Smoking Is A Risk Factor In Psoriasis

Although dry skin has long been associated with smoking, not until recently has it also been linked to psoriasis. Thousands of doctors are now advising patients to use a good shielding lotion as treatment for psoriasis, but will no doubt soon be adding cessation of smoking to their recommendations.Psoriasis is considered a chronic skin condition and presents as elevated, dry, scaly, itchy patches on the skin. The most common sites are the elbows, knees and other parts of the legs, the scalp, lower back, face, palms, and the soles of the feet. About one third of the diagnosed cases are genetic, although the first outbreak is frequently triggered by stress or physical injury. The condition is driven by the immune system – T cells, the white blood cells that help protect the body from infection and are responsible for creating scabs over wounds, become overactive and trigger other immune responses. These lead to inflammation and rapid turnover of skin cells. The immature skin cells then rise to the surface and form the scaly patches.A recent study, published in the December issue of Archives of Dermatology, found that those who smoke more than a pack of cigarettes per day were at twice the risk of having more severe psoriasis than those who smoke 10 cigarettes or less, and that patients who smoke are more likely to have psoriasis.Although no causal relationship was established, lead researcher Dr. Gerald G. Krueger, a professor of dermatology at the University of Utah School of Medicine stated that if one is not genetically predisposed to psoriasis, "one of the things that you can do to make sure that you get psoriasis is smoke."

Psoriasis Susceptibility Gene Identified

University of Michigan scientists have found a common genetic variation in an immune system gene that makes people much more likely to develop psoriasis – a disfiguring inflammatory skin disease. Named PSORS1 (SORE-ESS-1), for psoriasis susceptibility 1, the gene is the first genetic determinant of psoriasis to be definitively identified in a large clinical study. Its discovery could lead to new, more effective treatments for psoriasis without the risks and side-effects of current therapies. The gene's causative role in psoriasis was demonstrated in a University of Michigan Medical School study of 2,723 people from 678 families in which at least one family member had the disease. Results of the U-M study – the most comprehensive analysis of a psoriasis gene to date – will be published in the May 2006 issue of the American Journal of Human Genetics. Psoriasis is a chronic disease that affects about 2 percent of the U.S. population. People with psoriasis develop thick, flaky white patches on their skin and scalp. The disease is disfiguring and can have a negative effect on quality of life. About 25 percent of people with psoriasis eventually develop psoriatic arthritis, which can be severe. Unlike diseases caused by a mutation in just one gene, psoriasis is what scientists call a multi-factorial disease. This means that people must inherit several disease-related genes, plus be exposed to one or more environmental triggers, in order to get psoriasis. "For every individual with psoriasis who carries the PSORS1 gene, there are 10 other people with the gene who don't get psoriasis," says study director James T. Elder, M.D., Ph.D., a professor of dermatology and of radiation oncology in the U-M Medical School and the Ann Arbor VA Healthcare System. "It's as if you are pushing a shopping cart down the aisle at the grocery store and putting genes in your cart," Elder adds. "There are several different brands of each gene on the shelf and one of them is bad for you. If you pull down enough bad ones, then you can get sick. "But even if you get all the bad genes, you still need a trigger from the environment to develop the disease," explains Elder. "In psoriasis, strep throat is a very common initial trigger. It activates the immune system to attack the strep bacteria. But once the strep infection is cleared, the immune system starts attacking the patient's own skin cells. About half the time, strep-induced psoriasis goes away and never comes back. But for the other 50 percent of young people who get it, psoriasis progresses to become a chronic life-long disease." The PSORS1 gene is actually one of over 20 different varieties (scientists call them alleles) of a gene called HLA-C. "In terms of our grocery store analogy, think of PSORS1 as one of 20 'brands' of HLA-C on the shelf," Elder says. Located on human chromosome 6, HLA-C is one of several genes in the major histocompatibility complex (MHC) that regulate how the immune system fights off infection. MHC genes carry DNA-coded instructions for proteins whose job it is to distinguish between what belongs in the body and what doesn't. "There is a great deal of genetic variation in the MHC, because it's on the front lines of dealing with pathogens and cancer," Elder explains. "It's an area where it's good to be different. If everybody were the same, we'd be like hybrid corn. A plague could come along and wipe us all out." Scientists have been searching for genes associated with psoriasis for more than 30 years, but until now studies have been inconclusive, according to Rajan P. Nair, Ph.D., the study's first author and a U-M assistant research professor in dermatology. "Researchers have identified 19 candidate loci, or areas on chromosomes, that may be genetically linked to psoriasis," Nair says. "Many studies confirmed a strong association with the MHC, but no one could determine which gene in the MHC was involved in psoriasis." In a previous study, Nair and his U-M colleagues narrowed the search for the PSORS1 gene down to a 300,000-base-pair segment of chromosome 6 that included HLA-C and at least 10 other genes. To determine which of the 11 genes was linked to psoriasis, U-M scientists used a technique called haplotype mapping. Haplotypes are clusters of alleles that tend to be inherited together as a group, because they are located close to each other on the same chromosome. This means that small individual variations in DNA, which originated in a distant ancestor, are often passed intact from generation to generation. If a haplotype contains genetic changes that make people more susceptible to a disease, scientists can find it by comparing DNA sequences in haplotypes from people with the disease to those of people who don't have the disease. U-M researchers first sequenced and compared all DNA within the 300,000 base-pair target segment from 10 MHC chromosomes carried by five people enrolled in the study. Detailed analysis of these 10 DNA sequences revealed differences that were only present on psoriasis chromosomes, but never on normal chromosomes. Further analysis by U-M scientists narrowed the search down to one gene, HLA-C, and one specific disease-causing allele, HLA-Cw6. Drugs used to treat psoriasis are also used for other autoimmune diseases, such as lupus and rheumatoid arthritis. These drugs turn off the immune response, which leaves the body vulnerable to infection. Now that U-M scientists have identified HLA-Cw6 as being the PSORS1 gene, Elder says scientists can concentrate on finding ways to block its ability to bind to cell surface antigens, which could lead to the development of safer treatments for psoriasis. "What we're all shooting for is trying to find out which branches of the immune system are triggering psoriasis, so you don't have to shut down the whole immune system – only the parts that are important," Elder says. While Elder believes that PSORS1 is the major gene involved in susceptibility to psoriasis, he cautions that it's not the only one. He says much additional research will be required to find the other genes involved and to understand all the secrets of this complex and puzzling disease. "Access to a large, diverse pool of study subjects is vital to the success of this type of clinical research," Elder says. "We are grateful to the 5,000 people who have participated in our psoriasis study so far. It has been a collaborative effort involving physicians, scientists and patients from dermatology departments at many institutions – including the U-M, the University of Kiel in Germany, Detroit's Henry Ford Hospital, and the Ann Arbor VA Healthcare System."

Treating Psoriasis With Dermatitis-Ltd

Dermatitis-Ltd will improve the skin beauty and provide improve the appearance of the various forms of psoriasis.
The ingredients of Dermatitis-Ltd III are: zinc oxide, sodium chloride, magnesium stearate, polyethylene glycol, iron oxide, copper oxide, and sulfur (sulfur is used externally only and is not to be confused with sulfa which is taken internally only). Dermatitis-Ltd does not contain any potentially irritating preservatives, such as methylparaben, propylparaben, and Quaternium-15, and contains no irritating fragrances. Dermatitis-Ltd has a pH of 7.0 which is the perfect pH balance to allow the skin to normalize itself and heal itself

Psoriasis Treatment Beats Expectations In Phase II Trials

Celgene Corporation has reported better than expected phase II data evaluating CC-10004 as a potential oral therapy for patients with severe plaque-type psoriasis.

CC-10004 is a novel, orally available small molecule with anti-inflammatory activities that inhibits the production of multiple proinflammatory mediators including PDE-4, TNF-alpha, interleukin-2 (IL-2), interferon-gamma, leukotrienes, and nitric oxide synthase. CC-10004 is the lead investigational drug in this class of anti-inflammatory compounds, and is being studied in phase II proof of principle clinical trials for the treatment of psoriasis and other chronic inflammatory diseases.

At the 64th American Academy of Dermatology meeting, Dr Alice Bendix Gottlieb, professor of medicine at Tufts-New England Medical Center, presented data from a phase II trial evaluating the clinical response in patients with severe plaque psoriasis treated for 29 days with CC-10004.
Dr Gottlieb reported that that 73.7% of enrolled patients demonstrated improvement in their psoriasis symptoms with 15.8% of these patients showing a greater than 50% reduction in their psoriasis area and severity index (PASI) score.

In addition, 53.3% of the evaluable 15 patients demonstrated greater than 20% reduction in epidermal skin thickness, the protocol-defined definition of pharmacodynamic response. The mean reduction of epidermal thickness among the evaluable patients was 20.5%.

Furthermore, 52.9% of enrolled patients showed an improvement in their physician's global assessment scores and 58.8% showed a reduction in their psoriasis body surface area scores.
"We are very encouraged with the results of the psoriasis trials as they exceeded the predetermined guidelines we had established," said Dr Jerome Zeldis, Celgene's chief medical officer. "Based on these results, we are accelerating our clinical program and are moving forward with an adequate and well-controlled multi-center study."

How Severe Is My Psoriasis

People with psoriasis on less than 2 percent of their body are considered to have a mild case. Generally, isolated patches of psoriasis are found on the knees, elbows, scalp and hands and feet. Topical treatments—including moisturizers and over-the-counter and prescription creams, ointments and shampoos—are usually sufficient to keep the psoriasis in check.
Moderate psoriasis is defined as affecting between 2 percent and 10 percent of the body's surface. Psoriasis may appear on the arms, legs, torso, scalp and other areas. Appropriate therapies include topical treatments, phototherapy and oral medications, depending on the location and extent of the psoriasis and other individual factors.
Psoriasis covering more than 10 percent of the body is considered severe. Extensive areas of skin may be covered with psoriasis plaques or pustules, or widespread erythrodermic psoriasis can cause severe peeling of the skin. People with severe psoriasis are more likely to develop psoriatic arthritis. Powerful treatments, including phototherapy, oral medications or a combination of these, are usually necessary to manage severe psoriasis.

Determining The Best Treatment For 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.

Medicis Psoriasis Drug Gets Wider Use FDA Approval

Dermatology product maker Medicis Pharmaceutical Corp. on Thursday said the Food and Drug Administration has approved a wider use for the company's Vanos skin medication.
The wider use allows Medicis to market the steroid as a primary treatment for skin inflammation and itching for patients 12 and older. Such condition include eczema and exposure to poison ivy.
The drug was approved last year, and launched in April, as a treatment for plaque-type psoriasis, a chronic condition of red, scaly inflamed skin

Remicade Recieves Posts Phase III Trial Results

Centocor Inc. reported positive study results of tests using its drug Remicade in patients suffering from psoriasis.
The results of the phase-III study were presented by the Horsham, Pa., biotechnology company Friday at the annual American Academy of Dermatology meeting in San Francisco.

The study showed patients taking Remicade for 10 weeks achieved at least 75 percent improvement in their psoriasis, a chronic inflammatory disease. Nearly 2 million Americans suffer from the skin disorder.
Remicade is already approved as a treatment for rheumatoid arthritis and Crohn's disease.
The Food and Drug Administration is reviewing Centocor's application, filed in November, to expand the use of the drug to include treating moderate to severe psoriasis