New
Treatments For Psoriasis Address Chronic Illness
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
(Our Organization
is not responsible for the content of Internet sites.)
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
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. |
