Category Archives: Psoriasis

Although previous studies suggest that psoriasis may be independently associated with an increased risk of serious infectionthat which leads to hospitalizationthe research had various limitations, and thus, the relationship remains unclear, explains Zenas Yiu, PhD. In a study published in the British Journal of Dermatology, Dr. Yiu and colleagues sought to determine if patients with psoriasis, when compared with those without the condition, have a higher risk of hospitalization due to any infection, respiratory infections, soft tissue and skin infections, or death due to infection.

Using data from the nationally representative UK Clinical Practice Research Datalink linked to Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality records between January 2003 and December 2016, the researchers matched adults with psoriasis with up to six comparators on age, sex, and general practice. Hospitalization due to infection was ascertained from HES records and death from ONS mortality records. Stratified Cox proportional hazard models were estimated, with stepwise adjustment in different models for confounding factors, including body mass index, smoking, alcohol intake, socioeconomic status, and comorbid conditions. Approximately 70,000 patients with psoriasis and nearly 340,000 comparators were followed for a median of about 5 years.

People with psoriasis had a higher incidence rate of serious infection, at 20.5 per 1,000 person-years, than the comparators, at 16.1 per 1,000 person-years, says Dr. Yiu. After adjustment, people with psoriasis had a 36% increased relative probability of developing a serious infection during follow-up compared with the general population (hazard ratio, 1.36). However, this only translated to three out of 100 more people with psoriasis developing a serious infection after 10 years of follow-up, compared with the general population.

Dr. Yiu notes that while patients with psoriasis were found to have a small but increased risk of serious infection when compared with those without the condition, because the absolute increased probability of serious infection is small, people with psoriasis should not be unduly concerned. We recommend further research to investigate whether this slight increase in the risk of infection can be explained by biological mechanisms.

Risk of Hospitalization and Death due to Infection in People with Psoriasis: a Populationbased Cohort Study using the Clinical Practice Research Datalinkhttps://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.19052

More here:
Infection-Related Hospitalization & Mortality in Patients With Psoriasis - Physician's Weekly

AbbVie has submitted an application to the Food and Drug Administration (FDA) for review of upadacitinib in the treatment of active psoriatic arthritis (PsA) in adults.

The application is supported by data from two phase 3 studies (SELECT-PsA 1 and SELECT-PsA 2) that assessed the efficacy and safety of upadacitinib (15mg and 30mg) in more than 2000 adults with active PsA. SELECT-PsA 1 compared upadacitinib with placebo and adalimumab; SELECT-PsA 2 compared upadacitinib with placebo. The primary end point for both studies was the proportion of patients who achieved an American College of Rheumatology (ACR) 20 response at week 12.

Results from SELECT-PsA 1 showed that upadacitinib 15mg and 30mg achieved noninferiority at week 12 compared with adalimumab, with the 30mg dose showing superiority. Both doses of upadacitinib achieved statistically significant ACR20, ACR50, and ACR70 responses at week 12 compared with placebo, along with significant improvements for key secondary end points, including the Health Assessment Questionnaire Disability Index (HAQ-DI), Psoriasis Area Severity Index (PASI 75), and Minimal disease activity (MDA).

Additionally, findings from SELECT-PsA 2 demonstrated both doses of upadacitinib achieved statistically significant ACR 20, ACR50, and ACR70 responses at week 12 compared with placebo. Both doses of upadacitinib also achieved statistically significant responses for PASI 75 and MDA compared with placebo.

With regard to safety, upadacitinib demonstrated a profile consistent with that seen in previous clinical studies.

Upadacitinib, a selective and reversible Janus Kinase (JAK) inhibitor, is currently marketed under the brand name Rinvoq and is indicated for the treatment of moderately to severely active rheumatoid arthritis in adults who have had an inadequate response or intolerance to methotrexate.

For more information visit abbvie.com.

Read more from the original source:
Upadacitinib Application for Active Psoriatic Arthritis Submitted for Review - Monthly Prescribing Reference

Novartis' Cosentyx lost a race against Eli Lilly's Taltz after the latter scored an FDA approval in spondyloarthritis earlier this week. But Cosentyx, which facesan FDA review in that indication, is touting long-term data that will help it keep the pressure on Lilly's rival.

The drugbestedplacebo atreducing the symptoms ofnon-radiographic axial spondyloarthritis in patients after 52 weeks, according to long-term data from the phase 3 Prevent study released Thursday at the European League Against Rheumatology (EULAR)meeting.

The 52-week data adds to earlier 16-week data that showed Cosentyx significantly reduced disease symptoms over placebo. More than 35%of patients treated with Cosentyx hit the study's primary endpoint of reducing a targeted set of disease symptoms at 52 weeks compared with 19% of patients taking placebo. At 16 weeks, 42.2% of patients hit the same markversus 29.2% for placebo.

Cosentyx notched a European MedicinesAgency approval to treat non-radiographic axial spondyloarthritis in April and has already filed for regulatory approval in the U.S. and Japan.

The newest Cosentyx data will keep things competitive with Lilly's Taltz, which scored an FDA approval earlier this week as the first IL-17 inhibitor green-lighted in that indication.

RELATED:Eli Lilly's Taltz beats Novartis to the punch with FDA approval in spondyloarthritis

Taltz won its approval based onresults from the phase 3 Coast-X trial, which showed 30% of patients treated with Taltz saw reduced targeted disease symptoms after 52 weeks of treatment compared with 13% of patients treated with placebo.

At 16 weeks, 35% of Taltz patients stayed above that mark compared with 19% of placebo patients.

Non-radiographic axial spondyloarthritis is believed to affect more than 1 million U.S. patients each year, Lilly said.An FDA approval for Cosentyx would be the drug'sfourth, as it was for Taltz; both drugs are also cleared in psoriatic arthritis, ankylosing spondylitis and psoriasis.

In March, UCBs anti-TNF antibody Cimzia became the first FDA-approved drugfor non-radiographic axial spondyloarthritis. But that drug carries a boxed warning about the increased risk of serious infections.

RELATED:Novartis' Cosentyx can't top AbbVie's Humira in head-to-head psoriatic arthritis contest

Lilly and Novartis are not only jockeying for position in spondyloarthritis. The companies are also battling it out across their other indications.

In June, Lilly posted head-to-head phase 3 trial data showing TaltzbestedAbbVie's megablockbuster Humira at reducing psoriatic disease activity by half and completely clearing patient skin after 24 weeks. Lilly also went after Johnson & Johnson's Tremfya in psoriasis with a round of phase 4 data, showing in early August its drug hadtoppedTremfya at achieving total skin clearance after 12 weeks of treatment.

Meanwhile, Cosentyx posted middling results in November in a head-to-head matchup with Humira,failing to outdo AbbVie's behemothin active psoriatic arthritis patients.

While Cosentyx helped more patients numerically reach ACR20a benchmark on a commonly used scale from the American College of Rheumatology to measure joint swelling and moreits lead wasnt statistically relevant, Novartis said.

Editors' Note: This story has been updated to correct an error.

Continued here:
Novartis' Cosentyx chases Lilly's just-approved Taltz with long-term data in spondyloarthritis - FiercePharma

The challenges of the COVID-19 pandemic have spurred many marketers to create reassuring and empathetic TV ads, including some pharma companies. Several pharmas have adjusted TV strategies to run, along withtypical DTC or disease awareness commercials, ads that offerthanks to frontline healthcare workers ordetails about help to payfor medicine.

AbbVie is leading the way in televised financial support messages, starting with the Humira and Rinvoq brands. The pharma added messages to the end of those ads directed at people who have lost jobs or insurance during the crisis, with re-directs to where they can find assistance.

For Skyrizi, its newer-to-the-airwaves psoriasis medication, AbbVie created an entirely new spot talking about the challenging times and the potential for financial help. The commercial, which aired several times during the popular ESPN Sunday night series The Last Dance about basketball star Michael Jordan, speaks directly to patients who take Skyrizi, telling them financial assistance may be available to help you afford your medication.

RELATED:Pharma ups April TV spending for stuck-at-home viewers with AbbVie leading the way

The TV ads are part of the Illinois drugmaker'sbroader efforts to help patients continue to get their medications,AbbVie said in an emailed statement.

AbbVie understands this is a difficult time for patients affected by the COVID-19 crisis, and we are here to support them. Patients access news in a variety of ways, so AbbVie has updated television spots with COVID-19 support information, in addition to newspaper and social media ads to help increase awareness about our patient assistance resources, the statementsaid.

Other pharma companies offering financial assistancethat may be especially needed during the pandemic include Novo Nordisk for its diabetes brand Ozempic, Novartis for psoriasis med Cosentyx and Sunovion for bipolar depression treatment Latuda.

Some other pharma companies joined the broader thank you-themed TV ad trend that many brands have adopted. Marketers from Google and McDonalds to Dove and Glad are airing commercials expressing appreciation and pledging donations to help.

Pfizer, Amgen and Johnson & Johnson all created TV ads with messages of gratitude to people helping in the fight against COVID-19and offered hope for the future. Novartis also included thank-yous to heroic healthcare workers in a commercial for heart failure medicine Entresto as well as in the Cosentyx Connect financial assistance ad.

RELATED:AstraZeneca tackles COPD, asthma patients' COVID-19 concerns in new YouTube series

While the new ads offer help and hope, theyre also likely reaching more viewers. During the pandemic, the number of TV watchers has grown for the first time since 2012, according to market researcher eMarketer. It predicts an increase of 3% in TV viewer growth for the year, driven by stay-at-home orders during COVID-19, after more than seven years of single-digit slides. Still, the trend may not last for longeMarketer predicts a reversal in 2021 and an overall dip again next year.

Read more here:
AbbVie, Pfizer, Novartis and more air TV ads to offer COVID-19 thank-you's, support - FiercePharma

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.

Link:
Psoriasis: Causes, Triggers, Treatment, and More

Diagnosis

In most cases, diagnosis of psoriasis is fairly straightforward.

Psoriasis treatments reduce inflammation and clear the skin. Treatments can be divided into three main types: topical treatments, light therapy and systemic medications.

Used alone, creams and ointments that you apply to your skin can effectively treat mild to moderate psoriasis. When the disease is more severe, creams are likely to be combined with oral medications or light therapy. Topical psoriasis treatments include:

Topical corticosteroids. These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They reduce inflammation and relieve itching and may be used with other treatments.

Mild corticosteroid ointments are usually recommended for sensitive areas, such as your face or skin folds, and for treating widespread patches of damaged skin.

Your doctor may prescribe stronger corticosteroid ointment for smaller, less sensitive or tougher-to-treat areas.

Long-term use or overuse of strong corticosteroids can cause thinning of the skin. Topical corticosteroids may stop working over time. It's usually best to use topical corticosteroids as a short-term treatment during flares.

Topical retinoids. These are vitamin A derivatives that may decrease inflammation. The most common side effect is skin irritation. These medications may also increase sensitivity to sunlight, so while using the medication apply sunscreen before going outdoors.

The risk of birth defects is far lower for topical retinoids than for oral retinoids. But tazarotene (Tazorac, Avage) isn't recommended when you're pregnant or breast-feeding or if you intend to become pregnant.

Calcineurin inhibitors. Calcineurin inhibitors tacrolimus (Prograf) and pimecrolimus (Elidel) reduce inflammation and plaque buildup.

Calcineurin inhibitors are not recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma. They may 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.

Coal tar. Derived from coal, coal tar reduces scaling, itching and inflammation. Coal tar can irritate the skin. It's also messy, stains clothing and bedding, and has a strong odor.

Coal tar is available in over-the-counter shampoos, creams and oils. It's also available in higher concentrations by prescription. This treatment isn't recommended for women who are pregnant or breast-feeding.

This treatment uses natural or artificial ultraviolet light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight.

Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with medications.

Psoralen plus ultraviolet A (PUVA). This form of photochemotherapy 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 severe psoriasis or it's resistant to other types of treatment, your doctor may prescribe oral or injected drugs. This is known as systemic treatment. Because of severe side effects, some of these medications are used for only brief periods and may be alternated with other forms of treatment.

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 those patients with typical skin lesions (plaques) and then progress to stronger ones only if necessary. Patients 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.

There are a number of new medications currently being researched that have the potential to improve psoriasis treatment. These treatments target different proteins that work with the immune system.

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 they may be helpful to some people in reducing signs and symptoms, such as itching and scaling. These treatments would be most appropriate for those with milder, plaque disease and not for those with pustules, erythroderma or arthritis.

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 disease.

Although self-help measures won't cure psoriasis, they may help improve the appearance and feel of damaged skin. These measures may benefit you:

Coping with psoriasis can be a challenge, especially if the disease covers large areas of your body or is in places readily seen by other people, such as your face or hands. 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:

More:
Psoriasis - Diagnosis and treatment - Mayo Clinic

Editor's Note: This story is part of a new series on HealthCentral called "Get Your Ph.D.!", which is geared toward people who've got the basics of their condition down and want to up their expertise. Who's ready to go pro?!

If psoriasis had a street name, it would be known as Slim Shady. Not only does the exact cause of this condition baffle even the best of scientific minds (genetics and an overactive immune system are possible culprits, as are triggers like stress, skin trauma, and weight gain), but its characteristic itchy and painful lesions can crop up anywhere from head to toe. In the world of skin conditions, psoriasis is all kinds of sly.

While there are effective treatments available to manage symptoms and stop them from getting worseincluding topicals, ultraviolet light therapy, oral meds, and biologics, which target the immune systemthere is yet to be a foolproof, one-size-fits-all cure. Whats more, larger implications about the relationship between psoriasis and other diseases are still a question mark. Now, thanks to groundbreaking studies from some seriously smart researchers, there is new hope for a better understanding and treatment of the condition. We talked with three of these doctors to find out what theyre working on. Caution: Majorly impressive science ahead.

MEET THE EXPERT:

Title: Head of the Lab of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute (NHLBI)

Research: Exploring the link between psoriasis inflammation and heart disease

Skin health isnt usually among the conditions a cardiologist studies, let alone treats, but for Nehal N. Mehta, M.D., psoriasis plays a starring role in his research.

It started with a single patient. I met a 45-year-old physician who had been having recurrent heart attacks with no real risk factors, and when I examined him, I saw a patch of psoriasis on his right inner thigh that hed had since med school, Dr. Mehta says.

It could have been nothing, but then again, there were no other clues to go on. Dr. Mehta started wondering. On a hunch, he and his team began examining scans of people with psoriasis, and what they found was startling: The condition was not just skin deep. When you look at these images, theres inflammation everywherein the joints, in the skin, in the liver, in the spleenthis is a whole-body disease, Dr. Mehta says.

Then they applied those findings to people who also had a heart attack. It was a eureka moment. Even if you accounted for all the other risk factors people had for cardiovascular disease, if they had psoriasis, it increased their risk for a heart attack by 53 percent, Dr. Mehta says.

As it turns out, the same overactive immune cells in the skin that lead to psoriasis can also be found in the heart arteries. In the arteries, however, the immune system is associated with plaque buildupa major risk for heart attack. So if you treat the psoriasis thats causing the immune system to be overactive, says Dr. Mehta, you can also reduce the risk of heart artery disease. Treating remote inflammation in the body can reduce the plaque that leads heart disease and heart attack, he says.

The treatment he uses is a biologic medicationa protein-based injectible drug created from living cells that targets the areas of the immune system associated with psoriasis. Using a biologic treatment redistributes fat in your body in a beneficial way, so youre not only improving the skin but also HDL, the bodys good cholesterol, as well as glucose levels which reduces the risk for diabetes.

Why are these findings so crucial? In addition to showing that patients with psoriasis may warrant early heart disease intervention, says Dr. Mehta, it also reveals a new risk factor (and treatment) for people with heart conditions. Along with diabetes, hypertension, high cholesterol, family history, and smoking, inflammation from psoriasis is an important variable in cardiac events. You have patients who are now learning about a sixth risk factor for heart attacksits pretty wild, he says.

MEET THE EXPERT:

Title: Director of the Psoriasis and Phototherapy Treatment Center and Professor of Dermatology at University of Pennsylvania Perelman School of Medicine

Research: Studying the benefits of at-home phototherapy treatment

Long used to help treat psoriasis, Ultraviolet B phototherapy improves symptoms by penetrating the top layer of the skin with narrowband UVB light, preventing skin cells from growing too quickly. Patients prefer it to systemic medications because its virtually free of side effects. But phototherapy is expensive, time consuming (it requires 12 weeks of in-office treatments), and not always covered by insurance.

Enter: Joel Gelfand, M.D., the director of the Psoriasis and Phototherapy Treatment Center and a professor of dermatology at University of Pennsylvania Perelman School of Medicine. Dr. Gelfand is studying the effects of at-home phototherapy as a lower cost, more accessible alternative to in-office treatments, so that more people can benefit from it.

Helming whats known as the LITE Study, Gelfand and his team are conducting an ongoing randomized, controlled study of 1,050 patients to compare the effectiveness of home-based phototherapy devices to office-based treatments. The study charts the success rate and safety of 12 weeks of therapy in both environments. It also documents the outcomes for three different skin toneslight skin, olive to light brown skin, and dark brown to black skinto measure tolerance and effectiveness.

Up until now, there hasnt been enough data on at-home therapies, and this has led to decisional uncertainty from patients, dermatologists, and insurers, Dr. Gelfand says. What were doing is an example of real-world pragmatic research designed to shift the practice of medicine in a way thats more patient-centered.

Not only does the study aim to provide important data on treatment response in patients of different skin colors, but it will ultimately help broaden the options for anyone struggling with this disease. Says Dr. Gelfand, Were trying to make phototherapy accessible and affordable to anyone who needs it.

MEET THE EXPERT:

Title: Assistant Professor at the University of Texas Southwestern

Research: Slowing cell metabolism to prevent hyper-skin growth linked to psoriasis

Heres the thing about psoriasis treatment: Because most medications broadly target the immune cells responsible for the disease in a system-wide way, they come with some serious side effects that are, in a word, uncomfortable. But, what if by simply targeting certain cell pathways the disease could be treated without side effects?

This is the question that lead Richard Wang, M.D., an assistant professor of dermatology at the University of Texas Southwestern, to start looking at glucose transport and metabolism to understand their roles in cell growth and division in conditions like psoriasis, which is characterized by skin overgrowth.

In a lab experiment, Dr. Wang and his team blocked glucose transport in the skin cells of mice using genetic and chemical inhibitors. Glucose is critical for cell survival and cell growth, Dr. Wang says. To maintain normal functioning throughout the body, glucose moves through transporters in very specific pathways so that growth and division of cells is controlled.

In people with psoriasis though, inflammation sends cells false signals that an infection is happening and those glucose transporters, which regulate the amount of glucose in cells, respond by letting more glucose in. All this extra glucose causes cells to divide, grow, and thickenresulting in the visible scales and inflamed skin characteristic of psoriasis. By blocking those glucose transporters in the mice, we were able to shut this process down, inhibiting the growth of skin cells and controlling inflammation without disrupting the skins normal functioning, Dr. Wang says.

While Dr. Wangs research is ongoing, the promise is clear: There is potential for a new, more targeted chemical inhibitor topical agent to treat humans with mild-to-moderate psoriasis without the side effects of traditional treatments, he says.

Read more from the original source:
Meet the Scientists on the Frontlines of Psoriasis Research - HealthCentral.com

The latest American Academy of Dermatology-National Psoriasis Foundation phototherapy guidelines incorporate several advances in efficacy, safety and patient convenience that were unavailable a decade ago.

RELATED:Biologic guidelines for psoriasis let providers choose

Weve come a long way in the field of phototherapy over the last 10 years, says M. Alan Menter, M.D. He is chairman of dermatology at Baylor University Medical Center, co-chair of the AAD Psoriasis Guideline Workgroup and founder of the International Psoriasis Council.

To produce the phototherapy guidelines, Dr. Menter and co-authors reviewed available data regarding previous phototherapy modalities, along with newer technologies including narrowband UVB (NB-UVB). With a wavelength of 290 to 320 nm, NB-UVB offers greater specificity and targeting for psoriasis and eczema than does broadband UVB (BB-UVB, 290 to 400 nm).

Formerly the mainstay of phototherapy, BB-UVB has been replaced by newer modalities. As monotherapy for adults with generalized plaque psoriasis, guidelines state, BB-UVB provides less efficacy than does NB-UVB, oral psoralen plus UVA (PUVA) or topical PUVA. Very few dermatologists still use oral PUVA, says Dr. Menter, although it works well for resistant psoriasis.

Now we also have intense electrodes and dye lasers, which are smaller lamps that penetrate much better for focal areas such as thick psoriasis patches on the elbows or knees, he says. Such technologies include excimer lasers (308 nm), targeted NB-UVB (311 to 313 nm) and pulsed-dye lasers (PDLs).

Whichever technology one chooses, guidelines emphasize the need to tailor dosing to the patients skin type. For example, minimal erythema dose (MED) testing with NB-UVB should begin at 250 mJ/cm2 for patients with skin types I and II, versus 350 mJ/cm2 for types III and IV.

Whereas Goeckerman therapy was a difficult, messy and time-consuming combination of light therapy and tar treatment, Dr. Menter says, physicians can supplement NB-UVB with concomitant topical therapies such as vitamin D analogs, retinoids and corticosteroids to potentially boost efficacy.

Disclosures:

Dr. Menter reports no relevant financial interests.

References:

Elmets CA, Lim HW, Stoff B, et al. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019;81:775-804.

Continue reading here:
Psoriasis guidelines reflect rise of NB-UVB, targeted and home therapies - Dermatology Times

Editor's Note: This story is part of a new series on HealthCentral called "Get Your Ph.D.!", which is geared toward people who've got the basics of their condition down and want to up their expertise. Who's ready to go pro?!

Scientists have long known that obesity and psoriasis go hand-in-hand. Like chips and salsa or gin and tonic, if you have one disease, youre likely to have the other. The reason is that a high BMI can lead to inflammation in the body, which increases the risk for developing the challenging skin condition known as psoriasisor worsening existing symptoms if you already have it. Now, a new study published in the Journal of Investigative Dermatology suggests there may be another mechanism at work: Fat cells themselves may not be the culprits, say researchers, but rather specific types of foods are to blame.

In the study, conducted at the University of California, two groups of mice were fed different diets. Once group got a typical mouse meal; the other one was given a characteristic Western diet (basically, the mouse equivalent of a moderate-to-high fat, processed-sugar diet that mimicked what humans would eat on the same meal plan). The mice kept it up for four weeks, after which scientists took stock of their skin, and found that the creatures whod been chowing on the rodent version of burgers, fries, and shakes showed visible inflammatory changes including redness, scales, and thickened skinthe same hallmark symptoms consistent with human psoriasiseven if the mice hadnt appreciably gained weight.

This is important because many people think that its obesity alone that leads to the increased risk for psoriasis, says senior study author Sam T. Hwang, M.D., Ph.D., department chair and professor of dermatology at the University of California Davis School of Medicine. What this shows is that dietary changes can have a radical impact on the skinso its not just weight that makes a difference for developing psoriasis, but the types of foods you eat.

These so-called Western foods are typically high in saturated fat (butter, red meat, cheese and other dairy products made from whole milk, for example), plant-based oils (such as palm oil, coconut oil, and canola oil) and processed ingredients, like those in many baked goods. The foods also contain high levels of simple sugars, found in fruit juices, soda, candy, and even some whole fruits like apples, bananas, and watermelon.

So, what is it about these foods, common in American diets, that causes inflammation in the first place? Researchers believe they alter the composition of the microbiome, those billions of bacteria living in your gut that help maintain general health and the health of your immune system. Changing the balance of these bacteria through diet may ultimately lead to an inflammatory response related to psoriasis.

To break it down even further (we know, its complicated), high-fat foods cause bile acids from your gall bladder and liver to go into the gut to help with digestion, says Ronald Prussick, M.D., an assistant clinical professor of dermatology at George Washington University and medical director of the Washington Dermatology Center. These acids then cause bad bacteria to form, leading to inflammation inside the body.

What this all means: The study proposes that what you eat can alter the gut microbiome, causing changes in bile acid levels, which can affect inflammation.

This theory was tested in the study when the researchers administered cholestyramine, a drug used to lower cholesterol (high levels of which are found in fast foods and other western fare), to the mice and found that it helped reduce the risk of skin inflammation. Cholestyramine was shown to bind to bile acids in the intestine and release through the stool, allowing for inflammation to be lowered in the mice, Dr. Hwang says.

Doctors have long maintained that there is no single food that can treat or cure psoriasis, and thats still true. But if you have the skin condition or are at risk for the disease (which is frequently genetically determined), limiting or eliminating foods high in saturated fats and simple sugars can lessen the chances for inflammationand therefore possibly psoriasis, Dr. Hwang says.

What to eat instead? A Mediterranean-type diet, characteristically rich in healthy fats and omega-3 fatty acids, is known to help fight inflammation. It includes foods such as olive oil, avocados, nuts, seeds, fish like salmon and lake trout, and some meat or dairy from grass-fed animals, as well as fresh vegetables and fruits low on the glycemic index, like berries. Switching to a healthier diet can increase the chances of treating psoriasis more effectively, says Dr. Prussick.

Additionally, Dr. Prussick suggests cooking on lower heat by stewing, poaching, boiling, and steaming foods rather than grilling, frying, or toasting them. Heat causes sugars in foods to bind to proteins, known as advanced glycation end products (AGEs), which causes more inflammation, he says. He also recommends cooking with acids such as vinegar or lemon juice, which can reduce AGEs by 50%.

Read the original:
Psoriasis and Diet: What's the Link? - HealthCentral.com

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