New
Treatments Help People Manage Psoriasis
August Is Psoriasis Awareness
Month
New breakthrough treatments,
along with existing remedies, should mean more help for people with
mild and even severe forms of psoriasis.
"We're not only making
a tremendous amount of progress understanding the immunology of psoriasis
but also the genetics of psoriasis," says Dr. Paul Cabiran, a dermatologist
with the Ochsner Clinic in New Orleans.
"Before, treatments were more generalized,
and now they're more specific,” Dr. Cabiran says. “They're
getting much more sophisticated.”
That is a message health officials want
to communicate during August, which has been designated Psoriasis
Awareness Month by the US Department of Health and
Human Services (HHS).
Skin
Production Moves into Overdrive
An estimated 5.5 million Americans suffer
from psoriasis, which affects men and women equally, according to the
National Institute of Arthritis and Musculoskeletal and Skin
Diseases (NIAMS).
Psoriasis is a chronic (long-lasting) skin
disease characterized by scaling and inflammation. Scaling occurs when
cells in the outer layer of the skin reproduce faster than normal and
pile up on the skin’s surface.
People with psoriasis may suffer discomfort,
including pain and itching, restricted motion in their joints, and emotional
distress.
Experts say these symptoms mark an immune
process gone awry.
Defective immune system cells trigger a
cascade of events that results in the skin's outer layer growing at
a much faster rate than normal.
"In some cases, it's seven or eight
times the normal rate of skin growth," Dr. Cabiran explains. "The
process is accelerated tremendously so the dead layers build up too
quickly."
So quickly, that there is not enough time
for the old layers to slough off to make room for the new, hence the
scaly, thick patches or "plaques." The red color comes from
the increased blood supply that rapidly growing cells need for fuel.
The majority of psoriasis cases seem to
have a genetic component, though scientists are still working to find
the problem gene - or genes.
The relatively recent discovery that psoriasis
is an immune-based disease has paved the way for breakthroughs in treatment
for more severe forms of the disease.
"That understanding has led people
to say, 'Let's see what we can do to have more effective therapy,'"
says Dr. Kenneth Gordon, an associate professor at the Loyola University
Stritch School of Medicine in Chicago and chairman of the research committee
of the National Psoriasis Foundation.
Therapies
Improve with New Understanding
An estimated 25 percent to 33 percent
of people with psoriasis suffer from more severe forms of the disease,
which is measured by how much of their body surface is affected.
Traditionally, these individuals have been
treated with high-octane drugs that affect the whole body, not just
the area requiring care.
One of the most common treatments is methotrexate,
a chemotherapy drug most often used against cancer of the lymph system.
Another common drug is cyclosporine, which
suppresses the immune system and is used to prevent organ rejection
in transplant patients.
The problem is that, over the long term,
these therapies can increase the risk of cancer and may have adverse
affects on the liver, kidney, and blood pressure, Dr. Gordon says.
"We've been limited, and many physicians
have felt uncomfortable treating [psoriasis] aggressively," Dr.
Gordon says.
In March, however, the Food and
Drug Administration (FDA) approved the first biologic treatment
for psoriasis. Alefacept (called Amevive®), is widely considered
by experts to be a breakthrough drug.
A study in the Archives of Dermatology
found that people taking 15 milligrams of alefacept had a 75 percent
reduction in their Psoriasis Area and Severity Index (PASI), a measure
of the clinical severity of the condition.
Alefacept halts the overproduction of skin
cells by destroying the defective immune cells that are responsible.
"These biologic medications are designed
to attack a very specific part of the immune system and leave the rest
of the body intact," Dr. Gordon says. "The true benefit of
these medications, we think, is this ability to use them with a high
level of security about safety for long periods of time.
"Many patients get psoriasis when
they're young," Dr. Gordon says. "What you have is a situation
where people are going to have a disease for 30, 40, 50 years so long-term
safety is paramount."
Another biologic drug, etanercept (called
Enbrel®), has also been approved by the FDA for
psoriatic arthritis.
For milder forms of the disease, different
treatments are available.
"Topical therapies [creams] are more
reasonable with people with less body area involved because it takes
less time to cover themselves with creams every day," Dr. Gordon
says.
Dr. Cabiran says steroid creams and topical
Vitamin D are a common first step for people who simply have a little
patch on the elbow or knees or scalp.
People with larger areas affected might
benefit from phototherapy - light therapy.
"One of the most successful types
is narrow-band UVB, which is a very specific wave length of UVB light,"
Dr. Cabiran says. "You turn the light on for a few minutes. It's
a really great way to treat the whole body."
Always consult your physician for a diagnosis.
What
Is Psoriatic Arthritis?
Psoriatic arthritis is a form of arthritis
associated with psoriasis, a chronic skin and nail disease characterized
by red, scaly rashes and thick, pitted fingernails. The disease is similar
to rheumatoid arthritis in symptoms, characterized by joint inflammation.
However, psoriatic arthritis tends to affect
fewer joints than rheumatoid arthritis and does not produce the typical
rheumatoid arthritis antibodies. The arthritis associated with psoriatic
arthritis comes in five forms including the following:
- arthritis that affects the small joints
in the fingers and/or toes
- asymmetrical arthritis of the joints
in the extremities
- symmetrical polyarthritis, a type of
arthritis similar to rheumatoid arthritis
- arthritis mutilans, a rare type of
arthritis that destroys and deforms joints
- psoriatic spondylitis, arthritis of
the sacroiliac sac (in the lower back) and the spine
Always consult your physician for more
information.
Online
Resources
Archives
of Dermatology
Centers
for Disease Control and Prevention (CDC)
Food and
Drug Administration (FDA)
Healthfinder,
US Department of Health and Human Services (HHS)
Men's
Health Network
National
Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
National
Institutes of Health (NIH)
National
Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National
Psoriasis Foundation |
August 2003
In
This Issue:
New
Treatments Help People Manage Psoriasis
Skin
Production Moves into Overdrive
Therapies
Improve with New Understanding
What
Is Psoriatic Arthritis?
Erectile
Dysfunction: Learn More Because It Could Save Your Life
Vascular
Health Is Important
Healthy
Habits Count
Risk
Factors for Erectile Dysfunction
Online
Resources
Other
Resources:
Find
a St. John's Mercy Physician
Sports
& Therapy Services at St. John's Mercy
Men's
Health Information
St.
John's Mercy Classes and Programs
In
Other Men's Health News:
Erectile
Dysfunction: Learn More Because It Could Save Your Life
Erectile
dysfunction or ED, the inability to have an erection or sustain
one long enough for intimate relations, is a condition that regularly
affects some 30 million American men.
While once believed to
be a largely unavoidable rite of passage into the senior years,
chronic erectile dysfunction is now showing up in much younger men,
often beginning as early as 40 years old, experts say.
"It's an important
barometer of a man's overall health - particularly the health of
the blood vessels," says Dr. Andrew McCollough, director of
Sexual Health, Fertility, and Microsurgery at New York University
Medical Center. "So if a man is at risk for any type of vascular
disease, he is also at risk for ED, regardless of his age."
Vascular
Health Is Important
One reason: erections
are closely tied to vascular health.
For an erection to occur,
a man must experience a series of brain signals that combine with
local nerve stimulation to relax a pair of smooth muscles that run
the length of the inside of the penis. This, in turn, lets blood
flow from nearby vessels, into two tissue-filled chambers, also
located inside the organ.
The force of the blood
creates a pressure that lets the penis expand, creating an erection.
A thin membrane helps trap the blood and keep it in the penile chambers,
long enough to sustain the erection.
The entire process reverses
when the muscles in the penis contract.
"Obviously, anything
that impedes that entire process, particularly anything which affects
the ability of blood to flow freely into the penis, has the potential
to cause ED," Dr. McCullough says.
Not only is the problem
almost always the result of a physical condition, most men are surprised
to learn that some very common conditions, including high blood
pressure, high cholesterol, obesity, and diabetes, are often a major
cause, experts say.
"Frequently, erectile
dysfunction is the first sign of these problems, and it can show
up long before any typical symptoms develop," says Dr. Natan
Bar-Chama, director of male reproductive medicine and surgery at
Mount Sinai Medical Center in New York City.
Healthy
Habits Count
Diagnosing and treating
these common health problems, particularly in their early stages,
can not only protect a man's overall health, it can often have a
remarkable effect on erectile dysfunction, Dr. McCollough says.
Experts say most men are
very surprised to discover that by simply lowering their cholesterol
or their blood pressure - often through simple measures such as
diet and exercise - they can also boost their virility, says Dr.
Bar-Chama. The same is true, he says, of men who lose weight and
cut back on cigarettes and alcohol.
"This is particularly
true at the start of these conditions, before any real damage is
done to the blood vessels," Dr. McCollough adds.
Still, experts say most
men are resistant about seeing a physician for erectile dysfunction,
or even their general health. And physicians do not always make
it easy for men to come forward with their problems.
This, he says, not only
means that erectile dysfunction goes untreated, but that sometimes,
other health problems are also overlooked at their earliest, most
easily treated stages.
Both Drs. Bar-Chama and
McCollough warn men against obtaining drugs for treatment of erectile
dysfunction without first receiving a physical examination, including
important blood tests.
"You should never
attempt to treat chronic ED on your own," Dr. McCollough says.
Always consult your physician
for more information.
Risk
Factors for Erectile Dysfunction
According to the National
Institutes of Health (NIH), erectile dysfunction is a symptom
in many disorders and diseases.
Direct risk factors for
erectile dysfunction may include the following:
-
prostate problems
-
type 2 diabetes
-
hypogonadism in association
with a number of endocrinologic conditions
-
hypertension (high blood
pressure)
-
vascular disease and
vascular surgery
-
high levels of blood
cholesterol
-
low levels of HDL (high-density
lipoprotein)
drugs
-
neurogenic disorders
-
Peyronie's disease (distortion
or curvature of the penis)
-
priapism (inflammation
of the penis)
-
depression
-
alcohol ingestion
-
lack of sexual knowledge
-
inadequate interpersonal
relationships
-
many chronic diseases,
especially renal failure and dialysis
-
smoking
Age appears to be a strong
indirect risk factor in that it is associated with increased likelihood
of direct risk factors, some of which are listed above.
Always consult your physician
for more information.
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