant cycle of the condition may be frustrating too.

All of these emotional issues are valid. Its important you find a resource for handling them. This may include speaking with a professional mental health expert or joining a group for people with psoriasis.

Learn more about living with psoriasis.

Between 30 and 33 percent of people with psoriasis will receive a diagnosis of psoriatic arthritis, according to recent clinical guidelines from the AAD and the NPF.

This type of arthritis causes swelling, pain, and inflammation in affected joints. Its commonly mistaken for rheumatoid arthritis or gout. The presence of inflamed, red areas of skin with plaques usually distinguishes this type of arthritis from others.

Psoriatic arthritis is a chronic condition. Like psoriasis, the symptoms of psoriatic arthritis may come and go, alternating between flare-ups and remission. Psoriatic arthritis can also be continuous, with constant symptoms and issues.

This condition typically affects joints in the fingers or toes. It may also affect your lower back, wrists, knees, or ankles.

Most people who develop psoriatic arthritis have psoriasis. However, its possible to develop the joint condition without having a psoriasis diagnosis. Most people who receive an arthritis diagnosis without having psoriasis have a family member who does have the skin condition.

Treatments for psoriatic arthritis may successfully ease symptoms, relieve pain, and improve joint mobility. As with psoriasis, losing weight, maintaining a healthy diet, and avoiding triggers may also help reduce psoriatic arthritis flare-ups. An early diagnosis and treatment plan can reduce the likelihood of severe complications, including joint damage.

Learn more about psoriatic arthritis.

Around 7.4 million people in the United States have psoriasis.

Psoriasis may begin at any age, but most diagnoses occur in adulthood. The average age of onset is between 15 to 35 years old. According to the World Health Organization (WHO), some studies estimate that about 75 percent of psoriasis cases are diagnosed before age 46. A second peak period of diagnoses can occur in the late 50s and early 60s.

According to WHO, males and females are affected equally. White people are affected disproportionately. People of color make up a very small proportion of psoriasis diagnoses.

Having a family member with the condition increases your risk for developing psoriasis. However, many people with the condition have no family history at all. Some people with a family history wont develop psoriasis.

Around one-third of people with psoriasis will be diagnosed with psoriatic arthritis. In addition, people with psoriasis are more likely to develop conditions such as:

Though the data isnt complete, research suggests cases of psoriasis are becoming more common. Whether thats because people are developing the skin condition or doctors are just getting better at diagnosing is unclear.

Check out more statistics about psoriasis.

The rest is here:

Psoriasis: Causes, Triggers, Treatment, and More

Psoriasis is a common and commonly misunderstood disorder. Its not simply itchy, dry skin; according to the National Psoriasis Foundation (NPF), its caused by an immune-system dysfunction that brings on inflammation. Normally, a persons skin cells grow and shed in about a month, but for a person with psoriasis, that process is sped up, taking only about 3 or 4 days, and the result is a build-up of skin cells causing scales and plaque. About 8 million Americans deal with its discomfort every day, says the NPF.

Psoriasis is not curable, but thankfully its very treatable, says Mona Gohara, MD, associate clinical professor of dermatology at the Yale School of Medicine. Theres no need to endure the psychological or physical discomfort that may come along with this conditionseek treatment for it. There are a range of possible treatments, from topical creams and lotions to prescription oral medications. If you start at the bottom of therapeutic pyramid with creams, this may be enough to quell the irritation, says Dr. Gohara.

Some creams and lotions that can ease the dryness and itch are available over the counter; with others, youll need a prescription from a doctor. It takes a bit of trial and error to find what topical treatment may work best for you. Here, some guidance to the most common types of creams and lotions for psoriasis.

This is the active ingredient (approved by the FDA for treating psoriasis) in treatments that can help banish scales by softening them and making the outer layer of skin shed. You can find salicylic acid in many forms (not just lotions/creams/ointments, but also foams, soaps, gels, patches, and more). These treatments are designed to work in combo with others, because getting rid of the scales can help other treatments do their work more efficiently. If its a strong version, salicylic acid can irritate the skin and make hair more likely to break off, and that can lead to temporary hair loss, says the NPF.

The NPF says that these are the most frequently used treatments for psoriasis. Theyre designed to quell inflammation and pump the brakes on the growth of skin cells (this helps sidestep the buildup that produces scales). Steroid treatments come in different strengths; mild ones are available over the counter (OTC) and stronger types require a prescription. Generally, the stronger ones are needed for elbows, knees, and other hard to treat areas. These are powerful meds with potential side effects (thin skin, broken blood vessels, and more) and should be used carefully under a medical doctor's supervision. Also,the use of topical steroids on brown skin can create lightening, which may take time to repigment, says Dr. Gohara. Its always important to apply steroids directly on, not all around, lesions or areas of concern.

The NPF advises not to use a topical steroid for longer than three weeks without consulting a doctor, as well as to avoid stopping the use of one suddenly because that can cause a flare-up of your psoriasis. Another reason to use these under the care of a physician: Topical steroids can be absorbed via the skin and have an impact on internal organs when used for a long period of time or over a wide area of skin.

These prescription treatments also come in various forms not just creams, lotions and ointments, but also gels, foams, and more. In some medications, vitamin D is combined with a steroid. Like other treatments, meds with vitamin D slow down the pace of your skin cells' growth. (Depending on the specific medication, side effects can include skin irritation, stinging, burning, itching or excessive calcium in the urine.) One advantage of vitamin D creams is they dont run the risk of causing skin atrophy a very real side effect of chronic topical steroid use, says Dr. Gohara. But they can be more irritating. Generally, systemic side effects are rare, yet hypercalcemia is a theoretical risk, and your doctor may opt to have you get blood tests.

Vitamin A treatments

A topical retinoid, vitamin A is the active ingredient in prescription medication that comes in the form of a cream, gel, or foam. It also works by slowing the growth of skin cells. When using it, the plaques of psoriasis may turn bright red before clearing up. Side effects here also include skin irritation; the medication increases the risk of sunburn as well, so its critical to use sunscreen to protect your skin when using these meds.

Coal tar

This ingredient is found in different strengths in various treatment forms, including shampoo. It can be found in OTC products in its weaker strength and by prescription for stronger versions. Like other products, coal tar slows the growth of skin cells, but it can be stinky and irritating, and can stain your bedding and clothes (as well as blond hair).

Heres one of the challenging things about treating psoriasis: Your body can build up a tolerance to a certain medications, so something that seemed magical in its ability to bring you relief could suddenly stop working. On the other hand, a treatment that didnt work for you years ago could suddenly work wonders.

Thats why trial and error is a necessary part of psoriasis treatment. Finding the right treatment for psoriasis is much like finding the right partner. It may take some 'dating' until the right one finally comes along, says Dr. Gohara. Some may work for a bit, but then efficacy fizzles. Topical steroids are the most common culprit of this phenomenon, although it may happen with other topical or systemic medication as well.

According to the National Psoriasis Foundation, its key to moisturize daily it can lessen the itchy redness. They recommend that you use fragrance-free products and soaps that moisturize rather than dry you out, skip the way-hot shower (keep it lukewarm), and rub on moisturizer right after showering. The NPF recommends these OTC creams, based on information theyve heard from dermatologists while emphasizing that none of them are stand-ins for treatment from a healthcare provider. Still, theyre all deeply moisturizing and may improve some pesky symptoms such as flaking and itching:

Anti-Itch Concentrated Lotion with Calamine and Triple Oat Complex

This creamhas anti-inflammatory and antioxidant ingredients.

Moisturizing Cream for Psoriasis

CeraVe developed this with dermatologists to moisturize skin and rebuilt the skin barrier.

Hydra Therapy, Itch Defense Moisturizer

A shea butter lotion, it's designed to be used right after a shower.

Psoriasis Medicated Treatment Gel

$43.98

This gelhas salicylic acid to work on scales, itching, and dryness.

Skin Calming Intensive Itch Relief Lotion

With menthol and oatmeal, the lotion is especially good for nighttime itching, according to the manufacturer.

Ultimate Multi-Symptom Psoriasis Relief Cream

$28.82

A soothing cream with salicylic acid and a bunch of moisturizers.

Intense Skin Repair Body Lotion

Lubridermamazon.com

The manufacturer says this deeply moisturizing lotion lasts for 24 hours to help repair skin.

Medicated Moisturizing Psoriasis Cream

A salicylic acid cream that also contains aloe and shea butter.

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The Best Creams for Psoriasis - Over-the-Counter and ...

Psoriasis is a skin condition that creates red patches of skin with white, flaky scales. It most commonly occurs on the elbows, knees and trunk, but can appear anywhere on the body. The first episode usually strikes between the ages of 15 and 35. It is a chronic condition that will then cycle through flare-ups and remissions throughout the rest of the patient's life. Psoriasis affects as many as 7.5 million people in the United States. About 20,000 children under age 10 have been diagnosed with psoriasis.

In normal skin, skin cells live for about 28 days and then are shed from the outermost layer of the skin. With psoriasis, the immune system sends a faulty signal which speeds up the growth cycle of skin cells. Skin cells mature in a matter of 3 to 6 days. The pace is so rapid that the body is unable to shed the dead cells, and patches of raised red skin covered by scaly, white flakes form on the skin.

Psoriasis is a genetic disease (it runs in families), but is not contagious. There is no known cure or method of prevention. Treatment aims to minimize the symptoms and speed healing.

There are five distinct types of psoriasis:

People who have psoriasis are at greater risk for contracting other health problems, such as heart disease, inflammatory bowel disease and diabetes. It has also been linked to a higher incidence of cardiovascular disease, hypertension, cancer, depression, obesity and other immune-related conditions.

Psoriasis triggers are specific to each person. Some common triggers include stress, injury to the skin, medication allergies, diet and weather.

Psoriasis is classified as Mild to Moderate when it covers 3% to 10% of the body and Moderate to Severe when it covers more than 10% of the body. The severity of the disease impacts the choice of treatments.

Mild to moderate psoriasis can generally be treated at home using a combination of three key strategies: over-the-counter medications, prescription topical treatments and light therapy/phototherapy.

The U.S. Food and Drug Administration has approved of two active ingredients for the treatment of psoriasis: salicylic acid, which works by causing the outer layer to shed, and coal tar, which slows the rapid growth of cells. Other over-the-counter treatments include:

Prescription topicals focus on slowing down the growth of skin cells and reducing any inflammation. They include:

Controlled exposure of skin to ultraviolet light has been a successful treatment for some forms of psoriasis. Three primary light sources are used:

Treatments for moderate to severe psoriasis include prescription medications, biologics and light therapy/phototherapy.

Oral medications. This includes acitretin, cyclosporine and methotrexate. Your doctor will recommend the best oral medication based on the location, type and severity of your condition.

Biologics. A new classification of injectable drugs, biologics are designed to suppress the immune system. These tend to be very expensive and have many side effects, so they are generally reserved for the most severe cases.

Light Therapy/Phototherapy. Controlled exposure of skin to ultraviolet light has been a successful treatment for some forms of psoriasis. Two primary light sources are used:

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Psoriasis - Melbourne, FL Dermatologist

Researchers in China documented 2 cases of refractory erythrodermic psoriasis (EP) effectively treated with secukinumab, a fully humanized immunoglobulin (IgG)1k monoclonal antibody that neutralizes interleukin (IL)-17A. After 4 weeks of a standard treatment regimen, patients demonstrated a 75% reduction in the Psoriasis Area and Severity Index score (PASI).

Although secukinumab has been shown to result in rapid and sustained improvements of plaque psoriasis symptoms, clinical data on the treatment of EP with the drug are scarce. The condition, which accounts for 1% to 2.25% of all psoriatic cases, impacts over 80% of the body surface area (BSA) and usually occurs in patients with poor control of existing psoriasis.

Both patients included in the case series (1 male, 1 female) presented with severe EP and were resistant to treatment with acitretin or methotrexate. The male patient also presented with cirrhosis while the female patient had iridocyclitis. Both individuals continued with secukinumab for at least 32 weeks and no adverse reactions were observed during follow-up.

The 50-year-old female patient originally presented with plaque psoriasis lesions at age 26. Her erythroderma was initially relieved under oral acitretin but soon gradually thickened and spread to the whole body, authors wrote. In July of 2019 she presented to a dermatology clinic with extensive erythroderma (100% BSA) and a PASI score of 40.

Following once weekly treatment of 300 mg of secukinumab subcutaneously between weeks 0 through 4, and 300 mg every 4 weeks, the patients PASI score and BSA decreased to 9.8% and 40.45%, respectively, at week 4. By week 12, she achieved a 90% reduction in PASI score with no adverse events, while at 32 weeks she remained free of relapse and adverse events.

Similarly, a 46-year-old man who was diagnosed with plaque psoriasis during adolescence achieved initial alleviation using oral acitretin treatment at age 38. In May 2019, the drug exhibited decreased efficacy and the patient was admitted in July 2019 with extensive erythroderma (PASI 28, BSA 80%). The patient also exhibited signs of early cirrhosis caused by the drug and other factors, though tests revealed normal liver and kidney function.

At weeks 0,1,2,3, and 4 the male patient injected 300 mg of secukinumab, followed by a 300 mg dose once every 4 weeks. At week 4, the patients PASI score and BSA decreased to 7.6 and 29.6%, respectively. Results were sustained without any side effects after 40 weeks.

National Psoriasis Foundation guidelines, updated in 2010, recommend cyclosporine or infliximab as first-line therapy for unstable cases of EP and acitretin or methotrexate for patients who present with less acute disease.

However, traditional treatments, including acitretin, cyclosporine, methotrexate, and supportive symptomatic treatment, often have limited efficacy and adverse effects, which do not meet the expectations of patients, authors wrote.

Because patients in China typically use traditional Chinese medicine for initial treatment, individuals have often already developed moderate or severe psoriasis by the time they seek professional help.

As noted with other biologic drugs, the metabolism of secukinumab is not affected by renal function, and hemodialysis does not seem to affect its plasma concentration, researchers said.

Future clinical trials with large samples ought to be carried out to support findings while personalized plans based on patient characteristics to ensure retention rates and reduce adverse reactions are warranted.

Secukinumab may be a viable, rapid treatment option for patients with EP who experience failure of multiple therapies, authors concluded.

Reference

Liu L, Jin X, Sun C, and Xia J. two cases of refractory erythrodermic psoriasis effectively treated with secukinumab and a review of the literature. Dermatol Ther. Published online February 2, 2021. doi:10.1111/dth.14825

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Researchers Report 2 Cases of Erythrodermic Psoriasis Effectively Treated With Secukinumab - AJMC.com Managed Markets Network