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.