Smoking And Obesity Impact Psoriasis

Smoking and Obesity More Prevalent Among Psoriasis Patients
Researchers report that the prevalence of both smoking and obesity is higher among patients with psoriasis than in the general population.
Chicago, Ill. - infoZine - Mark D. Herron, M.D., now in private practice in Montgomery, Ala., and colleagues from the University of Utah School of Medicine, Salt Lake City, studied the impact of obesity and smoking on psoriasis. A case series of patients with psoriasis enrolled in the prospective Utah Psoriasis Initiative (UPI) was compared with three population databases: the Behavioral Risk Factor Surveillance System of the Utah population, the 1998 patient-member survey from the National Psoriasis Foundation, and 500 adult patients who attend the University of Utah Department of Dermatology clinics and do not have psoriasis."The prevalence of obesity in patients within the UPI population was higher than that in the general Utah population (34 percent vs. 18 percent) and higher than that in the non-psoriatic population attending our clinics," the authors write. "The prevalence of smoking in the UPI population was higher than in the general Utah population (37 percent vs. 13 percent) and higher than in the non-psoriatic population."
The authors found that obesity appears to be the consequence of psoriasis, and not a risk factor for onset of the disease. "Smoking appears to have a role in the onset of psoriasis, but obesity does not," they write."It seems certain that the cost of providing care for psoriasis - when coupled with the increased frequency of obesity and smoking in patients attending clinics such as ours - will continue to increase," the authors conclude. "An effort to control obesity and smoking in psoriasis patients and an increased appreciation of the effects of these comorbidities are clearly needed."JAMAEditor's Note: This study was supported by a grant from the Dermatology Foundation, Evanston, Ill., and by financial support from LineaGen Inc., Salt Lake City, Utah.
Editorial: Advances In PsoriasisIn an accompanying editorial, Mark G. Lebwohl, M.D., of Mount Sinai Medical Center, New York, examines recent advances in psoriasis treatment, and suggests that the impact of those treatments on all dermatologic disease has been profound.Summarizing the findings of Fortes and colleagues and Herron and colleagues, Dr. Lebwohl writes, "These studies do not answer the question, however, of whether psoriasis leads to smoking or smoking exacerbates psoriasis.""The current issue of the Archives demonstrates that psoriasis remains a therapeutically and intellectually challenging disease," he concludes. "As research and development continue, we undoubtedly will have better treatments. We can only hope that they will be treatments that patients can afford."JAMA Editor's Note: In the past year, members of Dr. Lebwohl's department have served as investigators for and received grants and honoraria from Abbott Laboratories, Allergan, Amgen, Astellas, Biogen Idec, Centocor, Connetics, Genentech, Novartis, and Warner Chilcott. Dr. Lebwohl is also a consultant (or has pending consulting agreements) for Abbott Laboratories, Amgen, Astellas, Biogen Idec, Centocor, Connetics, Genentech, Novartis, Pfizer, Warner Chilcott, and 3M. In addition, members of Mount Sinai's Department of Dermatology hold patents for short-contact tazarotene therapy, excimer laser treatment of vitiligo, and topical genistein. Finally, in the past year, Dr. Lebwohl has served as a speaker for Abbott Laboratories, Amgen, Astellas, Biogen Idec, Centocor, Connetics, Genentech, Novartis, Warner Chilcott, and 3M.

Study Indicates Psoriasis Drug Also Aids in Depression

LONDON (Reuters) - Amgen Inc.'s psoriasis drug Enbrel appears to reduce depression and fatigue, as well as improving symptoms of the chronic skin disease, researchers said on Thursday.
Psoriasis is characterized by inflamed, red, raised areas of skin that develop silvery scales. The condition can have a major psychological impact on patients.
A 618-patient trial of Enbrel, known generically as etanercept, found that those given the drug for 12 weeks had a 50 percent improvement in a commonly used rating scale for depression and suffered significantly less fatigue compared to those on placebo.
The clinical trial also reaffirmed the ability of Enbrel to fight psoriasis, with nearly half of patients taking it achieving a 75 percent or greater improvement in their psoriasis, compared with only 5 percent on placebo.
The findings by Ranga Krishnan of Duke University Medical Center, North Carolina, and colleagues were published online by the Lancet medical journal in Britain.
Enbrel works to treat a range of autoimmune diseases by blocking an inflammation-causing protein called tumor necrosis factor. These diseases, which include psoriasis and rheumatoid arthritis, occur when the body's immune system mistakenly attacks healthy tissue.
Rival drugs include Abbott Laboratories Inc.'s
Humira and Johnson & Johnson's Remicade.
The indictable medicines are expensive -- costing about 10,000 euros ($12,030) per patient a year in Europe -- but they are increasingly reimbursed through healthcare systems under strict conditions.
Enbrel was originally discovered by Immunex, now part of Amgen, and jointly developed with Wyeth, which markets the product outside North America.

Plant Extract May Prove Beneficial For Psoriasis

An extract found in the cotton plant, gossypol, has shown the strongest anti-inflammatory actions yet seen in the scientific world. In the lab it completely knocks out dozens of different forms of skin inflammation and normalizes dilated, inflammed and hyper-reactive blood vessels. Gossypol's first indication is for the treatment of psoriasis because it also has a normalizing effect on keratinocytes. Pharmaceutical companies are moving very fast on this substance and have already placed them in nanosomes for penetration into the skin and timed release. Two other skin disorders on their list are rosacea and atopic dermatitis. Once again, the researchers have never seen an anti-inflammatory as potent, fast acting, and effective on dozens of different inflammatory responses. It out-performed a medium potency, prescription only steroid in a split-face study which is unheard of. Also, the nanosomes drop it off at several different levels in the dermis to treat multiple levels of blood vessels and inflammation. Anecdotally, many patients report diminished burning and stinging sensations within minutes of nanosome delivered gossypol.

Psoriasis Health Care Advocates

"Psoriasis Cure Now," a nonprofit patient group that works on behalf of the psoriasis community, today announced its 2005 "Health Care Advocates of the Year."

The recipients are Sen. Arlen Specter of Pennsylvania, Rep. Rosa DeLauro of Connecticut, and Rep. Ralph Regula of Ohio. These three lawmakers were instrumental in putting Congress on record in support of increased federal research for psoriasis and psoriatic arthritis. Psoriasis research funding has traditionally lagged behind other research areas, receiving just $6.5 million last year out of a federal medical research budget at the National Institutes of Health (NIH) approaching $30 billion.

"People with psoriasis have no Hollywood stars or other glitzy backers to call on for support or to bring attention to this incurable disease," said Michael Paranzino, president of Psoriasis Cure Now. "In fact, we have traditionally suffered in silence. Yet these leaders took up our cause without fanfare and recognized how research on psoriasis will help not just the millions of Americans with the disease, but may also help us better understand other challenging diseases. We are grateful for their service to their constituents."

"The National Institutes of Health plays an important role in medical discoveries that improve people's health and save lives," said Congressman Regula (Ohio-16). "I am pleased that, together with the support of my colleagues, we have been able to direct some of NIH's focus towards this disease which affects millions of Americans."

Psoriasis is an incurable, recurring disease of the immune system that can first strike at any age, causing dry, painful skin lesions that can crack, bleed and itch. Many people with psoriasis also have psoriatic arthritis, a chronic, progressive and debilitating inflammatory disease that often causes joint pain, stiffness and swelling, as well as bone damage. Studies this year found a higher incidence of autism in children of mothers with psoriasis, and a higher incidence of cardiovascular death among patients with severe psoriasis.

People with psoriasis also have higher rates of depression and suicidal ideation. "Congress really came together this year on behalf of psoriasis patients and their families," Paranzino added, "and Senator Specter, Congressman Regula and Congresswoman DeLauro led the way. A cure will come more quickly thanks to their efforts."

According to the NIH, there are as many as 7.5 million Americans with psoriasis, including an estimated 75,000 people with psoriasis in Connecticut; about 270,000 with psoriasis in Ohio; and about 285,000 with psoriasis in Pennsylvania. Each of these states also has important psoriasis research centers, including the University of Pennsylvania, Case Western Reserve University and Yale University.

"Cutting edge research like that being conducted at centers such as Yale University will help us find better treatments and ultimately a cure for psoriasis," said Congresswoman DeLauro (Conn.-3). "Federal funding for this research is critical, which is why I have fought in Congress to ensure psoriasis research continues. I am honored to be recognized by Psoriasis Cure Now for this work."

Psoriatic Arthritis

When psoriasis and arthritis occur together, it is known as psoriatic arthritis. (Arthritis is not a single disorder but rather the name for joint disease from a number of causes. Arthritic disease causes painful inflammation of one or several joints, with the inflammation destroying the cartilage in the joints.) The most easily recognizable form of psoriatic arthritis affects the joints of the fingers and toes. Psoriatic arthritis is usually less painful than rheumatoid arthritis. It also usually causes less disability.Psoriatic arthritis generally affects the fingers and toes, but it can involve the wrists, lower back, knees and ankles. Psoriatic arthritis can be a serious disease, with a large percentage of patients reporting that their symptoms limit their work or home activities.Psoriatic arthritis usually appears between the ages of 30 and 50. Its symptoms usually include at least one of the following:
Pain in one or more joints
Movement that is restricted by pain in the joint or surrounding areas
Morning stiffness
Eye pain or redness
Because there is no laboratory test for psoriatic arthritis, people with psoriasis and joint pain may want to consult a specialist in joint diseases, called a rheumatologist, to evaluate their symptoms. Other joint diseases such as rheumatoid arthritis, gout, and Reiter’s syndrome all may be confused with psoriatic arthritis.

Stress Induced Psoriasis

Although psoriasis is believed to be the result of an immune system malfunction, Lebwohl says there have also been a number of genes identified with this condition. And like most genetic conditions, he tells WebMD that there is also a unique, genetically determined time frame in which psoriasis is triggered into action, and it's different for everybody who has it. Still, he says, something does have to act as the initial trigger, and often, that "something" is stress.

Indeed, in a study published in the Journal of the American Academy of Dermatology in 1988, doctors from the Baylor College of Medicine concluded that stress can not only trigger a psoriasis flare-up, but in some instances it may also play a significant role in the initial onset of the condition.

Since the fall season frequently kicks off an activity-packed school year -- stressful for parents as well as students -- it's not hard to see why this time of year can make psoriasis worse. Toss in a stress-filled holiday season, and some psoriasis patients can suffer well into the New Year.

But doctors say you can head off the effects of stress by engaging in some form of relaxation beginning at the start of the fall season. The Baylor research notes that several studies found hypnosis and biofeedback are effective stress reducers in some people with psoriasis.

And in at least one study published in a Swedish dermatology journal, doctors from McGill University in Quebec found that both meditation and guided imagery were effective relaxation methods in reducing psoriasis symptoms. Lebwohl reports that in another study, patients undergoing UV light therapy who practiced guided imagery -- imagining their psoriasis being healed -- experienced a quicker remission than those undergoing UV therapy alone.

Indeed, Moore tells WebMD that anything that helps you relax -- including meditative yoga, vigorous exercise, acupuncture, or even just taking time out of your day to listen to a favorite CD or drift away with a great novel -- can help keep your psoriasis under control, particularly during a stressful season. Remember that these techniques work best with traditional medical therapy instead of alone.

Vitae Enters Phase II Clinical Trials

Vitae Pharmaceuticals, Inc.announced today that it has initiated Phase II clinical studies with VTP-201227 for the treatment of psoriasis and VTP-195183 to enhance immune celllevels in specific cancer treatments. "Within the last 18 months, Vitae has progressed multiple products intoPhase II trials, created a significant partnership with GlaxoSmithKline, andexpanded our robust pipeline of discovery projects," said Jeffrey Hatfield,CEO of Vitae Pharmaceuticals. "We now have significant development efforts inthree major disease areas, including oncology, dermatology and hypertension.The speed of our progress demonstrates the ability of our team, our uniqueapproach and the strength of our drug discovery capabilities and proprietarytechnologies." The first Phase II clinical compound, VTP-201227, has a novel mechanism ofaction and is being developed at Vitae Pharmaceuticals as a topical agent forthe treatment of psoriasis with potential extensions into other dermatologicalindications. The Phase II trial is designed to include 128 psoriasis patientsat 16 study sites in the U.S. The first psoriasis patient was enrolled anddosed in the study this month. VTP-201227 is a potent, selective inhibitor of two specific enzymes thatare active in the skin. Therapeutic targeting of these enzymes by VTP-201227promotes naturally-occurring healing processes within the skin. The compoundhas been designed to be rapidly inactivated in systemic circulation and thushas the potential to have a more favorable safety profile. In preclinicalanimal models, VTP-201227 was shown to exhibit a superior therapeutic indexcompared to other topical dermatology drugs. The second Phase II clinical compound, VTP-195183, is being studied incombination with other therapies for its potential to boost the levels ofinfection-fighting white blood cells in certain oncologic conditions. Vitaeadvanced the clinical program for this compound and initiated a Phase IIclinical trial in October. The Phase II trial is designed as a proof-of-biology study to determine the effectiveness of VTP-195183 in combination withGranulocyte Colony Stimulating Factor (G-CSF) to enhance mobilization ofperipheral blood progenitor cells in patients for whom high-dose chemotherapyis planned. VTP-195183 is a novel subtype-specific nuclear receptor agonistthat has been shown to be generally safe and well tolerated in cancer patientsin Phase I studies. The Phase II clinical trial of VTP-195183 is beingconducted outside of the U.S.

Understanding Scalp Psoriasis

Psoriasis is a common skin condition affecting 2-3% of the population of the United Kingdom and Ireland.
Psoriasis is in simple terms only a vast acceleration of the usual replacement processes of the skin. It appears as raised red patches of skin covered with silvery scales.

With scalp psoriasis there is thick scale and redness that is also evident around the scalp margins. Many patients experience severe itching and a feeling of tightness and some report soreness. One patient has described the build-up of scales as being like 'a mountain on my head'.

For those with scalp patches which flare up from time to time it is possible to manage at home. Shampoo treatments are improving all the time and can be bought over the counter. Your pharmacist should be able to advise. However if your scalp is covered with thick scale or it does not clear up do consult your GP who may arrange referral to a Dermatologist.

There is a range of treatments which can be prescribed including coal tar, dithranol, salicylic acid, cortico-steroids and Vitamin D derivatives to bring the flare-up to a manageable level.

The method of applying the treatment is most important. It involves parting the hair in sections and rubbing the treatment along the exposed area. It is best to do this in a sequential fashion working your way around the hair. You may need someone to help you in order to see the top of your head properly.

Providing care is taken to avoid scratching the scalp, combing and brushing to remove scaling is not only good but necessary.

Scalp psoriasis should not prevent any cosmetic procedures. Having a perm or colouring the hair can have a positive effect on your self esteem. Hair dyes are gentler than they used to be but it would be best to seek advice from a hairdresser who should have up to date information about possible options rather than colour or tint your hair at home. It is also a good idea to make sure that there are no scratches on the scalp when the hair is treated as the chemicals concerned can cause irritation on the broken skin.

A good hairdresser should be able to help you manage your hair and scalp. Telephone in advance and speak to a stylist to explain the situation or try to find a hairdresser who will visit you in your home.

Some people with severe psoriasis suffer temporary thinning of the hair. This can be very distressing but the hair will grow again once the flare up has subsided.

Psoriasis is known as the waxing and waning condition, and it can and does go away. Some people may be lucky enough not to suffer a further flare up, others may experience long remissions. It is unusual for anyone to suffer extensive scalp psoriasis for a long time, provided they seek medical help and use treatments as directed.

Children Suffer From Psoriatic Arthritis Also

Juvenile psoriatic arthritis can be tricky to diagnose. While psoriasis is a common skin condition, associated primarily with a chronic rash all over the, only about 12 to 14 percent of people with psoriasis will develop related arthritis.CausesGenetic and environmental factors play a strong role in the development of psoriatic arthritis. A family history of psoriasis is linked to many children with juvenile psoriatic arthritis, as well as a family history of other forms of spondyloarthropathy. There is little relationship between the severity of a rash and the risk of getting juvenile psoriatic arthritis, however.NOTE: In some people with juvenile psoriatic arthritis, the arthritis shows up before the rash. In these cases, diagnosis can be so difficult that it may take up to 10 years to be certain of a definite diagnosis.Signs and Symptoms
Pitting or thickening and yellowing of the fingernails and toenails
A small round scaly patch on the scalp, belly button or buttocks
Joint problems in large joints, such as the hip and sacroiliac joints
Joint problems can occur on just one side or in the same joints on both sides of the body
Swelling of entire fingers or toes, making them resemble sausages (dactylitis)
Eye inflammation occurs in 10 to 20 percent of children
NOTE: Children with juvenile psoriatic arthritis should be examined by an eye specialist (ophthalmologist) annually to check for eye problems.Long-term Concerns
Damage to the eyes or other eye problems
Decreased range of motion of a joint
Shortening or lengthening of a limb or digit
Damaged cartilage and/or enlargement of a joint
NOTE: Many children have no long-term consequences of having juvenile psoriatic arthritis. Your child may have none, one or several of the concerns listed above, but you should be on the lookout for any or all of them.

Psoriasis Cover ups

People are curious when they see something different, especially on your skin. You have many choices about how to react to their curiosity. You may choose to ignore their attention, or you can explain that psoriasis is a skin disease that is not contagious. Educating people about psoriasis is very valuable because it helps them to accept people who live with skin that is different.
But when you wish to go out in public without addressing your skin condition, certain techniques can help you cope. Wearing long sleeves, pants, turtlenecks, hats or scarves, for example, can make coping in public a lot easier on days when you don't have the emotional energy to accept the stares and questions.
Cosmetic cover-up products can help for those times when clothing won't do. Masking psoriasis lesions and camouflaging redness can make it easier to feel confident in social situations. Dermablend is one brand name of a body makeup that some people use. It can be found in major department stores.
Caution: Never apply cosmetic cover-up to open skin lesions, unhealed cuts or raw or irritated skin. Avoid using cosmetics if skin allergies are present. If you're ever in doubt about applying a cover-up, seek the advice of your physician.
Note: Not all types of psoriasis can be camouflaged. Masking pustular or erythrodermic psoriasis is not a good idea, because minor irritants in cosmetics can produce stinging and redness, and this skin is already inflamed.
What can I do to make my psoriasis less noticeable?Using moisturizers regularly can help improve the redness and scaling of psoriasis lesions. Also, remove as much scale as possible if you are going to use a cosmetic cover-up. There are two ways you can get rid of psoriasis scale on your own:
Occlusion: You can coat each plaque with a thick layer of heavy, over-the-counter emollient cream and then cover it overnight with a plastic wrap. In the morning, wash away the scales in the shower. Note: never occlude a prescription drug without first consulting your doctor.
Hydration: After soaking for 10 to 15 minutes in warm water and bath oil, gently rub your skin with a towel to remove the scales

THE FACTS ON PSORIATIC ARTHRITIS

Psoriatic arthritis is a genetically determined autoimmune disease that occurs in less than 10 percent of persons with psoriasis. Its treatment often requires consultation with a rheumatologist in addition to treatment of the skin lesions by a dermatologist. Psoriatic arthritis is classified with the disease grouping called seronegative spondyloarthropathies which also includes ankylosing spondylitis, enteropathic arthritis, and Reiter’s Syndrome. It occurs most frequently in psoriasis patients whose disease is active, especially in persons with the pustular type of psoriasis. Occasionally it appears in a person who has no dermatologic signs or symptoms of psoriasis, in which case it must be diagnosed by its unique laboratory test results. Psoriasis of the fingernails and toenails is associated with a higher incidence of psoriatic arthritis.
Symptoms of psoriatic arthritis resemble those of rheumatoid arthritis, although the diseases are otherwise quite different. Arthritis changes cause deterioration and pain in small joints of the hands and feet, large joints of the legs and spine, and tendons. Nonspecific foot pain or "tennis elbow" may be an early symptom to appear and may be overlooked if not associated with psoriatic skin or nail lesions.
Confirmation of a diagnosis of psoriatic arthritis requires specific blood and serum tests to differentiate it from conditions such as rheumatoid arthritis and other autoimmune diseases.
Please see the National Psoriasis Foundation for information on the treatment of psoriatic arthritis.
A pediatric form of psoriatic arthritis may appear as early as age 2 to 4 years in girls. A peak period of pediatric onset is age 11 to 12 in both girls and boys. In children the arthritis may appear several years prior to the onset of psoriatic skin lesions; this may pose a problem in recognizing the nature of the underlying disease, especially if there is no known family history of psoriasis.
Although psoriatic arthritis and psoriasis occasionally occur in the absence of a history of psoriasis in the family, a genetic predisposition for psoriasis is considered to be a necessary condition for development of psoriatic arthritis. The evidence for inheritability is well established.
As in the case of psoriasis, an environmental "trigger" may initiate the development of psoriatic arthritis in a genetically predisposed person.

Nail Psoriasis

About 50 percent of persons with active psoriasis have psoriatic changes in fingernails and/or toenails. In some instances psoriasis may occur only in the nails and nowhere else on the body. Psoriatic changes in nails range from mild to severe, generally reflecting the extent of psoriatic involvement of the nail plate, nail matrix (tissue from which the nail grows), nail bed (tissue under the nail), and skin at the base of the nail. Damage to the nail bed by the pustular psoriasis can result in loss of the nail.

Nail changes in psoriasis fall into general categories that may occur singly or all together:
The nail plate is deeply pitted, probably due to defects in nail growth caused by psoriasis.
The nail has a yellow to yellow-pink discoloration, probably due to psoriatic involvement of the nail bed.

White areas appear under the nail plate. These are air bubbles marking spots where the nail plate is becoming detached from the nail bed (onycholysis). There may be reddened skin around the nail.

The nail plate crumbles in yellowish patches (onychodystrophy), probably due to psoriatic involvement in the nail matrix.

Psoriasis of the nails can resemble other conditions such as chronic infection or inflammation of the nail bed or nail fold. Psoriasis of the toenails can resemble chronic fungal infection of the nails.

A person with psoriatic nails should avoid any injury - bumps, scrapes, etc. - that may trigger a worsening of psoriasis (Koebner’s phenomenon). Nail psoriasis is treated by the dermatologist as part of the overall treatment of the disease.

Nail psoriasis is frequently associated with psoriatic arthritis

Psoriasis Sufferers Face Increased Risks From Heart Disease

People severely afflicted by psoriasis have a significantly increased risk of dying from heart disease, new research shows.
A Swedish study found that patients hospitalised with the skin disorder were 50% more likely to die from a heart condition than expected.
The extra risk increased sharply as patients got younger, rising to 162% for those admitted under the age of 40.
For severe psoriasis sufferers aged 40-59 when they were hospitalised, the risk was 91% higher than in the average population.
However the same trend was not seen in less seriously affected individuals who were not admitted to hospital.
The findings emerge from a Swedish study of almost 9,000 psoriasis patients admitted to dermatology wards and more than 19,000 outpatients.
They suggest a genetic defect linking the skin condition and heart problems.
Serious psoriasis sufferers are known to have raised levels of blood cholesterol, which is a chief indicator of heart and artery disease.
Previously this was blamed on the age of older patients or the long term effect of drugs used to treat the disorder.
But the Swedish researchers found high cholesterol levels in a group of 600 newly diagnosed patients who had been suffering from psoriasis for less than a year.

Thymodepressin Now in Clinical Development In US

Few diseases cause more misery than psoriasis, a condition that occurs when a person's immune system overreacts and begins to attack the skin. Psoriasis is a non-contagious skin disorder which most commonly appears as inflamed, fluid-filled skin lesions covered with a silvery white scale. In its more severe phase, the scaly, red blotches can become itchy or painful and cover large areas of skin.
Approximately 2% of the population suffers from this often painful inflammatory condition. In the United States alone, this translates to about 5.5 million patients, many of whom are suffering from a reduced quality of life, and its effect can be as bad as or worse than many other well known diseases or conditions.
GenaDerm, a specialty dermatological company, is in the race to provide better therapies for more effective treatment of psoriasis. GenaDerm is a subsidiary of Bioaccelerate Holdings Inc. (OTCBB:BACL). The privately held company is co-developing with Immunotech Developments Inc., for Thymodepressin(r) the first synthetic peptide developed for the treatment of autoimmune diseases including psoriasis. Immunotech is a biotechnology-focused firm that works to develop novel therapeutic peptides for the treatment of large market diseases.
Now in clinical development and testing in North America, Thymodepressin(r) has already proved to be an effective treatment for psoriasis in Russia, where the drug was invented and is currently sold.
Professor Vladislav Deigin, Chief Executive Officer and President of Immunotech and inventor of Thymodepressin(r) said, "Immunotech was established to pursue the development and commercialization opportunities presented by a scientific platform for the identification and production of peptides. We are delighted that this has been the basis of developing an effective treatment for such a chronic and debilitating condition. Key therapeutic goals in the treatment of psoriasis are alleviation of the condition, and sustainability of the relief provided by treatment. After successfully treating many psoriasis patients in Russia we are optimistic that clinical trials will confirm this efficacy in other countries."
Christopher O'Toole, Head of Specialty Pharmaceuticals for Bioaccelerate said, "In the United States alone, 30% of psoriasis sufferers or 1.5 million patients are seeking treatment. Of these, roughly one third have moderate to severe psoriasis. We are confident that Thymodepressin(r) will demonstrate similar clinical efficacy for this group of patients as it progresses through its planned clinical trial program, and thus provide more treatment options in the future."

Psoriasis And The Social Connection

People with psoriasis perceive they have less social support, have difficulty expressing their feelings and have more trouble with social relationships than others, a new study shows.
Newswise — The study says these life stresses may make them more prone to outbreaks of their psoriasis.
Researchers led by Angelo Picardi, M.D., suggest in the November-December issue of Psychomatics that “psychological interventions aimed at increasing emotional awareness, fostering the security felt in close interpersonal relationships and increasing social support might help reduce” outbreaks or at least lessen their severity.
The scientists from La Sapienza University in Rome studied 33 patients with psoriasis who had a recent worsening of their symptoms and 73 patients who had other minor skin conditions. Both groups were asked about stressful events over the past year, specifically about their social and emotional lives.
Psoriasis is an inflammatory skin condition that affects about 7 million Americans. The study participants had plaque psoriasis, the most common form, which appears as patches of raised, reddish skin covered by silvery-white scales and forms most commonly on the elbows, knees and lower back.
The researchers found that, in comparison with the group that had minor conditions, the patients with a recent psoriasis outbreak had lower perceived social support, more characteristics of bottled-up emotions and higher “attachment-related anxiety.” There were no differences in their scores, however, on measures that tested experiences in close relationships.
People who are high in attachment-related anxiety tend to worry about whether their partners really love them and often fear rejection. In addition, some people are more avoidant that others. People who are high in attachment-related avoidance are less comfortable depending on and opening up to others and are reluctant to ask their partners for comfort or support.
Age, gender, education, marital status and alcohol consumption were taken into consideration when assessing patient outcomes.
“Theoretical models emphasize that these persons tend to rely more on cognition and cognitive information than on feelings and emotional information,” Picardi said. “Clearly, self-regulation is compromised both internally and externally, which may increase susceptibility to disease.
“Perceived social support is a subjective measure, but when the level is higher, it is associated with better health,” Picardi added. “Immunological processes play a major role in the pathophysiology of psoriasis.” He said that prior research has shown that stress has particular effects on the skin, including slower wound healing, greater susceptibility of skin cells and a higher propensity for inflammation.
Picardi A, et al. Stress, social support, emotional regulation, and exacerbation of diffuse plaque psoriasis. Psychomatics 46(6), 2005.

Living With Psoriasis

"People judge us on the basis of our skin — our whole culture is based on cosmetics, lotions, creams and all that," said Finkelstein, of Oakland, Calif. "With (psoriasis), there's a whole layer of psychosocial problems, feelings of embarrassment, of shame, of ultimately feeling isolated."
But these days, Finkelstein, a filmmaker, has cast off the shy persona and is sharing his story with a new documentary, "My Skin's on Fire: Living With Psoriasis." DVDs of the film can be ordered for free at www.beyondpsoriasis.com.
He said now is an ideal time to shed light on the skin disease that affects more than 5 million people because, thanks to new medications, it's no longer a disease that needs to remain hopelessly hidden.
Rather than treating the disease topically, a new class of drugs known as "biologics" and "immuno-supressants" target the internal cause — an immune system on overdrive, which leads to the visible pile-up of inflamed skin cells. Inflammation normally protects the body, but too much of it is harmful.
"Here, really in the last 2 to 3 years, they've changed the disease of psoriasis. For many years it was considered an inflammatory skin disease. Now it's known as an 'immune-mediated disease,'" he says. "They've been able to pinpoint some of the mechanisms that misfire in the immune system."
But as Finkelstein's film shows, living with psoriasis is often far more than just a bothersome condition. Its obvious symptoms — flaky, red skin — can be a tremendous mental burden as well.
In the film, Finkelstein follows the typical trajectory of dealing with psoriasis. First, small patches of flaky skin crop up, usually when a person is a young adult. Then comes the diagnosis of psoriasis. The person may feel confused, wondering where they got such a disease, but a bit of questioning often reveals that it runs in the family — a trait kept hidden from most family members. Then, the person goes through a long trial of different treatments, many of which don't work.
Thankfully, that last step has been shortened by the advent of biologic drugs, said Dr. Alan Menter, a clinical professor of dermatology at the University of Texas Southwestern Medical School in Dallas and founder of the International Psoriasis Council.
Menter, who was interviewed for Finkelstein's film, said it accurately portrays the emotional burden of the disease.
For example, when patients first come to him for medical help, they often are overweight and depressed, Menter said. Most newly-diagnosed patients are young adults.
"For example, you take a 25-year-old, standing in the mirror seeing these crusted patches all over his or her body. They're trying to go out and get a date and it's crushing. They can hide it with clothing but that can't hide it from themselves or when they relationship starts becoming intimate," he said.
But Menter and Finkelstein are both optimistic that this will be less of a problem in the coming years, as more people are treated with medicines that truly help quell the disease.
"Right now I think there are something like 40 new drugs," Finkelstein said. "The future looks very bright for all of us who have suffered for so many years. I think it's a very good time to be talking about psoriasis."

What is Psoriasis?

Psoriasis is a common immune-mediated chronic skin disease that comes in different forms and varying levels of severity. Most researchers now conclude that it is related to the immune system (psoriasis is often called an "immune-mediated" disorder).It is not contagious. In general, it is a condition that is frequently found on the knees, elbows, scalp, hands, feet or lower back. Many treatments are available to help manage its symptoms. More than 4.5 million adults in the United States have it. Between 10 percent and 30 percent of people with psoriasis also develop a related form of arthritis, called psoriatic arthritis.

Psoriasis and the T-Cell Connection

Scientists believe that certain white blood cells called T lymphocytes (T cells) play an important role in psoriasis. "And the disease has a genetic component," says Lindstrom. In about one-third of psoriasis cases, there is a family history of the disease.
T cells circulate throughout the body, orchestrating the immune system's response to foreign invaders like bacteria or viruses. In people with psoriasis, the defective T cells are overactive and migrate to the skin as if to heal a wound or ward off an infection. This process leads to the rapid growth of skin cells, triggering inflammation and the development of lesions.
Both the environment and genetics may play a role in the development of psoriasis. "In genetically predisposed children, psoriasis can be triggered by a strep or other infection," says Lindstrom. That's what happened to author John Updike. After an attack of measles at the age of 6, Updike developed psoriasis "in all its flaming scabbiness from head to toe," as he later described it in his memoir, Self-Consciousness.

PSORIASIS: CURE OR REMISSION

While the disease never goes away, the symptoms of psoriasis subside for a while (remission) and then return (flare-up, or reactivation). Remission can last for years in some people; in others, flare-ups occur every few weeks. Certain triggers, such as stress and seasonal changes, can reactivate psoriasis. "Certain drugs may also exacerbate it," says Lindstrom, including lithium, prescribed for bipolar disorder (also called manic-depressive illness), beta-blockers used to treat high blood pressure, and antimalarial drugs.

Arthritis Drug Treats Psoriasis

A drug for rheumatoid arthritis can relieve the suffering of patients with moderate to severe psoriasis for a year, researchers said on Friday.
They found that infliximab, which is marketed under the name Remicade by Johnson & Johnson in the United States and by Schering-Plough Corp in other markets, improved symptoms of the chronic skin condition that affects 2 percent of the population in western countries.
"This is the first study to show that the very rapid and dramatic improvement that you see with psoriasis can, in the majority of patients, be maintained over at least the medium term -- over the course of a year," said Professor Christopher Griffiths, of the University of Manchester in England.
Previous trials have only looked into the impact of the drug on psoriasis over a short period of about 12 weeks.
The study published in The Lancet medical journal also showed patients saw a significant improvement in one of the most disturbing features of psoriasis: nail disease.
"Up until now it has been extremely difficult to treat," Griffiths told Reuters.
He and his colleagues compared the effects of the intravenous treatment to a placebo, or dummy drug, on 378 patients with the illness.
Each patient was given three intravenous infusions of the drug or a placebo over six weeks and then every 8 weeks for nearly a year. After less than 3 months on the treatment, 80 percent of the patients showed at least a 75 percent improvement, compared to 3 percent in the placebo group.
By the end of the trial, the drug completely cleared the skin condition in a quarter of patients but no one in the placebo group had the same result.
"Some of the patients were improved to the extent that they had no psoriasis and there was no impairment of their quality of life. So this is the best result you could possibly aim for with a treatment for psoriasis," said Griffiths.
"Compared with the other available treatments, it does work extremely effectively and extremely quickly."
The scientists said none of the patients given the drug had any serious side effects. But they stressed that the treatment is not a cure. It is likely patients would have to be on a long-term maintenance programme.
Psoriasis, an immune mediated disease, can develop at any age but it occurs most commonly before the age of 40. Psoriasis patches can also show up on the fingernails and toenails. About 15 percent of patients also suffer from arthritis linked to the condition.
European regulators recently approved infliximab for the treatment of psoriasis but the drug has not yet been approved for the skin condition in the United States.
The drug is also used as a treatment for Crohn's disease, an inflammatory bowel condition.

TREATING PSORIASIS WITH LIGHT THERAPY

Exposing the skin to ultraviolet (UV) light--either from the sun or an artificial source--sets off a biological process that kills T cells, which slows the buildup of skin cells and reduces inflammation.
Light boxes that emit UV light to treat moderate-to-severe psoriasis and other skin diseases are medical devices that require licensing by the FDA. A person steps into the light box, which is about the size of a telephone booth, while lamps direct the light onto the body.
"Treatment with these devices is complex," says Richard Felten, an FDA chemist and senior medical device reviewer. The physician must determine an individual's sensitivity to UV and adjust the light emissions for the most effective treatment with the least risk of side effects, he says. Side effects may include burning, darkened skin, premature aging, and skin cancer. Three to five treatments per week for several weeks or months may be needed to get the psoriasis under control, followed by weekly maintenance treatments.
Light therapy, or phototherapy, is usually done in the physician's office or a medical facility that has the devices, says Felten. "The FDA has cleared some devices for home use under certain conditions and with a doctor's prescription," he says. Home devices include handheld devices for scalp psoriasis and stand-alone light boxes for other areas of the body.
Light therapy usually involves a short wavelength of ultraviolet light, called UVB. For people with resistant moderate-to-severe psoriasis, a combination of an oral or topical drug called psoralen and a longer wavelength ultraviolet A (UVA) light is used. This treatment is called "psoralen plus UVA" (PUVA).
"Psoralen makes the patient more sensitive to the UVA," says Lindstrom, "so once they've taken a dose of psoralen, a smaller dose of UVA is needed to treat them." Patients must be very careful to protect both skin and eyes for 24 hours after psoralen use to prevent damage, she says.
The FDA has also approved a special type of laser, an excimer laser, as a phototherapy device to treat mild-to-moderate psoriasis. "These lasers can deliver a much more controlled beam of light to small areas of the affected skin," says Felten.

Systemic Psoriasis Treatments

The FDA has approved oral and injected drugs that circulate throughout the body to treat psoriasis that is moderate, severe, or disabling. These systemic drugs are very powerful, and while some may be used continuously, others can only be used for a limited time because of their severe side effects. Once a drug is discontinued, the psoriasis may reactivate. The risk of birth defects prevents many systemics from being taken by pregnant women or women planning to become pregnant.
Systemic drugs that may be prescribed for psoriasis include acitretin, methotrexate, cyclosporine, and biologics, which are drugs made from proteins of living cells. Methotrexate, cyclosporine, and the biologic drugs are immunosuppressants, meaning they lower the body's normal immune response. "These drugs suppress the immune cells that cause psoriasis, but they don't distinguish these cells from the immune cells that protect our body from infections," says Elektra Papadopoulos, M.D., an FDA dermatologist.
Acitretin, a retinoid that is given orally for severe psoriasis, helps normalize the growth of skin cells. One of the side effects is raised fat (lipid) levels in the blood, and people taking this drug must get regular blood tests to monitor their cholesterol and triglyceride levels.
Methotrexate and cyclosporine slow the growth of skin cells. Methotrexate, taken orally or by injection, is also a chemotherapy drug for cancer patients. Cyclosporine, taken orally, was first approved to prevent organ rejection in transplant recipients. People using either of these drugs must be closely monitored and should use them only for short periods of time because of serious, potentially fatal, side effects.
Biologics are the newest systemic psoriasis treatments. Since 2003, the FDA has licensed three biologics to treat moderate-to-severe plaque psoriasis: Amevive (alefacept), manufactured by Biogen Inc.; Raptiva (efalizumab), made by Genentech Inc.; and Enbrel (etanercept), marketed by Amgen Inc. and Wyeth Pharmaceuticals. Enbrel was first licensed in 2002 to treat the arthritis associated with psoriasis, and in 2004 to treat psoriasis itself.
"All are immunosuppressive and have different proposed mechanisms," says Papadopoulos. Amevive simultaneously reduces the number of immune cells, including T cells, and inhibits T-cell activation. Raptiva inhibits the activation of T cells and the migration of those cells across blood vessels and into tissues, including the skin.
Enbrel inhibits the action of an inflammatory chemical messenger in the immune system called tumor necrosis factor-alpha (TNF-alpha), which is believed to play a role in both the skin and the joint symptoms of psoriasis.
All three biologics are injected. The FDA has licensed Amevive to be given in a physician's office, either injected into the muscle or into a vein (intravenously). It's a once-a-week treatment for 12 weeks; further treatments may be given after a waiting period.
The FDA has licensed Raptiva and Enbrel for home treatment. People can inject themselves with Raptiva under the skin once a week or with Enbrel once or twice a week. Both drugs are recommended for continuous use to maintain results.
Since biologic drugs are immunosuppressants, they may carry an increased risk of infection and cancer. Rare but serious effects have also included blood abnormalities and autoimmune diseases such as lupus. Other side effects are flu-like symptoms and pain and inflammation at the injection site.
Some dermatologists prescribe biologics alone for psoriasis or in combination with topical treatments. Leonardi says when he prescribes biologics, "I don't have to resort to adding other systemic therapies such as methotrexate, cyclosporine, acitretin, or phototherapy."
"Biologics are an alternative treatment to some of the traditional therapies," says Papadopoulos.
"Now we need to get the expense down," says Leonardi, who has patients who pay $30,000 per year on drugs to treat psoriasis.
Bird feels fortunate that her insurance company covers most of the expense of Enbrel, which is prescribed for both her psoriasis and psoriatic arthritis. Because of the arthritis pain, she has used a cane to help her walk and has had surgery on her wrist to correct some of the arthritis damage. Although Enbrel has been less effective over time for the psoriasis, she says, it's reduced her arthritic pain by about 95 percent. "I can jog down to the corner to chase after the dog," she says. "And last summer, I went hiking with my children in Colorado."

Reducing Psoriasis Treatment Risks

Biologics, other systemic drugs, and phototherapy are powerful treatments with increased risks, says Lindstrom.
Biologics may raise the risk for developing cancer and serious bacterial or fungal infections that spread throughout the body (sepsis).
Cyclosporine can damage the kidneys, methotrexate puts the liver and lungs at risk, and phototherapy can cause skin cancer. To reduce these risks, doctors often put patients on "rotational therapy." "The thought is by moving from one therapy to another therapy over time, the risk to any individual organ is reduced," says Lindstrom.
"We also try to choose a drug with an appropriate benefit-risk ratio," she says. For mild psoriasis, a topical steroid may be appropriate. For more severe disease, where it becomes impractical to apply topicals over a large surface area several times a day, a patient may need a systemic treatment.
Most of the highly effective treatments for psoriasis affect the immune system in some way. For steroid drugs, which have been around for more than 50 years, the risks are well known. But less is known about the long-term side effects of newer drugs, such as the biologics. The safety and side effects of biologics and other immune-suppressing drugs to treat psoriasis continue to be monitored by drug manufacturers and the FDA

The Future of Psoriasis Treatments

Researchers continue to look for reasons why immune cells overreact and what genes may be responsible for psoriasis, hoping to find better treatments, and eventually a cure. Psoriasis research is aided by the visibility of the symptoms on the skin.
"You can see the disease," says Leonardi. "You don't have to do invasive testing to see the effects of therapy." Psoriasis research has a "tremendous spillover into other fields besides dermatology," he adds. "There is a huge need for drugs to suppress the immune system without the side effects."
Multiple sclerosis, Crohn's disease, rheumatoid arthritis, and type 1 diabetes are just a few of the diseases that may also benefit from psoriasis research.

Finding the Right Treatment for Psoriasis

You may need to try different treatments before you find one that works well for you. It is important to discuss your treatment and progress with your doctor.
A recent study found that education, stress reduction, and muscle relaxation training can be beneficial to many people with psoriasis. Adding these elements to a treatment plan can reduce disability, anxiety, and stress related to dealing with psoriasis.
Treatments for psoriasis have potential side effects. People with moderate or severe psoriasis may need treatment for the rest of their lives. Many doctors will recommend that treatments be changed or rotated after a certain period of time to improve treatment effectiveness and reduce side effects.

Treating Psoriasis: Amevive

AMEVIVE is the first biologic approved by the FDA for the treatment of moderate to severe chronic plaque psoriasis in adults who are candidates for systemic therapy or phototherapy. AMEVIVE is a prescription medication that is injected by your doctor (15 mg IM, into the muscle) once a week, for a total of 12 doses.

Amevivie is not without side effects.
The most serious adverse reactions were:
Lymphopenia (see WARNINGS)
Malignancies (see WARNINGS)
Serious Infections requiring hospitalization (see WARNINGS)
Hypersensitivity Reactions (see PRECAUTIONS, Allergic Reactions)
Commonly observed adverse events seen in the first course of placebo-controlled clinical trials with at least a 2% higher incidence in the AMEVIVE®-treated patients compared to placebo-treated patients were: pharyngitis, dizziness, increased cough, nausea, pruritus, myalgia, chills, injection site pain, injection site inflammation, and accidental injury. The only adverse event that occurred at a 5% or higher incidence among AMEVIVE®-treated patients compared to placebo-treated patients was chills (1% placebo vs. 6% AMEVIVE®), which occurred predominantly with intravenous administration.

Basic Treatment Protocol For Psoriasis

Treatment of psoriasis is determined by the location, severity and history of psoriasis in each individual. There is no one method of treatment, for each person with psoriasis may respond differently. One main objective of treatment is to slow down the more rapid than usual growth rate of the skin cells. The rapid growth rate of skin cells causes the red, scaly psoriasis patches. The underlying cause of this increased skin growth is not yet known. For patients with minimal psoriasis, therapy is limited to topical medications that are drugs applied to the skin. For patients with moderate to widespread psoriasis, topical treatments are often combined with ultraviolet light therapy. Either sunlight or artificial ultraviolet light therapy can be used. If topical and ultraviolet light therapy are not effective, or are not practical, systemic or oral medications can be used. These may be combined with ultraviolet light therapy, the so-called photo-chemotherapy or PUVA therapy. In severe cases and unresponsive cases of psoriasis, there are oral medications that slow down the growth rate of skin which are helpful. These drugs can have significant side effects and have to be used with the proper safeguard and caution. Even these strong drugs do not cure psoriasis but only help to control the disease.

Symptoms of Psoriasis

Individuals with psoriasis experience symptoms such as itching, cracking, stinging, burning, or bleeding. Lack of sunlight and low indoor humidity in the winter months can cause the psoriasis symptoms to worsen. The skin is most likely to crack at the joints where the body bends, or in areas where the individual scratches. Scratching should be strictly avoided, because it can cause bleeding and infection. Psoriasis has also been known to cause pits or dents to form in fingernails and toenails. There is also the possibility that the soft tissue inside the mouth and genitalia can be affected. In some cases, psoriasis will cause joint inflammation that produces arthritis symptoms. This condition is called psoriatic arthritis.People with psoriasis may notice that there are times when their skin worsens, then improves. Conditions that may cause flare-ups include changes in climate, infections, stress, and dry skin. Also, certain medicines, most notably beta-blockers, which are used in the treatment of high blood pressure, and lithium or drugs used in the treatment of depression, may cause an outbreak or worsening of the disease.

General Definition of Psoriasis

Psoriasis is a chronic scaling skin. It may range from just a few spots anywhere on the body to large areas of involvement. It is not contagious or spread able from one part of the body to another or from one person to another. There is no blood test to diagnose psoriasis. The diagnosis is made by observation and examination of the skin. Sometimes microscopic examination of the skin (biopsy) is helpful where the changes are not typical or characteristic. The exact cause of psoriasis is unknown, but hereditary and genetic factors are important. Psoriasis runs in families. This does not mean, however, that every child of a parent with psoriasis will develop psoriasis, but it is common that somewhere down the line psoriasis will appear in families. Psoriasis is not caused by allergies, infections, dietary deficiencies or excesses, or nervous tension.

The Appearance of Scalp Psoriasis

Scalp psoriasis occurs in at least half of all people with psoriasis. It can range from very mild with fine scaling to very severe with thick, crusted plaques. Scalp psoriasis may appear as lesions that extend from the hairline onto the forehead and the nape of the neck. It is common for the psoriasis to appear behind the ears. Scalp psoriasis usually accompanies plaques in other areas of the body. Scalp psoriasis scales appear powdery with a silvery sheen. Possible causes of scalp psoriasis include: scalp treatments and severe psoriasis can both cause temporary hair loss; itching, picking and scratching lesions can worsen the psoriasis by causing a Koebner phenomenon (psoriasis appearing on the site of skin injuries).

Treating The Different Types of Psoriasis

There are five different types of psoriasis. The most common form of psoriasis is called "plaque psoriasis," which is characterized by well-defined patches of red, raised skin. About 80 percent of people with psoriasis have this type. Plaque psoriasis can appear on any skin surface, although the knees, elbows, scalp, trunk and nails are the most common locations. The other types of psoriasis are: Guttate described as small, red, individual drops on the skin. Inverse psoriasis is smooth, dry areas of skin, often in folds or creases, that are red and inflamed but do not have scaling Erythrodermic psoriasis is characterized as periodic, widespread, fiery redness of the skin. Pustular psoriasis which involves either generalized, widespread areas of reddened skin, or localized areas, particularly the hands and feet (palmo-plantar pustular psoriasis).Typically, people have only one form of psoriasis at a time. Sometimes two different types can occur together, one type may change to another type, or one type may become more severe. For example, a trigger may convert plaque psoriasis to pustular.

Large Plaque and Small Plaque Parapsoriasis

Current terminology of parapsoriasis refers to 2 disease processes that are caused by T-cell–predominant infiltrates in the skin. These disease processes are large plaque parapsoriasis and small plaque parapsoriasis.
As the nomenclature and description of the disease spectrum under the descriptive term parapsoriasis evolved, the primary focus has been on the distinction of whether the disorder progresses to mycosis fungoides (MF) or cutaneous T-cell lymphoma (CTCL). Small plaque parapsoriasis is a benign disorder that rarely if ever progresses. Large plaque parapsoriasis is more ominous in that approximately 10% of patients progress to CTCL. Controversy exists in the classification of large plaque parapsoriasis because some think it is equivalent to the earliest stage CTCL, the patch stage.
The duration of parapsoriasis can be variable. Small plaque disease lasts several months to years and can spontaneously resolve. Large plaque disease is chronic, and treatment is recommended because it may prevent progression to CTCL.
Pathophysiology: The initiating cause of parapsoriasis is unknown, but the diseases likely represent different stages in a continuum of lymphoproliferative disorders from chronic dermatitis to frank malignancy of CTCL.

Small plaque parapsoriasis likely is a reactive process of predominantly CD4+ T cells. Genotypic pattern observed in small plaque parapsoriasis is similar to that observed in chronic dermatitis, and the pattern of clonality of T cells is consistent with the response of a specific subset of T cells that have been stimulated by an antigen. Multiple dominant clones can be detected by polymerase chain reaction (PCR) of T-cell receptor gene usage, which supports a reactive process. Lymphocytes do not show histologic atypia to suggest malignant transformation. Southern blot analysis of T-cell receptor genes from parapsoriasis does not identify a dominant clone of T cells.
Some physicians believe that small plaque parapsoriasis is an abortive T-cell lymphoma; however, no clear distinguishing evidence, such as genetic changes observed in other malignancies, exists to support this contention. Nevertheless, a hint to the verity of this hypothesis is the recent identification of increased telomerase activity in T cells from CTCL at low-grade stages, high-grade lymphoma, and in parapsoriasis, which is activity not exhibited in normal T cells. A better understanding is likely to develop from further molecular characterization.

Large plaque parapsoriasis is a chronic inflammatory disorder, and the pathophysiology has been speculated to be long-term antigen stimulation. This disorder is associated with a dominant T-cell clone, one that may represent up to 50% of the T-cell infiltrate. If the histologic appearance is benign, without atypical lymphocytes, classification of large plaque parapsoriasis is made. If atypical lymphocytes are present, many would classify such patients as having patch stage CTCL.

Pityriasis Lichenoides

Pityriasis lichenoides variants describe scaly dermatoses with necrotic papules that are clinically and histologically different from parapsoriasis. These diseases generally are benign and undergo spontaneous resolution.

Pityriasis lichenoides is a rare cutaneous disorder of unknown etiology. Pityriasis lichenoides encompasses a spectrum of clinical presentations ranging from acute papular lesions that rapidly evolve into pseudovesicles and central necrosis (pityriasis lichenoides et varioliformis acuta or PLEVA) to small, scaling, benign-appearing papules (pityriasis lichenoides chronica or PLC). Although historically, the term Mucha-Habermann disease has referred only to PLEVA, the term applies broadly to the entire spectrum of disease including PLC. A rare febrile ulceronecrotic variant has been reported, which is a severe form of PLEVA with high fever and marked constitutional symptoms. Lesions may self-involute and resolve completely over weeks, or new lesions occasionally may appear in crops, waxing and waning spontaneously for months to years thereafter.

Mucha-Habermann disease is not a vasculitic process despite reports of immunoglobulin and complement deposition in vessels. Fibrin is not present in the walls of vessels, and thrombi are not found in the lumen. A cell-mediated mechanism has been proposed based on a T-lymphocytic infiltrate with a cytotoxic/suppressor phenotype, diminished epidermal Langerhans cells, and a reduction of the CD4/CD8 ratio. Mucha-Habermann disease is not a lymphoproliferative disorder. CD30 (Ki-1) cells, which are associated with large cell lymphoma, have been identified in the infiltrate of both lymphomatoid papulosis and Mucha-Habermann disease, leading some authors to view this as a self-limited self-healing lymphoproliferative disease.

What is Parapsoriasis?

Parapsoriasis describes a group of cutaneous diseases that can be characterized by scaly patches or slightly elevated plaques that have a resemblance to psoriasis, hence the nomenclature. However, this description includes several inflammatory cutaneous diseases that are unrelated with respect to pathogenesis, histopathology, and response to treatment. Because of the variation in clinical presentation and a lack of a specific diagnostic finding on histopathology, a uniformly accepted definition of parapsoriasis remains lacking.
In 1902, Brocq initially described 3 major entities that fit the description:
Pityriasis lichenoides (acuta and chronica)
Small plaque parapsoriasis
Large plaque parapsoriasis (parapsoriasis en plaque)

Alternative Treatments For Psoriasis

The success rates of alternative treatment for psoriasis are difficult to measure, as conclusive test results are not available. Psoriasis has traditionally been one of the skin conditions that has stumped researchers and has proven very difficult to cure. Unfortunately, many alternative treatment types available may not actually work, and many “cures” play on the need of the patient and as merely a means to make money. There is not one treatment out there that is a miracle cure. If that was the case, the cure would widely be known and not be a secret, hidden cure.
However, there is no doubt that some alternative treatment types do work, and some treatments may benefit one person and not another. Many natural treatments include Acupuncture, Ayurveda, Dermatitis-Ltd, Manipulation, Osteopathy, Climate, Diet, Dietary Supplements, Homeopathy, Water Therapy, Chinese Medicine, Meditation and Relaxation, Herbal therapies, Topical Moisturizing Products, and Magnets. Seeking consultation from a doctor is very important before trying any self-treatments.

Healing Psoriasis Through the Power of the Mind

There is no doubt that the mind is a very powerful aid in healing, and scientific evidence supports the fact that stress can trigger, as well as make psoriasis worse in some people. Meditation and relaxation and related practices that reduce stress are often beneficial to people with psoriasis.
Hypnosis has been referred to in several scientific studies as aiding in the clearing of psoriasis. These it has been found to double the rate of clearance that UV light therapy alone (another useful psoriasis treatment.) Both on its own and as a supplement to other psoriasis treatment, it has been cited as being helpful in clearing psoriasis in several published case reports. One study examined the use of meditation and guided imagery in patients undergoing ultraviolet light (UV) treatments. Patients who relaxed during the treatments cleared faster; in some cases, twice as fast as patients who had the light therapy alone.
When used practiced in conjunction with other alternative treatments and traditional medical treatments, stress management, mental relaxation, or any means of giving patients a feeling of control over the negative mental aspects associated with psoriasis is helpful.

Can A Vitamin Cure Psoriasis?

Dietary supplements encompass vitamins, minerals and herbal products. These usually benefit the body as a whole, but there is no evidence that a particular any particular supplement is a cure for psoriasis. The supplements cited to as being beneficial to psoriasis include red clover, sarsaparilla, milk thistle and burdock. These most likely have no bad side effects if taken in usual doses. People who buy these supplements and others are responsible for safeguarding their own health. There is a risk that certain dietary supplements, even multivitamins, may interfere with prescription medications, and it is a good idea for patients to discuss with their doctor before starting any taking any new supplements.

Psoriasis Control Through Diet

It has been shown that a healthy diet and lifestyle benefits everyone, especially people with psoriasis. While there is no specific diet that people with psoriasis should follow, there is evidence that certain foods will contribute to either improving there are some connections between certain foods and the skin getting worse or clearing up. This must be is true for each individual with no general rules set guidelines of foods that are better or worse. It is helpful for patients to eat only what makes them feel the most healthy.

Treating Psoriasis Through Water Therapy

Water therapy is the combination of sea salts and water and is the basis of many powerful therapeutic treatments. There are numerous types of Water Therapy administered at spas, ayurvedic & holistic centers, and health clinics around the world. Sports therapy clinics use Hydrotherapy Baths to help patients recover from joint and muscle injuries. Dermatologists are recommending Bokek Dead Sea Salt baths for patients with psoriasis, eczema and other dry skin conditions. Estheticians emphasize the cleansing properties of a sea salt bath to clean pores and to detoxify the body. Cancer patients use water therapy to help deal with radiation treatments. There are even Water Therapies & therapeutic bath salts you can use on a daily or weekly basis in your own home.
Hippocrates, the Father of Medicine, discovered the therapeutic qualities of seawater by noticing the healing affects it had on the injured hands of fishermen. The seawater not only restricted infection risks, but patients who followed treatments involving the use of seawater found that it also promoted pain relief. It is now known that sea salt therapy is an effective treatment that assists in the rejuvenation of the cells and also induces a healthy exchange of minerals and toxins between the blood and the water.
Types of Water Therapies
Balneotherapy - a range of treatments with warm mineral salt water, from bathing or underwater massage jets to plain drinking. Alkaline water helps stimulate the secretion of bile, while hypnotic water has diuretic effects and is often used for treating kidney stones.
Heliotherapy - use of the sun’s creative properties. Despite recent awareness of skin cancers, sun remains an excellent source of energy, boosts immunity and stabilizes mood when used appropriately. Skin treatments combine this with sea salt baths but should only be used together under the supervision of a doctor.
Phytotherapy - treatments with wild-growing herbs, plants, flowers or leaves. Used in salt baths, oils or infusions, their effect can be superior to pharmacological treatments for some medical conditions. Perfect for combining with sea salts.
Thalassotherapy - therapeutic baths using warm seawater. The application of seawater (which is very similar to the body’s own internal fluids) allows magnesium and potassium to be drawn into the blood stream while toxins are actively eliminated.

Harnessing The Power Of The Sun To Treat Psoriasis

There is widespread acceptance and studies to support the benefits of sunlight on psoriasis. Getting the most benefits from the sunlight involves getting regular doses of sunlight every day. When combined with saltwater bathing, particularly Dead Sea Salt bathing, sunlight is an impressive short term remedy for psoriasis. Every Year, thousands of people seek treatment at the Dead Sea in Israel, where they enjoy safe sun exposure, and bathing in the uniquely saline water. The rates of complete and dramatic clearing of psoriasis at the Dead Sea are unmatched anywhere in the world.

Herbal Treatments For Psoriasis

traditional Chinese Medicne is an ancient system of healthcare encompasses many different types of practices. A primary component of TCM involves compounds of herbal remedies, mixed uniquely for each patient. There are many formulas available for psoriasis treatment: topical, oral, and injectable. Given their history of development, these formulas deserve respect on their ability to help some patients. Some of these make the skin more sensitive to ultraviolet light and are combined with traditional phototherapy.
It is important to keep in mind that these Traditional Chinese herbal preparations are not clinically produced and there can be variations that misuses occur that can have negative effects on people. There are many natural drugs which are very potent in humans, and should be used with care.

Taking a holistic approach to healing arthritis and rheumatism is essential when talking natural healing. Many different factors come into play including the very important factor of genetics, as well as psychological imbalances. The natural approach to healing generally accounts for a buildup of toxins in the system and these remedies serve to cleanse the system. There are many useful products that hare accepted as useful in treating arthritis and rheumatism, including Bog bean, Guaiacum, Black cohosh, Celery seed, Meadowsweet, Yarrow, Jamaican dog wort, Valerian, Passion flower and Capsicum. These have been used for many years by herbalists for arthritis treatment.
These herbs have already been mixed into the most beneficial compounds to yield the best result. Because many natural compounds are inherently very potent and may be toxic, getting the right balance is an experimental process. It is a good idea if you intend to use these products to purchase a ready-made compound from either a pharmacy or a herbalist

Psoriasis Treatment Through Manipulation

This term is used to describe any method of treating pain which includes realigning the joints, (such as Chiropractics). Manipulation of the joints must be done by a highly skilled person in order to avoid any risk that the practice might actually harm the inflamed joints rather than help them.
With little proof of helping with psoriatic arthritis patients, however, massage is quite helpful to relieve pain in the muscles and restore joint health after the inflammation has subsided

Treating Psoriasis With The Ancient Methods of Ayurveda

An ancient healing method based on prevention rather than cures, Ayurveda has roots in India thousands of years old. It is a more holistic approach, and does not focus on one affected area or one specific disease or condition. It focuses on balance though balancing lifestyle and meditation as well as a healthful diet and dietary supplements. This holistic approach to controlling Psoriasis might involve reducing stress, cleansing the body, exercise, and oils for the skin.

Using Acupuncture To treat Psoriasis

With roots in ancient China, this technique of relieving pain and treating disease involves inserting and manipulating fine needles in the body at varying depths at “meridians” or acupressure points. Acupuncture, though, is not a common way to treat psoriasis in China but there is evidence that it is an effective psoriasis treatment. This evidence is largely unsupported by clinical studies, and its success of varies from person to person. Generally, it takes many treatments in order to help. The benefits of this acupuncture include no side effects, so trying the treatment involves no risk of negative side effects. Acupuncture is becoming more widespread and accepted as a means of treating and controlling the pain associated with psoriatic arthritis and rheumatism.

Keeping the Skin Moist

Indeed a very important part of healing psoriasis, many moisturizing agents can be considered natural treatments natural compounds products. One treatment which has been studied and found effective is aloe vera. Other substances which may be helpful due to their moisturizing properties include neem oil, emu oil, jojoba, among others, but these have not been proven scientifically to help psoriasis.
Products including witch hazel, tea tree oil, mahonia ther aquifolium, capsaicin and evening primrose oil seem to have medicinal effects on the skin, and Capsicum (a natural component of hot peppers) is widely known to be an effective pain reliever when applied to the skin and to help relieve scaling, redness and itching. Bathing and moisturizing with oat- derivative products is soothing to may skin conditions.

The Profile of Scalp Psoriasis

Scalp psoriasis may occur in isolation or with any other form of psoriasis. The back of the head is a common site but multiple discrete areas of the scalp or the whole scalp may be affected. Scalp psoriasis is characterised by thick silvery white scale on patches of very red skin. It may extend slightly beyond the hairline. Scalp psoriasis, even though often adequately camouflaged by the hair, is often a source of social embarrassment due to flaking of the scale and severe 'dandruff'. Scalp psoriasis may not cause any symptoms at all or may be extremely itchy. It tends to be a chronic problem, lasting many years.
In very severe cases there may be some temporary mild localised hair loss but scalp psoriasis does not cause permanent balding.
Scalp psoriasis requires slightly different regimes from psoriasis affecting the skin elsewhere. This is due to hair, which makes application of many topical products difficult and protects the scalp from the effects of ultraviolet light. Unfortunately, many scalp treatments for scalp psoriasis are messy and smelly. Most treatments will need to be used regularly for several weeks before a benefit is seen.
Special medicated shampoos can be purchased from the chemist.
Coal tar shampoos are suitable for most patients with scalp psoriasis
Ketoconazole shampoo is effective for dandruff, seborrhoeic dermatitis and sebopsoriasis
The shampoos work best if rubbed into the scalp well, and left in for 5 or 10 minutes and then reapplied. They are safe for daily use but may irritate if applied more than twice weekly. If you dislike the smell of coal tar, try shampooing again with a favourite brand, and use a conditioner.
More severe cases require leave-on scalp applications.
Alcohol-based topical steroid and calcipotriol lotions can reduce itch but don't lift scale very well. Use topical steroids intermittently; overuse results in more extensive and severe psoriasis.
Salicylic acid and coal tar creams work much better, but are messy. Coconut compound ointment is a combination of coal tar, salicylic acid and sulphur and seems particularly effective. Leave on for at least an hour and shampoo off later. Most people rub the cream into the plaques at night and wash it off in the morning.
Use the scalp preparation daily at first then as the condition improves, reduce the frequency. Unfortunately in many cases the scale soon builds up again, so the creams may have to be applied regularly to keep the scalp clear.
Cutting hair short helps control scalp psoriasis, probably by making the treatments easier to apply, but is not appealing to everyone.

Treating Pustular Psoriasis

Pustular psoriasis usually occurs in adults. It is characterized by blister-like lesions filled with non-infectious pus and surrounded by reddened skin. Pustular psoriasis, which can be limited to one part of the body (localized) or can be widespread, may be the first symptom of psoriasis or develop in a patient with chronic plaque psoriasis.

Generalized pustular psoriasis is also known as Von Zumbusch pustular psoriasis. Widespread, acutely painful patches of inflamed skin develop suddenly. Pustules appear within a few hours, then dry and peel within two days.

Generalized pustular psoriasis can make life-threatening demands on the heart and kidneys.
Palomar-plantar pustulosis (PPP) generally appears between the ages of 20 and 60. PPP causes large pustules to form at the base of the thumb or on the sides of the heel. In time, the pustules turn brown and peel. The disease usually becomes much less active for a while after peeling.

Acrodermatitis continua of Hallopeau is a form of PPP characterized by painful, often disabling, lesions on the fingertips or the tips of the toes. The nails may become deformed, and the disease can damage bone in the affected area.

6-ThioguanineApproved for treating leukemia, it may be effective in treating psoriasis, especially pustular psoriasis. Possible side effects include anemia, decrease in white blood cells and platelets and bone marrow toxicity.

IsotretinoinFDA approved for the treatment of severe cystic acne, oral isotretinoin may also be effective in treating pustular psoriasis. Isotretinoin is a potent drug that can cause severe birth defects. For this reason, it should not be used by a woman who is pregnant or breast feeding. Women planning a pregnancy should discontinue taking isotretinoin and use birth control for at least one month before trying to become pregnant.

Non-traditional psoriasis treatments include:
*Soaking in warm water and German chamomile (Matricaria recutita) or bathing in warm salt water.
*Drinking as many as three cups a day of hot tea made with one or a combination of the following herbs: burdock (Arctium lappa) root, dandelion (Taraxacum mongolicum) root, Oregon grape (Mahonia aquifolium), sarsaparilla (Smilax officinalis), and balsam pear (Momardica charantia).
*Taking two 500-mg capsules of evening primrose oil (Oenothera biennis) a day. Pregnant women should not use evening primrose oil, and patients with liver disease or high cholesterol should use it only under a doctor's supervision.
*Eating a diet that includes plenty of fish, turkey, celery (for cleansing the kidneys), parsley, lettuce, lemons (for cleansing the liver), limes, fiber, and fruit and vegetable juices.
*Eating a diet that eliminates animal products high in saturated fats, since they promote inflammation.
*Drinking plenty of water (at least eight glasses) each day.
*Taking nutritional supplements including folic acid, lecithin, vitamin A (specific for the skin), vitamin E, selenium, and zinc.
*Regularly imagining clear, healthy skin.

Dermatitis or Psoriasis - Which One Do I Have?

Is it dermatitis or psoriasis? How to Determine which skin condition you have:
Dermatitis is simply an inflammation of the skin, it is anything that causes redness, itchy and/or irritation. It can be poison ivy, rosacea, acne, eczema, or psoriasis. Psoriasis defines the skin condition in more depth. Psoriasis is a noncontagious inflammatory skin disease characterized by recurring reddish patches. Psoriasis as an hereditary components illness; in fact it’s possible to find different people with this pathology in the same family. It's frequently found in a family composed by people with pathologies as: diabetes of the adult, rheumatoid arthritis, the systemic lupus erythematic, vitiligo and a member with psoriasis too.

Inverse Psoriasis: What It Is And How To Treat It

Inverse or Flexural psoriasis is localized in the flexural surfaces of the skin or skin folds. This type of psoriasis is often white in color, appears softened as if soaked by water, and may resemble a fungal infection. There is very little scaling, although the patches are inflamed and can be very sore. Appearing as it does in the folds of the skin, it is moister than other forms of psoriasis, and can be more uncomfortable physically. Flexural psoriasis rarely occurs by itself. It is more likely to accompany common plaque psoriasis. Psoriasis sufferers in their middle years or old age are more susceptible to this type of psoriasis as are people who are overweight and have more folds of skin.

The goal of psoriasis treatment is to reduce inflammation and to control flaking of the skin. Psoriasis treatment is based on the affected person’s health, age, lifestyle, and the severity of the psoriasis. A number of different psoriasis treatments are normally employed to determine which is the most effective.

Treatment can be difficult due to the sensitivity of skin in these fold areas. Steroid creams and ointments are considered very effective, but they should not be occluded (covered) with plastic dressings. Overuse or misuse of steroids, particularly in skin folds, can result in side effects, especially thinning of the skin and stretch marks. Because these areas are prone to yeast and fungal infections, doctors may test for infection and then may use diluted topical steroids in combination with other medications, for example, 1% or 2% hydrocortisone with anti-yeast or antifungal agents.

Other topical agents, such as Dovonex, coal tar or anthralin, can be somewhat effective in treating psoriasis in skin folds, but they may also be irritating. They should be used with caution and under the direction of a doctor. People with severe inverse psoriasis may occasionally require systemic drugs, such as methotrexate, to control the condition.

In December 2000, the U.S. Food and Drug Administration approved a drug called Protopic (also known by its generic name tacrolimus) for eczema. Many dermatologists have found it works well for psoriasis lesions in skin folds. Elidel (also known by its generic name pimecrolimus) can also be used for inverse psoriasis. Elidel is generally not as effective as Protopic but is less greasy.

Sometimes a product called Castellani's Paint (prescribed by a doctor and compounded by a pharmacist, or bought over the counter as brand name Castederm) is used to treat inverse psoriasis. It is a liquid that can be painted on the affected skin and can help to dry moist lesions of psoriasis in folds, as can the use of various powders. Some people will use creams at night and powders in the morning. Zeasorb and Zeasorb AF may be effective powders to use for inverse psoriasis.

Cause, Symptoms and Treatment of Guttate Psoriasis

Guttate psoriasis refers to a distinctive, acute clinical presentation of an eruption characterized by small, droplike, 1-10 mm in diameter, salmon-pink papules, usually with a fine scale. The word guttate is derived from the Latin word gutta, meaning drop. This variant primarily occurs on the trunk and the proximal extremities, but it may have a generalized distribution.

Guttate psoriasis is a relatively uncommon form of psoriasis. It is usually seen in patients younger than 30. Flares generally follow an infection, most notably strep throat.
Psoriasis seems to be an inherited disorder, and it appears to be related to the immune or inflammatory response. It often is aggravated by injury or irritation (cuts, burns, rash, insect bites ), and may be severe in immunosuppressed people (such as those who have chemotherapy for cancer, or with AIDS ) or in people who have autoimmune disorders (such as rheumatoid arthritis ). Medications, viral or bacterial infections, excessive alcohol consumption, obesity, lack of sunlight, overexposure to sunlight (sunburn), stress, cold climate, and frequent friction on the skin are also associated with flare-ups of psoriasis.

Normally, skin takes about a month for its new cells to move from the lower layers to the surface. In psoriasis, this process takes only a few days, resulting in the build-up of dead skin cells and formation of thick scales.

Symptoms of guttate psoriasis include skin lesions (scaly macule), redness, silvery scales, discrete, demarcated, teardrop-shaped patches of skin usually located all over the body
These areas may show a patchy loss of skin color and be very itchy.

Diagnosis is usually based on the appearance of the skin. There is often a history of recent sore throat. Your physician may choose to perform a skin biopsy or throat culture to help confirm the diagnosis.

Treatment is focused on control of the symptoms and prevention of secondary infections. It varies with the extent and severity of the disorder. If an infection can be identified, it should be treated with appropriate antibiotics. Severe or resistant cases, or cases involving large areas of the body, may require intensive treatment or hospitalization. Mild cases are usually treated at home.
Topical medications used to treat guttate psoriasis include:
Prescription or nonprescription shampoos, shampoos or lotions that contain coal tar, cortisone or other corticosteroids, lubricants, vitamin D containing medications (Dovonex) and/or retinoids (Tazorac).

Oral or injected immunosuppressive medications (such as corticosteroids or methotrexate) may be used, but only in very severe cases. Other medications may include retinoids or cyclosporine.
Other treatments may include exposure to sunlight or phototherapy. The skin is sensitized by applying coal tar ointment or by taking oral psoralens (a medication that makes the skin sensitive to light). The person is then exposed to ultraviolet light.

To minimize flare-ups, maintain good general health. Avoid respiratory and other infections.
Complications include pain, severe itching, complications secondary to treatments, and secondary skin infections.

Raptiva Targets T-Cells

Raptiva is a man-made antibody. It goes against T cells, the quarterbacks of the immune system. It doesn't kill the T cells -- instead, it blocks T cells from moving from the blood into the skin.
Mark Lebwohl, MD, of Mt. Sinai School of Medicine in New York, and colleagues treated nearly 600 moderate-to-severe psoriasis patients with two different doses of Raptiva. After 12 weeks of treatment:
28% of high-dose patients (2 mg/kg body weight injections once a week) had at least 75% improvement.
22% of low-dose patients (2 mg/kg body weight injections every other week) had at least 75% improvement.
"Continued [Raptiva] therapy provided continued benefit," Lebwohl and colleagues report. "In addition, extending the [Raptiva] treatment from 12 to 24 weeks resulted in improved responses in many subjects who did not initially have improvement of 75% or more."

Enbrel: From Arthritis to Psoriasis

Enbrel is a man-made protein that blocks a chemical messenger called TNF (tumor necrosis factor). Blocking TNF quiets the abnormal immune responses seen in arthritis -- and in psoriasis.
Craig L. Leonardi, MD, of St. Louis University, and colleagues tested three different doses of Enbrel in 652 adult patients with moderate-to-severe psoriasis. After 24 weeks of treatment:
59% of high-dose patients (50 mg injections twice a week) had at least 75% improvement -- 55% reported "clear" or "almost clear" status.
44% of medium-dose patients (25 mg injections twice a week) had at least 75% improvement -- 39% reported "clear" or "almost clear" status.
25% of low-dose patients (25 mg injections once a week) had at least 75% improvement -- 26% reported "clear" or "almost clear" status.
"Rapid clearing of skin lesions is an important aspect of effective psoriasis management and may correlate with the patient's satisfaction with treatment," Leonardi and colleagues write. "After two weeks of treatment, [Enbrel] produced statistically significant and clinically meaningful improvements in patients' global assessments of disease and in the quality of life."

New Options In Psoriasis Treatment

Not so long ago, psoriasis sufferers had few options. Now three already-available drugs offer relief from the agonizing skin disease.
The new drugs are Enbrel, Raptiva, and Amevive. All are "biological" drugs -- they use recent scientific breakthroughs to target specific body functions.
Psoriasis is an autoimmune disease; the new drugs block harmful immune responses. Amevive and Raptiva were approved earlier this year as psoriasis treatments. Enbrel was approved in 1998 to treat rheumatoid arthritis. Enbrel's manufacturer, Wyeth, a WebMD sponsor, has filed for formal approval as a psoriasis treatment.
Separate clinical studies of psoriasis patients treated with Enbrel and Raptiva appear in the Nov. 20 issue of The New England Journal of Medicine. So does an editorial by Thomas S. Kupper, MD, of Brigham and Women's Hospital in Boston.
"At this point, there are insufficient data to support claims that one of these agents is superior to another," Kupper writes. "There may be groups of people who have a better response to one or the other of these agents."
All of these drugs likely must be taken for long periods of time -- perhaps for life. Because they interfere with the immune system, there is a danger that they will raise patients' risk of infections and maybe even cancer. It's not clear how the drugs will work over years and years of treatment. But in the short term, all have remarkable safety records. That's particularly true for Enbrel, which has been used in more than 150,000 patients -- including long-term safety studies in 2,000 patients.

Sunshine and Psoriasis

Brief, regular periods of exposure to natural sunlight can improve or clear psoriasis in some people. This approach to treating psoriasis is called climatotherapy. Sunburn should be avoided because it can make psoriasis worse. Exposure to sunlight is not recommended for people who are sun-sensitive. Sun exposure can cause aging of the skin. An annual medical checkup is advised because sun exposure can increase the chance of skin cancer.

Plaque Psoriasis

Plaque psoriasis is the most common form of psoriasis. It is characterized by raised, inflamed (red) lesions covered with a silvery white scale. The scale is actually a buildup of dead skin cells. The technical name for plaque psoriasis is psoriasis vulgaris (vulgaris means common). Plaque psoriasis may appear on any skin surface, though the knees, elbows, scalp, and trunk are the most common locations. Sometimes the patches of infected skin are large, extending over much of the body. The patches, known as plaques or lesions, can wax and wane but tend to be chronic. These can be very itchy and if scratched or scraped they may bleed easily. The plaques usually have a well-defined edge and, while they can appear anywhere on the body, the most commonly affected areas are the scalp, knees and elbows. However, if the scalp is involved, you may develop psoriasis on the hairline and forehead. The actual appearance of the plaques can depend on where they are found on the body. Plaques found on the palms and soles can be scaly, however they may not be very red in color. This is due to the thickness of the skin at these sites. If the plaques are in moist areas, such as in the creases of the armpits or between the buttocks, there is usually little or no scaling. The patches are red and have a well-defined border. Chronic (or common) plaque psoriasis affects over 90% of sufferers. It appears usually on the scalp, lower back, elbows, arms, legs, knees and shoulders. It is very much an adult condition.

Get the Facts on Psoriasis

Psoriasis is a chronic skin condition affecting approximately 4.5 million people in the United States.
New skin cells grow too rapidly, resulting in inflamed, swollen, scaly patches of skin in areas where the old skin has not shed quickly enough.
Psoriasis can be limited to a few spots or can involve more extensive areas of the body, appearing most commonly on the scalp, knees, elbows and trunk.
Psoriasis is not a contagious disease.
The cause of psoriasis is unknown, and there currently is no cure.
Psoriasis can strike people at any age, but the average age of onset is approximately 28 years. Likewise, it affects both men and women, with a slightly higher prevalence in women than in men.
Approximately 30 percent of people with psoriasis are estimated to have moderate-to-severe forms of the disease.Psoriasis can be a physically and emotionally painful condition.
It often results in physical limitations, disfiguration and a significant burden in managing the daily care of the disease.
Psoriasis sufferers may feel embarrassed, angry, frustrated, fearful, depressed and, in some cases, even suicidal.

Psoriasis Defined

Psoriasis is a chronic scaling skin. It may range from just a few spots anywhere on the body to large areas of involvement. It is not contagious or spread able from one part of the body to another or from one person to another. There is no blood test to diagnose psoriasis. The diagnosis is made by observation and examination of the skin. Sometimes microscopic examination of the skin (biopsy) is helpful where the changes are not typical or characteristic. The exact cause of psoriasis is unknown, but hereditary and genetic factors are important. Psoriasis runs in families. This does not mean, however, that every child of a parent with psoriasis will develop psoriasis, but it is common that somewhere down the line psoriasis will appear in families. Psoriasis is not caused by allergies, infections, dietary deficiencies or excesses, or nervous tension.

Variety of Psoriasis Treatments

Today, there are many different treatments to help control psoriasis. Some can be found over the counter at a drugstore, while others require a prescription from your doctor.
No single treatment works for everyone.
The goal is to find a treatment that works the best for you with the fewest side effects. Your doctor will look at what kind of psoriasis you have and recommend the treatment regimen that is best for you.
More about choosing a treatment with your doctor
Below are links to more information about the different kinds of treatments that can help with psoriasis.
Topical treatmentsTopical treatments–agents applied to the skin–are usually the first line of defense in treating psoriasis. More about topicals
PhototherapyPhototherapy (UVB, PUVA and lasers) involves exposing the skin to wavelengths of ultraviolet light under medical supervision. More about phototherapy
Systemic medicationsSystemics are prescription medications that affect the entire body, and are usually reserved for patients with moderate to severe psoriasis. Biologics are a type of systemic medication. Systemics Biologics
Alternative approaches, diet & climateMany people choose to treat their psoriasis in nontraditional ways, including mind and body therapies, Alternative approaches ,
dietary supplements Your diet and psoriasis ,
and sunlight Sun and water therapy