Category Archives: Psoriasis

noviembre de 2014

La psoriasis es una enfermedad de la piel que causa descamacin e inflamacin (dolor, hinchazn, calentamiento y coloracin). Regularmente las clulas de la piel crecen desde las capas ms profundas y suben lentamente a la superficie, reemplazando constantemente a las clulas muertas de la superficie. Este proceso se llama renovacin celular, y tarda aproximadamente un mes. Con la psoriasis, la renovacin celular ocurre en slo unos pocos das, lo que provoca que las clulas nuevas suban demasiado rpido y se acumulen en la superficie.

En la mayora de los casos la psoriasis causa parches o placas de piel gruesa, enrojecida y con escamas plateadas. Estas placas pueden producir picor o dolor. A menudo se encuentran en los codos, las rodillas, otras partes de las piernas, el cuero cabelludo, la parte baja de la espalda, la cara, las palmas de las manos y las plantas de los pies. Tambin pueden aparecer en otras partes tales como las uas de las manos y los pies, los genitales y la parte interior de la boca.

A cualquier persona le puede dar psoriasis, pero ocurre ms frecuentemente en los adultos. En algunos casos, las personas con psoriasis tienen antecedentes familiares. Ciertos genes parecen estar vinculados a esta enfermedad. La psoriasis aparece con igual frecuencia en hombres y mujeres.

La psoriasis comienza en el sistema inmunitario, principalmente con un tipo de clulas blancas presentes en la sangre llamadas linfocitos T. Los linfocitos T ayudan a proteger el cuerpo contra infecciones y enfermedades. En la psoriasis, los linfocitos T se activan indebidamente, causando la activacin de otras respuestas inmunitarias. Esto produce hinchazn y el rpido reemplazo celular en la piel. Las personas que tienen psoriasis pueden notar que a veces la piel mejora y otras veces empeora. Los factores que pueden causar el empeoramiento de la piel con psoriasis incluyen:

La psoriasis puede ser difcil de diagnosticar porque en ocasiones los sntomas se parecen a los de otras enfermedades de la piel. En estos casos, el mdico debe examinar una pequea muestra de piel en el microscopio.

El tratamiento para la psoriasis depende de:

Los tratamientos para la psoriasis no funcionan igual para todo el mundo. El mdico debe cambiar el tratamiento si ste no funciona, provoca una mala reaccin o si deja de funcionar.

Tratamiento tpico:

Los tratamientos aplicados directamente a la piel (cremas, pomadas) pueden:

Fototerapia:

La luz ultravioleta natural producida por el sol y la luz ultravioleta artificial se usan a veces para tratar la psoriasis. Un tratamiento, llamado PUVA, combina el uso de la luz ultravioleta con un medicamento que sensibiliza la piel a la luz.

Tratamiento sistmico:

Si la psoriasis es fuerte, los mdicos pueden recetar medicamentos o ponerle una inyeccin. Esto es un tratamiento sistmico. Normalmente no se usan antibiticos para el tratamiento de la psoriasis a menos que una infeccin bacteriana empeore la psoriasis.

Terapia combinada:

Al combinar los tratamientos tpicos (los que se aplican a la piel), la fototerapia y los tratamientos sistmicos, muchas veces se puede usar una dosis ms baja de cada uno. La terapia combinada tambin puede dar mejores resultados.

Los mdicos estn aprendiendo ms acerca de la psoriasis a travs del estudio de:

1 AMS Circle Bethesda, MD20892-3675 Telfono: 301-495-4484 Llame gratis: 877-22-NIAMS (877-226-4267) TTY: 301-565-2966 Fax: 301-718-6366 Correo electrnico: NIAMSinfo@mail.nih.gov Sitio web: http://www.niams.nih.gov

En esta publicacin puede encontrar informacin sobre los medicamentos que se usan para tratar la enfermedad aqu mencionada. Hemos brindado la informacin ms actualizada disponible al momento de su desarrollo. Es posible que desde entonces haya surgido ms informacin sobre estos medicamentos.

Para obtener la informacin ms actualizada o para hacer preguntas sobre cualquiera de los medicamentos que est tomando, llame gratis a la Administracin de Drogas y Alimentos (FDA, por sus siglas en ingls) de los Estados Unidos al

Llame gratis: 888-INFO-FDA (888-463-6332) Sitio web: http://www.fda.gov

Si desea informacin adicional sobre medicamentos especficos, visite Drugs@FDA en http://www.accessdata.fda.gov/scripts/cder/drugsatfda. Drugs@FDA es un catlogo donde puede hacer una bsqueda para los medicamentos aprobados por la FDA.

Esta publicacin no tiene los derechos de autor reservados. Se invita a los lectores a duplicar y distribuir tantas copias como consideren necesario.

Copias adicionales de esta publicacin estn disponibles a travs del:

1 AMS Circle Bethesda, MD20892-3675 Telfono: 301-495-4484 Llame gratis: 877-22-NIAMS (877-226-4267) TTY: 301-565-2966 Fax: 301-718-6366 Correo electrnico: NIAMSinfo@mail.nih.gov Sitio web: http://www.niams.nih.gov

Continue reading here:
Qu es la psoriasis?

What Are the Treatments for Psoriasis?

Despite the fact that psoriasis is incurable, it responds well to many topical and systemic treatments. Even people with severe psoriasis can get relief during flare-ups in about 85% to 90% of cases.

Topical treatments are rubbed directly into the affected skin to bring local relief without the system-wide side effects of medicines taken by mouth. Topical treatments for psoriasis include:

Salicylic acid . Some doctors recommend salicylic acid ointment, which smoothes the skin by promoting the shedding of psoriatic scales. Using salicylic acid over large areas of skin, however, may cause the body to absorb too much of the medication, leading to side effects. Salicylic acid may also cause skin irritation and weaken hair shafts, which can cause breakage and temporary hair loss. The effectiveness of these preparations are modest at best.

Steroid-based creams. The mainstay of psoriasis treatment, steroid creams decrease inflammation, relieve itching, and block the production of cells that are overproduced in psoriasis. Stronger preparations, which are more effective than milder ones, can cause side effects that include burning, dryness, irritation, and thinning of the skin. Be especially careful to follow your doctor's instructions on their use.

Calcipotriene -containing topical ointment. Calcipotriene, which is related to vitamin D, has proven to be effective for treating psoriasis, especially when combined with a topical corticosteroid cream. It's best to use only limited amounts to avoid side effects.

Coal-tar ointments and shampoos. These products can help slow the rapid growth of skin cells and alleviate symptoms, but some people are vulnerable to the side effects, especially folliculitis, a pimple-like rash affecting the hair follicles. These medicines should be used only under a doctor's supervision.

Prescription retinoids. These topical preparations containing a synthetic form of vitamin A can help improve psoriasis. These preparations don't work as quickly as steroids. Topical retinoids can sometimes cause dryness and irritation of the skin.

Read the original post:
psoriasis treatment - WebMD

What Is It?

Psoriasis is a chronic skin disorder that causes scaling and inflammation.

Psoriasis may develop as a result of an abnormality in the body's immune system. The immune system normally fights infection and allergic reactions.

Psoriasis probably has a genetic component. Nearly half of patients have family members with psoriasis.

Certain medications may trigger psoriasis. Other medications seem to make psoriasis worse in people who have the disease.

Psoriasis causes skin scaling and inflammation. It may or may not cause itching. There are several types of psoriasis:

Plaque psoriasis. In plaque psoriasis, there are rounded or oval patches (plaques) of affected skin. These are usually red and covered with a thick silvery scale. The plaques often occur on the elbows, knees, scalp or near the buttocks. They may also appear on the trunk, arms and legs.

Inverse psoriasis. Inverse psoriasis is a plaque type of psoriasis that tends to affect skin creases. Creases in the underarm, groin, buttocks, genital areas or under the breast are particularly affected. The red patches may be moist rather than scaling.

Pustular psoriasis. The skin patches are studded with pimples or pustules.

Guttate psoriasis. In guttate psoriasis, many small, red, scaly patches develop suddenly and simultaneously. Guttate psoriasis often occurs in a young person who has recently had strep throat or a viral upper respiratory infection.

About half of people with skin symptoms of psoriasis also have abnormal fingernails. Their nails are often thick and have small indentations, called pitting.

A type of arthritis called psoriatic arthritis affects some people with psoriasis. Psoriatic arthritis may occur before skin changes appear.

Your doctor will look for the typical skin and nail changes of this disorder. He or she can frequently diagnose psoriasis based on your physical examination.

When skin symptoms are not typical of the disorder, your doctor may recommend a skin biopsy. In a biopsy, a small sample of skin is removed and examined in a laboratory. The biopsy can confirm the diagnosis and rule out other possible skin disorders.

Psoriasis is a long-term disorder. However, symptoms may come and go.

There is no way to prevent psoriasis.

Treatment for psoriasis varies depending on the:

Treatments for psoriasis include:

Topical treatments. These are treatments applied directly to the skin.

Daily skin care with emollients for lubrication. These include petroleum jelly or unscented moisturizers.

Corticosteroid creams, lotions and ointments. These may be prescribed in medium and high-strength forms for stubborn plaques on the hands, feet, arms, legs and trunk. They may be prescribed in low-strength forms for areas of delicate skin such as the face.

Calcipotriol (Dovonex) slows production of skin scales.

Tazarotene (Tazorac) is a synthetic vitamin A derivative.

Coal tar

Salicylic acid to remove scales

Phototherapy. Extensive or widespread psoriasis may be treated with light. Phototherapy uses ultraviolet B or ultraviolet A, alone or in combination with coal tar.

A treatment called PUVA combines ultraviolet A light treatment with an oral medication that improves the effectiveness of the light treatment.

Laser treatment also can be used. It allows treatment to be more focused so that higher amounts of UV light can be used.

Vitamin A derivatives. These are used to treat moderate to severe psoriasis involving large areas of the body. These treatments are very powerful. Some have the potential to cause severe side effects. It's essential to understand the risks and be monitored closely.

Immunosuppressants. These drugs work by suppressing the immune system. They are used to treat moderate to severe psoriasis involving large areas of the body.

Antineoplastic agents. More rarely, these drugs (which are most often used to treat cancer cells) may be prescribed for severe psoriasis.

Biologic therapies. Biologics are newer agents used for psoriasis that has not responded to other treatments. Psoriasis is caused, in part, by substances made by the immune system that cause inflammation. Biologics act against these substances. Biologic treatments tend to be quite expensive. And they must be injected rather than taken as a pill.

If you are unsure whether you have psoriasis, contact your doctor. Also contact your doctor if you have psoriasis and are not doing well with over-the-counter treatment.

For most patients, psoriasis is a long-term condition.

There is no cure. But there are many effective treatments.

In some patients, doctors may switch treatments every 12 to 24 months. This prevents the treatments from losing their effectiveness and decreases the risk of side effects.

Drugs associated with:

Micromedex Care Notes:

Symptom checker:

Mayo Clinic Reference:

National Psoriasis Foundation6600 SW 92nd Ave. Suite 300 Portland, OR 97223-7195 Phone: 503-244-7404 Toll-Free: 1-800-723-9166 Fax: 503-245-0626 http://www.psoriasis.org/

Disclaimer: This content should not be considered complete and should not be used in place of a call or visit to a health professional. Use of this content is subject to specific Terms of Use & Medical Disclaimers.

Read this article:
Psoriasis Guide: Causes, Symptoms and Treatment Options

Definition and Etiology

Psoriasis is a common; typically chronic papulosquamous skin disease that may be associated with a seronegative spondyloarthropathy. The etiology of psoriasis is unknown.

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Psoriasis affects 2% of the U.S. population, and about 11% of these patients have psoriatic arthritis (PsA). Psoriasis may begin at any age however generally there are two peaks of onset, the first at 20-30 years and the second at 50-60 years. Men and women are equally affected.

U.S. primary care physicians initially see 58% of the estimated 150,000 new cases of psoriasis per year, however dermatologists manage 80% of the 3 million office and hospital visits for psoriasis each year.

The type and clinical manifestations of psoriasis in a patient depend on a combination of genetic influences, environmental factors (i.e. trauma and climate) and associated diseases (particularly bacterial infections). Additionally, certain medications, notably lithium, antimalarials, beta blockers, interferon, and ethanol (if abused) have been reported to induce psoriasis or exacerbate preexisting disease in some patients. Emotional stress may also lead to psoriasis flares.

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Psoriasis is associated with the metabolic syndrome and cardiovascular (CV) disease. Psoriasis patients are not only more likely to have CV risk factors but severe psoriasis may serve as an independent risk factor for CV mortality.

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Psoriatic skin lesions are the result of inflammation in the dermis and hyperproliferation with abnormal differentiation of the epidermis. The primary pathologic process is most likely dysregulation of activated T cell interactions with antigen-presenting cells and overproduction of pro-inflammatory cytokines such as interferon- and tumor necrosis factor- (TNF- ). Evidence for this theory derives from the dramatic improvement of severe psoriasis in patients treated with immunosuppressive therapies such as cyclosporine (a potent T cell inhibitor used to prevent transplant rejection) or with TNF- inhibitors (used in other inflammatory diseases such as inflammatory bowel disease, rheumatoid arthritis and ankylosing spondylitis).

Recently, additional cytokine mediators, IL-12 and IL-23, have been linked to psoriasis as they promote differentiation of nave CD4+ lymphocytes into Th1 and Th17 cells respectively. The U.S Food and Drug Administration (FDA) has recently approved a novel therapy for psoriasis targeting Il-12 and IL-23, which will be discussed in the therapy section.

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Although considered a single disease, psoriasis has several morphologic expressions and a full range of severity.

Plaque-type psoriasis, or psoriasis vulgaris, is the most common form, occurring in about 80% of all psoriasis patients. A typical lesion is a well-demarcated, red-violet plaque with adherent white silvery scales (Fig. 1).

Lesions are typically symmetrical and the face is usually spared. The most commonly involved areas are the elbows and knees, scalp, sacrum, umbilicus, intergluteal cleft, and genitalia. In addition to physical trauma (Koebner phenomenon), other causes of cutaneous injury such as viral exanthems or sunburn may elicit the formation of any type of psoriatic lesion. About 70% of patients complain of pruritus, skin pain, or burning, especially when the scalp is involved. A characteristic finding, coined Auspitz sign, is pinpoint bleeding when psoriatic scale is lifted and correlates with histologic elongation of dermal papillae vessels in combination with suprapapillary epidermal thinning.

Guttate psoriasis (Fig. 2), named for its small droplet-shaped lesions, accounts for about 18% of all cases. This type is more common among children and young adults and is more likely to involve the face. Patients frequently have a history of a preceding upper respiratory tract infection or pharyngitis, particularly Group A Streptococcus. Some cases of acute guttate flares following streptococcal infection are precipitated by its superantigen exotoxin.

Pustular psoriasis (Fig. 3 and B) accounts for approximately 1.7% of cases. It is characterized by sterile pustules, which may be generalized or localized to the palms and soles. There is a female predominance in localized pustular psoriasis, however the incidence is equal in men and women in the generalized type. The average age at onset for pustular psoriasis is 50 years. Pregnancy and rapid tapering of systemic corticosteroids are known triggers. Generalized pustular psoriasis in pregnancy is also known as impetigo herpetiformis. Impetigo herpetiformis and generalized pustular psoriasis must be treated more aggressively because untreated, may lead to serious complications such as sepsis and bacterial superinfection.

Inverse psoriasis involves intertriginous areas (i.e skin folds of axilla, inguinal, intergluteal and inframammary regions). Plaques are typically pink to red and minimally scaly. Lesions may mimic cutaneous candidiasis however satellite lesions (if present) distinguish candidiasis from inverse psoriasis. Consider inverse psoriasis if candidiasis is recalcitrant to appropriate therapies.

The least common form of psoriasis is exfoliative dermatitis or psoriatic erythroderma, which accounts for 1% to 2% of all cases. Erythroderma is defined as a scaling pruritic, erythematous inflammatory skin eruption that involves over 90% of the body surface. Erythrodermic psoriasis may develop gradually or acutely during the course of chronic plaque-type psoriasis, but it may be the first manifestation of psoriasis, even in children. Psoriasis is the most common cause of erythroderma in adults and the second (following drug eruptions) in children. The mean age at onset is approximately 50 years. Men with the condition outnumber women, and concomitant psoriatic arthropathy is common. The most common precipitating factor is the withdrawal of potent topical, oral, and intramuscular corticosteroids. Although psoriasis patients are typically thought to be at decreased risk of cutaneous infection, those with erythrodermic psoriasis may be at risk for Staphylococcus aureus septicemia as a result of their compromised skin barrier therefore it is important for emergent evaluation by a dermatologist. Additionally, erythroderma may result in temperature dysregulation, hypoalbuminemia, and high output cardiac failure.

The nails (Fig. 4) are involved in up to 50% of psoriasis patients; in patients with psoriatic arthritis (PsA), the prevalence exceeds 80%. Pitting of the nail plate is the most common manifestation and is the result of damage to the proximal nail matrix. The pits tend to be large, deep, and randomly dispersed on the nail plate. Distal onycholysis, or lifting of the nail plate, is a common finding in psoriatic nail disease. Yellow-brown dyschromia (oil droplet sign) of the nail bed corresponds to psoriasis in that location and is the result of abnormal keratinization of the nail bed.

PsA affects up to one third of patients with psoriasis and is a destructive arthropathy and enthesopathy. Although PsA may share clinical features with rheumatoid arthritis (involving small and medium sized joints), it most commonly presents as inflammation of the proximal and distal interphalangeal joints in the hands and feet. Arthritis occurs after the onset of skin involvement in two thirds of cases however in 10-15% of patients, it occurs prior to the development of skin lesions. The severity of skin and nail involvement does not correlate with the severity of joint disease in patients with PsA. Early recognition and intervention is important as PsA may lead to loss of function. For this reason, patients with joint involvement are typically treated with more aggressive therapies such as a TNF inhibitor.

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A clinical diagnosis is usually sufficient for classic skin and nail lesions. The differential diagnosis is expansive however with several dermatologic conditions, which may present similarly including: atopic dermatitis, pityriasis rubra pilaris, drug reactions, tinea corporis, secondary syphilis, and cutaneous T cell lymphoma (mycosis fungoides variant). Therefore, it may be necessary to perform skin biopsy, potassium hydroxide (KOH) examination of scales, and serologic evaluations such as RPR and CBC with differential, blood smear and immunophenotyping (CD 4 to CD 8 ratio).

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The choice of treatment depends on the severity of disease and response in the individual patient.

Betamethasone dipropionate 0.05% (Diprolene)

Fluocinonide 0.05% (Lidex)

Desoximetasone 0.25% (Topicort)

PUVA*

Cyclosporine (Gengraf, Neoral, Sandimmune)

Acitretin (Soriatane)

Ustekinumab (Stelara)

Calcipotriol (Dovonex)

calcipotriene (Dovonex)

Calcitriol (Vectical)

Etanercept (Enbrel)

Adalimumab (Humira)

* *(PUVA) Psoralen combined with ultraviolet A.

Patients with limited disease (affecting less than 5% body surface area), not significantly involving the hands, feet or genitalia are treated primarily with class I or II topical corticosteroids. Steroid sparing agents such as calcipotriene, calcitriol (Vitamin D analogues), pimecrolimus and tacrolimus (calcineurin inhibitors) may also be used as monotherapy or in combination with a topical corticosteroid. Patients may complain of burning with application. The U.S. FDA currently recommends pimecrolimus and tacrolimus as second-line agents given potential cancer risk.

Phototherapy is a first line therapy for moderate to severe psoriasis. It may be used as monotherapy or in combination with topical or systemic therapies. There are several disadvantages to this treatment method as it is costly, requires special equipment and necessitates two or three office visits per week. It is advantageous for patients with additional comorbidities that preclude initiation of systemic therapies. Narrow band UVB therapy is the most commonly utilized form of phototherapy. Although more effective toward long term remission of psoriasis, psoralen plus UVA (PUVA) therapy is less utilized given increased risk of melanoma and non-melanoma skin cancers. Caution must also be taken in patients with fair skin, those who are taking photosensitizing medications, those with a history of skin cancer, and those who are chronically immunosuppressed after organ transplantation (as these patients are already at increased risk of non melanoma skin cancer).

Systemic therapy is effective, in treating severe disease (affecting more than 5% body surface area) and disease significantly involving the hands, feet or genitalia, however they have greater potential for toxicity. Systemic treatments for psoriasis are generally prescribed after consultation with a dermatologist.

Methotrexate (MTX) is the antimetabolite most often prescribed by dermatologists for moderate-to-severe psoriasis. Hepatotoxicity is the primary clinical concern when planning long-term methotrexate therapy. Mild transaminase elevations (less than twice the upper limit of normal) are to be expected during therapy, but these levels do not correlate with hepatic fibrosis. A 2009 consensus conference advocates following the American College of Rheumatology guidelines for patients with no risk factors for liver injury and recommend considering liver biopsy or switching to another treatment after 3.5 to 4 g to total cumulative methotrexate dosage. Folic acid (FA) supplementation at 1 mg daily is recommended to abate the gastrointestinal side effects of methotrexate without reducing efficacy (although many providers hold FA on the day of MTX therapy). It also helps to prevent megaloblastic anemia.

Cyclosporine is particularly useful for erythrodermic psoriasis as it takes effect rather quickly. Nephrotoxicity and hypertension are the two most serious side effects of cyclosporine therapy and should be monitored closely. Hyperlipidemia is also a potential side effect and given an already increased risk of CV disease in patients with severe psoriasis, fasting lipid profiles should be obtained regularly.

The biologic immunomodulators are monoclonal antibodies and fusion proteins that represent a paradigm shift in the treatment of moderate-to-severe psoriasis. These compounds were designed to antagonize cell-cell interactions, memory-effector T cells, or pro inflammatory cytokines.

Alefacept is a fusion protein composed of leukocyte function antigen-3 and human immunoglobulin 1 (IgG1). Alefacept was the first biologic to receive FDA approval for psoriasis in 2003. Although not mandated by the FDA, its pharmaceutical company voluntarily pulled alefacept from manufacturing and distribution in November 2011.

Efalizumab is a humanized monoclonal antibody directed against the CD-11a subunit of leukocyte function antigen-1 (LFA-1) expressed on T cells. By blocking the interaction of LFA-1 and its ligand intercellular adhesion molecule-1, T cell activation and migration into psoriatic plaques are decreased. Efalizumab was approved by the FDA for psoriasis in 2003. After three cases of progressive multifocal leukoencephalopathy caused by the JC virus were reported in association with efalizumab therapy for psoriasis, the manufacturer voluntarily withdrew the drug from the U.S. market in June 2009.

Etanercept is a cloned and engineered fusion protein made of two p75 TNF receptors and the Fc portion of human IgG. It binds and inactivates TNF and prevents its significant proinflammatory effects in the target tissue of skin and joints. Etanercept is FDA approved for RA, PsA, ankylosing spondylitis, and chronic to severe plaque psoriasis in adults. Etanercept is given at a starting dose of 50 mg injected subcutaneously (SQ) twice weekly for 12 weeks followed by 50 mg once weekly for maintenance of moderate to severe chronic plaque psoriasis. For PsA, 50mg is injected SQ weekly.

Infliximab is a chimeric (human-mouse) monoclonal antibody that binds TNF. It is FDA approved for rheumatoid and psoriatic arthritis and Crohn's disease with and without methotrexate (MTX). For the treatment of severe plaque psoriasis and PsA (with or without MTX), infliximab is delivered by an intravenous infusion over a 2-hour period at weeks 0, 2, and 6 followed by maintenance infusions every 8 weeks. The serious immediate infusion reaction rate is 1%, and about 1% of patients experience delayed hypersensitivity reactions consisting of myalgia, arthralgia, fever, or skin eruption. Neutralizing antibodies are formed in about 20% of patients treated for 1 year, which can result in dose creep, whereby dose escalation or more frequent dosing of infliximab becomes necessary to keep symptoms under control. Concomitant methotrexate administration reduces the development of antichimeric antibodies.

Adalimumab is a human anti-TNF monoclonal antibody that blocks the interaction of TNF with the p55 and p75 cell-surface receptors. It is FDA approved for plaque psoriasis, PsA, ankylosing spondylitis, Crohn's disease, ulcerative colitis, juvenile idiopathic arthritis, and rheumatoid arthritis. For moderate to severe plaque psoriasis, it is given at a starting dose of 80mg SQ, followed by 40mg SQ every other week beginning one week after the initial dose. For PsA, 40mg of adalimumab is administered every other week as monotherapy or in combination with methotrexate or other nonbiologic disease-modifying antirheumatic drugs (DMARDS).

Ustekinumab utilizes monoclonal antibodies directed against the p40 subunit of cytokines IL-12 and IL-23, which have been recently described as significant mediators of psoriasis. In September 2009, ustekinumab obtained FDA approval for the treatment of moderate to severe plaque psoriasis. It is also used to treat moderate to severe Crohn's disease that is resistant to TNF inhibitors. For patients weighing 100kg or less, 45mg is injected SQ initially, 4 weeks later, then every 12 weeks thereafter. Patients weighing greater than 100kg may receive 90mg SQ initially, 4 weeks later, followed by every 12 weeks thereafter.

The greatest theoretical risks associated with the biologic immunomodulators are serious infections, particularly granulomatous, and increased rates of malignancy, particularly the lymphoproliferative diseases. To date, controlled trials and postmarketing surveillance studies have not conclusively demonstrated a higher-than-expected frequency of lymphomas in patients who have been treated the longest with anti-TNF agents. Although the risk for reactivating tuberculosis is considered greater for infliximab and adalimumab than with etanercept, a baseline tuberculin skin test (PPD) is recommended for all biologic immunomodulator therapies. Additional laboratory evaluation should include: hepatitis B screening, hepatic function panel and complete blood count with differential.

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See more here:
Psoriasis - Cleveland Clinic Center for Continuing Education

TalkPsoriasis

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cost-of-daavlin-nationalbiological-units

200211

** Originally posted by Praxedes ** Hi everyone, I am looking to buy a narrow band UVB unit and will probably be paying out of pocket. I would like to know how much you guys paid for yours, or what the cost was before insurance. The units I am most interested in are the daavlin dermapal (the handheld unit), the 2 Series daavlin, and the handheld dermalight from nationalbiological ... Read More

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npf-292 (Inactive)

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opie-fonzie-ritchie-and-andy-loves-obama

200211

** Originally posted by nomobties ** Someone sent this to me in an e-mail and I thought it was entertaining enough to pass along. This is Ron Howard telling us in a creative way why he is voting for Barack Obama. In sending this I am in no way endorsing Senator Obama nor am I telling you all how to vote. My first sentence is enough of a reason why I am passing this along. Enjoy. http://www.funnyordie.com/videos/cc65ed6 ... Read More

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ktdogs6

started-light-treatment-today

200211

** Originally posted by ktdogs6 ** Most of you know my story....clinical trial using Enbrel....ins co denied continuation on Enbrel. Saw my dermatologist and I decided to begin light treatment. My dermatologist is a gem....I told him what treatment I would accept and what I would not....he was absolutely satisfied with my decisions (I did my homework, I mean real homework about the ... Read More

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JerseyMikeK

providence-ri-volunteers-needed-for-psoriasis-study

200211

** Originally posted by MikeK ** Home > News> Local Volunteers needed for psoriasis study Advertisement Text size: small | medium | large By Artie Tefft Published: October 14, 2008 PROVIDENCERhode Island Hospital is currently recruiting volunteers to take part in a study of adults 18 and older with moderate to severe plaque-type psoriasis. The clinical research study will evaluate ... Read More

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CrazzyRe

say-what-cant-hear-ya-for-the-buzzing

200211

** Originally posted by Re ** hey guys! Well I was sent by one ENT to another that specializes in diseases. Holy Cow! He was gorgeous! Okay I am getting to it. First let me just say, that I drooled so badly that Charlie (hubby sitting in room with me)had to get me some paper towels to mop it up. LOL This new ENT is sending me to get an MRI, he did a bunch of balance test and while ... Read More

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JerseyMikeK

happy-birthday-chris-toomstone

200211

** Originally posted by MikeK ** I hope that it's the best one ever! Mike ... Read More

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npf-10684 (Inactive)

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sharing-my-story

200211

** Originally posted by amandamiller ** I am new with this site, and i thought I could take a moment to share my story about psoriasis. When I was a little girl, I remember looking at my mom and seeing "boo boo's" all over her body. As i grew older and she explained to me what the "boo boo's actually were...Psoriasis. I also found out that my great aunt had it. My mom always was trying ... Read More

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npf-6287 (Inactive)

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pparcca-update-contact-your-senators-today

200211

** Originally posted by Alyssa_B ** On Monday, June 23, 2008, Sen. Norm Coleman (R-Minn.) became the first Republican to co-sponsor S. 1459, the Senate version of the Psoriasis and Psoriatic Arthritis Research, Cure, and Care Act. With his support, this critical legislation is now bipartisan in both the House and Senate--improving its chances of moving forward in the legislative process ... Read More

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npf-1917 (Inactive)

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no-voice-3

200211

** Originally posted by nailgal72 ** Hey everyone, I was wondering if anybody has had he problem with loosing their voice? I have not been able to talk for 2 weeks :(. I don't have any drainage or congestion so I don't have a clue what it could be:confused:. I am on Remicade Infusions, and Mtx, and didn't know if it could be a side effect from the Remicade. I had a strep test done ... Read More

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npf-329 (Inactive)

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stressed-7

200211

** Originally posted by frommyvalentino ** I'm moving in a week to the day...and I'm stressed, just a little. I've had 3 breakdowns, in the last week. One tonight, and now I can't sleep (which sucks considering it's 2am, and I have to get up for work by 6am.) I found out that my job isn't gurantteed anymore. They have an opening, but nothing is set in stone until I get there on the ... Read More

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npf-1001 (Inactive)

npf-1001

cell-phones-1

200211

** Originally posted by brianrt ** SO how did everyone ever live without their cell phones? All i ever see is peope yacking and texting like there was no tomorrow! I dont know why that bothers me so much lol. I got ran into at the store the other day some chick was walking down the aisle texting someone 90 to nothing, whats your pet peeve ... Read More

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npf-395 (Inactive)

npf-395

shhhhhh-i-have-a-secret

200211

** Originally posted by TJM718 ** I put mayonaise on my eggs. What's your secret?:D ... Read More

TalkPsoriasis

npf-10680 (Inactive)

npf-10680

how-long-can-someone-take-soriatane

200211

** Originally posted by mark9989 ** Does anyone have information or self stories about how long one can take Soriatane? I have been on Soriatane for 10 years, and am very concerned of future problems with the liver or some sort of cancer forming. Does Soriatane have a link to such things? Also, does any males have drinks while using Soriatane. Sometimes, I wont take my dose for the ... Read More

TalkPsoriasis

npf-8902 (Inactive)

npf-8902

flexible-spending-accounts-1

200211

** Originally posted by murray50 ** I'm a bit angry right now; I was diagnosed with psoriasis of the hands and feet earlier this year. Recently my skin started cracking so I bought moisture creams & lotions thinking that my medical flexible spending account would reimburse the cost; each pay period I have money deducted from my paycheck (pre-tax) to cover medical expenses that aren't ... Read More

TalkPsoriasis

JerseyMikeK

skin-conditions-often-damaging-to-self-esteem

200211

** Originally posted by MikeK ** Skin conditions often damaging to self-esteem Published Friday October 24th, 2008 With more than 10 million Canadians affected by moderate to severe skin conditions, a new Canadian survey sheds light on how just one of many debilitating conditions plaque psoriasis has a tremendous psychological and social impact on patients that lead to diminished ... Read More

TalkPsoriasis

npf-2635 (Inactive)

npf-2635

whats-your-cause

200211

** Originally posted by Actress ** Ok, so we all have things we like to see rights for. My list is quite a few........ 1. NPF 2. ACLU 3. PeTA 4. SSCCFD PCF (South Santa Clara Couty Fire Dept Paid Call Fire-fighters) 5. Humaine Society 6. ASPCA 7. Greenpeace 8. WWF 9. AAMA 10. Gay rights Except for number one, they are in no particular order. I have strong beliefs for human and animal ... Read More

TalkPsoriasis

npf-10608 (Inactive)

npf-10608

forum-mechanics

200211

** Originally posted by JMc ** Hi. I just responded to someones concern about being switched from PsA diagnosis to chronic pain diagnosis. Does this forum send us a message when someone responds to us or do we just make a note for ourselves later to check. I would hate to give someone a suggestion that he/she had a question about without getting back to them. Jeanne ... Read More

TalkPsoriasis

npf-1743 (Inactive)

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TalkPsoriasis Support Community - Inspire

Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Plaque psoriasis is the most common presentation of psoriasis. It presents as small to large, well demarcated, red, scaly and thickened areas of skin. It most likely to affect elbows, knees, and lower back but may arise on any part of the body.

It tends to be a relatively persistent or chronic pattern of psoriasis that can be improved with treatment but is difficult to clear completely with topical treatments alone. It is characterised by large flat areas (plaques) of psoriasis with typical silvery scale. These plaques may join together to involve very extensive areas of the skin particularly on the trunk and limbs. It is often accompanied by scalp and nail psoriasis.

Most cases of plaque psoriasis are described as 'large plaque' or 'small plaque' psoriasis. The plaques may be localised (e.g. to elbows and knees) or generalised (involving scalp, trunk and limbs).

Large plaque psoriasis describes thick, well-demarcated, red plaques with silvery scale. This type of psoriasis often has early onset (<40 years) and may be associated with metabolic syndrome. There's often a family history of psoriasis. It can be quite resistant to treatment.

Small plaque psoriasis often presents with numerous lesions a few millimetres to a few centimetres in diameter. The plaques are thinner, pinkish in colour and have a fine scale. They may be well-defined or merge with surrounding skin. Family history is less common. Although it may arise at any age, small plaque psoriasis often arises in those over than 40 years of age. This type of psoriasis often responds well to phototherapy.

Uncommon subtypes or descriptions of chronic plaque psoriasis include:

More images of plaque psoriasis ...

Patients with chronic plaque psoriasis should be assessed by a dermatologist. Factors considered may include the following.

Patients to be treated with systemic therapy will be asked to undertake screening tests to ensure the medication is safe for them and as a baseline.

Localised or mild chronic plaque psoriasis is usually managed initially with one or more topical agents. The following agents are usually effective for plaque psoriasis:

If plaque psoriasis is too extensive or severe to be effectively managed with topical treatments alone, phototherapy or systemic agents can be used and are usually very effective at improving and even clearing the psoriasis. For more information on these and other treatments, see DermNet's page on treatment for psoriasis.

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Plaque psoriasis. DermNet NZ

Psoriasis is a chronic skin disease that causes areas of thickened, swollen, and red skin, often covered with silver scales.

In people without psoriasis, skin cells grow deep in the skin and slowly rise to the surface. This process is called cell turnover, and it takes about a month. With psoriasis, it can happen in just a few days because the cells rise too fast and pile up on the surface.

This disease affects 2 percent to 2.6 percent of the United States population, or between 5.8 and 7.5 million people. Anyone can get psoriasis, but it occurs more often in adults. Sometimes there is a family history of the disease. Certain genes have been linked to it, and men and women get psoriasis at about the same rate.

This condition begins in the immune system, mainly with a type of white blood cell called a T cell. T cells help protect the body against infection and disease. With psoriasis, T cells are put into action by mistake. They become so active that they set off other immune responses. This leads to swelling and fast turnover of skin cells.

People with this condition may notice that sometimes the skin gets better and sometimes it gets worse. Things that can cause your symptoms to worsen include:

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Psoriasis - eMedTV: Health Information Brought To Life

When Jackie was 15, patches of skin near her elbows turned thick and red and began to itch. Sometimes it would get a little better. Other times it got worse. But it never seemed to go away.

Jackie's doctor told her she had a condition known as psoriasis. He recommended a prescription cream and suggested Jackie get outside for 20 minutes in the early mornings before the sun got too strong.

Psoriasis (pronounced: suh-RYE-uh-sus) is a disease that causes skin cells to build up on the surface of the skin. There they form itchy, red areas (called plaques) and thick scales. Psoriasis can appear anywhere on the body, but is usually found on the scalp, knees, elbows, and torso.

Psoriasis can get better then worse again. It may seem to disappear and then come back. Once someone has it, though, the tendency to get outbreaks isn't likely to go away permanently. For many people, psoriasis isn't a big deal. For others, it can be quite serious.

Right now, there's no cure for psoriasis, but there are good ways to treat it. Eating healthy foods, using moisturizers, and keeping weight in a normal range seem to help for some people. If psoriasis gets bad, though, most people need to see a doctor.

Doctors aren't sure why people get psoriasis, but they do know how the disease works. We all have a kind of white blood cell, called a T lymphocyte (or T cell), in our blood. These cells are part of the immune system. They travel through the bloodstream fighting off bacteria, viruses, and other things that make us sick. Psoriasis causes a person's T cells to mistakenly attack healthy skin as if they were trying to fight an infection or heal a wound.

When psoriasis triggers T cells to attack healthy skin, the body's immune system reacts as it would to a wound or infection it sends more blood to the area to make skin cells and white blood cells.

Our skin cells are made deep in the skin. Normally, they take about a month to rise to the surface. Once they get there, they die and are sloughed off. With psoriasis, this process is sped up. Skin cells rise to the surface in a few days instead of a month.

The dead skin and white blood cells can't be shed quickly enough. They build up on the surface of the skin as thick red patches. As the skin cells die, they form silvery scales that eventually flake off.

You can't catch psoriasis from another person. You may inherit the genes that make you more likely to get it, though. About 40% of people with psoriasis have a family member who has the disease.

Some of the things that can increase the chances of a psoriasis outbreak are:

People with psoriasis will probably notice one or more of these things:

There are different types of psoriasis:

If you think you might have psoriasis, it's a good idea to see a doctor. He or she will look at your skin, scalp, and nails. The doctor will also ask questions if anyone in your family has psoriasis, if you've been ill recently, or if you've started a new medication.

In some cases, the doctor may remove a sample of skin (known as a biopsy) to examine it more closely. A biopsy can help doctors decide whether someone has psoriasis or another condition with similar symptoms.

There are lots of ways to treat psoriasis. Different treatments work for different people, so doctors often try a few to find the one that works best:

A doctor might try one therapy for a while and then switch to another. Or a doctor may combine different therapies. It's all about finding one that works for each person.

Sometimes what works for a while might stop working. This is one reason why it's important to work closely with a doctor. Trying out new treatments can get a little frustrating, but most people eventually find one that works.

Making healthy choices can help with psoriasis. Here are some things you can do:

People who have psoriasis may feel self-conscious about how it looks. That's one reason why some people turn to a trained therapist or join a support group of people who understand what they might be going through.

The key to psoriasis treatment is keeping up on whatever your doctor prescribes. If that means applying an ointment twice a day, then find a way to remind yourself to do it (like setting an alarm on your phone) so you don't forget. Psoriasis is one of those things that you need to stay focused on treating, even when you're feeling OK.

Reviewed by: Rupal Christine Gupta, MD Date reviewed: April 2015

Continued here:
Psoriasis - KidsHealth

1. Gudjonsson JE, Elder JT. Psoriasis: epidemiology. Clin Dermatol. 2007;25(6):535546....

2. Langley RG, Krueger GG, Griffiths CE. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis. 2005;64(suppl 2):ii18ii23.

3. Capon F, Trembath RC, Barker JN. An update on the genetics of psoriasis. Dermatol Clin. 2004;22(4):339347.

4. Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58(5):826850.

5. Kimball AB, Gladman D, Gelfand JM, et al. National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening. J Am Acad Dermatol. 2008;58(6):10311042.

6. Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet. 2007;370(9583):263271.

7. Habif TP. Psoriasis and other papulosquamous diseases. In: Clinical Dermatology. 5th ed. Hanover, N.H.: Mosby Elsevier; 2010:264275.

8. Reich K. Approach to managing patients with nail psoriasis. J Eur Acad Dermatol Venereol. 2009;23(suppl 1):1521.

9. Gottlieb A, Korman NJ, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008;58(5):851864.

10. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H; CASPAR Study Group. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54(8):26652673.

11. Krueger G, Koo J, Lebwohl M, Menter A, Stern RS, Rolstad T. The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey. Arch Dermatol. 2001;137(3):280284.

12. Gelfand JM, Feldman SR, Stern RS, Thomas J, Rolstad T, Margolis DJ. Determinants of quality of life in patients with psoriasis: a study from the US population. J Am Acad Dermatol. 2004;51(5):704708.

13. Horn EJ, Fox KM, Patel V, Kimball AB, Gordon KB, Lebwohl MG. Treatment satisfaction and health-related quality of life among individuals with psoriasis: National Psoriasis Foundation Survey Findings. Psoriasis Forum. 2008;14(2):2734.

14. Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999;41(3 pt 1):401407.

15. Hsu S, Papp KA, Lebwohl MG, et al.; National Psoriasis Foundation Medical Board. Consensus guidelines for the management of plaque psoriasis. Arch Dermatol. 2012;148(1):95102.

16. Menter A, Korman NJ, Elmets CA, et al.; American Academy of Dermatology. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009;60(4):643659.

17. Drugdex system. http://thomsonreuters.com/products_services/healthcare/healthcare_products/a-z/drugdex_system/. Accessed May 8, 2012.

18. Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol. 2010;62(1):114135.

19. Stelara (ustekinumab) [package insert]. Horsham, Pa.: Janssen Biotech; 2012. http://www.stelarainfo.com/pdf/PrescribingInformation.pdf. Accessed May 8, 2012.

20. Clinical pharmacology. http://www.clinicalpharmacology.com [login required]. Accessed January 4, 2012.

21. Del Rosso JQ, Kim GK. The rationale behind topical vitamin D analogs in the treatment of psoriasis: where does topical calcitrol fit in? J Clin Aesthetic Derm. August 2010. http://www.jcadonline.com/the-rationale-behind-topical-vitamin-d-analogs-in-the-treatment-of-psoriasis-where-does-topical-calcitriol-fit-in/. Accessed May 8, 2012.

22. Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol. 2009;61(3):451485.

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Psoriasis - American Family Physician

Psoriasis,psoriasis kenxro/Shutterstock.coma chronic, recurrent inflammatory skin disorder. The most common type, called plaque psoriasis (psoriasis vulgaris), is characterized by reddish, slightly elevated patches or papules (solid elevations) covered with silvery-white scales. In most cases, the lesions tend to be symmetrically distributed on the elbows and knees, scalp, chest, and buttocks. The lesions may remain small and solitary or coalesce into large plaques that often form geometrical patterns with a central area of normal skin. In many cases the nails become thickened, irregularly laminated, and brittle. In addition to plaque psoriasis, there are four other types of psoriasis, including guttate, pustular, inverse (or flexular), and erythrodermic.

Psoriasis is an immune-mediated (or autoimmune) disorder that occurs when immune cells known as T lymphocytes, or T cells, attack healthy skin cells in both the nonvascular horny outer layer of the skin and its deeper vascular layer. This attack causes the life span of the skin cells to shorten to about 3 to 5 days (skin cells normally live about 20 to 28 days) and forces the cells to reproduce more rapidly than normal. Psoriasis occurs in both sexes with equal frequency, being most prevalent between the ages of 10 and 30. It is most often seen in northern climates. An estimated 2 to 3 percent of the U.S. population is affected by psoriasis. In contrast, between 0.05 and 0.3 percent of Asians experience the condition. In European countries the incidence of psoriasis is highly variable, affecting anywhere from less than 1 percent to more than 6 percent of populations.

The onset of psoriasis is usually gradual but occasionally explosive. Precipitating factors may include injury to the skin, acute infection, and psychological upsets. Ordinarily, the lesions become less severe and sometimes disappear during the summer, possibly owing to the effect of sunlight. The severe complications of psoriasis are extensive sloughing of the outer layer of the skin, with resulting inflammation, and psoriatic arthritis. Generally, however, individuals with psoriasis are in relatively good health. The variability in the progression and severity of the disorder has led researchers to suspect that the underlying causes of psoriasis are the result of complex interactions between genetic and environmental factors.

There is no permanent cure for psoriasis, but there are a variety of treatments aimed at relieving the associated skin symptoms. Topical treatments for psoriasis come in different forms (e.g., creams and gels) and generally provide relief from inflammation and scaling. Some, such as retinoids (derivatives of vitamin A) and synthetic forms of vitamin D, work by slowing skin cell reproduction, whereas others, such as corticosteroids, coal-tar ointment, and salicylic acid, work by reducing inflammation. Psoriasis can also be treated with phototherapy, in which the skin is exposed to ultraviolet light. While phototherapy can be highly effective, it does have side effects, including pain, irregular pigmentation, and scarring. In addition, long-term treatments are associated with an increased risk of skin cancer. Oral medications are also available to treat psoriasis but are often used as a last resort. This is because the drugs that are most effective in treating psoriasis suppress the immune system, making patients susceptible to a multitude of infections and illnesses that can be life-threatening. Oral drugs that are used to reduce inflammation include methotrexate, cyclosporine, and azathioprine. Oral drugs called biologics (because they are made from human or animal proteins) modulate the immune system by attacking immune cells that are working improperly. Several biologics have been approved for psoriasis, including alefacept (Amevive), infliximab (Remicade), and etanercept (Enbrel).

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psoriasis | pathology | Britannica.com