Molecule Against Psoriasis

A number of chronic diseases break out because the body attacks an imaginary enemy. A research group at the Norwegian University of Science and Technology (NTNU) has created a molecule that prevents our immune system from running wild.
When the body thinks it is under attack, it defends itself in the best way possible, for instance by starting a defence inflammation.
This reaction is highly appropriate if the enemy is an influenza virus or something else that actually needs to be fought. However, sometimes the body misinterprets the signals, and starts a defence inflammation against a non-existent enemy. The result could be so-called autoimmune diseases: psoriasis, arthritis, Bechterew’s, asthma, allergies, ulcerative colitis, multiple sclerosis, Crohn’s disease – and numerous others. The list is longer than we care to imagine, and affects large parts of the population. “Judas enzyme” sends the wrong messageProfessor Berit Johansen at the Department of Biology at NTNU previously discovered which enzyme that misinterprets signals and reprograms cells to divide much faster than they should – thus provoking disease. The enzyme is called phospholipase A2, less formally known as the “Judas enzyme”.Now, Professor Johansen and her research group have created various stop molecules that prevent the “Judas enzyme” from sending the wrong messages to the cell nucleus. By doing so, the inflammatory reaction can be prevented. One of these stop molecules was recently tested in mice infected with psoriasis. The results are more than promising: Every single mouse got better, in all respects. In addition, it turned out that a high dosage yielded better effect than a low dosage.Medical testing right around the cornerThis discovery means that a substantial part of the road to a new type of medication is history. The next step is testing on humans. Early next year, the substance will be available as a cream, ready to be applied on the first test persons. This testing will take place in France.Professor Berit Johansen’s new firm, Avexxin, is also testing out two other molecules, one against rheumatoid arthritis, and one against nephritis.

By Hege Tunstad and Lisa Olstad/Gemini Research Journal

Psoriasis and Psoriatic Disorders

This study will evaluate a twice-daily topical treatment for body psoriasis in adolescents. Eligible patients must have body psoriasis, such as on arms, legs, chest, or back. The study involves six office visits (some visits require blood draws) with a board-certified dermatologist, and includes free treatment for up to eight weeks, and compensation for time and travel.
The research site is in Shreveport, La.

For more information
please see http://www.centerwatch.com/patient/studies/cat126.html.

What Is Known About 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.

Factors That May Influence Psoriasis

Most people living with psoriasis experience good days when their skin clears and bad days when psoriasis flares. A trigger is usually needed to make psoriasis appear — whether it is for the first time or the thirtieth. Common psoriasis triggers are:
Infection
Studies show that some infections can trigger psoriasis. Dermatologists have seen people with a family history of psoriasis get strep throat and develop their first psoriasis lesions two weeks later. Strep throat often precedes an outbreak of guttate psoriasis. Inverse psoriasis is frequently aggravated by a thrush infection. Infections that can trigger psoriasis are:
Candida albicans (thrush)
Human immunodeficiency virus (HIV)
Staphylococcal skin infections (boils)
Streptococcal pharyngitis (strep throat)
Viral upper respiratory condition
Treating the infection in many cases lessens or clears the psoriasis.
Reaction to Certain Medications
Some people develop psoriasis for the first time or experience a flare-up after taking certain medication. Medications that can trigger psoriasis are:
Anti-malarial drugs. Dermatologists have seen people develop psoriasis for the first time after taking an anti-malarial medication.
Beta-blockers (medication used to treat high blood pressure) and heart medication. These worsen psoriasis in some people.
Corticosteroids.
These medications, which range in potency from extremely mild to very strong, are used to treat psoriasis and can be very effective. It is important to use these medications as directed. Overuse and sudden withdrawal of some oral corticosteriods can aggravate psoriasis.
Indomethacin (non-steroidal medication used to treat arthritis and other inflammatory conditions) worsens psoriasis in some people.
Lithium (used to treat manic depression and other psychiatric conditions) aggravates psoriasis in about 50% of people who have psoriasis.
If you have psoriasis or a family history of psoriasis, be sure to let the doctor prescribing any of the above medications know. Other medications can sometimes be substituted.
Skin Injury
People with psoriasis often notice new lesions 10 to 14 days after the skin is cut, scratched, rubbed, or severely sunburned.
This is called the “Koebner phenomenon” and is named after Dr. Koebner who in the 19th century observed that a patient developed new lesions in areas where his horse bit him. This relationship between skin injury and developing new psoriatic lesions has been observed in many patients. Today, a wide range of traumas and skin conditions are known to trigger Koebner’s phenomenon:
Skin Trauma
Skin Conditions
Acupuncture
Boils
Bites
Dermatitis
Bruises
Herpes blisters
Burns
Lichen planus
Chafing
Scabies
Chemical irritation
Vitiligo
Cuts and scrapes
Other
Pressure against the skin
Shaving
Sunburn and peeling
Adhesive tape on the skin
Tattoos
Vaccinations
Other
Research shows that about 50% of people with psoriasis experience the Koebner phenomenon — developing a psoriatic lesion at the site of a skin injury or in the same place as another skin condition. About 10% of psoriasis patients develop a new psoriatic lesion each time the skin is injured. The likelihood of developing the Koebner phenomenon may increase when psoriasis lesions are already present.
Stress
Ask anyone with psoriasis what triggers a flare-up, and stress is likely to top the list. Scientific studies confirm that stress can worsen psoriasis and increase itching. Some people can even trace their first outbreak to a particularly stressful event.
Having psoriasis is, in itself, stressful. When lesions are visible, people may stare and not want to get near. They may ask, “What did you do to your skin?” Even a spouse, parents, children, friends, and co-workers can be visibly uncomfortable. Some people report that a spouse cannot bear to touch them during severe outbreaks. Others say they feel embarrassed or ashamed by their skin.
When psoriasis develops on the hands and feet, it is often difficult for people to perform daily tasks, such as picking up objects, typing, and walking. This can make holding a job or caring for a child extremely challenging. The itching and pain caused by psoriasis also makes daily life difficult.
Treating psoriasis can add to the stress. Some treatments are time-consuming. Broadband phototherapy requires three to five visits per week to a clinic, and narrowband requires two to three. Topical medications can be time-consuming to apply. After spending time and money to treat the psoriasis, a person may find the treatment ineffective. Potential side effects deter some people from opting for systemic medications, such as methotrexate and cyclosporine. The cost of treating psoriasis adds stress to many people’s lives. Some living with psoriasis find that they cannot afford to pay for the newer treatments, such as the biologics.
When the everyday stress of living with psoriasis is compounded by a stressful event at work, a personal crisis, or an especially hectic time, such as the holidays, the stress can feel overwhelming.
People may try to alleviate stress with an herbal or natural over-the-counter remedy. However, some food supplements and herbal remedies interact negatively with prescription medications. People also turn to alcohol and others drugs to reduce stress. Research shows that this actually increases stress.
Dermatologists recommend that their patients tell them if they feel overwhelming stress. There are many healthy ways to relieve stress. Many patients find that psychological counseling or joining a support group effectively reduces stress. Your dermatologist may be able to help you find a therapist or a support group. Some patients prefer to adopt a popular relaxation technique, such as meditation. Exercise also can help reduce stress.
Weather
Winter tends to be the most challenging season for people living with psoriasis. Numerous studies indicate cold weather is a common trigger for many people and that hot and sunny climates appear to clear the skin.
Cold winter weather is dry, and indoor heat robs the skin of needed moisture. This usually worsens psoriasis. Psoriasis can become even more severe when the stress of the holidays and winter illnesses combine to compromise immune systems.
While hot and sunny may help clear psoriasis, air-conditioning can dry out the skin and aggravate psoriasis. Moisturizing can help prevent this.
Other
Science has not uncovered all psoriasis triggers. Hormones, smoking, and heavy drinking appear to trigger psoriasis in some people.
How hormones affect psoriasis is still not well understood. Research shows that many people develop their first psoriatic lesions just after puberty when hormone levels fall. When hormones levels increase during pregnancy, psoriasis improves for many women. A recent study showed that 55% of pregnant women with psoriasis reported an improvement, 21% saw no change, and 23% experienced worsening. After delivery, only 9% reported improvement and 65% saw their psoriasis worsen. More research is needed to understand these effects.Research suggests that localized (on the palms and soles) pustular psoriasis may be more common in people who smoke tobacco. Other studies suggest a correlation between smoking and developing plaque psoriasis. There also seems to be a link between smoking and developing severe psoriasis. Quitting smoking improves psoriasis for some; however, quitting does not always clear the psoriasis. More research is needed in this area.It is now believed that heavy drinking may trigger psoriasis in some people. Heavy drinking also may make treatment less effective. Again, more research is needed.More Good Days than BadWhile there is no cure, psoriasis can be successfully managed so that one experiences more good days than bad. Numerous treatment options are available, and recent advances are revolutionizing the management and care of psoriasis. A dermatologist considers a patient’s overall health, age, lifestyle, and the severity of the psoriasis in order to find a treatment option that will achieve maximum effectiveness.

References:Behnam SM et al. “Smoking and psoriasis.” SKINmed. 2005 May-June;4(3):174-176.Bowcock AM et al.
“Genetics of psoriasis: The potential impact on new therapies.” Journal of the American Academy of Dermatology. 2003 August;49
(2):S51-55.Murase, JE et al. “Hormonal Effect on Psoriasis in Pregnancy and Post Partum.” Archives of Dermatology. 2005 May;141(5):601-606.

Severe Psoriasis Linked to Heart Attacks

Severe forms of the itchy skin condition, psoriasis, should be considered a risk factor for heart attack, a new study suggests. Researchers who studied medical records for more than 680,000 British patients found that people in their 40s with severe psoriasis were more than twice as likely to suffer a heart attack than people without the skin disease.
The link may be inflammation, the body's normal response to injury and infection, which plays a role in both heart disease and psoriasis, researchers said.
Severe forms of the itchy skin condition, psoriasis, should be considered a risk factor for heart attack, a new study suggests. Researchers who studied medical records for more than 680,000 British patients found that people in their 40s with severe psoriasis were more than twice as likely to suffer a heart attack than people without the skin disease.
Mild psoriasis slightly raised the risk for heart attack, by 20 percent for people in their 40s. But study co-author Dr. Joel Gelfand of the University of Pennsylvania said people with mild psoriasis "on their elbows and knees" shouldn't worry.
"I don't want to overly alarm people," Gelfand said. "If you have psoriasis you should see a physician and go through a screening to make sure you don't have other cardiovascular risk factors."
The study, which was partly funded with a grant from the maker of a psoriasis drug, appears in Wednesday's Journal of the American Medical Association.
Psoriasis causes itchy, painful patches of thick, red, scaly skin. The chronic disease is thought to start with the immune system overreacting and targeting the body's own cells. More than 5 million Americans suffer from it, but most do not have the severest form.
There isn't a precise definition of severe psoriasis. About 100,000 Americans have 10 percent or more of their skin affected, and an estimated 500,000 say psoriasis is a significant problem for them in their everyday life.
People with psoriasis are more likely to smoke and to have diabetes, high blood pressure and high cholesterol. But the researchers found that even when they took those risk factors into account, psoriasis still increased the risk of heart attack.
Dr. Fred Leya of Loyola University Health System said cardiologists have long noticed the connection between psoriasis and heart disease. The study should encourage doctors to be more aggressive at controlling cardiovascular risk factors like cholesterol in their patients with psoriasis, he said.
"This is not a breakthrough discovery, but an important documentation of the facts," said Leya, who wasn't involved in the study.
Dr. William Weintraub, a cardiologist and research director at Christiana Care Health System in Newark, Del., questioned the study's importance for patients.
"Severe psoriasis is relatively uncommon, and the risk for heart attack with mild psoriasis is relatively minor," said Weintraub, who was not involved in the study.
Based on their findings, the researchers predict that 1 out of 623 people with severe psoriasis in their 40s will have a heart attack related to their psoriasis each year, Gelfand said. For mild cases, 1 in 3,646 people in their 40s would have a heart attack each year.
Gelfand and another co-author reported financial ties to companies investigating drug treatments for psoriasis. The study was funded by the National Institutes of Health and a grant to University of Pennsylvania from Cambridge, Mass.-based Biogen Idec Inc., which has a psoriasis drug in development.

Psoriasis Symptoms

Individuals with psoriasis experience skin conditions such as itching, cracking, stinging, burning, or bleeding (ICN Pharmaceuticals, Inc.). These symptoms are usually worse in the winter months due to the lack of sunlight and low indoor humidity (Hall 132). The skin is most likely to crack at the joints where the body bends or in areas where the individual fails to refrain from scratching. Scratching can also lead to bleeding and infection which is why it should be avoided at all costs. This skin condition has also been known to affect fingernails and toenails by causing pits or dents in them. There is also the possibility that the soft tissue inside the mouth and genitalia can be affected. In some cases, individuals experience joint inflammation, which can lead to the development of arthritis symptoms. This condition is known as psoriatic arthritis.

Psoriasis May Affect The Eyes

Psoriasis is a common skin disease. Ocular signs occur in approximately 10% of patients, and they are more common in men than in women. Patients with ocular findings almost always have psoriatic skin disease; however, it is rare for the eye to become involved before the skin.

Psoriasis involves hyperproliferation of the keratinocytes in the epidermis. The cause of the loss of control of keratinocyte turnover is unknown. However, environmental, genetic, and immunologic factors appear to play a role. Psoriasis is associated with certain human leukocyte antigen (HLA) alleles, particularly human leukocyte antigen Cw6 (HLA-Cw6). In some families, psoriasis is an autosomal dominant trait.

Disease exacerbations can be triggered by trauma, stress, alcohol, medications, and infection (eg, staphylococcal, streptococcal, human immunodeficiency virus). The epidermis is infiltrated by a large number of activated T cells, which appear to be capable of inducing keratinocyte proliferation. Conjunctival impression cytology demonstrated a higher incidence of squamous metaplasia, neutrophil clumping, and nuclear chromatin changes in patients with psoriasis.

Statistics On Psoriasis

The following statistics show that psoriasis and psoriatic arthritis are common, life-altering and often debilitating conditions.
Worldwide
Psoriasis affects an estimated 2-3 percent of the world's population.
125 million people worldwide have psoriasis, according to the World Psoriasis Day consortium.
National health concern
According to the National Institutes of Health (NIH), between 5.8 and 7.5 million Americans have psoriasis.
Studies have shown that between 10 percent and 30 percent of people with psoriasis also develop psoriatic arthritis.
National Psoriasis Foundation Benchmark SurveyIn 2001, the National Psoriasis Foundation commissioned the Benchmark Survey on Psoriasis and Psoriatic Arthritis. The results provided prevalence information, increased our understanding of the impact of psoriasis and psoriatic arthritis, and demonstrated that psoriasis and psoriatic arthritis carry a substantial burden.
The statistics below come from the Benchmark Survey.
Prevalence
2.2 percent of American adults have been diagnosed with psoriasis, confirming that psoriasis is a common disease.
11 percent of those diagnosed with psoriasis have also been diagnosed with psoriatic arthritis. This is a prevalence of 0.25 percent of American adults in the general population.2
Psoriasis prevalence in African Americans was 1.3 percent compared to 2.5 percent of Caucasians.
Quality of life
Psoriasis is not a cosmetic problem. Nearly 60 percent reported their disease to be a large problem in their everyday life.
Nearly 40 percent with psoriatic arthritis reported their disease to be a large problem in everyday life.
Patients with psoriasis covering more of their body (more extensive skin disease) experienced a greater negative impact on their quality of life.
Psoriasis had a greater impact on quality of life in women and younger patients.
Treatment satisfaction
Less than 40 percent of respondents indicated they were very satisfied with any of the four therapies assessed in the study (acitretin [brand name Soriatane], cyclosporine, methotrexate or PUVA [psoralen plus ultraviolet light A]).
Nearly 80 percent of persons who were very dissatisfied with their treatment did not have severe disease (less than 10 palms of coverage or <10 percent BSA).
Members of the National Psoriasis Foundation reported their disease to be significantly less of a burden and were more satisfied with treatment.
Age of onset
Psoriasis often appears between the ages of 15 and 25, but can develop at any age.
Psoriatic arthritis usually develops between the ages of 30 and 50, but it can develop at any time.
Severity of psoriasis
The National Psoriasis Foundation defines mild psoriasis as affecting less than three percent of the body; 3 percent to 10 percent is considered moderate; more than ten percent is considered severe. The palm of the hand equals 1 percent of the skin. However, the severity of psoriasis is also measured by how psoriasis affects a person's quality of life. Psoriasis can have a serious impact even if it involves a small area, such as the palms of the hands or soles of the feet.
The majority of people with psoriasis have mild disease.
Nearly one-quarter of people with psoriasis have cases that are considered moderate to severe.
Cost of psoriasis
Overall costs of treating psoriasis may exceed $3 billion annually. A 1993 study estimated that between $2 and $3 billion was spent annually on psoriasis treatments.
Genetic aspects of psoriasis
About one out of three people with psoriasis report that a relative had psoriasis.
If one parent has psoriasis, a child has about a 10 percent chance of having psoriasis. If both parents have psoriasis, a child has approximately a 50 percent chance of developing the disease.

A Closer Look At 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.

Hygiene Key To Controlling Nail Psoriasis

There are a number of things you can do to help prevent nail fungus and infections during the hot summer months, says the American Society for Dermatologic Surgery.
The society offers the following tips:
Purchase your own tools for use in nail salon procedures. Infectious particles can be transmitted on tools such as emery boards, which cannot be sterilized.
Ask about the sanitation standards of nail salons. How do they clean their equipment and how often? How often do they change the filters in the foot massages?
Keep your toenails trimmed, clean and neat. Keeping your nails healthy helps prevent the spread of infection and helps your overall health.
Make an annual visit to a dermasurgeon to have your skin and nails checked for early signs of illness or problems.
Don't have your cuticles cut during salon procedures. If too much of the cuticle is cut back during a manicure, the cuticle can be separated from the nail, and infectious agents can get into the exposed area.
Don't shave your legs before they're exposed to circulating water in a pedicure spa. Nicks and cuts from shaving can be infected by bacteria in inadequately cleaned pedicure spas.
Don't ignore infections. If there's redness or soreness after a procedure, it may be a sign of an infection. See your dermasurgeon.
Only go to licensed, trained professionals. Each manicurist should have a state-issued cosmetology license that is current and visibly displayed.

Historical References To Psoriasis

Psoriasis has been around since the days of Greek mythology, more than 2,500 years ago. It was considered a curse from the gods.The Bible refers to psoriasis but mistakenly calls it leprosy. For hundreds of years, people with the disease were ostracized and forced to wander as homeless beggars. Some had to wear warning bells so others could avoid their paths. Some suffered the same fate as lepers, who were burned at the stake in the 14th century."Amazingly, psoriasis was a disease that had been misunderstood for more than 2,000 years before it was clearly defined (in the early 1800s) and named what we know it as today."

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.

More Research On the Cause Of Psoriasis

Psoriasis partially results from an overly acidic body and skin. The pH (potential of hydrogen) as you remember from your high school general science or chemistry class, ranges from 0 to 14 with 7 being neutral. As you rethink your past history, you will see that ‘all’ the psoriasis triggers come from ‘acidic items’ regardless of whether they are foods, drinks, stress, or merely out of breath. We all know that if we hold our breath for 30 seconds or 60 seconds, we will all notice that our face turns pink or red. We all know, but hardly think that the cause is a build up of carbon dioxide which is an ‘acidic’ gas and we have a shortage of oxygen. Very similarly, when we exercise for a short period, we have a build up of ‘lactic acid’, which is a body waste, which is obviously acidic. Likewise, those with psoriasis need to be very concerned about the build up of acids in our blood stream due to the foods and beverages that we consume. We all know of our triggers such as alcohol, coffee, various medications, etc. which all have a pH below 7.0 or are termed acidic. Our objective therefore should be to balance, buffer or neutralize the acids with alkaline.

Acidity is measured as a pH of 1 to 7. Alkalinity is 7 to 14.The numbers refer to how many hydrogen atoms are present compared to an ideal or standard solution. Normally, blood is slightly alkaline, at 7.35 to 7.45; urine pH is the best and easiest way to check on the proper foods and drinks being eaten. Try to keep the pH in the 6.8 to 7.00 range for optimal functioning of the body and brain. If we are excessively alkaline, we don't have the mental and physical 'go' so we need our 'energy' brain and muscle foods and drinks during the day and very alkaline foods at night to calm the body and brain (parasympathetic system).

This scale is logarithmic; meaning that each number is ten times stronger than the preceding number. For example, a pH of 2 is ten times more acidic than a pH of 3 and one hundred times more acidic than a pH of 4.

Water is alkaline with a pH of about 7.3, and likewise more alkaline foods such as more “fresh vegetables and fruits are needed which are alkaline (higher pH than 7.0). Acidic foods and drinks are the problem with a pH of below 7.0 such as coffee at 2.2. To improve your total body and skin condition, eat and drink 90% of the alkaline foods with 10% meats while avoiding breads, pastas, sugars, desserts, etc.

The body has several different ways to ensure that the pH balance stays in the normal range of 7.35 to 7.45. These are referred to as buffer systems. Through normal day-to-day activity in the body, acids are formed as waste products that need to be neutralized, alkalized, or buffered and eliminated. Some of the acids are released with CO2 from exhaling; others are excreted via the kidneys. With acidic foods and drinks, there is always more carbon dioxide (acidic) while alkaline foods produce much more oxygen (think of your high school classes of the tree, grass, and plants giving off oxygen). These systems work together in the healthy human body to keep the pH level within normal ranges. Sometimes with extreme intake of acidic foods and drinks, the normal system cannot compensate and the body becomes even more stressed resulting in more stress hormones, which are also acidic in nature. Likewise, simple illnesses such as influenza, minor surgery, or emotional and mental stress continue to lower the pH of the body and with more resulting skin blushing and flushing. Likewise, almost all medications are acidic except anti-acid medications such as Zantac, Milk of Magnesium, etc.

The adrenal cortex secretes cortisol, a natural body hormone of about 10 mg of cortisol daily, with peak cortisol levels occurring early in the morning and therefore the flushing and papules will look best in early mornings after this natural anti-inflammatory drug. The hormone that will report back to the original brain centers together with other body organs to tell it to stop the whole cycle. But since cortisol is a potent hormone, the prolonged secretion of it will lead to health problems such as the break down of cardiovascular system, digestive system, musculoskeletal system with resulting osteoporosis and arthritis - rheumatism, and the immune system. Also when the organism does not have a chance for recovery, it will lead to both catecholamine and cortisol depletion. The whole idea is "not to keep" the body in a 'fight or flight' system with any stress, stimulation or food/drinks.

Researching Possible Causes Of Psoriasis

Researchers believe the immune system sends faulty signals that speed up the growth cycle in skin cells. Certain people carry genes that make them more likely to develop psoriasis, but not everyone with these genes develops psoriasis. Instead, a "trigger" makes the psoriasis appear in those who have these genes. Also, some triggers may work together to cause an outbreak of psoriasis; this makes it difficult to identify individual factors.
Possible psoriasis triggers include: emotional stress; injury to the skin; some types of infection; reaction to certain drugs. Once the disease is triggered, the skin cells pile up on the surface of the body faster than normal. In people without psoriasis, skin cells mature and are shed about every 28 days. In psoriatic skin, the skin cells move rapidly up to the surface of the skin over three to six days. The body can't shed the skin cells fast enough and this process results in patches also called "lesions" forming on the skin's surface.

The Treatment of 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.

Looking For The Cause Of Psoriasis

There are many beliefs as to what causes psoriasis. Although no one knows for sure, many scientists believe that a biochemical stimulus triggers the abnormally high skin growth which in turn causes the skin lesions (National Psoriasis Foundation). Heredity also plays a role in the development of psoriasis. Individuals who have a family member with a severe case of psoriasis tend to experience early onset of the disease (Camisa 55). Recent research studies indicate that psoriasis may be a disorder of the immune system. The T cell, a white blood cell, normally works to fight off infection and disease. Scientists believe that having an abnormal immune system causes abnormal activity by T cells in the skin. These abnormally active T cells cause skin inflammation and increased cell production. Diet and vitamin influences have also been thought to play a role in psoriasis development and progression (Kligman 729).
Because psoriasis is a lifelong condition, the levels of its severity and improvement can fluctuate over time. Psoriasis is not a contagious skin condition. An individual instead, has a genetic predisposition for psoriasis, which can be activated by certain environmental factors or emotional stress. Individuals with psoriasis may find that their condition tends to flare up due to stress, certain medications, winter weather, and infections (ICN Pharmaceuticals, Inc.). Most often psoriasis affects the scalp, knees, elbows, hands, and feet (National Psoriasis Foundation).

Clinical Trials For Psoriasis and Psoriatic Disorders

This study will evaluate the use of Enbrel (etanercept) to treat psoriasis for a period of up to one year. Candidates 18 or older with moderate-to-severe plaque psoriasis who are able to start Enbrel therapy as prescribed may be eligible. People with skin conditions other than psoriasis that would interfere with study evaluations, or people taking Remicade (infliximab), Humira (adalimumab) or Amevive (alefacept) will not qualify. Research sites are located throughout Canada.

Natural Treatment For Psoriasis

Psoriasis is a difficult disorder to treat. But researchers report in the American Journal of Therapeutics that they have identified a natural preparation from a plant that effectively treats mild to moderate psoriasis. The plant, Mahonia aquifolium, grows wild in North America and was used in folk medicine to treat skin diseases.
But according to an article in the American Journal of Therapeutics (March/April 2006, Volume 13, No. 2, p. 121-126), a natural preparation from a plant holds promise for psoriasis sufferers.
Steve Bernstein and other researchers from the Dermatology and Cosmetic Center in Rochester, New York conducted a randomized, double-blind, placebo-controlled study using a proprietary topical cream prepared with Mahonia aquifolium.
This plant, also known as the barberry, Oregon grape, or berberis, grows wild in North and South American and Europe. It was initially used in American folk medicine as an oral medication for inflammatory skin diesases including psoriasis and syphilis.
Of the 200 psoriasis patients enrolled in the trial, 97 completed the 12-week course and 74 completed the same regimen using a placebo cream.
Bernstein and his colleagues traced a statistically significant improvement of the signs and symptoms of moderate plaque psoriasis compared with patients receiving placebo. The medication was well tolerated when applied to the affected area twice a day for twelve weeks. No significant side effects were reported by either the active or control group.
The researchers concluded that the cream containing Mahonia aquifolium extract is a safe and effective treatment for mild to moderate psoriasis.

The Psychological Impact Of Plaque-Type Psoriasis

Plaque-type psoriasis is usually on elbows, knees and the lower back. The scalp is frequently involved, but psoriasis can occur on any surface of the skin including nails. Some patients develop blisters on their skin in the affected areas, and this can be very painful.
The rash of psoriasis can itch, but often it does not have symptoms. Most patients with psoriasis are embarrassed by its appearance, and they dress to hide it from others. There is a significant psychological impact of the disease as it sometimes prevents people from being hired for jobs, and it can limit social activities because other people think psoriasis patients are contagious.

Psoriasis - Know Your Triggers

(HealthDay News) -- Psoriasis, a chronic skin condition that affects some 4.5 million American adults, is characterized by red, scaly skin patches. Psoriasis can appear on any part of the body, including the scalp, face, hands and feet.
Stress can be a major trigger for psoriasis, the National Psoriasis Foundation says. Taking time to relax and manage stress can help alleviate flare-ups. Any damage to the skin, including scratches or sunburn, can also trigger an outbreak.
The foundation also notes that certain medications can contribute to psoriasis symptoms, including lithium, antimalarial drugs, and certain drugs used to treat high blood pressure and arthritis. Allergies, weather and diet can also impact psoriasis.
Discuss with your doctor how to best control your symptoms.
-- Diana Kohnle

Treating Psoriasis

Remember that treating psoriasis is a mixture of both science and art, and fine-tuning may improve the outcome, even with relatively small changes. It's best to make these in close partnership with a trusted physican. A small proportion of persons with psoriasis will learn that their disease is primarily based on an allergic reaction to something. Indeed, the hope of every person with psoriasis is for a real cure, but at this writing there isn't one in sight. The clinical management of this disease remains quite complex, with much trial and error required. It's always a good idea to look into any rumored new therapy, whether you actually try it or not. And if you do try it, don't be too put off by apparent failures, or too ecstatic at what appear to be promising results. Although psoriasis is stubborn, it is also manageable. This information sets forth current opinions from recognized authorities, but it does not dictate an exclusive treatment course. Persons with questions about a medical condition should consult a physician who is knowledgeable about that condition.

Dietary Changes May Help Control Psoriasis

Two dietary elements that have proven results are flax seed and sea cucumber.

Flax seed is one of the most nutritionally complete foods available, but the components most relevant to psoriasis treatment are Omega 3 and mucilage. The Omega 3 helps correct the Omega 3 deficiency frequently found in those with skin diseases, and the mucilage prevents toxic buildup in the bowel – thereby addressing another common factor in skin disease, the excretion of excess toxins.

Sea cucumber is a marine animal related to starfish and sea urchins, but shaped liked a cucumber. Like flax seed, it also contains a broad range of nutrients, and has been used by the Chinese since ancient times in the prevention of disease and as a longevity tonic. Two of its most important nutrients – glucosamine and chrondroitin sulfate – are now used in the West for treatment of arthritis, a condition developed by 30 percent of those who suffer from psoriasis. Sea cucumber may prevent psoriatic arthritis, and will also reduce the pain and inflammation associated with psoriasis on the skin.

Consult with your doctor before taking these nutrients as they can interact or counteract with some drugs you may be taking for other conditions.

Adding flax seed and sea cucumber may help provide the nutrients needed to reduce psoriasis symptoms, possibly forever.

Living with Psoriasis

Psoriasis, a chronic skin condition that affects some 4.5 million American adults, is characterized by red, scaly skin patches. Psoriasis can appear on any part of the body, including the scalp, face, hands and feet.
Stress can be a major trigger for psoriasis, the National Psoriasis Foundation says. Taking time to relax and manage stress can help alleviate flare-ups. Any damage to the skin, including scratches or sunburn, can also trigger an outbreak.
The foundation also notes that certain medications can contribute to psoriasis symptoms, including lithium, antimalarial drugs, and certain drugs used to treat high blood pressure and arthritis. Allergies, weather and diet can also impact psoriasis.
Discuss with your doctor how to best control your symptoms.

Scalp Psoriasis Or Seborrhea?

Scalp psoriasis and seborrheic dermatitis of the scalp can be hard to differentiate. Both are common skin disorders that often affect the scalp. They share some similar symptoms — such as itchy, red, scaly skin. Fortunately, they also share some similar treatments, including daily use of an over-the-counter medicated shampoo, containing:
Ketoconazole
Tar
Pyrithione zinc
Selenium sulfide
Salicylic acid
There is no single test to confirm a diagnosis of psoriasis or seborrheic dermatitis. These skin disorders typically are diagnosed with a visual exam of the affected skin. Sometimes, however, a skin biopsy may be used to help differentiate between the two disorders.

Psoriasis Grants Awarded

The National Psoriasis Foundation has awarded four different university researchers $30,000 each in grant money to further their work into the disease and to provide data to the National Institutes of Health.
The Psoriasis Foundation's seed grant program emphasizes innovative psoriasis or psoriatic arthritis research projects in genetics, immunology or clinical research focused on understanding the mechanism of the disease. The program is designed to provide researchers with funding to generate preliminary data that can be used in grant applications to the National Institutes of Health.
"Funding these types of research projects is an integral part of our research and advocacy strategies," said Gail Zimmerman, president and CEO of the Psoriasis Foundation. "These grants will help promising researchers further understand the underlying causes of psoriasis and psoriatic arthritis, and help us come closer to a cure."
The grant recipients are Dr Andrew Blauvelt, a professor at Oregon Health & Science University; Dr Kristina Callis, an instructor at the University of Utah Health Sciences Center; Dr Shane Curran, a post-doctoral fellow at Columbia University; and Dr Carl Edwards, an associate professor at the University of Colorado at Denver Health Sciences Center.
The research projects undertaken by these academics include work on discovering how the molecule Il-23 is involved in the development and maintenance of psoriasis; study into the disease genetics; research into understanding the environment of joints in psoriatic arthritis; and investigations on how specific molecules and cells work together to produce inflammation in psoriasis and psoriatic arthritis.

Common 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.

A variant of a single immune system gene boosts the risk for psoriasis, researchers report.
A team from the University of Michigan looked for the gene -- called PSORS1 -- in more than 2,700 people from 678 families in which at least one family member had psoriasis.
According to the researchers, PSORS1 is the first genetic determinant of psoriasis to be definitively identified in a large clinical trial. The finding may help in the development of new, more effective treatments for the disfiguring inflammatory skin disease.
To develop psoriasis, people must inherit several disease-related genes and also be exposed to one or more environmental triggers, such as a strep infection, the researchers noted.
"For every individual with psoriasis who carries the PSORS1 gene, there are 10 other people with the gene who don't get psoriasis," study director Dr. James T. Elder, a professor of dermatology and of radiation oncology, said in a prepared statement.
The PSORS1 gene is actually one of more than 20 different varieties of a gene called HLA-C, one of several genes that regulate how the immune system fights off infection.
While Elder and his colleagues have identified the PSORS1 gene -- which they believe is the major gene involved in psoriasis susceptibility -- they said that much more research is needed to identify other genes involved in the development of psoriasis.
The findings appear in the May issue of the American Journal of Human Genetics.

FDA Approves Taclonex For Use In Treating Psoriasis Vulgaris

Warner Chilcott and LEO Pharma announced today that Taclonex® (calcipotriene 0.005% and betamethasone dipropionate 0.064%), a once-daily topical ointment for the treatment of psoriasis vulgaris in adults, is now available for prescription in the United States. Available outside the U.S. as Dovobet® or Daivobet®, Taclonex® was cleared for marketing by the U.S. Food and Drug Administration (FDA) in January. Psoriasis is a lifelong skin disease affecting more than five million adults in the United States.
"The availability of Taclonex® is significant because it makes the treatment of psoriasis easy for patients," said Dr. Mark Lebwohl, Chair, Department of Dermatology, Mount Sinai School of Medicine, New York. "It only needs to be applied once a day and is rapidly effective. In clinical studies, most patients saw improvement within the first week of use. Additionally, the two-compound ointment is more effective than either of its components alone, and also appears to be more tolerable than the components alone based on a lower percentage of total adverse events reported in clinical studies."
"At Warner Chilcott, we are continually striving to improve treatment and quality of life for people suffering from diseases of the skin," said Roger Boissonneault, CEO of Warner Chilcott. "We recognize that psoriasis can be a disabling condition that alters a person's life, both physically and emotionally, and we are pleased to provide Taclonex® as a new tool in managing its symptoms. Based on the efficacy and rapid action it has demonstrated in clinical studies, we are confident that Taclonex® will be an important new therapy for the topical treatment of psoriasis."
Taclonex® Clinical Trials
The efficacy and safety of Taclonex® have been demonstrated in seven large, multicenter clinical trials, which enrolled approximately 7,000 psoriasis patients (more than 3,000 of whom were treated with Taclonex®) amenable to topical therapy, with lesions affecting at least 10% of one or more body regions. Patients treated with Taclonex® had significantly greater and more rapid improvement in the Psoriasis Area and Severity Index (PASI) than patients treated with either calcipotriene or betamethasone dipropionate alone. In addition, Taclonex® was safe and well tolerated.
In one randomized, multicenter, double-blind trial, investigators enrolled 1,603 patients to compare the mean change in PASI from baseline to four weeks. They compared Taclonex® with calcipotriene, betamethasone dipropionate, or vehicle (placebo), all used once daily. The study demonstrated that the mean percentage change in PASI from baseline was significantly greater for patients treated with Taclonex® than for those receiving once-daily betamethasone, calcipotriene, or placebo at week 1 (-39.2% vs. -33.3% vs. -23.4% vs. -18.1%, p<0.001)

Cream With Ingredients From Fish Can Relieve Psoriasis Symptoms

A new skin cream has shown promising results in the treatment of psoriasis and eczema. The cream contains fish enzymes and gelatine and is under development by researchers at the Norwegian University of Science and Technology (NTNU) in Trondheim and the University of Bergen, Norway. Enzymes from roeAn important ingredient in the product is the enzyme zonase, which is found in fish eggs. The enzyme can break down dead skin cells without harming living cells. Used in the treatment of psoriasis, this cream helps to dead skin to flake off, while stimulating the growth of new cells. But enzymes need water to function as they should. With typical creams, the moisture evapourates a short time after application to the skin. The challenge for manufacturers is to find a new and better method to bind water to the cream. Dr. Ingvild Haug is a specialist in fish collagen (gelatine) Collagen from fish is built up completely different from collagen from other animals. Dr. Haug has studied how these special properties can be exploited. For example, fish collagen has the unrivalled ability to bind water within a mixture of water and oil. Before, such mixtures needed to include a stabiliser to keep them from separating. Dr. Haug found a method to use fish collagen to do the job. With the support of a skin care company, she has used this quality to improve skin cream. The method is patented, and the product is now undergoing clinical testing at the University Hospital in Linköping, Sweden, to ensure the product will perform as expected. Dr. Haug is working with other application for fish gelatine. This includes finding out if fish gelatine can be used to improve capsules of medicine and food supplements. -This rethinking can provide products that are easier to swallow and that can also hinder regurgitation. Everyone who has taken fish-oil capsules knows what I'm talking about, points out Dr. Haug. Workers with soft handsResearchers at the University of Bergen, Norway, were the first to note the properties of zonase early in the 1980s. Investigation has continued since then with Professor Bernt Walther in the lead. The enzyme is found in fish roe and serves to help the fry escape the egg. As has happened many time before: an accidental discovery in everyday life leads to a new product. The starting point was at a hatchery at a salmon fish farm. All day, workers had their hands in the cold sea water, handling the salmon fry. Usually, such activities would lead to red and chapped skin. But those who worked with the salmon fry had surprisingly soft and supple skin. The Bergen researchers looked into the case and found the enzyme zonase to be the reason.

Benjamin Franklin Suffered From Psoriasis

In his memoirs, Benjamin Franklin wrote of his psoriasis and his problems treating it late in life. He stopped taking pills a doctor had given him because his teeth were loosening and falling out. He found baths and sunlight helpful in controlling it, but never found a cure.
Now, 300 years after Franklin's birth, there's still no cure. Many treatments have harmful side effects. New protein-based injectable medicines can cost up to $25,000 annually, beyond the reach of many patients.

Cause Of Psoriasis

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 Treatments In Clinical Trials

Several Companies Post Positive Results in Clinical Trials:

Efalizumab (Raptiva) Appears Safe for Up to 3 years of Psoriasis ...DG News - 23 hours ago... Efalizumab (Raptiva) appears to be safe for up to 3 years of continuous weekly therapy for chronic moderate to severe plaque psoriasis, researchers reported ... Low-Dose Regimens of Acitretin (Soriatine) Effective in the ... DG News
Nucryst Pharmaceuticals granted new acne patentDrugResearcher.com, France - 22 hours ago... of Nucryst's silver for the treatment of acne, inflammatory skin conditions such as atopic dermatitis, and hyperproliferative skin disorders such as psoriasis. ...
Celgene's psoriasis therapy beats expectations in phase IIPharmaceutical Business Review - Mar 7, 2006... Corporation has reported better than expected phase II data evaluating CC-10004 as a potential oral therapy for patients with severe plaque-type psoriasis. ...
Centocor's psoriasis drug posts positive phase III dataPharmaceutical Business Review - Mar 7, 2006... that treatment with Centocor's Remicade resulted in rapid, significant improvement and long-term response in patients with moderate to severe plaque psoriasis. ...
Advitech Announces the Introduction of Dermylex in Toronto and ...CCNMatthews (press release), Canada - 4 hours ago... Laboratories Limited ("Jamieson") to conduct a special product introduction program for Dermylex, its product for the management of mild to moderate psoriasis. ...
Bexarotene Gel 1% Enhances Efficacy of Phototherapy for Psoriasis ...DG News - Mar 6, 2006... with bexarotene gel 1% appears to enhance the efficacy of narrowband ultraviolet B (UVB) phototherapy with minimal toxicity in patients with plaque psoriasis. ...

Basic 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.

New Treatments In Psoriasis Therapy

Recent research has shown that calcineurin inhibitors (TCIs), such astacrolimus ointment and pimecrolimus cream, may be effective in treating psoriasis, although they are currently only approved by the U.S. Food and Drug Administration (FDA) for the treatment of atopic dermatitis, another chronic skin condition in which the skin becomes itchy, dry and inflamed. TCIs interfere with the activation of T-cells, a type of white blood cell responsible for triggering immune responses that contribute to the development of skin conditions such as atopic dermatitis and psoriasis.
"In clinical trials, pimecrolimus and tacrolimus showed promise in treating facial psoriasis and inverse psoriasis, which is characterized by smooth, red lesions in the skin folds," stated Dr. Stein Gold.
"Tacrolimus inthe gel form is currently in clinical trials for the treatment of body psoriasis. Side effects tend to be mild and include minor itching and a sensation of warmth after application." Another new topical medication that has been approved by the FDA to treat moderate to severe plaque psoriasis is clobetasol propionate spray. In spray form, clobetasol propionate penetrates the skin easily to diminish the psoriasis plaques and minimize inflammation. In a recent study, patients using the clobetasol propionate spray over a four-week period saw a marked decrease in their disease severity, with most patients considering their psoriasis clear or almost clear by week four. In follow-up interviews after the completion of the study, the greatest proportion of patients still considered their psoriasis to be clear or almost clear.
"Patients like the spray because it is easy to use and not as messy as other topical medications," explained Dr. Stein Gold. "That is important because patients who like using a product will be more inclined to consistently use the treatment as directed, which will lead to more rapid results."
Combinations with topical corticosteroids also are effective for the treatment of psoriasis. A combination of calcipotriene and betamethasone dipropionate, a vitamin D analogue and a potent corticosteroid, was recently approved by the FDA in an ointment form for the treatment of psoriasis.
In a recent study of patients using the combination once daily, more than80 percent of patients with mild to localized psoriasis reported reaching a Psoriasis Activity and Severity Index (PASI) score of 50 or better after fourweeks, which means that this measure of psoriasis severity improved by 50 percent from the start of the study. The PASI is the standard measurement tool to determine what percentage of the body is affected by psoriasis and how
severe a patient's psoriasis is at any given time. In addition, many patients with severe psoriasis who participated in the study reported a reduction in PASI score of more than 70 percent.

New Psoriasis Treatment

A new drug for the treatment of severe chronic plaque psoriasis is to become available on the Pharmaceutical Benefits Scheme (PBS) soon, federal Health Minister Tony Abbott said.
The drug Raptiva will become available on April 1 for those patients who have exhausted other treatment options or had an inadequate response from them.
Mr Abbott said so-called refractory chronic plaque psoriasis is a disfiguring and disabling condition that affects about 17,000 Australians.
"It has a major impact on the quality of life, social relationships and participation in daily life of these patients," he said in a statement.
Mr Abbott said it was estimated about 6,000 people would start Raptiva in the first full financial year of listing.
He said the annual cost to the PBS for Raptiva would be about $12,700 per patient and its listing would add about $171 million to PBS expenditure between 2005-06 and 2008-09.

New Therapies May Offer Psoriasis Sufferers Some Relief

It’s a new era for patients covered in the itchy, scaly skin disease psoriasis. After years with few good treatments, doctors finally have a handful of therapies that promise to help control the incurable condition with fewer bad side effects.
What changed? Scientists learned that psoriasis isn’t just a skin-deep disorder but a dysfunction of the immune system, so the new therapies target the real culprit.
“Five to six years ago, I was telling my patients it was the wasteland,” says Dr. Craig Leonardi of St. Louis University Medical School, who participated in studies of the new treatments. “Now there’s this huge explosion of amazing drugs coming forward.”
The new options don’t help everyone, cautions Dr. Michael Tharp, dermatology chief at Chicago’s Rush University Medical Center. And they’re very expensive, costing $10,000 a year or more.
But, “it’s a great first step,” Tharp says. “Now we’ve got very directed molecules and know where they work and how they work. ... I hope it is just the beginning.”
Two unique psoriasis shots, Amevive and Raptiva, recently won Food and Drug Administration approval. Two drugs already sold to treat other conditions — Enbrel and Remicade — are used against psoriasis, too. A list of other potential treatments is under study.
Keeping symptoms at bayThe four newest options haven’t yet been compared to each other, but because each works somewhat differently, specialists expect hard-to-treat patients to find some relief among the bunch.
Some 4.5 million Americans have psoriasis. Of those, 1.5 million suffer moderate to severe symptoms — their skin covered in red or white scaly patches that burn and itch. It’s triggered when certain immune system cells, called memory effector T cells, run amok, causing skin cells to multiply faster than normal and become inflamed.
It can be life-altering.
“I wouldn’t wear anything but long-legged pants and long-sleeved shirts because I got so tired of people asking me questions,” says Lyle Newcomb, 60, of Milwaukie, Ore., who tried every treatment without success. “You don’t allow yourself to get real close to anybody because you don’t know how they’re going to accept it.”
Then Newcomb entered a study of Raptiva. “I had never been clear of psoriasis in my life, but I was totally clear in three weeks,” and, two years later, weekly shots keep symptoms at bay.
Ointments and light therapy — ultraviolet beams, sometimes with light-sensitizing drugs, a few times a week — are effective for milder psoriasis.
Until now, severely hit patients had two powerful options, each with serious side effects. The immune suppressor cyclosporine, commonly used to prevent rejection of transplanted organs, can destroy kidneys. Inflammation-suppressing methotrexate, also used for cancer and rheumatoid arthritis, can cause liver damage.
Fewer risks and side effectsThe new biologically engineered treatments promise more targeted therapy without those risks:
Amevive and Raptiva interfere with the harmful T cells, dramatically clearing psoriasis lesions in 20 percent to 40 percent of patients.
Amevive causes those T cells to die, explaining why some people’s symptoms don’t return for months after a three-month course of weekly shots. About 3,500 patients have begun Amevive since FDA approval in January, says maker Biogen Inc. The intramuscular shots are given in a doctor’s office.
In contrast, Raptiva keeps harmful immune cells from getting into and inflaming skin, so patients must take it indefinitely. Sales will begin by Thanksgiving, say makers Genentech Inc. and Xoma Ltd. Patients give themselves weekly under-the-skin shots.
That difference means more than convenience; some insurance pays for in-office therapy but not at-home drugs.
Instead of targeting T cells, Enbrel and Remicade inhibit a protein, TNF, that’s crucial to inflammation. FDA-approved for certain types of arthritis, some doctors already use the drugs for psoriasis’ skin lesions. The FDA now is evaluating Enbrel injections for that use; a final-stage study of intravenous Remicade is about to begin.
Specialists call the four new treatments largely safe but acknowledge that even mildly tinkering with the immune system for years might spur infections or cancer. “We’re crossing our fingers,” Tharp says.
That plus their huge cost means the new drugs are reserved for the worst patients. For less severe psoriasis sufferers, “we’re back in the stone ages,” Tharp says, urging companies to study better options for them, too.

The Effects of 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.

Aging Population Drives Prescription Dermatological Growth

The aging of the worldwide population and a focus on lifestyle treatments that revitalize youthfulness and stave off skin damage are the driving forces behind a healthy prescription dermatological drug market, which should see sales jump to $11.1 billion by 2010, according to

a new study from the market research firm Kalorama Information, a division of MarketResearch.com, the leading provider of industry-specific market research reports.
With 2005 sales reaching $8.4 billion, The Worldwide Market for Prescription Dermatological Drugs predicts that sales in the antiaging, photodamage, hair treatment, psoriasis, and skin cancer segments will grow further at a rate of 5.7% over the next four years as consumer demand for newer and better derma drugs continues to increase as the aging population struggles to deal with a myriad of skin disorders and diseases.
While sales of prescription acne, Rosacea, dermatitis, seborrhea, and hyperpigmentation/melasma products have continued to perform well-although with slower growth rates during the last five years as many of these drugs are older or have lost patent protection-the overall market has been bolstered by recent trends in cosmeceuticals, a favorite among aging Baby Boomers.
"The aging population is better educated and wants to see results-whether they have wrinkles, skin cancer, or psoriasis. Today's consumers are savvy to innovative dermatological treatments, derma drug delivery developments, and new prescription drug information which is widely available on the internet," notes Mary Anne Crandall, RN, the author of the final report. "This has changed the face of dermatology as cosmetic dermatology is now in vogue and manufacturers are racing to find new treatments to satiate public demand."

Options In Psoriasis Skin Care

Dermatitis-Ltd III. is a great option for individuals whose skin has been left sensitive and delicate by over-the-counter or prescription medications which often are messy, smelly, stain clothing, or thin the skin such as steroids. Skin appears more conditioned, even, elastic, and calm with Dermatitis-Ltd III. The ingredients of Dermatitis-Ltd are: zinc oxide, sodium chloride, magnesium stearate, polyethylene glycol, iron oxide, copper oxide, and sulfur. Zinc oxide is well known for its ability to protect and heal the skin.

Psoriasis Has Been Around For Thousands Of Years

Psoriasis has been around since the days of Greek mythology, more than 2,500 years ago. It was considered a curse from the gods.The Bible refers to psoriasis but mistakenly calls it leprosy. For hundreds of years, people with the disease were ostracized and forced to wander as homeless beggars. Some had to wear warning bells so others could avoid their paths. Some suffered the same fate as lepers, who were burned at the stake in the 14th century."Amazingly, psoriasis was a disease that had been misunderstood for more than 2,000 years before it was clearly defined (in the early 1800s) and named what we know it as today."

Understanding Psoriasis Flares

JERRY BAGEL, MD: The definition of a psoriasis flare is when a person with psoriasis gets worse. If a patient has localized psoriasis, and they move to moderate or severe psoriasis, that's clearly a flare. And at that point, different treatments need to be implemented.
When does psoriasis flare?JERRY BAGEL, MD: Psoriasis can flare independently of any known risk factors. But in general, people tend to get worse in the winter than they do in the summer. In the summer people with psoriasis can go outside and get extra exposure to ultraviolet light, which is helpful, whereas in the wintertime they tend to be inside. In addition, in the winter their skin tends to be drier. They can be more itchy, scratch more, and the trauma that occurs from scratching can result in exacerbating psoriasis.
PAUL YAMAUCHI, MD, PhD: A person on certain psoriasis medications can improve quite dramatically, but when you stop the medication, the psoriasis comes right back; it's sometimes rip-roaring and that can be very frustrating.
How often do flares occur?JERRY BAGEL, MD: The frequency of flares is dependent upon the individual. Some people can have low-grade psoriasis, and then it flares. If they treat it appropriately, they can do well for a few years. Other people are treated for a flare, go into remission, and flare again two to three months later because their psoriasis is that severe. But if you want an average, I think many people with severe psoriasis, who have it over 20 percent of their body, stay clear with good treatment for about six months, and then they flare again.
What is the pattern of flares for people with mild psoriasis?JERRY BAGEL, MD: The treatment of localized psoriasis is topical therapy. Topical steroids are pretty much the mainstay of topical therapy, but we have used vitamin D derivatives such as Dovonex (calcipotriene) for the past 15 years with lots of benefit.
In general, these treatments are suppressive, so they do not result in much remission. Some people might stay clear for a couple of weeks and others people might not respond to topicals at all.
How soon after phototherapy do people flare?JERRY BAGEL, MD: People who have more than 10 percent of their body surface area covered with psoriasis are candidates for phototherapy, which includes narrow band UVB and PUVA, as well as broadband UVB, but we're not using that as much now because narrow band works better. If patches are thin, people can come in three times a week for about 25 treatments and clear. If you pick your patients properly, you're probably going to get a six-month remission. But most people won't get six months' remission if they have real thick plaques. If you go with PUVA, where you have to take pills before you come in for ultraviolet light, one go-around would involve about 25 treatments. You can expect six months' remission, and many patients stay clear on PUVA for about a year.
Do people flare after taking the immunosupressant medications cyclosporin and methotrexate?JERRY BAGEL, MD: Cyclosporin and methotrexate are suppressive so when a patient is discontinued from both of those two medications, their psoriasis will recur in about six weeks and will be as bad as it was before they started their treatment.
How often do people flare on biologic treatments?JERRY BAGEL, MD: In the 40 percent of people who do very well with one 12-week course of Amevive (alefacept), they can stay very clear for six months. In fact, I've had some people stay clear for a year. And I see people continue to get better up to 12 to 24 weeks after they've discontinued the last dose, and when they start to flare, it's a very slow recurrence of their psoriasis, close to back to where it was in the beginning.
PAUL YAMAUCHI, MD, PhD: There are biologics that must be given continuously. Raptiva (efalizumab), when abruptly stopped, can potentially result in a flare-up of the psoriasis. With Enbrel (etanercept), if a patient had to stop it, and the psoriasis did not flare up, patients can be in remission at least three months.
Does a flare during any type of treatment mean the therapy isn't working?JERRY BAGEL, MD: It takes time for most medications to help people with psoriasis. Depending upon the medication, it could take two weeks to eight weeks. So just because your psoriasis might be getting worse initially does not mean that the therapy's not working.
When should patients change therapies when flares occur?JERRY BAGEL, MD: Primary therapy does not necessarily have to be stopped if people are getting worse. It depends if the flare is significant. If it's the natural progression of the disease getting worse and hasn't responded to therapy yet, you just hang in there or add something else because it's not working quickly enough. But if you see someone who's doing well on therapy and then they get significantly worse, yes, then you should probably switch your therapy around.

Psoriasis Treatment: One Patients Journey

Treatment for intense psoriasis icky, effective

Editor's note: Over several weeks, reporter Jessi De La Cruz is detailing the intensive treatment she is being given for psoriasis through a special program at the University of Michigan.
Sunlight, moisturizer and rest.
Those are the key ingredients in confronting the skin disease of psoriasis and putting it into remission.
I learned these basic yet not-so-simple rules during my first week at the Dermatology Treatment Center at the University of Michigan Medical Center in Ann Arbor. After one week of intensive, outpatient treatment, my psoriasis was dramatically less painful and less visible.
Psoriasis is a noncontagious, autoimmune disease for which there is no cure. A person with psoriasis produces new skin cells four to six times faster than a healthy person. They build up into inflammed lesions -- or plaques -- which can be itchy, painful and unsightly. Some people also develop arthritis from their skin cells gone amuck, but that hasn't happened to me so far.
The UM Dermatology Treatment Center is one of about a dozen such facilities in the U.S. designed to intensively treat psoriasis and other skin diseases without hospitalization.
When I arrived at the hospital Jan. 9, my first task was to fill out paperwork, change into dark brown, hospital-issued pajamas and get a quick tour of the center. The tour consisted of being shown the locker room, the photolight beds, an activity room stocked with magazines, a TV and a DVD player, and a quiet room where someone was sleeping under a towel. I nodded, tried to smile and felt like running from the room in my hospital-issued booties.
Instead, I stayed and met the doctor and other patients. I was given the combination to a locker that would be mine for the duration of my treatment, a bar of Dove soap and a stout jar of heavy body cream.
When I was called for my intial treatment, I tentatively entered a room with lots of towels and jars of ointments. The nurse coated my body from head to toe with a steroid cream, wet my pajamas (which I put back on) with warm water and gave me a jogging suit to put over my pajamas. The suit would keep moisture in and speed up the cream's effectiveness, she said.
My time in the sauna suit lasted three days, two applications daily. I also was introduced to photolight therapy which is used to slow the growth of skin cells. In between, my body was slathered in coal tar to increase my skin's ability to absorb the light. And to top it off, literally, I had oil and steroids on my scalp and then had my head wrapped in plastic wrap and taped over to fight the psoriasis on my scalp.
I spent the week cold, squishy, slimy, damp and itchy. Toward the end of the week, I also found myself nursing a sunburn. The nurses like it if you're pink from the light because it means your skin cells are halting production. I was more a shade of magenta bordering on red by Wednesday -- so I didn't get light treatment again until Saturday.
After treatment on Saturdays, we are given a one-day reprieve from the goops, gels, oils, light and hospital food -- all starting again on Mondays at 7:30 a.m. sharp.
Although it sounds (and often feels) terrible, this treatment is working. My skin has not felt softer nor looked better in years. And I can commiserate with others who share this disease.
I'm becoming a master at Tetris, daytime TV and napping. I'm also learning how to manage a disease I will never be rid of but, hopefully, don't have to live with in the same way for the rest of my life.

National Psoriasis Foundation

The National Psoriasis Foundation is the leading patient-driven, nonprofitorganization dedicated to improving the quality of life of more than 5 millionAmericans diagnosed with psoriasis and/or psoriatic arthritis and theirfamilies. We focus on education, advocacy and research toward bettertreatments and a cure.

For more information, please call the PsoriasisFoundation, headquartered in Portland, Ore., at 800.723.9166 or visithttp://www.psoriasis.org

New Component In Psoriasis Research

An immune molecule that normally assists in cell “suicide” may be an important trigger in the development of the common skin disease psoriasis, according to scientists from the Technion-Israel Institute of Technology and State University of New York, Stony Brook.
The culprit, a molecule called Fas, acts as a middleman between activated immune cells and a handful of inflammatory hormones involved in psoriasis flare-ups, say Technion researcher Dr. Amos Gilhar and colleagues. The study appears in the January, 10 2006 American Journal of Pathology.
Psoriasis is a non-contagious, lifelong skin disease that usually appears as scaly and inflamed patches of skin, although it can take several different forms. In patients with psoriasis, the white blood cells that make up the body’s immune defense system go into overdrive, triggering other immune responses that pile up skin cells at an abnormal rate.
Current treatments for psoriasis such as the drug Enbrel focus on these inflammatory hormones, but the researchers were able to stop the development of psoriasis in mice long before these hormones came into play by injecting an Fas-blocking antibody.
“The finding that antibodies to Fas can prevent psoriasis further demonstrates the complexity of the disease and its numerous molecular pathways,” Gilhar says.
Dr. Alice Gottlieb, chair of the Clinical Research Center at the Robert Wood Johnson Medical School in New Jersey agrees. “This research shows that activation of the Fas pathway is important in starting the ball rolling in psoriasis,” comments Gottlieb (who was not involved with this study). “These findings could have implications for other immune diseases such as rheumatoid arthritis and Crohn's disease,”
The researchers suspected that the Fas molecule was in the middle of this process, since it is found at high levels in psoriatic skin and leads an intriguing dual life. Most of the time, Fas guides the normal process of cell suicide called apoptosis. But in cells where apoptosis is blocked by other molecules, as it is in psoriatic cells, Fas switches roles and encourages the production of common inflammatory hormones instead.
To figure out exactly where Fas stood in the development of psoriasis, Gilhar and colleagues transferred grafts of clear, non-involved skin from human psoriasis patients to mice. They injected the mice with white blood cells bearing the Fas molecule on their surfaces to jump-start the formation of psoriatic skin lesions.
By blocking Fas action with a special antibody, the researchers were able to show that Fas actually is the key middleman in psoriasis formation. Without Fas, the natural killer cells were unable to trigger the production of the inflammatory hormones that lead to the characteristic skin thickening and other signs of psoriasis.
There is some evidence that Fas is involved in other skin conditions such as eczema, so future treatments targeting the Fas pathway may prove useful for a variety of diseases, suggests Dr. Richard Kalish, Gilhar’s collaborator from SUNY Stony Brook. However, researchers need to develop a human antibody to Fas before the technique could be tested in people.
“The current study is one of the many wonderful papers that have come out of this very productive collaboration across many miles between Dr. Gilhar and Dr. Kalish,” says Gottlieb.
According to the National Psoriasis Foundation in the United States, 1-3 percent of the world’s population suffers from psoriasis. About 30 percent of people with psoriasis have severe cases, where the affected skin covers more than 3 percent of their body. In some people, the disease is associated with a form of arthritis.
The Technion-Israel Institute of Technology is Israel's leading science and technology university. Home to the country’s winners of the Nobel Prize in science, it commands a worldwide reputation for its pioneering work in nanotechnology, computer science, biotechnology, water-resource management, materials engineering, aerospace and medicine. The majority of the founders and managers of Israel's high-tech companies are alumni. Based in New York City, the American Technion Society is the leading American organization supporting higher education in Israel, with 17 offices around the country.

Winter Psoriasis

Asking people with psoriasis whether their psoriasis acts up in the winter or summer quickly reveals one of the mysteries of the disease: it can be different for everyone. Some people experience flares in the winter, others in the summer, and some both or neither.

Tips for inclement weather:
Wear gloves while you wash dishes or clean inside, and when you're outside in the cold or driving.
Place a bowl of water or damp towel on the radiator, which will put water back in the air. Take care to redampen the towel.
Apply moisturizer while your skin is still wet from bathing or showering, which traps water in the skin. Avoid prolonged hot baths or showers.
Drink plenty of water. If the body doesn't get enough water, your skin's water reservoir can become depleted.
Minimize the use of soaps. They dry out the skin.
Turn off the heat at night, and keep it low during the day. Cool air is less drying.
Anecdotal reports suggest it is more common for psoriasis to become agitated or flare during the winter, but some people do suffer more during the summer.
Conversely, during a hot and humid summer, when the air contains more water vapor, the saturated air keeps us from sweating as we normally would, which essentially locks water in. This is perhaps why some people fare better with their psoriasis during humid summers.
A small percentage of people have psoriasis that flares when they are exposed to sunlight. Intensive exposure to sunlight, salty sea water or some other environmental factor also may play a role in why a person's psoriasis appears worse in the summer.
In a study published in the January 2001 issue of Archives of Dermatology, researchers measured and compared the impact of psychological stress on the skin in students without psoriasis during three different stress level periods: after winter vacation, during final exams and after spring break. The researchers measured water loss in the students skin during these periods and found that during periods of stress, the skin's ability to maintain a normal permeability barrier and retain water appears to be reduced.
A person's legs and arms have fewer oil glands than elsewhere in the body, which already causes them to be drier. Our skin also has what doctors call a "permeability barrier"-an ability to prevent the passage of substances through it. In people with psoriasis, the level of water that passes through this barrier is increased-the skin loses its ability to hold water, which contributes to the formation of dry, scaly lesions. During the cold winter, when the air contains less moisture, even more water is stripped from the skin, which may contribute to a flare.
Winter, according to researchers, is just a more stressful time. Researchers studying weekly and seasonal variations in heart attacks, which are also stress related, have found that Mondays during the winter months, especially January, have the highest rates of heart attacks.
In the homeThe dehumidified air in most people's homes during the winter, whether from electric or forced air heat, fires or woodburning stoves, also strips the skin of natural moisture. More water escapes from skin at low humidity. Normal skin achieves a balanced level of water loss when humidity is at 60 percent. In most homes during the winter, the humidity is much lower.
Experiencing one heating environment at the office and another at home, with short, cold, "uncontrolled" moments in between, can also further dry out the skin and potentially make psoriasis worse.
Not everyone experiences changes in their psoriasis brought on by changes in the weather. Climate also may play a role. Someone who lives in dry, desert heat may find relief during the summer, but flare when they are experiencing a humid summer.
There is no firm scientific proof that winter or summer directly cause a person's psoriasis to worsen. Nonetheless, to the people it happens to it is pretty obvious.