Regular Beer May Boost Psoriasis Risk
September 2, 2010
Drink fewer regular beers, and you may cut your risk of developing psoriasis, concludes a new study. An analysis of the Nurses Health study II, an ongoing study of female registered nurses who were between ages 25 and 42 in 1989, revealed that women who drank 5 or more 12-ounce regular (non-light) beers a week had around twice the risk of developing psoriasis that women who didn't drink had. Drinking fewer regular beers did not appear to boost the chances of the skin disorder.
The type of alcohol mattered: Consuming light beer, wine and liquor didn't raise risk.
The study authors speculate that starches used in the beer's brewing process may be to blame. Barley, for example, contains gluten, which has been shown to be associated with psoriasis. Incidentally, light beer also contains gluten—but in lower amounts.
People with psoriasis have elevated levels of antigliadin antibodies and may have a so-called latent-gluten sensitivity, according to the authors. Several studies suggest that a gluten-free diet may improve psoriasis in some individuals with gluten sensitivity.
There is a lot more to learn about the relationship between alcohol and psoriasis. For example, these findings may not extend to men.
In the meantime, it can't hurt—and may help—to curb your consumption of regular beer. Talk to your doctor about your general alcohol intake and your risk of psoriasis.
Source: Abrar, et al. Alcohol Intake and Risk of Incident Psoriasis in U.S. Women. Archives of Dermatology, Aug 16, 2010. DOI:10.1001/acrhdermatol.2010.204
Do You Have the Psoriasis Blues?
September 2, 2010
Having psoriasis may seriously dampen your mood. According to a new study, people with psoriasis are about a third more likely to suffer from depression, anxiety and suicidal thoughts than the general population. The risk of depression may be especially high in people with severe skin disease. And the younger set—particularly men—may be especially vulnerable.
The study, published in the Archives of Dermatology, was based on medical data from over 145,000 people in the United Kingdom with mild psoriasis and about 4,000 individuals with severe psoriasis (who took one or more systemic psoriasis treatments). The study captured the incidence of clinical depression, anxiety and suicidal thoughts, but the severity or duration of the mood disorders could not be assessed.
Psoriasis has long been known to exact a toll on mental health. In fact, a 2009 survey from the National Psoriasis Foundation captured its social and emotional impact, as we've previously reported.
Feeling angry, frustrated or sad about psoriasis is normal. But it's important not to allow those feelings to take over your life.
A variety of resources, including joining a support group, seeing a mental health professional, and taking medications, may help. Talk to your doctor about the options. Cognitive behavioral therapy, for example, effectively treats both depression and anxiety. Achieving better control of psoriasis may also improve mood.
Sources: Kurd, et al. The Risk of Depression, Anxiety and Suicidality in Patients With Psoriasis. Archives of Dermatology, August 2010. DOI: 10.1001/archdermatol.2010.186; and
The National Psoriasis Foundation
Reducing Your Risks of Heart Disease
July 26, 2010
Several studies have suggested that psoriasis increases your risks of cardiovascular disease. That means that if you have the skin disease psoriasis, you may have higher chances of a life-threatening heart attack or stroke.
It’s well-known that taking these seven steps may lower your risks substantially:
- Get regular exercise
- Eat a heart healthy diet
- Lose weight
- Control cholesterol
- Manage blood pressure
- Reduce blood sugar
But for many of us, making appropriate changes is easier said than done.
If you're stuck in contemplation mode, here's a big push to take action to protect your heart. The American Heart Association (AHA) has released a scientific statement that confirms lifestyle interventions that truly work.
According to the AHA, the best way to lower your risks of heart disease is to use a combination of strategies.
Who
Enlist a counselor, your health care provider and your family and friends, suggests the American Heart Association. Joining a group can also help. You are the most important person on the team. When you believe that you can make and sustain positive changes, you have a much higher chance of being successful, according to the statement. Look to people who have made the changes you want to achieve to help you stick to a heart healthy lifestyle.
What
Cognitive behavioral strategies are an essential element of any successful plan, according to the AHA statement:
- Set goals for physical activity, dietary changes and weight loss. Specific goals lead to higher performance compared to vague goals, according to the scientific evidence. Examples: "Instead of dessert, I'll eat fruit." and "I'll walk a mile before work each day." Soliciting feedback from your health care provider helps you stay on the right track.
- Record your progress using a diary or online tracker. Studies consistently show that monitoring leads to better performance and more weight loss, according to the AHA statement. Each day, write down your physical activities, what you ate and how much you weigh. Celebrate your successes!
- Schedule follow-up sessions with your health care provider after 6 weeks, 3 months, 6 months, 9 months and 12 months. Then, every six months thereafter, suggests the AHA. Frequent visits (in person, by phone or by email), helps you learn and practice new skills such as monitoring your blood pressure using an at-home monitor. Your health care provider can also help you identify problems, brainstorm solutions, evaluate the pros and cons of certain strategies, implement a plan, and then evaluate its success, according to the AHA statement.
Why
According to the National Center for Health Statistics, Americans' life expectancy could increase by almost 7 years if all forms of cardiovascular disease are eliminated. Decide to adopt a heart healthy lifestyle for a longer, healthier life.
Helpful Tools
Life's Simple 7 Action Plan: This free tool from the American Heart Association assesses your current health based on information you supply, and provides you with an individual action plan to protect your heart.
One-on-One Counseling: Schedule an appointment with a dietitian, personal trainer or weight loss coach.
E-Counseling: If you choose online support instead of in-person visits, several studies suggest that electronic counseling that sends you messages about your progress, combined with use of an online weight loss program (that offers progress charts, recipes and tips) results in greater weight loss than an online program alone, according to the AHA statement.
How-To and Motivational Videos: Learn how to cook healthy meals, perform exercises, more. The AHA’s statement reviewed studies that suggest videos can help you become more heart healthy.
Home Blood Pressure Monitor: If you have high blood pressure, ask your doctor if you could benefit from using a home blood pressure monitor. The American Heart Association recommends an automatic, cuff-style, bicep (upper-arm) monitor. Wrist and finger monitors are not recommended because they yield less reliable readings.
Get Free Heart Healthy Recipes from the National Heart, Lung and Blood Institute
Sources: Interventions To Promote Physical Activity and Dietary Lifestyle Changes for Cardiovascular Risk Factor Reduction in Adults. A Scientific Statement From the American Heart Association. July 2010.;
The American Heart Association; and
National Heart, Lung and Blood Institute
Tanning Beds Are No Substitute for Phototherapy
June 30, 2010
Now that summer is in full swing, many people are heading to tanning salons. But experts emphasize that tanning booths may be harmful to skin—including if you have psoriasis.
In a recent webinar on indoor tanning, an expert from the FDA said, "We do not believe that tanning is safe." Furthermore, if you have a skin condition, you shouldn't attempt to self-treat it using a tanning bed.
"The spectrum of light used in tanning booths is very different than the spectrum used in phototherapy boxes," explains Mark Lebwohl, M.D., chair of dermatology at Mount Sinai Medical Center in New York City and a chairman of the American Academy of Dermatology's Psoriasis Task Force. Phototherapy boxes use therapeutic ranges of ultraviolet B (UVB) light, whereas tanning booth boxes vary in their ratios of UVA to UVB, so their benefits, if any, are questionable.
Tanning booths are also associated with skin cancers, including the deadliest form, malignant melanoma, according to new data. Phototherapy boxes, on the other hand, have a long history of safe use for psoriasis, according to Dr. Lebwohl. Studies have shown no association with increased risks of skin cancers.
You want a trained technician to administer light therapy. "These medical professionals protect patients in ways that tanning salons do not," says Dr. Lebwohl. "We can deliver UVB light more carefully through a phototherapy unit. We also protect the face—which is particularly at risk for skin cancers—with special glasses and a covering."
Living far from a facility that offers phototherapy isn't reason enough to use tanning beds. Neither the American Academy of Dermatology nor the National Psoriasis Foundation endorses the practice. Use a home phototherapy unit instead, suggests Dr. Lebwohl. Talk to your dermatologist and visit the National Psoriasis Foundation to learn more about home UVB equipment.
Sources: Mark Lebwohl, M.D., chair of dermatology at Mount Sinai Medical Center in New York City and a chairman of the Psoriasis Task Force at the American Academy of Dermatology; Indoor Tanning: Risks of Ultraviolet Radiation, a webinar hosted by FDA's Center for Devices and Radiological Health, May 26, 2010; American Academy of Dermatology; and National Psoriasis Foundation
Paying for Psoriasis Treatment
June 30, 2010
If you've skipped a doctor visit or gone without a psoriasis treatment because of the cost, you're not alone. According to a 2009 survey by the National Psoriasis Foundation (NPF), a whopping 44% of respondents with psoriasis and/or psoriatic arthritis went without a needed treatment because of financial issues. This is shocking considering the majority of respondents had public or private health insurance.
Among the reasons for forgoing treatment:
- lack of insurance (12%),
- necessary treatment was not covered (11%), or
- co-pays were too high (11%).
Here's the rub: Skipping treatment may worsen your disease and cost you more—in money and quality of life—down the road. Two-thirds of survey respondents have moderate to severe psoriasis; without treatment, 15% more of these individuals would develop severe or very severe disease.
Fortunately, there is help. The National Psoriasis Foundation offers a set of resources on accessing health care, including a list of financial assistance programs for people who qualify. Talk to your doctor, too. If a recommended treatment isn’t covered by your insurance plan, your doctor may be able to write a letter of medical necessity to appeal the coverage decision, or your doctor may suggest alternative treatments.
The bottom line: It's critical to see your doctor regularly to manage psoriasis and psoriatic arthritis. With good health, you can handle any other challenge that comes your way.
Source: National Psoriasis Foundation 2009 Survey
Diet and Weight Loss in Psoriasis
May 25, 2010
Psoriasis and obesity are both challenging health problems—together, they spell double trouble. Weight gain is a strong risk factor for psoriasis in women, suggests preliminary research. Other studies have identified an association between psoriasis and obesity. So the question is: Could weight loss improve psoriasis? Researchers from Italy made an initial attempt to find some answers. Here's what expert commentators had to say about the study.
The study asked: does moderate weight loss improve response to the psoriasis medication cyclosporine in people with psoriasis who are also obese? Sixty-one obese individuals were treated with cyclosporine and half also went on a low-calorie diet supervised by a dietitian. Everyone was encouraged to exercise for at least 40 minutes four or more times per week. After 24 weeks, the diet intervention group lost an average of 15.4 pounds, compared to 7.7 pounds for the medication-only group. The Italian researchers concluded that a calorie-controlled diet increases response to cyclosporine.
But, in the Archives of Dermatology, expert commentators point to several flaws in the study that limit the usefulness of its conclusions. The bottom line: The answer to the weight question still remains.
So what does emerging research on weight control and psoriasis mean for you? "Although the therapeutic and long-term impact of diet and weight loss on psoriasis remains unclear, the net benefit of moderate weight loss is likely to be positive and is therefore recommendable for most patients with psoriasis who are not at their ideal body weight," write the commentators.
So, if you're overweight, get on the move! Adopting a healthy diet and an active lifestyle can improve your cardiovascular health—and just may improve your psoriasis. Talk to your doctor about the best approaches for you.
Psoriasis Med Doesn't Raise Fracture Risk
May 25, 2010
If you take acitretin (Soriatane) or isotretinoin (Accutane) for severe psoriasis, there's less to worry about. An observational study of a half million Danes concludes systemic vitamin A analogues, sometimes used to treat psoriasis, don't appear to increase the risk of bone fractures—the major result of osteoporosis.
Previous studies have shown mixed results: most trials showed no detrimental effects of oral retinoids on bone mineral density (BMD), but a few found effects with specific medications, large doses or longer durations of treatment. This study, published in the Archives of Dermatology, found no trends associated with dose or duration for acitretin and isotretinoin.
The upshot: While encouraging, this study isn't the last word on the subject. Since this was an observational study, the researchers couldn’t account for some factors, such as sun exposure, use of UV light therapy, smoking habits and body mass index—which may influence osteoporosis risk one way or another.
But, for general health, it remains important to reduce your chances of osteoporosis. In an accompanying editorial, John J. DiGiovanna, M.D., wrote: "Sound measures for good skeletal health, including adequate nutrition (especially vitamin D and calcium, etc.) and healthy physical activity, should be encouraged. Monitoring may be indicated for individuals with a family or personal history of osteoporosis…" People with psoriatic arthritis, for example, may have a higher risk of the bone disease.
Talk to your doctor about your personal risk of osteoporosis; prevention strategies such as a calcium-rich diet and weight-bearing exercise; and getting bone mineral density testing.
Can Adalimumab Help You Beat the Blues?
April 29, 2010
Many people with psoriasis suffer with depression symptoms, partly due to the itching, pain and repeated flare-ups of their skin disease. Finding ways to reduce depression is a worthy goal. That's why researchers are intrigued by the possibility that TNF-alpha blockers may help reduce depression symptoms. A previous study of etanercept found that, in addition to treating psoriasis, the medication may reduce depression—either directly or indirectly. Recently, researchers wondered whether another TNF-alpha inhibitor, adalimumab, would reduce depression.
Why would a TNF blocker possibly improve depression? Some research suggests that depression results from inflammation, including from tumor necrosis factor (TNF), one type of inflammatory protein. If the connection proves true, tumor necrosis factor (TNF) is one type of inflammatory protein. If that is true, medications that block TNF may help treat depression.
According to the study, published in the Journal of the American Academy of Dermatology, adalimumab substantially reduced symptoms of depression compared to placebo in people with moderate to severe psoriasis. Participants who experienced a 75% improvement in their psoriasis symptoms (as measured by the Psoriasis Area and Severity Index [PASI]) had greater relief of depression than those with no skin and joint improvement.
It's unclear whether adalimumab had a direct or indirect effect on depression. The researchers also couldn't determine to what degree depression in psoriasis results from TNF and to what extent it is a consequence of living with a lifelong disease that affects appearance. Further studies are needed to answer these questions.
In the meantime, the researchers suggest that people with psoriasis should be screened and treated for depression symptoms.
The bottom line: It's natural to feel anger and frustration over the difficulties of the disease. But don't let these emotions keep you down. Share your feelings with family and friends, and seek the help of a mental health professional if you have difficulty coping.
About the study: 96 people with moderate to severe psoriasis were randomly assigned to receive 40 mg of adalimumab every other week or a placebo. During the trial, neither the participants nor the researchers were aware of the treatment given. Depression symptoms were measured by a self-assessment questionnaire called the Zung self-rating depression scale. After 12 weeks (or earlier termination) of treatment, people receiving adalimumab reported a 6-point reduction of depression scores.
New Nozzle for Clobex® Spray
April 29, 2010
Galderma Laboratories, L.P., announced the availability of a new nozzle for Clobex (clobetasol propionate 0.05%) Spray, a topical steroid available by prescription used to treat moderate to severe plaque psoriasis in adults, according to a news release.
The spray and new nozzle, which is now available at the pharmacy, will help people with plaque psoriasis apply the medication more easily and precisely to affected areas of the skin and scalp. Clobex® Spray should not be applied to the face, underarms, or groin. It also should not be used on thinning skin. Follow your doctor's directions.
To learn more about Clobex®, visit www.clobex.com.
What Health Care Reform Means for You
April 14, 2010
As many of you know, the Patient Protection and Affordable Care Act was signed into law by President Obama on March 23. If you or a loved one has psoriasis or psoriatic arthritis, the National Psoriasis Foundation has outlined some key ways the new law will affect you.
Beginning this year:
- Insurance companies will not be able to deny coverage to children with pre-existing conditions, such as psoriasis.
- Young adults up to age 26 may remain covered by their parents' insurance policies.
- Lifetime limits on medical coverage will be eliminated.
- Insurance companies can no longer drop coverage for people who get sick or need treatment.
- People who have been uninsured for six months and have a pre-existing medical condition will be able to obtain insurance through "high risk pools," with some help with costs. Starting in 2014, people in this program will obtain coverage through insurance "exchanges."
- Medicare patients will receive a $250 rebate when they enter the "doughnut hole"—the gap in coverage during which they pay 100% of the cost of their medication.
Future changes to Medicare:
- Starting in 2011, Medicare patients will receive a 50% discount on the cost of drugs when they reach the doughnut hole.
- Each year, the doughnut hole will get gradually smaller until 2020, when it will be eliminated. Medicare patients will still be required pay for 25% of the cost of their medications.
Beginning in 2014:
- Insurance companies will not be able to deny coverage to anyone with a pre-existing condition or charge higher premiums because of a person's health status.
- Most Americans will be required to have health insurance. Most people will continue to get health insurance through their employers.
- People without affordable employer-provided health insurance will be able to purchase coverage through new state health insurance exchanges. Financial assistance will be available, based on income.
- Plans offered through exchanges will be required to offer an "essential benefits package" that covers basic medical services, including prescription drugs.
- Low-to-moderate income individuals and families, including those in the Medicaid program, will receive help with out-of-pocket costs such as premiums and co-pays.
- Annual caps on the dollar amount of coverage a plan provides will be eliminated.
For a detailed summary of the provisions of the new health care law, visit the Kaiser Family Foundation.
A Useful Indicator of Psoriasis Severity?
April 14, 2010
Activated blood platelets—cell fragments that release substances that can increase inflammation—are believed to play a role in asthma, arthritis, and inflammatory bowel disease. Researchers wondered if these platelets also play a role in psoriasis. According to their study findings, platelets are indeed activated in psoriasis, especially in individuals with extensive disease. What's more, levels of activated platelets are closely related to psoriasis activity, and one marker—levels of platelet-derived microparticles—may prove to be a useful indicator of psoriasis severity.
For the study, researchers compared blood samples from 21 people with plaque psoriasis to a similar number of healthy individuals. They discovered levels of the microparticles were significantly increased in people with psoriasis, especially in those with extensive disease. In addition, there was a significant correlation between levels of the microparticles and the Psoriasis Area and Severity Index (PASI) score, a standard tool used to assess severity of the skin disease. When psoriasis improved, levels of the microparticles decreased. This study may bring scientists one step closer to understanding how psoriasis develops and worsens.
Nationwide Study Finds Psoriasis Is a Risk Factor for Stroke, Heart Attack
March 29, 2010
People with psoriasis are more likely to experience heart attack and stroke, according to new study findings presented at the American College of Cardiology's 2010 scientific sessions. Risks of atrial fibrillation (irregular heartbeat) and of undergoing angioplasty (a procedure that opens up blocked arteries) also appear to be higher.
The association between cardiovascular disease and psoriasis has been suggested before, but this is the first nationwide study to examine it. Researchers tracked heart troubles among the entire adolescent and adult population of Denmark over ten years, including over 40,000 Danes with psoriasis, according to a news release.
Having more severe psoriasis conferred greater risks. For instance, having moderate to severe psoriasis raised the risk of heart attack by 24% and stroke by 45%. Younger age did not appear to be protective. Adults under age 50 with moderate to severe disease had increased risks of both atrial fibrillation and stroke.
It's believed that inflammation, which plays a major role in psoriasis, could be the underlying factor that increases these heart and stroke risks.
The good news is knowledge is power. "I believe that our results call for increased awareness of psoriasis as a contributor to cardiovascular disease and for a discussion of future medical management," said Ole Ahlehoff, M.D., of Copenhagen University Hospital Gentofte, the study's lead researcher.
You can take steps starting today to help protect your heart. Talk to your doctor about the most effective ways to:
- quit smoking
- lose excess weight
- get regular, aerobic exercise
- consume a low fat, low sodium diet
- relax and relieve stress
- manage high cholesterol, high blood pressure, and other cardiovascular risk factors
A Diet & Fitness Program for People With Psoriasis
March 29, 2010
FitInYourSkin.com™ is a new website dedicated to instructing and inspiring individuals with psoriasis to live healthier with their disease. It offers a free 30-minute exercise DVD hosted by fitness trainer Jackie Warner. "While growing up, I witnessed the emotional and physical struggles my grandmother faced living with psoriasis," states Warner in a press release. "I know that exercise improves not only your health, it can also improve your overall wellbeing."
If you're too embarrassed by your skin to attend a gym or you find exercising physically difficult, this program potentially may help. To access most of the website's content, registration is required. Fit In Your Skin™ is funded by the pharmaceutical company Centocor Ortho Biotech, Inc. in partnership with the National Psoriasis Foundation.
Before beginning any exercise or diet program, talk to your doctor to determine what's appropriate for you.
TNF Blockers Improve Life With Psoriatic Arthritis
March 17, 2010
Anti-TNF therapy is associated with significant physical and mental improvements in people with psoriatic arthritis, according to a British study published in Arthritis Care & Research.
Psoriatic arthritis, which some people with psoriasis develop, is characterized by stiffness, pain, swelling and tenderness of the joints and surrounding ligaments and tendons. People with mild arthritis can be successfully treated with nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections. For people with moderate to severe psoriatic arthritis that is extensive or aggressive or that impairs quality of life, treatment with methotrexate, TNF blockers, or both is the standard of care.
For the study, data was analyzed from 596 psoriatic arthritis patients (average disease duration, 12.4 years) enrolled in the British Society for Rheumatology Biologics Register.
At six months, scores derived from questionnaires that assessed physical functioning and mental health rose among people taking a TNF blocker. As would be expected, improvements were most substantial in participants who also experienced improvements in their disease activity—but the impact on quality of life is noteworthy.
Improvements in physical function, as measured by a health assessment questionnaire, were similar for all three TNF blockers: etanercept, infliximab and adalimumab, according to a news report.
This study confirms suggestions from previous research that anti-TNF treatment might improve quality of life for people with psoriatic arthritis. Potential side effects from TNF blockers include rare cases of serious infections and malignancies, as well as other effects.
Enter the Addressing Psoriasis™ Contest
March 17, 2010
Addressing Psoriasis™ is in full swing. Now in its second year, the psoriasis awareness program helps people with plaque psoriasis feel more confident in their everyday style and learn more about their condition. One of the highlights is a contest culminating in a fashion show hosted by Project Runway's Tim Gunn where people with psoriasis take center stage.
This year's contest asks entrants to submit a 300-word personal essay about the challenges of living with moderate to severe plaque psoriasis, including its impact on your personal style, and how you think Gunn, a fashion consultant, may help you to present your best self to the world. A photo that illustrates your story needs to accompany the entry.
Five winners with the most compelling entries will be chosen and will receive a trip to New York City for a one-on-one consultation with Gunn. "Through my involvement in the first year of Addressing Psoriasis, I learned how much of an impact psoriasis can have on a person's physical and emotional wellbeing," says Gunn. "As someone who has always been an advocate of confidence as the ultimate fashion staple, I'm thrilled to continue to help encourage people with psoriasis to address their condition, which includes visiting a dermatologist and embracing their personal style."
Addressing Psoriasis™ is sponsored by Amgen and Pfizer with participation from the American Academy of Dermatology, the National Psoriasis Foundation, Psoriasis Cure Now, the Dermatology Nurses' Association and the Society of Dermatology Physician Assistants.
To enter the contest, view complete official rules and find resources about psoriasis, visit www.addresspsoriasis.com.
Antidrug Antibodies May Lower Response to Adalimumab
March 3, 2010
The biologic therapy adalimumab (Humira®) was approved in 2008 to treat moderate to severe plaque psoriasis. Many people have benefited from the treatment, but others have failed to respond to it. Some respond well initially, and then start to experience fewer benefits. To discover why, researchers tested an intriguing theory: Do antibodies to the medication form and interfere with adalimumab's effectiveness?
In the observational study published in the Archives of Dermatology, the researchers assessed antibody formation and psoriasis improvement in 29 people with moderate to severe plaque psoriasis treated with adalimumab. At the end of the 24-week study, the scientists found that thirteen of the patients developed antibodies to adalimumab, a TNF blocker. What's more, high concentrations of antibodies correlated with low levels of adalimumab in the blood. The researchers speculate that antibodies form complexes with adalimumab in the blood, which are removed from the body by the liver and the spleen—decreasing medication levels. Such a mechanism would help explain the lack of response to the biologic therapy.
The researchers conclude that high levels of antibodies are associated with less response to adalimumab treatment. But antidrug antibodies probably don't tell the whole story. Some participants who failed to respond to treatment actually had no antibodies. Further research is needed to clarify what role antidrug antibodies play in psoriasis treatment.
Enhanced MRI May Help Diagnose Psoriatic Arthritis
March 3, 2010
It's difficult to distinguish psoriatic arthritis, the joint disease that develops in some people with psoriasis, from rheumatoid arthritis (RA). The disorders produce similar symptoms—tenderness, pain and swelling in the joints with stiffness and fatigue. And no definitive test diagnoses one or the other (although some people with RA present with rheumatoid factor, an antibody, in the blood). Now a new study suggests that contrast-enhanced MRI may help distinguish the two autoimmune disorders. And that is important for psoriatic arthritis diagnosis—and treatment.
Enhanced MRI uses contrast media to improve the visibility of bodily structures. In the study published in the American Journal of Roentgenology, contrast-enhanced MRI of the hands and wrists revealed a key difference: The rate of uptake of contrast material to the synovial membrane, one area of the joint, was different in RA versus psoriatic arthritis.
When combined with other test results, the MRI results may help diagnose psoriatic arthritis. And that's crucial: A clear diagnosis allows for better treatment. Although there is some overlap between psoriatic arthritis and rheumatoid arthritis treatments, it's becoming clear that certain medications treat one disease better than the other. More research on contrast-enhanced MRI needs to be done before it can be widely recommended.
Treating Both Psoriasis and Psoriatic Arthritis
February 17, 2010
When it comes to effectively treating psoriasis—a skin disease—together with psoriatic arthritis—a joint disease—there's still a lot to learn. The challenge is to optimize treatment of both diseases for the best overall outcome. Although etanercept, a biologic therapy, treats both diseases, the recommended doses are different.
The goal of treatment for psoriatic arthritis is to reduce joint swelling and pain and to reduce joint damage, thereby preserving function and improving quality of life. Fifty milligrams of etanercept once a week is the suggested dose. To see if more frequent doses of etanercept might better treat psoriatic arthritis, researchers compared two different regimens.
In the Psoriasis Randomized Etanercept Study in Subjects with Psoriatic Arthritis (PRESTA), 752 patients in various countries were randomly assigned to receive 50 mg of etanercept via injection either once a week or twice a week for the first three months. To prevent bias, neither the researchers nor the participants were aware of the dosages given. Afterwards, everyone received a maintenance dose of 50 mg once a week.
The Results Are In
Skin Symptoms
At the end of the first three months, 46% of participants who took the injection twice weekly had "clear" or "almost clear" skin based on doctors' assessments, compared to 32% of those receiving the once-a-week dose. But by six months, skin improvement was similar. According to the researchers, an initial twice-weekly dose may result in "more rapid clearance of skin lesions."
Arthritis Symptoms
Notably, a similar number of participants experienced improvement in psoriatic arthritis symptoms—regardless of the initial dose. Inflammation of the finger or toe and an area of the joint capsule (conditions called dactylitis and enthesitis) are clinically important components of psoriatic arthritis, and these conditions improved equally well on both etanercept regimens. According to the researchers, "50 mg weekly is a sufficient dose for treatment of joint symptoms alone." Their finding coincides with recommendations on the medication label.
What about combination treatment? About 25% of participants received methotrexate treatment at the same time as etanercept (at an average dose of 12.7 mg/week). In this subset of participants, some benefit of combination therapy was apparent after three months for skin—but not joint symptoms—and only in those who received 50 mg of etanercept twice weekly during this period.
The bottom line: Based on the results of the PRESTA study, what's considered optimal treatment of psoriasis and psoriatic arthritis will differ by individual. If you have both diseases, talk to your doctor about the best treatment for you.
Etanercept was generally well-tolerated during the study. According to the medication label, the most common side effects are injection site reactions, headache and upper respiratory infections. Serious side effects are possible. Ask your doctor or pharmacist for more information.
Pick Up the Phone for Psoriasis Care?
February 17, 2010
Telemedicine has revolutionized some aspects of health care, including empowering patients to take a more active role in their own care. Researchers wonder if it can transform psoriasis care, but few dermatologists participate in the practice—perhaps because they feel more comfortable evaluating psoriasis skin symptoms in person.
To test the effectiveness of phone-based care, researchers in Austria asked ten people with psoriasis each to transmit 8 "mobile visits" to teledermatologists. For each "visit," participants took images of their skin lesions with a smartphone equipped with a 1.3-mexapixel camera and special software. Teledermatologists then emailed treatment instructions to patients within 24 hours via phone. For the sake of comparison, office-based dermatologists separately evaluated the participants during "face-to-face" visits.
The results: Both the teledermatologists and the office-based dermatologists made similar assessments of psoriasis severity; they also gave similar treatment recommendations. The only potential difference: determinations of induration of skin lesions and of the entire skin area affected. These differences may have been due to teledermatologists' inability to see the full body and to feel the lesions.
The bottom line: With proper instructions, teledermatology offering remote follow-up care could be a feasible option for people with psoriasis. But larger studies are needed to evaluate how telemedicine will affect patient participation and treatment outcomes.
How Much Do You Know About Psoriatic Arthritis?
February 4, 2010
Up to 30% of people with psoriasis go on to develop psoriatic arthritis, an autoimmune disorder characterized by joint swelling, inflammation, and pain. Commonly, the joint disease develops an average of 10 years after the skin disease, but a small percentage of people develop psoriatic arthritis before psoriasis or simultaneously. These are a few of the noteworthy facts presented by M. Elaine Husni, M.D., M.P.H., vice chair of Rheumatology and director of the Arthritis and Musculoskeletal Center at the Cleveland Clinic, in a webcast hosted by the National Psoriasis Foundation.
Here are some other points of interest from her talk:
- Psoriatic arthritis may develop if you have mild, moderate or severe psoriasis.
- The severity of skin disease does not always predict severity of joint disease.
- Men and women are equally affected.
- Onset of psoriatic arthritis usually occurs between ages 30 and 50.
- Psoriatic arthritis may affect any joint in the body; 16% of patients have more than 5 affected joints.
- No single treatment works for everyone. But many treatment options—including combinations of medications—are available.
- Psoriatic arthritis is chronic and progressive. Prompt diagnosis and treatment help slow the disease and the joint destruction that occurs in 20 to 50% of cases.
To learn more, view Dr. Husni's presentation on psoriatic arthritis diagnosis and treatment on the National Psoriasis Foundation's website. (Please note that you will be required to login to view this presentation.)
The bottom line: If you're experiencing joint pain along with psoriasis, see your doctor for an evaluation. It may not be psoriatic arthritis, but getting the right diagnosis and effective treatment can go a long way toward finding relief.
Adalimumab May Improve Psoriatic Arthritis Symptoms
February 4, 2010
In related news, a study published in Dermatology suggests that psoriasis treatment may improve psoriatic arthritis symptoms. Researchers from Abbott Laboratories, the makers of Humira® (adalimumab), looked at data from three randomized clinical trials of people with moderate to severe psoriasis and joint disease to estimate the effect of adalimumab on psoriatic arthritis. Based on their prediction model, they posit that adalimumab, a TNF (tumor necrosis factor) blocker, reduced symptoms related to psoriatic arthritis, including joint symptoms and pain. Furthermore, they believe the biologic medication may possibly prevent worsening of the arthritis.
While this study should be interpreted cautiously, it does suggest that treating psoriatic arthritis could bring some relief. According to the study, adalimumab reduced the risk of adverse events associated with psoriatic arthritis flares (within 17 weeks) by approximately 75% over placebo (1.1% versus 4.8%).
Medications that treat psoriatic arthritis include nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), biologics, systemics, antimalarial drugs, and others.
The study researchers point out that having joint disease in addition to skin disease sometimes results in poorer quality of life, impaired physical functioning, and higher costs—so it makes sense to consider these benefits when weighing the relative benefits and risks of psoriatic arthritis treatment.
Ustekinumab (Stelara®) Compared to Etanercept (Enbrel®)
January 21, 2010
In September 2009, the U.S. FDA approved ustekinumab (Stelara®) for plaque psoriasis. The biologic drug, a human monoclonal antibody, is the first in a new class of medications that work by blocking interleukin-12 and interleukin-23, naturally-occurring proteins that help regulate the immune system but are believed to play a role in psoriasis.
To help determine the relative benefits and safety of ustekinumab, scientists from the University of Manchester in England compared it to another biologic drug, etanercept (Enbrel®), which has a different method of action. A TNF-alpha inhibitor, etanercept blocks selective steps in psoriasis’ inflammatory process. Other TNF-alpha blockers, including adalimumab (Humira®) and infliximab (Remicade®), were not studied.
For the trial, the researchers randomly assigned 903 people with moderate to severe plaque psoriasis to receive injections of ustekinumab—either a 45 mg or 90 mg dose—or a high dose of etanercept (50 mg) over 12 weeks. Ustekinumab was administered as two injections given the first and fourth weeks; etanercept was given as twice-weekly injections.
According to the results published in The New England Journal of Medicine, ustekinumab showed "superior" effectiveness to etanercept over the 12-week period. More people taking ustekinumab experienced a 75% improvement in psoriasis severity: 68% of people receiving 45 mg of ustekinumab and 74% of those receiving the 90 mg dose, compared to 57% of people receiving etanercept. In addition, a higher proportion of people using ustekinumab had skin clearance or minimal skin disease after 12 weeks, according to their doctors.
In a crossover study, people who didn't respond to etanercept received two injections of ustekinumab (90 mg) at weeks 16 and 20. At week 28, the researchers reported that 49% of those patients achieved at least 75% improvement in psoriasis severity.
Both drugs showed similar safety profiles over the 12-week study period. Around 70% of people in all three groups experienced at least one adverse health event. Four people in each treatment group also experienced a serious medical event.
The study was funded by Centocor, a subsidiary of Johnson & Johnson and the marketers of Stelara® (ustekinumab).
So what does this study mean for patients with psoriasis? It's further evidence that researchers are honing in on good targets for psoriasis treatment. "The results of this study could have implications for determining the optimal approach to the treatment of psoriasis and, in particular, the need for therapeutic strategies targeting Th1 cells, Th17 cells, or both to provide optimal benefit and safety," write the study authors. If your plaque psoriasis isn't well-controlled with systemic medications, it also demonstrates the effectiveness of biologic medications.
If you are taking etanercept, and your psoriasis has improved with treatment, this study alone isn't reason to switch treatments. The safety profile of etanercept has been established over years of clinical use. As a relatively new drug, ustekinumab's long-term safety isn't yet fully understood. But for people with moderate to severe plaque psoriasis who have not responded to other treatments, talk to your doctor about the benefits and risks of ustekinumab.
Costs of Psoriasis Treatment Rising
January 21, 2010
Costs associated with systemic psoriasis treatments—including prescription drugs, doctor office visits, laboratory testing and monitoring procedures—are increasing at a much high rate than general inflation, according to a new study published in the Archives of Dermatology.
In addition, the cost of brand-name psoriasis medications from 2000 through 2008 increased by an average of 66%. At that rate, the costs of several brand-name psoriasis drugs greatly outpaced the rate of inflation for prescription drugs overall.
According to the study, the priciest treatment regimen over one year is alefacept (two 12-week treatments) at $27,577 per year, and the least costly treatment is methotrexate at $1,197 to $1,393 annually, depending on the dose. Costs of phototherapy, other systemic agents and other biologics ranged in between. Annual expenses associated with biologic medications generally exceeded those of other psoriasis treatments.
It's important to point out that these costs are not what patients actually pay. But even with insurance pricing structures in place, the authors note that people with moderate to severe psoriasis may wind up paying more for their healthcare.
The study does have limitations. This particular cost model calculates costs of psoriasis treatment over an entire year, while some medications are taken for shorter periods. In addition, the authors used average wholesale prices of drugs, which may be higher than prices obtained by hospitals, insurance companies, and pharmacies. On the other hand, the study didn't count expenses associated with hospitalizations or medication side effects, nor did it include indirect costs, such as time away from work.
Itchiness May Increase Stress
January 6, 2010
It's well known that people with psoriasis may experience stress as well as skin itchiness. But a new study published in the Archives of Dermatology suggests that itchiness itself may be psychologically stressful—separate from any links to skin disease.
A Japanese study of over 2200 generally healthy adults without psoriasis found that those who reported itchy skin were more likely to experience psychological stress than those without itching. And the more frequent the itch, the higher the perceived level of distress.
According to background information in the article, itchiness may change with the severity of skin disease and with skin's physical and chemical characteristics. Itch severity may even change between day and night, possibly owing to dysfunction of itch mediators.
Why is all this important? Stress triggers psoriasis flares in some people. So it makes sense to reduce your levels through various techniques, such as regular exercise, yoga, meditation, and simplifying your life. Calming the itch may be another strategy.
According to the National Psoriasis Foundation, these ingredients are among those approved by the U.S. Food and Drug Administration (FDA) for treating itch: calamine, hydrocortisone, camphor, diphenhydramine hydrochloride (HCl), benzocaine, and menthol. Aloe vera, jojoba, zinc pyrithione, capsaicin, and other natural substances also have been used to moisturize, soothe, remove scales, or relieve itchy skin.
Since natural ingredients as well as medications may cause side effects such as irritation and dryness, talk to your doctor about which anti-itch treatments are right for you to relieve your psoriasis symptoms.
Could the Placebo Effect Help Treat Psoriasis?
January 6, 2010
Researchers from the University of Rochester Medical Center and Stanford University explain the results of their recent study by asserting an intriguing hypothesis: Harnessing the placebo effect may help treat psoriasis and other diseases.
In the 11 to 14-week study published in Psychosomatic Medicine, the researchers started 46 people with psoriasis on a standard treatment: a full-dose of corticosteroid cream (0.1 percent acetonide triamcinolone). Then participants were randomly assigned to three different groups: group 1 continued to receive a full dose of the psoriasis medication, group 2 received a full dose only 25 to 50% of the time, and group 3, the control, received a reduced dose of medication. Groups 2 and 3 received the same overall amount of medication.
The results: In one arm of the study, group 2, who received a full dose of steroid medication only part of the time, experienced a similarly low relapse rate (around 25%) as group 1 who received it the entire time. Group 2 also experienced greater improvement in psoriasis severity than group 3.
The findings could indicate that a partial schedule of corticosteroid treatment may be as effective as more frequent dosing (the current standard). But the researchers believe another factor is at work: the placebo effect.
Participants in group 2 didn’t know when they received real medication or a placebo, but cues offered repeatedly—qualities associated with the drug, like its shape, color, smell, and packaging and administration by a healthcare worker—may have conditioned the participants so that they experienced the same powerful effect anyway.
How might conditioning work? According to the emerging field of psychoneuro-immunology, "the ability of the human immune system to fight disease is closely linked with a person's mind. Thoughts and moods are captured in neurochemicals that cause the release of hormones which interact with disease-fighting cells," explains the press release.
"Our study provides evidence that the placebo effect can make possible the treatment of psoriasis with an amount of drug that should be too small to work," said Robert Ader, Ph.D., M.D., the lead study author and distinguished professor in the University of Rochester School of Medicine & Dentistry. "While these results are preliminary, we believe the medical establishment needs to recognize the mind's reaction to medication as a powerful part of many drug effects, and start taking advantage of it," said Dr. Ader.
If conditioned responses are that powerful, they could dramatically affect psoriasis treatment and treatment of other chronic conditions, such as asthma, multiple sclerosis, and chronic pain. People may be able to take less of an active drug, which reduces the chances of side effects. Some people who couldn't tolerate treatments could potentially start receiving the medications. It could also lower healthcare costs.
Detecting Health Conditions Associated With Psoriasis
December 24, 2009
Managing skin symptoms is usually the focus of psoriasis treatment. But a growing body of research shows that psoriasis is associated with other serious conditions—such as psoriatic arthritis, depression, malignancy (cancer), metabolic syndrome, and cardiovascular disease—that also warrant doctors' attention. That's why the authors of a recent article published in the American Journal of Medicine summarized what's known about these diseases and provided recommendations to primary care doctors who treat people with psoriasis. For your health, it's also important for you to know about detecting and managing conditions linked with psoriasis.
Why people with psoriasis develop these conditions in greater numbers is still not completely understood, but researchers continue to learn more about the potential pathways. For example, scientists suspect that the chronic inflammation present in psoriasis is partly to blame for cardiovascular disease.
Awareness is Key
To better treat people with psoriasis, the authors suggest that primary care doctors perform regular screenings and examinations for associated conditions. Among their recommendations:
- Recognize the early signs of psoriatic arthritis to minimize joint destruction and deformities. (Screening tools vary, but radiography is used most often to detect joint damage.) Refer patients with psoriatic arthritis to a rheumatologist.
- Assess people with psoriasis for metabolic syndrome and cardiovascular disease. To reduce health risks, aim to maintain
-
- body mass index (BMI) under 25 kg/m2
- blood pressure below 120/80 mm Hg
- fasting blood glucose below 100 mg/dL
- fasting LDL "bad" cholesterol levels below 100 mg/dL and HDL "good" cholesterol levels at 50 mg/dL or higher (Total cholesterol should be 200 mg/dL or lower.)
- Perform visual examinations to detect skin malignancies and assess lymph nodes for enlargement.
Tip: Work with your doctor to reduce your risks and promote early detection of disease. Timely and appropriate treatment can result in better health and a better quality of life.
Complementary and Integrative Approaches to Psoriasis Treatment
December 24, 2009
In light of emerging news about health risks associated with psoriasis, Valori Treloar, M.D., a dermatologist and the author of The Clear Skin Diet, presented a talk in June 2009 on incorporating lifestyle changes that may improve psoriasis and reduce the chances of developing associated health conditions, such as heart disease, high blood pressure, diabetes, insulin resistance and obesity. Based on her understanding of current research, Dr. Treloar suggested that people with psoriasis talk with their doctors about an integrative approach that addresses diet and nutrition, physical activity, stress reduction, healthy weight loss, and more.
You may view Dr. Treloar's complete presentation at the National Psoriasis Foundation's website.
Here are some of Dr. Treloar's recommendations. Before you adopt any of these strategies, discuss them with your doctor to find out if they are safe and appropriate for you.
Diet and Nutrition
- Eat 5 to 8 servings of vegetables and two servings of fruit to get a healthy helping of antioxidants and fiber.
- Minimize refined carbohydrates and increase dietary fiber.
- Eliminate hydrogenated vegetable oils (trans fats).
- Eliminate high fructose corn syrup (found in a wide variety of commercially prepared foods and beverages).
- Consider taking high-quality fish oil capsules with meals—but stop if they make your psoriasis worse!
- To get adequate vitamin D intake, consider a vitamin D supplement.
- Consider a gluten-free diet for 3 months (no wheat, barley, rye and possibly oats).
Physical Activity
- Work with a personal trainer when you begin exercising to minimize injury.
- Perform flexibility exercises.
- Get 2½ hours of moderate-intensity aerobic exercise each week, if you are under age 65.
- Do muscle-strengthening exercises two days a week for about 20 to 30 minutes.
Stress Reduction
- Learn to say "no" and to accept help.
- Try to get good quality sleep.
- Do meditation, yoga, mindfulness training, biofeedback, or tai chi.
Control Weight: Aim for a body mass index (BMI) within the healthy range of 19 and 25.
And if you smoke, quit!
Treating Psoriasis in People With Hepatitis C
December 10, 2009
Treating psoriasis in people with hepatitis C virus infection presents special challenges. Not only is psoriasis worsened by interferon therapy, the standard of care for hepatitis C treatment, but many psoriasis treatments may harm the liver further, suppress the immune system, or both—something to avoid in people with a chronic infection.
To determine the best treatment options for patients with hepatitis C, a National Psoriasis Foundation medical board reviewed current research on psoriasis treatments and their potential effects on the liver and immune system.
The goals: Find out which psoriasis treatments improve quality of life for people with chronic hepatitis C, while minimizing side effects and avoiding additional liver damage. Too few studies existed of sufficient size and duration to make firm recommendations. But the medical board published some observations in the Journal of the American Academy of Dermatology worth sharing.
Mild Psoriasis
People with hepatitis C and limited psoriasis may be treated with topical therapies. When needed, ultraviolet B light therapy may be considered as second-line treatment.
Moderate to Severe Psoriasis
For individuals with hepatitis C and moderate to severe psoriasis, a combination of ultraviolet B light therapy and topical treatments may be tried as first line treatment. Second line treatments include: psoralen plus ultraviolet A light therapy (PUVA) and systemic medications such as acitretin, etanercept, and possibly other TNF blockers.
Other systemic therapies such as cyclosporine and alefacept are considered third line psoriasis treatments. Since little is known about the role of efalizumab in patients with psoriasis and hepatitis C, the medical board urged extreme caution before using this drug.
Many more questions need to be answered to determine optimal psoriasis treatments for patients with hepatitis C. Future research may provide greater insight.
Scientists Discover New Type of Immune Cells
December 10, 2009
Scientists have discovered a new type of immune cell called T-helper 22 (Th22), which can protect the body from inflammation and aid in tissue repair. "[The discovery] represents a milestone on the way to developing new treatment methods for inflammatory skin diseases, such as psoriasis," according to a press release from Helmholtz Zentrum Munchen, a German research center for environmental health that participated in the study.
T-helper cells are white blood cells that help activate other immune cells when the body is infected by viruses or bacteria. They also warn skin cells of environmental dangers and stimulate these cells to protect themselves, in addition to playing other roles.
In the study, published online in The Journal of Clinical Investigation, researchers examined skin samples from patients with moderate to severe plaque psoriasis, as well as other inflammatory skin conditions. During the process, they discovered the novel T-helper cell Th22.
The scientists hope that future research on Th22 cells will one day lead to development of new psoriasis treatments, as well as treatments for other chronic skin diseases and certain respiratory diseases characterized by inflammation.
Addressing Joint Pain
November 26, 2009
Anywhere from 6 to 30 percent of people with psoriasis also develop psoriatic arthritis, a condition that causes joints to become red, swollen and painful. It's not easy to determine who will develop the joint disease (people with mild, moderate or severe psoriasis symptoms can have it). Plus, psoriatic arthritis symptoms can be mistaken for other forms of arthritis and infection.
Yet, if left untreated, psoriatic arthritis sometimes leads to persistent inflammation, progressive joint damage and disability. That's why researchers of a small study published online in The Journal of Dermatological Treatment were eager to survey rheumatologists, who specialize in arthritis treatment, to ask how best to coordinate care with dermatologists, who specialize in skin conditions, to treat people with psoriasis complaining of joint pain. The American Academy of Dermatology also issued guidelines on psoriatic arthritis treatment that discuss the vital role of dermatologists.
According to these sources, dermatologists play a pivotal role in preventing joint damage in psoriasis patients. Over 60 percent of people with psoriasis receive care of their skin disease from a dermatologist, so these skin doctors are often the first to hear about joint problems.
Here's what you might expect your dermatologist to do:
- At each visit, ask if you’re experiencing joint stiffness, swelling, tenderness or pain and, if so, record when your symptoms started, how long they lasted and how they respond to exercise
- Examine joints for warmth, swelling and redness
- Prescribe a nonsteroidal anti-inflammatory drug (NSAID) to reduce joint swelling and pain, if appropriate
- Refer you to a rheumatologist if joint pain doesn't improve with medication or appears to have another cause
Dermatologists with resources and expertise may take additional steps. A psoriatic arthritis screening tool is being developed to help dermatologists identify patients with signs and symptoms of inflammatory arthritis, according to the American Academy of Dermatology.
To help health care providers further treat psoriatic arthritis, the American Academy of Dermatology (AAD) guidelines present a wealth of detailed information. Patients with mild psoriatic arthritis can be successfully treated with NSAIDs or injections of corticosteroids. For people with moderate to severely active psoriatic arthritis, methotrexate, TNF blockers or a combination of these therapies is considered first-line treatment.
American Academy of Dermatology GuidelinesWhat you can do: As an informed patient, speak up if you start to experience joint discomfort or pain; don't dismiss the symptoms, which may also include fatigue. The symptoms could indicate a number of different conditions. But if it turns out to be psoriatic arthritis, early detection and treatment may limit joint damage helping you enjoy a better quality of life.
The Latest on Psoriasis and Cancer Risk
November 26, 2009
A number of studies have shown an increased risk for leukemia, lymphoma, and various other cancers among people with psoriasis. But due to differences in study designs—for example, cigarette smoking was sometimes taken into account, sometimes not—trials have produced inconsistent results. So researchers conducted a large, population-based study to help clarify the association between early psoriasis and the risk of developing various cancers. They also examined how disease duration and psoriasis treatments may affect cancer risks.
For the study, the researchers compared medical data on 36,702 people with psoriasis living in the United Kingdom to a similar number of people without the skin disease.
The findings suggest that overall risk of developing cancer (excluding non-melanoma skin cancers) is only slightly higher in people with psoriasis compared with those without the inflammatory disease. When the researchers looked at disease duration, a longer history of psoriasis seemed to increase risk for colorectal, bladder and kidney cancers, as well as for pancreatic cancer, leukemia and lymphoma. People taking oral medication or, in other words, who may have more severe psoriasis, also appeared to have an increased risk of developing cancer.
This study does have limitations. The researchers couldn't rule out the possibility that the subgroup results were due to chance. They also note that further investigation is needed to determine how psoriasis and/or psoriasis treatments might influence cancer risks.
The bottom line: Don't worry. Continue to get recommended regular health screenings for cancer and avoid behaviors that increase your cancer risk, such as smoking.
How does PUVA Stack Up as a Psoriasis Treatment?
November 15, 2009
Psoralen plus ultraviolet A light therapy (PUVA) has been widely used to treat chronic plaque psoriasis, but researchers' ability to evaluate its effectiveness—especially compared to other psoriasis treatments—was limited. So to advance PUVA research, the scientists tested the treatment—taking oral psoralen, a light-sensitizing medication, then receiving UVA radiation from a light box—against UVA therapy plus a placebo in a study that used gold standard scientific methods. The conclusion: PUVA is indeed a highly effective treatment that helps clear skin affected by psoriasis. The results also roughly estimate how PUVA may stack up against other psoriasis treatments.
Compared to narrow band ultraviolet B light therapy, PUVA may be similarly effective or more effective, according to several studies. Based on results of this trial, published in the Journal of the American Academy of Dermatology, PUVA also may be comparable to the systemic psoriasis medications infliximab (Remicade®) and cyclosporine (Neoral®). More head-to-head comparison studies of PUVA with traditional and biologic medications are needed to confirm the results.
For this study, 40 people with plaque psoriasis were randomly assigned to PUVA treatment or UVA plus placebo (the control). Effectiveness of PUVA was defined as achieving 75% or more improvement in the Psoriasis Area Severity Index (PASI), a standard tool used to evaluate psoriasis treatments, after 12 weeks. The result: By one measure, eighty-six percent of study participants achieved this level of improvement in their psoriasis symptoms compared to zero percent in the control group. The most common reported side effects of PUVA were nausea, skin redness, itching, skin tightening, tenderness and vomiting.
Minorities Experience More Severe Psoriasis and Greater Distress Over Their Disease
November 15, 2009
A National Psoriasis Foundation survey reveals that minority groups—African Americans, Asians, Latinos and others—are more likely to suffer psychological effects from psoriasis and psoriatic arthritis than Caucasians. One possible reason: more members of these ethnic groups have very severe disease, generally defined as psoriatic skin rashes covering more than 10 percent of the body.
While only 8 percent of Caucasians taking the survey reported having very severe psoriasis, 10 to 23 percent of people in other racial groups had very severe disease. Nearly a quarter of African American (23 percent) respondents, for example, had very severe psoriasis.
"The prevalence of very severe psoriasis among minority respondents to the survey may both explain and be reinforced by the negative psychological and social effects they experience," said Mark Lebwohl, M.D., professor and chairman of dermatology at the Mount Sinai School of Medicine and chair of the National Psoriasis Foundation Medical Board, in a press release. "In psoriasis, emotional and physical distress feed off each other, and emotional stress is a documented trigger for flares of both psoriasis and psoriatic arthritis."
Among the notable findings:
- 72 percent of minority respondents said psoriasis interfered with their capacity to enjoy life, compared with just 54 percent of Caucasian respondents.
- 75 percent said psoriasis impacted their overall emotional wellbeing, compared with 62 percent of Caucasian respondents.
- Minority respondents were also more likely than Caucasian respondents to feel self-conscious, embarrassed, angry or frustrated, and helpless with regard to their psoriasis.
- Minority respondents were more likely to say that psoriasis made their appearance unsightly, and that they choose clothing to conceal psoriasis.
Why Emotions Matter
Since emotional distress can trigger flares of psoriasis and psoriatic arthritis, these results are important for treating these diseases. The stress may also contribute to poor mental health, including depression—two good reasons why people with psoriasis who have difficulty coping should seek care from a mental health professional.
The good news is these results may help foster the creation of programs and services to help people with psoriasis cope with the autoimmune disorder.
About the Survey:
The National Psoriasis Foundation conducted the survey by telephone and internet from 2004 to 2009. Nearly 5,000 people with psoriasis participated. Eighty-seven percent of respondents identified their race as Caucasian; 2 percent African American; 2 percent Asian American; 4 percent Hispanic/Latino/Mixed ethnicity and 1 percent Native American. Clinical research indicates that psoriasis is generally less prevalent among people of Asian and some African descents.
New Guidelines on Using Ultraviolet Light Therapy for Psoriasis
November 2, 2009
The American Academy of Dermatology (AAD) has released new, evidence-based guidelines on the treatment of psoriasis with ultraviolet (UV) light therapy.
These guidelines are the fifth of six installments on the care of psoriasis. Previous sections discussed general recommendations on managing psoriasis, topical medications and systemic and biologic treatments.
Light therapy, also called phototherapy, involves exposing skin affected by psoriasis to wavelengths of ultraviolet light. The goal is to suppress inflammation and reduce skin overgrowth. According to the guidelines, published online in the Journal of the American Academy of Dermatology, light treatment is an important option for many patients with psoriasis.
Light therapy effectively clears psoriasis in many cases. This psoriasis treatment is cost-effective and doesn't suppress the immune system the way traditional and biologic systemic medications do.
Some people with psoriasis are better candidates for certain UV light therapies than others. With these guidelines, physicians can make better-informed treatment decisions about the safety, effectiveness, dosage and scheduling of specific phototherapies for individual patients. Based on the best available scientific research and expert opinion, the clinical guidelines offer recommendations on the most common light therapies, used alone or in combination with topical or systemic psoriasis medications. These include:
- Broadband Ultraviolet B (UVB) light therapy: Skin is exposed to wavelengths of UVB light from a light box, also called a light panel.
- Narrowband Ultraviolet B (UVB) light therapy: Skin is exposed to a narrower range of UVB rays. According to the current guidelines, narrow band UVB is believed to provide better results than broad band UVB.
- Psoralen plus Ultraviolet A (PUVA) light therapy: After taking psoralen, a medication that makes the body more sensitive to light, a person receives a dose of UVA light from a light box.
- Excimer laser or targeted phototherapy: Instead of light boxes, a 308-nanometer laser delivers photons of light to targeted skin lesions.
Light therapy is administered for a specific period of time over multiple sessions. Side effects may include redness, burning and premature aging of the skin. Light therapy may potentially cause skin cancer, so a person receiving the psoriasis treatment needs to be monitored by a dermatologist.
New, Steroid-free Prescription Cream for Psoriasis
November 2, 2009
People with mild to moderate plaque psoriasis have a new topical skin medication: Prescription Zithranol® cream offers a novel delivery system that rapidly releases the medication anthralin into psoriatic plaques, according to Elorac, the dermatology company that makes the psoriasis cream. The active ingredient is surrounded by a layer of lipids that melts with body temperature when applied to skin affected by psoriasis.
How anthralin helps clear skin is not fully understood, but the compound is believed to decrease inflammation and slow the turnover of skin cells from psoriasis. Anthralin medication in other topical formulations has been used for many years to treat the chronic autoimmune skin disease.
How to Apply Zithranol Cream
Zithranol (1.2% anthralin) cream is applied once a day to psoriatic skin (including scalp psoriasis) for a short time (as determined by your health care provider) and then rinsed away with cool or lukewarm water.
Side effects of Zithranol include allergic reactions, skin irritation and staining; although, according to Elorac, these effects are less common than in other topical anthralin creams. People with acute or actively inflamed skin from psoriasis should not use the cream. Women who are pregnant or nursing should consult their physicians before using Zithranol, since the effects of the psoriasis cream on these patients are unknown. The topical psoriasis treatment has not been evaluated for use in children.
Survey Reveals the Social and Emotional Impact of Psoriasis
October 15, 2009
If you feel frustrated, depressed or angry about dealing with psoriasis, you're not alone. An insightful survey of people with psoriasis reveals that the chronic inflammatory skin disease significantly impacts quality of life.
Over six years, the National Psoriasis Foundation collected responses from nearly 5,000 people diagnosed with psoriasis and/or psoriatic arthritis. The advocacy group gathered information about disease severity, the impact of psoriasis on the workforce and on self-esteem, and the effectiveness of psoriasis treatments. Among the highlights:
Psoriasis and Work
An encouraging sixty percent of respondents with psoriatic disease were working full- or part-time jobs at the time of the surveys, which was comparable with the rate of employment of the general U.S. population. Among those not employed, more than a quarter reported that psoriasis and/or psoriatic arthritis influenced their decision to stay out of the workforce. Remarkably, 44 percent of people with psoriatic arthritis who were not working said it was due wholly or in part to the burden and/or disability of their diseases. Not surprisingly, the severity of disease appears to be another factor.
Psoriasis and Self-Esteem
Having a positive body image is important for self-esteem. Yet seventy-three percent of people with psoriasis reported feeling self-conscious about the severe skin rash associated with the disease, which often includes red, itchy plaques, lesions and/or pustules on one or more parts of the body, such as the palms, elbows, knees, scalp and feet. People with moderate to severe psoriasis (75 percent of respondents) may feel particularly self-conscious. Sixty-five percent went further and said that psoriasis makes their appearance unsightly, and 41 percent acknowledged changing their clothing to hide their psoriasis.
Psoriasis and Emotional Health
The impact of psoriasis is more than skin deep; it also deeply affects emotions. Seventy-three percent of respondents said they feel angry or frustrated over their psoriasis and a similar number (71 percent) said their condition causes them to feel helpless. A majority said psoriasis interferes with their capacity to enjoy life and impacts their overall emotional wellbeing.
Many people with psoriasis also deal with other symptoms related to the condition. Seventy-two percent suffer from itching; 70 percent from physical irritation and 59 percent from pain. Psoriatic arthritis, for example, causes arthritis pain, joint stiffness and swelling in and around the joints. All told, living with psoriasis and/or psoriatic arthritis is challenging for many people.
Coping With Psoriasis
What helpful information might you take away from these survey results? Recognize that you may need help managing a chronic autoimmune disease such as psoriasis. Before psoriasis takes a toll on your physical and mental health, talk to your doctor about appropriate psoriasis treatments, join a psoriasis support group, and seek care from a mental health professional if you experience depression. With proper treatment and the right support, there is help and hope for people with psoriasis.
Flu Shots and You
October 15, 2009
With all the news about the H1N1 (swine) flu, you may have questions about whether people with psoriasis should receive the flu vaccine and, if so, how people with the disease should be vaccinated against the influenza virus. Here’s what people with psoriasis need to know about immunizations.
This year, you need to protect yourself from various flu strains, including H1N1 (swine) flu and the seasonal flu. Vaccines are currently available for both. The sooner you get vaccinated, the sooner you'll be protected. Despite a popular misconception, getting a vaccine for one will not protect you against the other.
Taking Immunosuppressant Drugs?
If you're taking immunosuppressant medications for psoriasis, you need to take extra precautions to protect yourself from serious influenza infection. According to the National Psoriasis Foundation, those taking biologic drugs, such as:
- Amevive (alefacept)
- Enbrel (etanercept)
- Humira (adalimumab)
- Remicade (infliximab)
- Simponi (golimumab)
- Stelara (ustekinumab)
Depending on your overall health and psoriasis treatments, your doctor may have different or additional recommendations. Ask your doctor about what is—and isn't—right for you.
Staying Germ-Free: Advice Worth Repeating
Follow these simple tips from the Centers for Disease Control and Prevention (CDC) to avoid getting sick:
- Wash your hands often with soap and water or use an alcohol-based hand sanitizer.
- Try to avoid close contact with people who are sick.
- Avoid touching your eyes, nose and mouth, since it spreads germs.
Learn the Facts About Urinary Incontinence
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