People with psoriasis who smoke tend to have more severe cases than nonsmokers, but it may be a consequence and not a cause of the skin condition, researchers said on Monday.
The condition, which afflicts up to 3 percent of the world's population and runs in families, varies in severity though heavy smoking was associated with more severe cases, said Italian researchers from Istituto di Ricovero e Cura a Carattere Scientifico in Rome.
"Specifically, patients who smoked more than a pack of cigarettes (more than 20 cigarettes) daily had twice the risk of more severe psoriasis compared with those who smoked 10 cigarettes or less per day," lead author Cristina Fortes wrote in this month's issue of the journal Archives of Dermatology.
The number of years spent smoking also was associated with more severe forms of the condition, which afflicts between 1 percent and 3 percent of the world's population and usually develops between the ages of 15 and 35.
However, an editorial in the journal said the study did not reveal whether smoking was a cause or a consequence of psoriasis, which most often appears in the scalp, knees, elbows and torso and frequently creates embarrassment.
A separate study in the same journal found a higher prevalence of obesity among psoriasis patients. The report by dermatologist Mark Herron of the Utah School of Medicine in Salt Lake City said smoking may have a role in causing psoriasis but obesity was definitely an outgrowth of having the condition.
Psoriasis, which appears to have a genetic component, is caused by an overactive immune system that causes skin cells to develop rapidly and rise to the skin surface where they are not shed rapidly enough and form itchy lesions, according to the National Psoriasis Foundation.
Outbreaks can be triggered by injuries such as scratches or sunburn and severe cases can affect the skin's ability to control body temperature and prevent infections.
Tuesday, December 20, 2005
Friday, December 16, 2005
treating Psoriasis And The Depression That May Accompany It
A drug used to treat psoriasis may also relieve the depression and fatigue associated with the condition, researchers report.
And it may one day offer a new avenue of treatment for depression itself, the scientists say.
Etanercept, which goes under the brand name Enbrel, works by blocking a protein called tumor necrosis factor-alpha, which is produced by the body and promotes inflammation. High concentrations of TNF-alpha have also been linked to major depression, the researchers says.
"When people get a cold, infections, psoriasis, arthritis, they tend to feel bad and have low energy, they want to sleep more, they are moody and depressed," says lead researcher Dr. Ranga Krishnan, chairman of Duke University's department of psychiatry. "It has been shown that this is due to the elevation of cytokines such as TNF-alpha," he adds.
The question that Krishnan and his colleagues wanted to answer was whether blocking TNF-alpha could improve the symptoms of depression and fatigue.
To test the theory, Krishnan's team assigned 618 psoriasis patients to receive injections of 50 milligrams of etanercept twice a week for 12 weeks, or a placebo. After this period, the patients were all given etanercept for an additional 84 weeks.
The researchers found that after 12 weeks, 47 percent of the patients receiving etanercept had a 75 percent or greater improvement in their psoriasis, compared with 5 percent of those receiving a placebo.
In addition, patients receiving etanercept had a significant improvement in guilt, irritability, interest, appearance, work, sleep and sexual symptoms, compared with those receiving a placebo.
Patients receiving the drug also showed lower levels of fatigue.
Improvement was strongly related to the improvements in joint and skin pain caused by psoriasis, the researchers report.
The researchers noted that the improvement in depression was not correlated with improvement in symptoms. However, the study was not designed to detect the effect of etanercept on primary depression.
The study findings were published Wednesday in an early online edition of The Lancet.
People shouldn't consider getting TNF-alpha injections to fight depression based on this study, Krishnan says. "The next question is, if we treat people with depression without psoriasis, would it be a benefit," he says. "If it does, it opens up a whole new avenue of treating depression."
One expert thinks that relieving the symptoms of psoriasis is the reason that patients felt less depressed and less tired.
"There has been some data that the drug gives an increased feeling of well-being," says Dr. Jeffrey M. Weinberg, director of the clinical research center in the department of dermatology at St. Luke's-Roosevelt Hospital Center, in New York City. "But I think any therapy that improves psoriasis is going to improve depression and fatigue."
Weinberg adds that he doesn't think his psoriasis patients are depressed at the start of therapy. "But my patients are very happy when they are doing better," he says. "Not only can we improve the disease, but the disease also has a social-psycho impact, and successful therapy can positively impact that."
And it may one day offer a new avenue of treatment for depression itself, the scientists say.
Etanercept, which goes under the brand name Enbrel, works by blocking a protein called tumor necrosis factor-alpha, which is produced by the body and promotes inflammation. High concentrations of TNF-alpha have also been linked to major depression, the researchers says.
"When people get a cold, infections, psoriasis, arthritis, they tend to feel bad and have low energy, they want to sleep more, they are moody and depressed," says lead researcher Dr. Ranga Krishnan, chairman of Duke University's department of psychiatry. "It has been shown that this is due to the elevation of cytokines such as TNF-alpha," he adds.
The question that Krishnan and his colleagues wanted to answer was whether blocking TNF-alpha could improve the symptoms of depression and fatigue.
To test the theory, Krishnan's team assigned 618 psoriasis patients to receive injections of 50 milligrams of etanercept twice a week for 12 weeks, or a placebo. After this period, the patients were all given etanercept for an additional 84 weeks.
The researchers found that after 12 weeks, 47 percent of the patients receiving etanercept had a 75 percent or greater improvement in their psoriasis, compared with 5 percent of those receiving a placebo.
In addition, patients receiving etanercept had a significant improvement in guilt, irritability, interest, appearance, work, sleep and sexual symptoms, compared with those receiving a placebo.
Patients receiving the drug also showed lower levels of fatigue.
Improvement was strongly related to the improvements in joint and skin pain caused by psoriasis, the researchers report.
The researchers noted that the improvement in depression was not correlated with improvement in symptoms. However, the study was not designed to detect the effect of etanercept on primary depression.
The study findings were published Wednesday in an early online edition of The Lancet.
People shouldn't consider getting TNF-alpha injections to fight depression based on this study, Krishnan says. "The next question is, if we treat people with depression without psoriasis, would it be a benefit," he says. "If it does, it opens up a whole new avenue of treating depression."
One expert thinks that relieving the symptoms of psoriasis is the reason that patients felt less depressed and less tired.
"There has been some data that the drug gives an increased feeling of well-being," says Dr. Jeffrey M. Weinberg, director of the clinical research center in the department of dermatology at St. Luke's-Roosevelt Hospital Center, in New York City. "But I think any therapy that improves psoriasis is going to improve depression and fatigue."
Weinberg adds that he doesn't think his psoriasis patients are depressed at the start of therapy. "But my patients are very happy when they are doing better," he says. "Not only can we improve the disease, but the disease also has a social-psycho impact, and successful therapy can positively impact that."
Wednesday, December 14, 2005
New Treatment in The Psoriasis PIcture
An extract found in the cotton plant, gossypol, has shown the strongest anti-inflammatory actions yet seen in the scientific world. In the lab it completely knocks out dozens of different forms of skin inflammation and normalizes dilated, inflammed and hyper-reactive blood vessels. Gossypol's first indication is for the treatment of psoriasis because it also has a normalizing effect on keratinocytes.
Pharmaceutical companies are moving very fast on this substance and have already placed them in nanosomes for penetration into the skin and timed release. Two other skin disorders on their list are rosacea and atopic dermatitis.
Once again, the researchers have never seen an anti-inflammatory as potent, fast acting, and effective on dozens of different inflammatory responses. It out-performed a medium potency, prescription only steroid in a split-face study which is unheard of. Also, the nanosomes drop it off at several different levels in the dermis to treat multiple levels of blood vessels and inflammation. Anecdotally, many patients report diminished burning and stinging sensations within minutes of nanosome delivered gossypol.
Pharmaceutical companies are moving very fast on this substance and have already placed them in nanosomes for penetration into the skin and timed release. Two other skin disorders on their list are rosacea and atopic dermatitis.
Once again, the researchers have never seen an anti-inflammatory as potent, fast acting, and effective on dozens of different inflammatory responses. It out-performed a medium potency, prescription only steroid in a split-face study which is unheard of. Also, the nanosomes drop it off at several different levels in the dermis to treat multiple levels of blood vessels and inflammation. Anecdotally, many patients report diminished burning and stinging sensations within minutes of nanosome delivered gossypol.
Tuesday, December 13, 2005
Combination Therapy For Psoriasis
For people with mild psoriasis, one type of treatment is usually enough. But people with moderate or severe psoriasis often benefit from a combination of treatments. The best combinations are those in which the two therapies have complementary effects, so they can work together to create improved results. And since such combinations have better results, lowers doses of each treatment can be given, reducing the overall side effects.
A number of different regimens of pills, light therapy and topical agents can be used for combination therapy.
Here are the most common combinations:
Acriten plus light therapy: One popular regimen is acitretin, a retinoid taken as a pill, in combination with light therapy. While retinoids are only moderately effective on their own, they help light therapy work faster. So, skin clears with shorter treatments and fewer sessions, minimizing side effects from prolonged use of ultraviolet light. Adding light therapy also permits lower doses of acitretin to be used. Instead of taking 50 mg a day or more, people using combination therapy usually need only 10 or 25 mg a day. Researchers also suspect that acitretin may reduce the risk of skin cancer from light therapy, although this theory has yet to be proven.
Acitretin with ultraviolet B (UVB) is called reUVB, while acitretin with psoralen plus ultraviolet A (PUVA) is called rePUVA. The regimen requires the patient to begin taking acitretin about two weeks before adding light therapy.
Acitretin is relatively safe, but should not be taken by pregnant women because it can cause birth defects. Possible side effects include hair loss, cracking of the lips and high blood cholesterol.
UVB is also relatively safe; the most common side effects are burns. PUVA is more effective than UVB, but can lead to skin cancer if used too often. Cyclosporine and PUVA should not be combined because of the potential for cancer.
Methotrexate with UVB: Methotrexate pills and UVB is also a popular treatment combination. Methotrexate is very effective, but it has the potential to damage the liver and bone marrow. Combining this drug with UVB allows for lower, safer doses of methotrexate to be used. It also reduces the number and length of UVB treatments needed.
The combination usually involves several weeks of treatment with methotrexate before adding UVB treatments. The methotrexate dose is tapered and discontinued after the skin clears, and a maintenance regimen of UVB continues. The disadvantage of the regimen is that psoriasis may return after methotrexate is discontinued.
PUVA with UVB: A combination of PUVA and UVB appears to clear up skin more quickly than using either treatment alone. Another benefit to this combination is that overall exposure to ultraviolet radiation is reduced. The main drawback of this relatively new combination is that the long-term effects are unknown.
Methotrexate with cyclosporine: Methotrexate with cyclosporine, which is one of the most successful combinations used to treat psoriatic arthritis, also works well for psoriasis itself. It is especially effective in people who have pustules on their body. Low doses of methotrexate combined with low doses of cyclosporine clear skin better than either treatment alone and with fewer side effects. Cyclosporine is very effective against psoriasis, but it can cause kidney damage and elevated blood pressure.
Questions to ask your doctor:
Do you think I would benefit from combination therapy?
What type of combination therapy might be best for me?
What special precautions do I need to take with this treatment regimen?
Supported through an educational grant from Biogen Idec. For more information on psoriasis from Biogen Idec please click here.
A number of different regimens of pills, light therapy and topical agents can be used for combination therapy.
Here are the most common combinations:
Acriten plus light therapy: One popular regimen is acitretin, a retinoid taken as a pill, in combination with light therapy. While retinoids are only moderately effective on their own, they help light therapy work faster. So, skin clears with shorter treatments and fewer sessions, minimizing side effects from prolonged use of ultraviolet light. Adding light therapy also permits lower doses of acitretin to be used. Instead of taking 50 mg a day or more, people using combination therapy usually need only 10 or 25 mg a day. Researchers also suspect that acitretin may reduce the risk of skin cancer from light therapy, although this theory has yet to be proven.
Acitretin with ultraviolet B (UVB) is called reUVB, while acitretin with psoralen plus ultraviolet A (PUVA) is called rePUVA. The regimen requires the patient to begin taking acitretin about two weeks before adding light therapy.
Acitretin is relatively safe, but should not be taken by pregnant women because it can cause birth defects. Possible side effects include hair loss, cracking of the lips and high blood cholesterol.
UVB is also relatively safe; the most common side effects are burns. PUVA is more effective than UVB, but can lead to skin cancer if used too often. Cyclosporine and PUVA should not be combined because of the potential for cancer.
Methotrexate with UVB: Methotrexate pills and UVB is also a popular treatment combination. Methotrexate is very effective, but it has the potential to damage the liver and bone marrow. Combining this drug with UVB allows for lower, safer doses of methotrexate to be used. It also reduces the number and length of UVB treatments needed.
The combination usually involves several weeks of treatment with methotrexate before adding UVB treatments. The methotrexate dose is tapered and discontinued after the skin clears, and a maintenance regimen of UVB continues. The disadvantage of the regimen is that psoriasis may return after methotrexate is discontinued.
PUVA with UVB: A combination of PUVA and UVB appears to clear up skin more quickly than using either treatment alone. Another benefit to this combination is that overall exposure to ultraviolet radiation is reduced. The main drawback of this relatively new combination is that the long-term effects are unknown.
Methotrexate with cyclosporine: Methotrexate with cyclosporine, which is one of the most successful combinations used to treat psoriatic arthritis, also works well for psoriasis itself. It is especially effective in people who have pustules on their body. Low doses of methotrexate combined with low doses of cyclosporine clear skin better than either treatment alone and with fewer side effects. Cyclosporine is very effective against psoriasis, but it can cause kidney damage and elevated blood pressure.
Questions to ask your doctor:
Do you think I would benefit from combination therapy?
What type of combination therapy might be best for me?
What special precautions do I need to take with this treatment regimen?
Supported through an educational grant from Biogen Idec. For more information on psoriasis from Biogen Idec please click here.
Monday, December 05, 2005
Living With Psoriasis
PSORIASIS may not be as life threatening as heart disease, diabetes or cancer but its total impact can be just as debilitating. It is a chronic skin disease affecting 2 - 3% of the population. It is found in all age groups. Men and women are equally likely to get it. Although psoriasis may occur for the first time at any age, most people have the first symptoms between the ages of 20 to 30 years old. There are several types of psoriasis, ranging from mild forms on restricted skin areas to severe forms covering the entire skin surface. The disease often seriously compromises the quality of life of the affected persons.
Psoriasis is immunologically and genetically determined, with a multifactorial inheritance. It can be triggered in predisposed persons by a number of factors, including bacterial infections, trauma, psychological stress, certain drugs, certain diseases, alcohol and over-exposure to the sun.
Prof Dr P.C.M. van de Kerkhof … ‘ Generally, it (psoriasis) has a greater impact on a patient’s psychosocial status compared to the impact on physical activity’“Patients with psoriasis are faced with numerous misconceptions and social prejudices. These misconceptions exclude psoriasis patients from public facilities such as receiving equal service or treatment in hair salons, public pools and health clubs,” explains Prof Dr P.C.M. van de Kerkhof.
This was one of the key findings of a study published in the British Journal of Dermatology 2004, shared by Prof Kerkhof in his lecture titled Psoriasis – State-of-the-Art in Management at the 7th Asian Congress of Dermatology held in Kuala Lumpur recently.
Prof Kerkhof, who is the Chief of the Department of Dermatology at the University Medical Centre of St Radboud in Nijmegen, The Netherlands, is also a much sought-after expert on skin disorders and studies particularly on psoriasis.
The quality of life of psoriasis patients is affected to a similar degree to that of patients with other diseases, such as migraine and mild rheumatoid arthritis, according to the findings by him.
Psoriasis can take on many forms. The most common is well-defined coin-shaped red, thick and scaly patches which when scraped or scratched, show bleeding points. It usually appears on the elbow, knees and scalp but may also affect the upper body, joints and nails.
There are a variety of types but no matter what form it takes, psoriasis patients can feel very uncomfortable, both because of the itch, the look and the stares from an innocent but uninformed public.
The negative impact psoriasis has on the physical dimension of quality of life includes burning sensations, joint pain, itching sensations and scaling skin. Those aspects will have a negative impact on the mental dimension of such patients, such as being stigmatised and a generally depressed attitude on life, especially one’s social life.
“Generally, it has a greater impact on patients’ psychosocial status in comparison with the impact on their physical activities, although both areas can be affected,” explains Prof Kherkhof.
“Severe chronic skin conditions such as psoriasis can be described as ‘life ruining’ although it is not ‘life-threatening’ compared to other man-killers like hypertension, diabetes and cancer,” he adds.
It has also been found that psoriasis has a significant impact on sexual relationships and sexual activity. It can also impair the quality of life of families. Treatment time, reluctance to leave home or avoidance of public places may interfere with family leisure time.
Quality of life can be adversely affected by treatments that require a great deal of time and/or effort to take/apply, are “messy” in nature, are slow acting, induce unpleasant side-effects, and/or do not produce a “satisfactory” degree of response in a patient.
Last year, another study commissioned by the National Psoriasis Foundation (of the United States) was published in the Journal of Investigative Dermatology. The study revealed that even a “small” amount of psoriasis can negatively impact daily life.
Psoriasis presents a unique challenge to patients, doctors and society as a whole.Closer to home, the first preliminary work on a National Psoriasis Registry only started in 1998. According to the statistics from the Registry, major aggravating factors are stress and exposure to strong sunlight over a period of time. Most patients suffer from plaque psoriasis (73.5%). Drugs such as traditional medication, body-building supplements, antibiotics and others also worsen the condition.
According to the National Psoriasis Registry, out of 25,717 patients who consulted the Dermatology Department of Kuala Lumpur Hospital from 1995 to 1999, psoriasis was the fourth most common skin problem with 5.2% (1,344 patients), after skin infection, eczema and acne.
Although Malaysia is only beginning to track and learn the dynamics of the condition, it is hoped that the knowledge and learning will help experts to provide better assistance to other and new psoriasis sufferers.
Psoriasis is immunologically and genetically determined, with a multifactorial inheritance. It can be triggered in predisposed persons by a number of factors, including bacterial infections, trauma, psychological stress, certain drugs, certain diseases, alcohol and over-exposure to the sun.
Prof Dr P.C.M. van de Kerkhof … ‘ Generally, it (psoriasis) has a greater impact on a patient’s psychosocial status compared to the impact on physical activity’“Patients with psoriasis are faced with numerous misconceptions and social prejudices. These misconceptions exclude psoriasis patients from public facilities such as receiving equal service or treatment in hair salons, public pools and health clubs,” explains Prof Dr P.C.M. van de Kerkhof.
This was one of the key findings of a study published in the British Journal of Dermatology 2004, shared by Prof Kerkhof in his lecture titled Psoriasis – State-of-the-Art in Management at the 7th Asian Congress of Dermatology held in Kuala Lumpur recently.
Prof Kerkhof, who is the Chief of the Department of Dermatology at the University Medical Centre of St Radboud in Nijmegen, The Netherlands, is also a much sought-after expert on skin disorders and studies particularly on psoriasis.
The quality of life of psoriasis patients is affected to a similar degree to that of patients with other diseases, such as migraine and mild rheumatoid arthritis, according to the findings by him.
Psoriasis can take on many forms. The most common is well-defined coin-shaped red, thick and scaly patches which when scraped or scratched, show bleeding points. It usually appears on the elbow, knees and scalp but may also affect the upper body, joints and nails.
There are a variety of types but no matter what form it takes, psoriasis patients can feel very uncomfortable, both because of the itch, the look and the stares from an innocent but uninformed public.
The negative impact psoriasis has on the physical dimension of quality of life includes burning sensations, joint pain, itching sensations and scaling skin. Those aspects will have a negative impact on the mental dimension of such patients, such as being stigmatised and a generally depressed attitude on life, especially one’s social life.
“Generally, it has a greater impact on patients’ psychosocial status in comparison with the impact on their physical activities, although both areas can be affected,” explains Prof Kherkhof.
“Severe chronic skin conditions such as psoriasis can be described as ‘life ruining’ although it is not ‘life-threatening’ compared to other man-killers like hypertension, diabetes and cancer,” he adds.
It has also been found that psoriasis has a significant impact on sexual relationships and sexual activity. It can also impair the quality of life of families. Treatment time, reluctance to leave home or avoidance of public places may interfere with family leisure time.
Quality of life can be adversely affected by treatments that require a great deal of time and/or effort to take/apply, are “messy” in nature, are slow acting, induce unpleasant side-effects, and/or do not produce a “satisfactory” degree of response in a patient.
Last year, another study commissioned by the National Psoriasis Foundation (of the United States) was published in the Journal of Investigative Dermatology. The study revealed that even a “small” amount of psoriasis can negatively impact daily life.
Psoriasis presents a unique challenge to patients, doctors and society as a whole.Closer to home, the first preliminary work on a National Psoriasis Registry only started in 1998. According to the statistics from the Registry, major aggravating factors are stress and exposure to strong sunlight over a period of time. Most patients suffer from plaque psoriasis (73.5%). Drugs such as traditional medication, body-building supplements, antibiotics and others also worsen the condition.
According to the National Psoriasis Registry, out of 25,717 patients who consulted the Dermatology Department of Kuala Lumpur Hospital from 1995 to 1999, psoriasis was the fourth most common skin problem with 5.2% (1,344 patients), after skin infection, eczema and acne.
Although Malaysia is only beginning to track and learn the dynamics of the condition, it is hoped that the knowledge and learning will help experts to provide better assistance to other and new psoriasis sufferers.
Thursday, December 01, 2005
FDA Approval For Spray Clobex
Galderma Laboratories announced today that the U.S. Food and Drug Administration (FDA) has granted the company approval to market its CLOBEX® (clobetasol propionate) Spray, 0.05% for the treatment of moderate-to-severe plaque psoriasis. CLOBEX® Spray is the only available super-high potency corticosteroid formulation that provides the clinically proven strength of clobetasol in a non-aerosol spray formulation.
CLOBEX® Spray was demonstrated to be safe and effective in two multi-center, randomized, double-blind studies involving 209 patients with moderate-to-severe psoriasis. In the first clinical trial, 82% of patients became clear or almost clear after four weeks of treatment, with 47% of these subjects becoming clear or almost clear in as early as two weeks. In a second study, 78% of patients were clear or almost clear after four weeks.
CLOBEX® Spray reflects the proven and well-known clinical profiles of CLOBEX® Lotion and Shampoo. Available by prescription since September 2003 and June 2004 respectively, CLOBEX® Lotion and Shampoo are clinically proven to reduce and/or eliminate the signs and symptoms of moderate-to-severe psoriasis.
CLOBEX® Spray was demonstrated to be safe and effective in two multi-center, randomized, double-blind studies involving 209 patients with moderate-to-severe psoriasis. In the first clinical trial, 82% of patients became clear or almost clear after four weeks of treatment, with 47% of these subjects becoming clear or almost clear in as early as two weeks. In a second study, 78% of patients were clear or almost clear after four weeks.
CLOBEX® Spray reflects the proven and well-known clinical profiles of CLOBEX® Lotion and Shampoo. Available by prescription since September 2003 and June 2004 respectively, CLOBEX® Lotion and Shampoo are clinically proven to reduce and/or eliminate the signs and symptoms of moderate-to-severe psoriasis.
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