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.