August Is Psoriasis Awareness Month

New medications are aiding physicians in the treatment of psoriasis, a chronic illness in which the body suddenly begins overproducing skin cells. August is Psoriasis Awareness Month. 

The cells pile up on the surface of the skin before they have a chance to mature, creating bright red patches covered with silvery scales.

The National Institutes of Health (NIH) estimates that psoriasis affects between 2 percent and 2.6 percent of the US population, or between 5.8 million and 7.5 million people.

These patches of skin cause itching, burning and stinging sensations. They most often occur on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet, but they can occur on skin anywhere on the body.

Experts believe the disease is linked to the immune system and is genetic in nature.

"If you have a family history, it makes it more likely you will get psoriasis," says Dr. Steven Feldman, a professor of dermatology at the Wake Forest University School of Medicine.

But beyond that, no one is sure why some people suffer from psoriasis and others do not or what causes the disease to start or spread.

"No one knows what triggers the onset of the disease," says Gail Zimmerman, president of the National Psoriasis Foundation.

"We do know there is a genetic component and some type of environmental component that come together and trigger the disease, but we don't know what the trigger is," she says.

"1-2-3" Approach Allows Treatment Variety

Physicians generally treat psoriasis in steps based on the severity of the disease, according to the NIH.

In what is known as the "1-2-3" approach, treatment of the individual with psorisais is based on the size of the areas involved, the type of psoriasis, and the patient's response to initial treatments.

Step one involves treatment applied directly to the skin, such as a steroid cream or ointment.

Step two involves light-based therapy, often involving exposure to ultraviolet rays.

And, step three involves medicines that affect the immune system in a way to prevent the overproduction of skin cells.

Up to now, those step-three systemic treatments involved either vitamin A derivatives or chemotherapy drugs.

Both are effective, but must be limited in use or they harm the patient, Dr. Zimmerman says.

"Biologic" Agents Added To Therapy Choices

However, there is a new set of systemic medications known as "biologics" that are proving very effective in treating psoriasis.

These medications are made using living proteins, Dr. Zimmerman explains. The proteins interfere with the way the damaged immune system is promoting overproduction of skin cells.

The biologics are injectable, and are usually self-administered at home by a patient.

The new medications also are less intrusive on people's lives, she says. Most of them can be cut back to one injection a week once the patient begins responding to treatment.

The first biologic drug approved by the US Food and Drug Administration (FDA), Amevive, can cause a remission for up to seven months in which the patient needs to take no medication at all.

Unfortunately, the biologic drugs do not work on every person with psoriasis, Dr. Zimmerman says. She estimates between 30 percent to 40 percent of people will respond dramatically to the drugs.

"You don't know it's going to work in you until you've been on them for a few weeks, and since they are very expensive that can create a challenge," she says.

However, since the biologic drugs are relatively new, physicians also will continue to rely on and improve upon the more time-tested treatments, Dr. Feldman says.

Always consult your physician for more information.

Online Resources

Centers for Disease Control and Prevention (CDC)

HealthierUS.Gov

National Institutes of Health (NIH)

National Library of Medicine

National Psoriasis Foundation

National Women's Health Information Center

Office of Research on Women's Health

US Food and Drug Administration

August 2004

New Treatments For Psoriasis Address Chronic Illness

"1-2-3" Approach Allows Treatment Variety

"Biologic" Agents Added To Therapy Choices

Psoriasis Therapy Wide-Ranging

Other Resources:

Find a St. John's Mercy Physician

Women's Services at St. John's Mercy

Women's Health Information

St. John's Mercy Classes and Programs

Psoriasis Therapy Wide-Ranging

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) offers the following information on the different types of treatment for psoriasis:

Topical Treatments
Corticosteroids reduce inflammation and the turnover of skin cells, and they suppress the immune system. Available in different strengths, topical corticosteroids (cortisone) are usually applied to the skin twice a day.

Short-term treatment is often effective in improving, but not completely eliminating, psoriasis. Long-term use or overuse of highly potent (strong) corticosteroids can cause thinning of the skin, internal side effects, and resistance to the treatment's benefits.

Calcipotriene is a synthetic form of vitamin D3 that can be applied to the skin. Applying calcipotriene ointment twice a day controls the speed of turnover of skin cells. Calcipotriene can irritate the skin.

Topical retinoids are synthetic forms of vitamin A. The retinoid tazarotene, also called tazorac, is available as a gel or cream that is applied to the skin. If used alone, this preparation does not act as quickly as topical corticosteroids, but it does not cause thinning of the skin or other side effects associated with steroids.

Preparations containing coal tar (gels and ointments) may be applied directly to the skin, added (as a liquid) to the bath, or used on the scalp as a shampoo.

The medication anthralin reduces the increase in skin cells and inflammation. Physicians sometimes prescribe a 15- to 30-minute application of anthralin ointment, cream, or paste once each day to treat chronic psoriasis lesions.

Salicylic acid is a peeling agent, which is available in many forms such as ointments, creams, gels, and shampoos, can be applied to reduce scaling of the skin or scalp. Often, it is more effective when combined with topical corticosteroids, anthralin, or coal tar.

Clobetasol propionate is a foam topical medication that has been approved for the treatment of scalp and body psoriasis. The foam penetrates the skin very well, is easy to use, and is not as messy as many other topical medications.

Light Therapy
Much of sunlight is composed of bands of different wavelengths of ultraviolet (UV) light. When absorbed into the skin, UV light suppresses the process leading to disease, causing activated T cells in the skin to die. This process reduces inflammation and slows the turnover of skin cells that causes scaling.

Some physicians will start treating patients with UVB instead of topical agents. A UVB phototherapy, called broadband UVB, can be used for a few small lesions, to treat widespread psoriasis, or for lesions that resist topical treatment.

Psoralen and ultraviolet A phototherapy (PUVA) treatment combines oral or topical administration of a medicine called psoralen with exposure to ultraviolet A (UVA) light. PUVA treatment taken two to three times a week clears psoriasis more consistently and in fewer treatments.

Systemic Treatment
For more severe forms of psoriasis, physicians sometimes prescribe medicines that are taken internally by pill or injection. This is called systemic treatment.

Recently, attention has been given to a group of drugs called biologics, which are made from proteins produced by living cells instead of chemicals. They interfere with specific immune system processes.

Retinoids, such as acitretin, are compounds with vitamin A-like properties that may be prescribed for severe cases of psoriasis that do not respond to other therapies. Most patients experience a recurrence of psoriasis after these products are discontinued.

Taken orally, the medication cyclosporine acts by suppressing the immune system to slow the rapid turnover of skin cells. It may provide quick relief of symptoms, but the improvement stops when treatment is discontinued.

A physician may select this therapy for individuals with severe psoriasis who have not responded to, or cannot tolerate, other systemic therapies.

Alefacept, or Amevive, is the first biologic drug approved specifically to treat moderate to severe plaque psoriasis. It is administered by a physician, who injects the medication once a week for 12 weeks. The medication is then stopped for a period of time while changes in the skin are observed and a decision is made regarding the need for further treatment.

Always consult your physician for more information.