Category Archives: Psoriasis

February 22, 2017

Psoriasis is a lifelong disease that is associated with significant cosmetic and physical disability and puts patients at increased risk for many major medical disorders. A multidisciplinary team of researchers at the University of Calgary, Canada, have found that psoriasis patients who developed depression were at a 37% greater risk of subsequently developing psoriatic arthritis, compared with psoriasis patients who did not develop depression. Their findings are published in the Journal of Investigative Dermatology.

Psoriasis is a long-lasting inflammatory skin disease characterized by red, itchy, and scaly patches of skin. Approximately 8.5% of psoriasis patients have psoriatic arthritis, which is characterized by psoriasis plus inflammation of and around the joints.

"For many years, the rheumatology and dermatology communities have been trying to understand which patients with psoriasis go on to develop psoriatic arthritis and how we might detect it earlier in the disease course," explained senior investigator Cheryl Barnabe, MD, MSc, of the McCaig Institute for Bone and Joint Health and the O'Brien Institute for Public Health, Cumming School of Medicine, at the University of Calgary, Alberta, Canada.

Depression is common among patients with psoriasis. Based on recent laboratory work demonstrating that major depressive disorder is associated with increased systemic inflammation, the team of researchers hypothesized that psoriasis patients who develop depression are at increased risk of subsequently developing psoriatic arthritis.

Investigators used The Health Improvement Network (THIN), a primary care medical records database in the United Kingdom, to identify over 70,000 patients with a new diagnosis of psoriasis. Through follow-up records, they identified individuals who subsequently developed depression and those who developed psoriatic arthritis. Patients were followed for up to 25 years or until they developed psoriatic arthritis.

Statistical analysis showed that patients with psoriasis who developed major depressive disorder were at 37% greater risk of subsequently developing psoriatic arthritis compared with patients who did not develop depression, even after accounting for numerous other factors such as age and use of alcohol.

The study highlights the need for physicians to manage patients with psoriasis to identify and address depression. This could include rapid, effective treatment of psoriasis and psychosocial management of the cosmetic burden of psoriasis. The study also draws into question the biological mechanisms by which depression increases the risk for developing psoriatic arthritis. These mechanisms may include altered systemic inflammation as a consequence of depression, or even the role of lifestyle behaviors such as physical activity or nutrition, which are typically worsened by depression, and which may place an individual at risk for psoriatic arthritis.

"There is a tendency to think of depression as a purely 'psychological' or 'emotional' issue, but it also has physical effects and changes in inflammatory and immune markers have been reported in depressed people," commented Scott Patten, MD, PhD, the O'Brien Institute for Public Health, Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine. "Depression may be a risk factor for a variety of chronic conditions and this research is an example of how big data approaches can identify these associations."

Laurie Parsons, MD, of the Cumming School of Medicine, added: "It is evident to physicians who treat patients with psoriasis, that there is a significant psychological and social burden associated with this disease, which is reflected in an increase in the rates of depression. This study brings us a little closer to understanding the role of chronic inflammation as a systemic player in both the physical and psychological manifestations of psoriasis and underscores the need for closer attention to symptoms of depression in this group of patients."

"This study raises important questions on the role of systemic inflammation, which is also elevated in depression, in driving a disease phenotype, which needs to be confirmed in clinical cohorts," concluded Dr Barnabe.

Explore further: Higher risk for depression with psoriasis

More information: "Depression Is Associated with an Increased Risk of Psoriatic Arthritis among Patients with Psoriasis: A Population-Based Study," by Ryan T. Lewinson, PhD, Isabelle A. Vallerand, PhD, Mark W. Lowerison, MSc, Laurie M. Parsons, MD, Alexandra D. Frolkis, PhD, Gilaad G. Kaplan, MD, MPH, Andrew G.M. Bulloch, PhD, Mark G. Swain, MD, MSc, Scott B. Patten, MD, PhD, and Cheryl Barnabe, MD, MSc, Journal of Investigative Dermatology, volume 137, issue 4 (April 2017) dx.doi.org/10.1016/j.jid.2016.11.032

(HealthDay)There is an increased risk of depression among women with psoriasis, according to a study published online July 17 in the British Journal of Dermatology.

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(HealthDay)The incidence of psoriatic arthritis (PsA) is 2.7 cases per 100 psoriasis patients, with risk factors including severe psoriasis phenotype and low level of education, according to a study published in the April ...

The chronic inflammatory skin condition psoriasis was associated with the risk of major depression, although the risk was unrelated to the severity of the disorder, according to an article published online by JAMA Dermatology.

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Depression puts psoriasis patients at significantly greater risk of psoriatic arthritis - Medical Xpress

A new drug to treat moderate-to-severe plaque psoriasis carries a black box warning that suicidal ideas and behavior, including completed suicides, have occurred in patients during the drugs clinical trials.

While FDA recently approved Siliq (Valeant Pharmaceuticals), the agency said the drug is only available through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the Siliq REMS Program. Prescribers must be certified with the program and counsel patients about this risk. Pharmacies must also be certified with the program and can only dispense Siliq to patients who are authorized to receive it.

Related:Clear skin within reach for psoriasis patients

In addiiton, patients must sign a Patient-Prescriber Agreement Form and be made aware of the need to seek medical attention should they experience new or worsening suicidal thoughts or behavior, feelings of depression, anxiety or other mood changes.

Valeant plans to start marketing the drug in the second half of 2017.

Siliq is intended for patients who are candidates for systemic therapy (treatment using substances that travel through the bloodstream, after being taken by mouth or injected) or phototherapy (ultraviolet light treatment) and have failed to respond, or have stopped responding to other systemic therapies.

Related:6 facts to know about the new psoriasis drug

"Moderate-to-severe plaque psoriasis can cause significant skin irritation and discomfort for patients, and todays approval provides patients with another treatment option for their psoriasis," said Julie Beitz, MD, director of the Office of Drug Evaluation III in the FDAs Center for Drug Evaluation and Research, in a FDA statement. "Patients and their health care providers should discuss the benefits and risks of Siliq before considering treatment."

Siliqs safety and efficacy were established in 3 randomized, placebo-controlled clinical trials with a total of 4,373 adult participants with moderate-to-severe plaque psoriasis who were candidates for systemic therapy or phototherapy. More patients treated with Siliq compared to placebo had skin that was clear or almost clear.

The most common adverse reactions reported with the use of Siliq include joint pain (arthralgia), headache, fatigue, diarrhea, throat pain (oropharyngeal pain), nausea, muscle pain (myalgia), injection site reactions, influenza, low white blood cell count (neutropenia) and fungal (tinea) infections.

Read more:New biosimilar for RA to save millions

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Psoriasis drug approved with boxed warning | Formulary Journal - ModernMedicine

Chicago Sun-Times

Ask the Doctors: Healthy diet can restrict psoriasis flare-ups Chicago Sun-Times Dear Doctor: I've had psoriasis for close to seven years, and lately it has been flaring up more often. Is there anything I can do with my diet to control this, or even prevent it from happening? Dear Reader: That's a good question. Thanks to the ...

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Ask the Doctors: Healthy diet can restrict psoriasis flare-ups - Chicago Sun-Times

Back to Browse Journals Psoriasis: Targets and Therapy Volume 7

Marina Agozzino,1 Cecilia Noal,2 Francesco Lacarrubba,3 Marco Ardig4

1Dermatology Unit, Second University of Naples, Naples, 2Dermatology Unit, University of Trieste, Trieste, 3Dermatology Clinic, University of Catania, Catania, 4Clinical Dermatology Department, San Gallicano Dermatological Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy

Abstract: Reflectance confocal microscopy (RCM) evaluation of inflammatory skin diseases represents a relatively new technique that, during the past 5years, has attracted increasing interest, with consequent progressive increment of publications in literature. The success of RCM is directly related to the high need for noninvasive techniques able to both reduce the number of skin biopsies and support clinical diagnosis and patient management. RCM helps to visualize microscopic descriptors of plaque psoriasis (PP) with good reproducibility between observers and a high grade of correspondence with histopathology. Several clinical tests are used for the therapeutic management of PP, but they are limited by subjective interpretation. Skin biopsy presents objective interpretation, but the procedure is invasive and not repeatable. RCM has been used not only for the evaluation of skin cancer or inflammatory skin diseases, but also for monitoring the efficacy of different treatments in PP. In this review, we present some examples of RCM applications in therapeutic psoriasis follow-up.

Keywords: reflectance confocal microscopy, psoriasis noninvasive follow-up, psoriasis monitoring

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Monitoring treatment response in psoriasis: current perspectives on the clinical utility of reflectance confocal ... - Dove Medical Press

Espedilla: Beating Psoriasis at home (part 3) | SunStar Sun.Star Psoriasis would be a lot worse if you won't kick the habit of smoking. In fact, one study have shown that people who smoked more than a pack a day were twice as likely to have a serious case of psoriasis than those who smoked half a pack or less. Women ...

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Espedilla: Beating Psoriasis at home (part 3) | SunStar - Sun.Star

People with psoriasis who havent seen improvement with standard treatments now have a new option. The Food and Drug Administration (FDA) has approved the injectable drug Siliq (broadalumab) for the treatment of moderate-to-severe plaque psoriasis in adults.

Because of an association with suicidal thoughts and behaviors, Siliq will be sold with a "black box" warning and should be considered only for patients whose psoriasis has not respondedor has stopped respondingto phototherapy or to other systemic medicines taken orally or via injection.

Plaque psoriasis is an autoimmune condition that causes cells to build up on the surface of the skin, forming thick red patches and flaky silver-white scales. Current treatment options for psoriasis include topical treatments (like corticosteroids) phototherapy (using an ultraviolet light box or a laser) and systemic drugsdelivered via a pill, an injection or an IV infusionthat work throughout the body.

Siliq is unique because it binds to the receptor of a protein called interleukin-17, a known contributor to inflammation. By blocking the receptor from being activated, it keeps the body from receiving signals that can fuel inflammatory responses and psoriasis progression. Two other psoriasis drugs currently on the market work similarly, but instead bind to the protein itself.

This small difference is significant, says Dr. Richard Fried, a member of the National Psoriasis Foundation medical board, since responses to drug treatments can vary dramatically from person to person. "Having another agent in our armamentarium that works by a different mechanism is a welcome addition and may prove beneficial to many psoriasis suffers," he says in an email. (Fried says he has no involvement with the drug or the drug company.)

In the three clinical trials considered for drug approval, more than 50% of patients who used Siliq achieved total skin clearancethe ultimate goal of psoriasis treatmentswithin a year. The most common side effects of the drug were joint and muscle pain, headache, fatigue, diarrhea, throat pain, nausea, flu, low white blood cell count, fungal infections and reactions at the injection site.

The drug also comes with a more serious warning, as well. In a total of six clinical trials totaling about 6,200 participants, six suicides were reported by people receiving Siliq. People with a history of suicide attempts or depression had an increased risk of suicidal ideation and behavior.

Because of these events, the labeling for Siliq will include a Boxed Warning, and the drug will only be available through a restricted REMS (Risk Evaluation and Mitigation Strategy) program. In order to prescribe it, doctors must be certified with the program and must counsel patients about this risk. Patients must also agree to seek medical attention should they experience new or worsening mood changes, anxiety or suicidal thoughts.

A causal association between Siliq and increased risk of suicidal ideation and behavior has not been established. Fried, a dermatologist and clinical psychologist, points out that psoriasis itself can be associated with mental health problems .

"E ffective treatment has consistently shown reduction in the incidence and severity of depression and reduced likelihood of suicide," says Fried. He adds that the data on Siliq suggests that it is not only effective in treating psoriasis, but that many patients experience improvement in anxiety and depression, as well.

Siliq, like other psoriasis medications, also affects the immune system. It can raise patients risk of infections and shouldnt be used by people with certain chronic conditions, such as Crohns disease or active tuberculosis infections. People should also avoid immunizations with live vaccines while being treated with Siliq.

"Patients and their health care providers should discuss the benefits and risks of Siliq before considering treatment," said Dr. Julie Beitz, director of the Office of Drug Evaluation III in the FDAs Center for Drug Evaluation and Research, in an agency press release .

The drug's recommended dosage schedule is an injection once a week for the first three weeks, followed by an injection every other week. Valeant Pharmaceuticals, Siliq's manufacturer, says that pricing information is not available at this time, and expects to begin sales and marketing in the second half of 2017.

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How a New Psoriasis Drug Is Different From Others - TIME

THURSDAY, Feb. 16, 2017 (HealthDay News) -- The injected drug Siliq (brodalumab) has been approved by the U.S. Food and Drug Administration to treat moderate-to-severe plaque psoriasis in adults.

Siliq is approved for patients who've already failed to respond to other systemic therapies, the agency noted.

The autoimmune disease -- so-called because the immune system produces antibodies that attack the body's own tissues -- causes thick, scaly patches of red skin. The drug is designed to inhibit the body's inflammatory response that plays a role in the development of plaque psoriasis, the FDA said in a news release.

The disease occurs most often in people with a family history, usually between ages 15 and 35.

Saliq was evaluated in clinical studies involving more than 4,300 people with moderate-to-severe plaque psoriasis. The most common side effects included joint pain, headache, fatigue, diarrhea, throat pain, nausea, muscle pain and injection-site reactions.

More-serious potential side effects are suicidal thoughts and behavior, especially among people with a history of suicidal behavior or depression, the FDA said. But "a causal association between treatment with Siliq and increased risk of suicidal ideation and behavior has not been established," the agency added.

The drug's label will include a boxed warning of possible suicidal thoughts and behavior, the FDA said. The agency also warned against the drug's use by people with the gastrointestinal disorder Crohn's disease or active tuberculosis.

Siliq is marketed by Valeant Pharmaceuticals, based in Bridgewater, N.J.

The FDA has more about this approval.

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Siliq Approved for Plaque Psoriasis - Montana Standard

By Robert Preidt

HealthDay Reporter

THURSDAY, Feb. 16, 2017 (HealthDay News) -- A new drug to treat tough cases of the skin condition psoriasis has won approval from the U.S. Food and Drug Administration.

Valeant Pharmaceuticals' injectable drug Siliq (brodalumab) was approved for adults with moderate-to-severe psoriasis that isn't responding to other recommended treatments. However, the drug carries a warning about increased risk for suicidal behavior.

Psoriasis is characterized by raised patches of red skin and flaking. The condition usually begins between ages 15 and 35 and is thought to be an autoimmune disorder, meaning the body mistakenly attacks healthy cells.

"Moderate-to-severe plaque psoriasis can cause significant skin irritation and discomfort for patients, and today's approval provides patients with another treatment option for their psoriasis," said the FDA's Dr. Julie Beitz.

Beitz is director of the Office of Drug Evaluation III in the FDA's Center for Drug Evaluation and Research.

The drug is intended for patients who are candidates for systemic therapy -- treatment with pills or injectable drugs that travel through the bloodstream -- or phototherapy (ultraviolet light treatment), and have failed to respond or stopped responding to past therapies, the FDA said.

The drug works by inhibiting the inflammatory response that contributes to development of plaque psoriasis, the most common form of the skin disease, the FDA said.

Siliq's approval was based on three clinical trials that included more than 4,300 patients. Compared to those who took a placebo, more of those participants who took the drug had skin that was clear or almost clear, the agency said.

However, the drug carries a "boxed warning" about the risk of suicidal thoughts and attempts and it's only available through a suicide risk evaluation program, the FDA said.

Among patients who took Siliq, those with a history of suicide attempts or depression had greater risk of suicidal thoughts and attempts compared to others, according to trial results. However, a direct cause-and-effect relationship wasn't established.

"Patients and their health care providers should discuss the benefits and risks of Siliq before considering treatment," Beitz said in an agency news release.

Because Siliq affects the immune system, patients also may have a greater risk of getting an infection, or an allergic or autoimmune condition, the FDA said.

The most common side effects reported in the trials included joint and muscle pain, headache, fatigue, nausea or diarrhea, low white blood cell count and fungal infections.

WebMD News from HealthDay

SOURCE: U.S. Food and Drug Administration, news release, Feb. 15, 2017

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FDA OKs Injectable Psoriasis Drug for Tough Cases - WebMD

eMaxHealth

Natural Treatment For Psoriasis Unlinks The Condition To Type 2 Diabetes With Unlimited Healing eMaxHealth Psoriasis is a skin issue that some might say has nothing to do with diabetes, but let's look at the liver again. To break it down, one known cause of psoriasis is an overload of copper in the body, according to a 2013 study done in Iranian patients ...

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Natural Treatment For Psoriasis Unlinks The Condition To Type 2 Diabetes With Unlimited Healing - eMaxHealth

Marion Morrissey from Co Limerick was diagnosed with psoriasis at 15.

Living with a chronic skin condition can be very difficult as although it may not be life threatening, treatment can be all-consuming and the anxiety caused by such a visible disorder can take its toll.

Up to 140,000 people in Ireland suffer from psoriasis, an auto-immune disorder which causes the skin to reproduce at a rapid pace resulting in itchy, painful scales all over the body, including the scalp and nails.

And if this discomfort wasnt enough, 40,000 will go on to develop psoriatic arthritis which affects the back and joints causing severe pain and immobility.

This month, Arthritis Ireland has launched a campaign entitled More than Skin Deep, which provides expert information on the condition and advice for sufferers.

There is a lot of research going on in Ireland into psoriatic arthritis and its causes, says consultant rheumatologist Prof David Kane.

These are mainly looking at the genes that cause the condition in families and using ultrasound imaging and synovial tissue biopsy of the joints to study patients who have the disease in order to find new targets for treatments.

For immediate pain relief there are a range of painkillers but these do not deal with the underlying inflammation which will ultimately lead to permanent joint damage.

But fortunately there are now a lot of specific treatment options for psoriatic arthritis that will reverse the joint inflammation, reduce pain and prevent joint damage.

Marion Morrissey from Co Limerick knows only too well what it is like to have the condition as she has suffered with it since she was a teenager.

I was diagnosed with psoriasis at 15 so have lived with the condition for more years than I have lived without it and it has affected absolutely everything in my life, says the 39 year old.

My initial diagnosis was of a very dry flaky scalp at the hairdressers. I then went to my GP who diagnosed psoriasis. But that GP (and many others since), didnt have much time or empathy as psoriasis wasnt perceived to be serious as its not usually life threatening.

But my condition got progressively worse until I had almost 75 per cent body coverage. Then when I was 24 I got nail psoriasis which looks like a fungal infection there was no treatment for this but luckily, being female, I could paint my nails. Over the years I have tried every treatment available from conventional to alternative creams, lotions, ointments, sprays, moisturisers, shampoos and PUVA light treatment anything that offered even a glimmer of hope, but none really worked.

Morrissey, who is married with three children and runs her own healthcare training company, http://www.safeaid.ie, was dealt a further blow when the skin condition transferred to her joints.

I developed psoriatic arthritis aged 32 and became really worried about my quality of life, she admits. The pain and stiffness started in my fingers and toes it was really severe especially in the mornings, really affecting my ability to carry out normal daily activities.

My fingers and toes would be hot and throbbing and had a sausage-like appearance so this along with the stiffness and pain made many tasks difficult. Driving was affected as getting a grasp on the steering wheel and pressing on the pedals was hard due to the pain in my toes. Even brushing my daughters hair was a problem as I couldnt hold the brush and this really took its toll emotionally.

The pain and stiffness spread to her knees, ankles, elbows and neck until eventually Morrissey sought help. She was diagnosed with psoriatic arthritis and put on medication and while it took several different drugs to discover which would work best for her condition, her current medication is keeping the pain under control and for the first time in years, she is living life to the full.

I got my official diagnosis from a rheumatologist who gave me steroid injections in my fingers and toes, says Morrissey. But this only worked for a month or so before the symptoms came back. Then I was put on many different types of anti-inflammatory drugs which also just kept things at bay for a while before I got significantly worse.

The pain was so bad at one point that I had to set my alarm for 4am in order to take a cocktail of medication so I could function and get downstairs by 7am. With a new baby and two older children, this was incredibly difficult, particularly as I was also trying to keep my business going.

But 4 years ago I was started on a different drug and I havent looked back since. I have been given my life back and cannot even begin to compare it now to what it was before.

I am totally symptom-free and to date, havent experienced any side effects. I live a very full and busy life both at home and in work and I am very thankful.

My advice for anyone who has just been diagnosed with psoriasis or psoriatic arthritis is to be assertive and keep going until you find the right treatment as the results can be life changing.

Kane says lifestyle changes can also help ease the often crippling symptoms of this condition.

Medication is the cornerstone of treatment for psoriatic arthritis, he says. But patients can also help manage their condition by having a healthy diet, managing their weight to reduce the strain on their lower limb joints, exercising to keep joints and muscles healthy, managing stress levels and seeking help for anxiety and depression.

Anyone who is concerned they may have the condition should raise this with their GP or dermatologist both should be able to spot early signs of psoriatic arthritis.

For more information visit http://www.arthritisireland.ie

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Psoriasis has affected absolutely everything in my life - Irish Times