Defining Psoriasis

Psoriasis is a chronic scaling skin. It may range from just a few spots anywhere on the body to large areas of involvement. It is not contagious or spread able from one part of the body to another or from one person to another. There is no blood test to diagnose psoriasis. The diagnosis is made by observation and examination of the skin. Sometimes microscopic examination of the skin (biopsy) is helpful where the changes are not typical or characteristic. The exact cause of psoriasis is unknown, but hereditary and genetic factors are important. Psoriasis runs in families. This does not mean, however, that every child of a parent with psoriasis will develop psoriasis, but it is common that somewhere down the line psoriasis will appear in families. Psoriasis is not caused by allergies, infections, dietary deficiencies or excesses, or nervous tension.

Types Of Psoriasis

There are five different types of psoriasis. The most common form of psoriasis is called "plaque psoriasis," which is characterized by well-defined patches of red, raised skin. About 80 percent of people with psoriasis have this type. Plaque psoriasis can appear on any skin surface, although the knees, elbows, scalp, trunk and nails are the most common locations. The other types of psoriasis are: Guttate described as small, red, individual drops on the skin. Inverse psoriasis is smooth, dry areas of skin, often in folds or creases, that are red and inflamed but do not have scaling Erythrodermic psoriasis is characterized as periodic, widespread, fiery redness of the skin. Pustular psoriasis which involves either generalized, widespread areas of reddened skin, or localized areas, particularly the hands and feet (palmo-plantar pustular psoriasis).Typically, people have only one form of psoriasis at a time. Sometimes two different types can occur together, one type may change to another type, or one type may become more severe. For example, a trigger may convert plaque psoriasis to pustular.

The Chronic Psoriasis Picture

Psoriasis is a chronic scaling skin. It may range from just a few spots anywhere on the body to large areas of involvement. It is not contagious or spread able from one part of the body to another or from one person to another. There is no blood test to diagnose psoriasis. The diagnosis is made by observation and examination of the skin. Sometimes microscopic examination of the skin (biopsy) is helpful where the changes are not typical or characteristic. The exact cause of psoriasis is unknown, but hereditary and genetic factors are important. Psoriasis runs in families. This does not mean, however, that every child of a parent with psoriasis will develop psoriasis, but it is common that somewhere down the line psoriasis will appear in families. Psoriasis is not caused by allergies, infections, dietary deficiencies or excesses, or nervous tension.

Understanding Psoriasis

Psoriasis is a common immune-mediated chronic skin disease that comes in different forms and varying levels of severity. Most researchers now conclude that it is related to the immune system (psoriasis is often called an "immune-mediated" disorder).It is not contagious. In general, it is a condition that is frequently found on the knees, elbows, scalp, hands, feet or lower back. Many treatments are available to help manage its symptoms. More than 4.5 million adults in the United States have it. Between 10 percent and 30 percent of people with psoriasis also develop a related form of arthritis, called psoriatic arthritis.

Google Asked To Stop Running Ads Promoting 'Miracle Cures"

Contact: Michael Paranzino of Psoriasis Cure Now, 202-253-4863 or michael@psorcurenow.org Web: http://www.psorcurenow.org
KENSINGTON, Md., June 20 /U.S. Newswire/ -- "Psoriasis Cure Now," a nonprofit patient advocacy group, today asked internet search giant Google to enforce its own corporate policy against accepting advertisements that promote phony cures for incurable diseases. Google is currently running numerous paid ads designed to deceive people with psoriasis, a painful, incurable and often debilitating immune system disease that affects as many as 7.5 million Americans.
"The Google brand stands for integrity and credibility," said Michael Paranzino, president of Psoriasis Cure Now, "which is why we have asked Google to enforce its own sensible policy prohibiting ads for phony medical 'cures.' People with painful, incurable diseases are particularly vulnerable to scam artists seeking to prey on their misfortune. We hope Google will enforce its policy to protect its users from false and potentially unhealthy advertising."
Google's content policy clearly states: "Advertising is not permitted for the promotion of miracle cures, such as 'Cure cancer overnight!'" ( https://adwords.google.com/select/contentpolicy.html ) Yet as of yesterday, nine different paid ads alongside search results for the word "psoriasis" made just that kind of bogus claim, including: "Psoriasis Can Be Cured"; "New Psoriasis Cure"; "eradicate your psoriasis in 2-3 days"; and "treatment guaranteed to end Psoriasis."
Unfortunately, there is no cure for psoriasis. In fact, scientists believe a dozen or more different genes may play a role in this complex disease, along with environmental triggers that make psoriasis even more difficult to treat.
Google competitor Yahoo! is not running any psoriasis advertisements that make obviously false claims. "We applaud Yahoo! for its practice and look forward to Google enforcing its policy to protect both its users and its corporate image," Paranzino added.

The Genetics Of Psoriasis

A new gene associated with a variant of psoriasis and seborrheic dermatitis has been identified by a research group led by Dr. Ohad Birk at the Morris Kahn Laboratory of Human Genetics at Ben Gurion University and Soroka Medical Center. The gene discovered by the Israeli researchers is of much interest as it allows the first major molecular insight into why the specific skin cells proliferate excessively, causing these two common skin diseases. Psoriasis and seborrheic dermatitis affect 2-3% of the population worldwide and 85% of AIDS patients. Both skin diseases are caused by excessive proliferation of specific cells (keratinocytes) in the skin. To date, there is only very limited understanding as to the molecular mechanisms causing these two common disorders. The two-and-a-half-year study examined an Israeli Moroccan Jewish family with 44 members over five generations who showed signs characteristic of psoriasis and seborrheic dermatitis. By using advanced techniques to analyze DNA samples of the affected members of the family and comparing them to normal, unmutated DNA, Ramon Birnbaum, a doctoral student at Birk's laboratory, has succeeded in pinning the beginning of the molecular pathway on a mutation in a gene that is normally expressed, or "turned on" in the keratinocytes. The gene is believed to suppress or regulate cell proliferation and is thought to be a transcription factor, meaning that it switches on other genes, which may also play a role in the disease. When mutated, this regulation malfunctions, enabling excessive proliferation of skin cells and calling in cells of the immune system. The findings, to be reported in this month's issue of Nature Genetics, allow new insights into the mechanism of disease in psoriasis and seborrheic dermatitis. In turn, these insights are likely to assist pharmaceutical companies in developing "smart drugs" for these two common skin diseases.

Types Of Psoriasis

Plaque-type psoriasis is the most common form of the disease and is commonly referred to as psoriasis vulgaris (Camisa 56). It is characterized by inflamed skin lesions topped with silvery white scales. It can assume many different appearances based on where it is located, the activity of the disease, and the treatment being administered. It is most commonly found on the elbows, knees, scalp, sacrum, umbilicus, intergluteal cleft, and genitalia (Camisa 56).
Guttate psoriasis is characterized by small dot-like lesions. It is most common in children and young adults who have a prior history of upper respiratory infection, pharyngitis, or tonsillitis (Camisa 64). The lesions are not as scaly as plaque-type psoriasis and are likely to be found on the trunk and involve the face (Camisa 64).
Pustular psoriasis is characterized by pustules, which are blister-like lesions of non-infectious fluid, and intense scaling. Individuals with pustular psoriasis are often among the most seriously ill and may have to be hospitalized (Camisa 67).
Erythrodermic psoriasis is the most uncommon form of psoriasis and is characterized by intense redness and swelling, exfoliation of dead skin, and pain. Erythrodermic psoriasis usually develops during the course of chronic psoriasis, however in some cases it may be the initial type of psoriasis even in children (Camisa 74). Individuals with this type of psoriasis may experience chills, low grade fever, and may be rather uncomfortable (Camisa 75).
Inverse psoriasis is characterized by smooth inflamed lesions in the body folds -- armpits, under the breast, skin folds of the groin, buttocks, and genitals.
Koebner's Phenomenon psoriasis are psoriatic lesions which appear at the site of injury, infection or other skin psoriasis, or may be a new lesion in an existing case.
The degree of psoriasis can also vary from individual to individual. It ranges in severity from mild (affects less than 2% of body) to moderate (affects 2-10% of body) to severe (affects greater than 10% of the body). Skin injury and irritation, sun exposure, diet, stress and anxiety, medications, and infections have been known to make psoriasis worse.

Folk Remedies Have A Place In The Treatment Of Psoriasis

Psoriasis is a difficult disorder to treat. But researchers report in the American Journal of Therapeutics that they have identified a natural preparation from a plant that effectively treats mild to moderate psoriasis. The plant, Mahonia aquifolium, grows wild in North America and was used in folk medicine to treat skin diseases.
Psoriasis is a difficult disorder to treat because the severity and distribution of psoriatic plaques varies immensely, and because current medications can have undesirable side effects. This common skin disorder affects more than 4.5 million people in North America.
But according to an article in the American Journal of Therapeutics (March/April 2006, Volume 13, No. 2, p. 121-126), a natural preparation from a plant holds promise for psoriasis sufferers.
Steve Bernstein and other researchers from the Dermatology and Cosmetic Center in Rochester, New York conducted a randomized, double-blind, placebo-controlled study using a proprietary topical cream prepared with Mahonia aquifolium.
This plant, also known as the barberry, Oregon grape, or berberis, grows wild in North and South American and Europe. It was initially used in American folk medicine as an oral medication for inflammatory skin diesases including psoriasis and syphilis.
Of the 200 psoriasis patients enrolled in the trial, 97 completed the 12-week course and 74 completed the same regimen using a placebo cream.
Bernstein and his colleagues traced a statistically significant improvement of the signs and symptoms of moderate plaque psoriasis compared with patients receiving placebo. The medication was well tolerated when applied to the affected area twice a day for twelve weeks. No significant side effects were reported by either the active or control group.
The researchers concluded that the cream containing Mahonia aquifolium extract is a safe and effective treatment for mild to moderate psoriasis.

The Historical Picture Of Psoriasis

Psoriasis has been around since the days of Greek mythology, more than 2,500 years ago. It was considered a curse from the gods.The Bible refers to psoriasis but mistakenly calls it leprosy. For hundreds of years, people with the disease were ostracized and forced to wander as homeless beggars. Some had to wear warning bells so others could avoid their paths. Some suffered the same fate as lepers, who were burned at the stake in the 14th century."Amazingly, psoriasis was a disease that had been misunderstood for more than 2,000 years before it was clearly defined (in the early 1800s) and named what we know it as today."

Living With Nail Psoriasis

Erosion of the nail plate and tenderness of the fingertip may have several causes, the most common being onycholysis, a spontaneous separation of the nail plate from the underlying skin. It classically occurs at the distal end of the nail and can be quite painful. It is a common condition, primarily occurring in females and in the elderly. Treatment consists of avoiding trauma to the nail, avoiding irritants and keeping the nail dry.
Another common condition is fungal infections of the nail (medical term: onychomycosis), and this should be considered especially if the condition is spreading to other nails, as is the case with this reader. Note that dermatologists often see patients with obvious clinical evidence of fungal even though the lab tests are negative, so a course of oral anti-fungal therapy might still be indicated. There are also a whole host of other conditions that your dermatologist could consider, including bacterial infections, eczema, psoriasis and even warts beneath the nail. These are far too numerous to list here, but your dermatologist should be familiar with the most common ones.
You should also realize that many nail disorders are extremely difficult to treat since the nail plate is not "living" tissue. Many nail disorders are incurable, but pain or tenderness should be relieved with appropriate therapy.

comment by Dr. Julian Schamroth, a veteran Jerusalem dermatologist

A Factual Picture Of Psoriasis

Psoriasis facts and figures.
Psoriasis is a chronic skin condition affecting approximately 4.5 million people in the United States.
New skin cells grow too rapidly, resulting in inflamed, swollen, scaly patches of skin in areas where the old skin has not shed quickly enough.
Psoriasis can be limited to a few spots or can involve more extensive areas of the body, appearing most commonly on the scalp, knees, elbows and trunk.
Psoriasis is not a contagious disease. The cause of psoriasis is unknown, and there currently is no cure.
Psoriasis can strike people at any age, but the average age of onset is approximately 28 years. Likewise, it affects both men and women, with a slightly higher prevalence in women than in men.
Approximately 30 percent of people with psoriasis are estimated to have moderate-to-severe forms of the disease.Psoriasis can be a physically and emotionally painful condition. It often results in physical limitations, disfiguration and a significant burden in managing the daily care of the disease.
Psoriasis sufferers may feel embarrassed, angry, frustrated, fearful, depressed and, in some cases, even suicidal.

Signs And Symptoms Of Scalp Psoriasis

Psoriasis that affects the scalp is also called seborrheic psoriasis. The scalp may be the first site to be affected by psoriasis. The condition may resemble severe dandruff. Patches of thick, flaky skin may extend to the forehead below the hairline. Scales may build up in the outer ear. Other than the forehead and the ears, the face is usually spared. However, some people may have patches of inflamed skin that resemble seborrheic dermatitis a type of dandruff eczema that affects the scalp and face.Psoriasis on the scalp is common and, in many cases, it is the only area affected. It usually consists of red, scaly patches that are sometimes lumpy. The edge of the patch tends to be well defined. This type of psoriasis can extend beyond the hairline, onto the forehead. Psoriasis of the scalp does not damage the hair follicle and is not associated with alopecia (hair loss), but if the scale is thick and forms hard lumps, it can lead to temporary hair thinning. However, this is not permanent and will grow back again after the psoriasis clears.This form of psoriasis can be extremely uncomfortable. It is often very itchy, and the psoriatic patches that are inflamed and sore can start to bleed if they are scratched or picked. The condition is not caused by poor hygiene or hair care. Scalp psoriasis can be demoralizing, as the look of dead skin cells on clothing can be embarrassing, and it is not always easy to brush them off inconspicuously. Itchiness is another big problem, not only because of the social implication but also because it inflames the condition and makes it worse. Forehead along the hairline is a common site as is the temples, nape of the neck, around the ears, as well as the hair parting. Massaging a little warm baby/olive/coconut oil gently into the scalp, preferably before going to bed to allow plenty of time to soak (bind up the head in an old towel) will help. Wash out with cream shampoo (i.e. Dry Hair Products), add a little lemon juice to the final rinse to get rid of excess grease. Only shampoo three times a week, more than this and the natural oils may be washed out. Always treat the head as gently as possible, do not comb or brush harshly. Perms and colorants can be used as long as the skin is not broken. Shampoo the hair and scalp with a tar-based shampoo that can be purchased over-the-counter or by prescription. Shampoos, scalp steroid lotions, vitamin D analogues and some tar preparations such as tar pomade may be used on the scalp.

Signs And Symptoms Of Psoriatic Arthirtis

Although psoriatic arthritis normally affects only people with psoriasis, skin and joint problems usually don't develop simultaneously. Many people have psoriasis long before they develop arthritic symptoms, and a few have joint pain for decades before skin symptoms appear. But to receive a diagnosis of psoriatic arthritis, you must have signs and symptoms of both conditions:
Patches of thick, red skin covered with silvery scales, especially on your elbows, knees, scalp or the lower end of your spine. These patches (plaques often itch or burn, and the skin at your joints may crack.
Pain, redness, swelling and reduced motion in your joints — especially the small joints at the ends of your fingers and toes. The joints in your spine and your sacroiliac joints — the two large joints that connect your pelvis and the triangular bone at the end of your spine (sacrum) — also may be affected.
Stiffness and fatigue in the morning.
Pitted, discolored nails that may separate from the nail beds.
Eye inflammations such as conjunctivitis or iritis.
In addition to general arthritic symptoms, there are five distinct types of psoriatic arthritis, each with its own characteristics:
Asymmetric arthritis. The mildest form of psoriatic arthritis, asymmetric arthritis usually affects joints on only one side of your body or different joints on each side — including those in your hip, knee, ankle or wrist. One to three joints are generally involved, and they're often tender and red. When asymmetric arthritis occurs in your hands and feet, swelling and inflammation in the tendons can cause your fingers and toes to resemble small sausages (dactylitis).
Symmetric arthritis. Unlike asymmetric arthritis, symmetric arthritis usually affects four or more of the same joints on both sides of your body. It's similar to rheumatoid arthritis, one of the most common and debilitating of the many arthritic conditions. Although symmetric arthritis is generally milder than rheumatoid arthritis, it can cause progressively disabling joint damage. More women than men have symmetric arthritis, and psoriasis associated with this condition tends to be severe.
Distal interphalangeal joint predominant (DIP). A small percentage of people with psoriatic arthritis — most of them men — have DIP, which affects the small joints closest to the nails (distal joints) in the fingers and toes. DIP is sometimes misdiagnosed as osteoarthritis, a type of arthritis that results from the destruction of cartilage on the ends of the bones. But psoriatic arthritis usually causes nail problems that don't occur with osteoarthritis.
Spondylitis. This form of psoriatic arthritis can cause inflammation in your spine as well as stiffness and inflammation in your neck, lower back or sacroiliac joints. Inflammation can also occur where ligaments and tendons attach to your spine. As the disease progresses, movement tends to become increasingly painful and difficult. Psoriatic spondylitis isn't the same as ankylosing spondylitis, another arthritic condition. Ankylosing spondylitis doesn't occur with psoriasis and usually affects the entire spine, whereas psoriatic spondylitis may affect only your neck or low back.
Arthritis mutilans. A small percentage of people with psoriatic arthritis have arthritis mutilans — a severe, painful and crippling form of the disease. Over time, arthritis mutilans destroys the small bones in the hands, especially the fingers, leading to permanent deformity and disability.
The symptoms of psoriatic arthritis are likely to be better at some times and worse at others. But because skin and joint problems frequently flare up and go into remission at different times, you may have severe psoriasis when your joints are relatively pain-free and aching joints when your skin clears.
Juvenile psoriatic arthritisChildren with psoriatic arthritis usually develop signs and symptoms of the disease around age 9 or 10. Symptoms are often mild, although some children may have severe and debilitating problems that last into adulthood.
In general, children have many of the same signs and symptoms that adults do, but they're more likely to develop skin and joint problems simultaneously. And because children's bones are still forming, abnormal bone development can affect growth.

Psoriatic Arthritis

Tens of millions of Americans experience the pain and physical limitations of arthritis. Yet arthritis isn't a single medical problem but a group of more than 100 conditions that can cause inflammation in your joints, muscles, tendons, ligaments and bones.
One of these conditions is psoriatic arthritis, which may affect as many as 1 million of the approximately 6 million Americans who have psoriasis. Most are adults in their 30s, 40s and 50s, but children also can develop a form of the disease.
In addition to the inflamed, scaly skin that's typical of psoriasis, people with psoriatic arthritis have swollen, painful joints — especially in their fingers and toes — and pitted, discolored nails. They may also develop inflammatory eye conditions such as conjunctivitis.
There are several types of psoriatic arthritis, with symptoms that range from mild to severe. In general, the disease isn't as crippling as other forms of arthritis, but if left untreated it can cause discomfort, disability and deformity. Although no cure exists for psoriatic arthritis, medication, physical therapy and lifestyle changes often can relieve pain and slow the progression of joint damage.

Treating Psoriasis With Immune Suppressants, Steroids, Lotions And Tar

Topical lotions, ointments, creams, gels, and shampoos for the skin and scalp are prescribed for mild-to-moderate cases of psoriasis or in combination with other treatments for more severe cases. FDA-approved prescription topicals to treat psoriasis include corticosteroids, retinoids, calcipotriene, and coal tar products. These drugs slow down skin cell production and reduce inflammation.
Corticosteroids are synthetic drugs that resemble naturally occurring hormones. Side effects may include thinning of the skin and stretch marks at the area where the topical is applied. Corticosteroids may also suppress the adrenal glands' production of natural steroids, which could leave the body susceptible to disease.
Retinoids are derivatives of vitamin A and calcipotriene is a synthetic form of vitamin D. Retinoids and calcipotriene are not the same as over-the-counter vitamin A and D supplements, which have no value for treating psoriasis, says Wilkin. "These topical creams on the skin deliver the vitamin-like chemicals right to where you want them," he says. Skin irritation where the topical is applied may be a side effect. Retinoids are also available by prescription as oral systemic drugs.
Coal tar products can help with scaling, itching, and inflammation but are not used as commonly as some other topicals, says Lindstrom. They are messy, can stain, and have a strong odor.
Carol Bentson of Washington, D.C., has had plaque psoriasis for more than 30 years, causing "major itching" all over and pain along the scalp line. She has treated it with topical corticosteroids, ultraviolet light, and cortisone injected into her scalp, elbows, toes, and legs. At times, "ointment wouldn't penetrate the areas of heavy plaque buildup, no matter how much I put on," she says.
Bentson has accumulated "sacks of lotions" to treat psoriasis. She would find a topical treatment that worked for a while but then quit working, forcing her to switch to another one.
"With a potent topical steroid, there is a phenomenon called tachyphylaxis," says Craig Leonardi, M.D., associate clinical professor of dermatology at the Saint Louis University Medical School. "Prolonged use can cause down-regulation [decrease] of steroid receptors in cells. The net effect is that the skin becomes less responsive to steroids over time."
Wilkin adds that this unresponsiveness may be a temporary effect. "A patient may need to be off the steroid for a few days or a week and when put back on it, the responsiveness could come back."
Exposing the skin to ultraviolet (UV) light--either from the sun or an artificial source--sets off a biological process that kills T cells, which slows the buildup of skin cells and reduces inflammation.
Light boxes that emit UV light to treat moderate-to-severe psoriasis and other skin diseases are medical devices that require licensing by the FDA. A person steps into the light box, which is about the size of a telephone booth, while lamps direct the light onto the body.
"Treatment with these devices is complex," says Richard Felten, an FDA chemist and senior medical device reviewer. The physician must determine an individual's sensitivity to UV and adjust the light emissions for the most effective treatment with the least risk of side effects, he says. Side effects may include burning, darkened skin, premature aging, and skin cancer. Three to five treatments per week for several weeks or months may be needed to get the psoriasis under control, followed by weekly maintenance treatments.
Light therapy, or phototherapy, is usually done in the physician's office or a medical facility that has the devices, says Felten. "The FDA has cleared some devices for home use under certain conditions and with a doctor's prescription," he says. Home devices include handheld devices for scalp psoriasis and stand-alone light boxes for other areas of the body.
Light therapy usually involves a short wavelength of ultraviolet light, called UVB. For people with resistant moderate-to-severe psoriasis, a combination of an oral or topical drug called psoralen and a longer wavelength ultraviolet A (UVA) light is used. This treatment is called "psoralen plus UVA" (PUVA).
"Psoralen makes the patient more sensitive to the UVA," says Lindstrom, "so once they've taken a dose of psoralen, a smaller dose of UVA is needed to treat them." Patients must be very careful to protect both skin and eyes for 24 hours after psoralen use to prevent damage, she says.
The FDA has also approved a special type of laser, an excimer laser, as a phototherapy device to treat mild-to-moderate psoriasis. "These lasers can deliver a much more controlled beam of light to small areas of the affected skin," says Felten.
The FDA has approved oral and injected drugs that circulate throughout the body to treat psoriasis that is moderate, severe, or disabling. These systemic drugs are very powerful, and while some may be used continuously, others can only be used for a limited time because of their severe side effects. Once a drug is discontinued, the psoriasis may reactivate. The risk of birth defects prevents many systemics from being taken by pregnant women or women planning to become pregnant.
Systemic drugs that may be prescribed for psoriasis include acitretin, methotrexate, cyclosporine, and biologics, which are drugs made from proteins of living cells. Methotrexate, cyclosporine, and the biologic drugs are immunosuppressants, meaning they lower the body's normal immune response. "These drugs suppress the immune cells that cause psoriasis, but they don't distinguish these cells from the immune cells that protect our body from infections," says Elektra Papadopoulos, M.D., an FDA dermatologist.
Acitretin, a retinoid that is given orally for severe psoriasis, helps normalize the growth of skin cells. One of the side effects is raised fat (lipid) levels in the blood, and people taking this drug must get regular blood tests to monitor their cholesterol and triglyceride levels.
Methotrexate and cyclosporine slow the growth of skin cells. Methotrexate, taken orally or by injection, is also a chemotherapy drug for cancer patients. Cyclosporine, taken orally, was first approved to prevent organ rejection in transplant recipients. People using either of these drugs must be closely monitored and should use them only for short periods of time because of serious, potentially fatal, side effects.
Biologics are the newest systemic psoriasis treatments. Since 2003, the FDA has licensed three biologics to treat moderate-to-severe plaque psoriasis: Amevive (alefacept), manufactured by Biogen Inc.; Raptiva (efalizumab), made by Genentech Inc.; and Enbrel (etanercept), marketed by Amgen Inc. and Wyeth Pharmaceuticals. Enbrel was first licensed in 2002 to treat the arthritis associated with psoriasis, and in 2004 to treat psoriasis itself.
"All are immunosuppressive and have different proposed mechanisms," says Papadopoulos. Amevive simultaneously reduces the number of immune cells, including T cells, and inhibits T-cell activation. Raptiva inhibits the activation of T cells and the migration of those cells across blood vessels and into tissues, including the skin.
Enbrel inhibits the action of an inflammatory chemical messenger in the immune system called tumor necrosis factor-alpha (TNF-alpha), which is believed to play a role in both the skin and the joint symptoms of psoriasis.
All three biologics are injected. The FDA has licensed Amevive to be given in a physician's office, either injected into the muscle or into a vein (intravenously). It's a once-a-week treatment for 12 weeks; further treatments may be given after a waiting period.
The FDA has licensed Raptiva and Enbrel for home treatment. People can inject themselves with Raptiva under the skin once a week or with Enbrel once or twice a week. Both drugs are recommended for continuous use to maintain results.
Since biologic drugs are immunosuppressants, they may carry an increased risk of infection and cancer. Rare but serious effects have also included blood abnormalities and autoimmune diseases such as lupus. Other side effects are flu-like symptoms and pain and inflammation at the injection site.
Some dermatologists prescribe biologics alone for psoriasis or in combination with topical treatments. Leonardi says when he prescribes biologics, "I don't have to resort to adding other systemic therapies such as methotrexate, cyclosporine, acitretin, or phototherapy."
"Biologics are an alternative treatment to some of the traditional therapies," says Papadopoulos.
"Now we need to get the expense down," says Leonardi, who has patients who pay $30,000 per year on drugs to treat psoriasis.
Bird feels fortunate that her insurance company covers most of the expense of Enbrel, which is prescribed for both her psoriasis and psoriatic arthritis. Because of the arthritis pain, she has used a cane to help her walk and has had surgery on her wrist to correct some of the arthritis damage. Although Enbrel has been less effective over time for the psoriasis, she says, it's reduced her arthritic pain by about 95 percent. "I can jog down to the corner to chase after the dog," she says. "And last summer, I went hiking with my children in Colorado."
Reducing Treatment Risks
Biologics, other systemic drugs, and phototherapy are powerful treatments with increased risks, says Lindstrom.
Biologics may raise the risk for developing cancer and serious bacterial or fungal infections that spread throughout the body (sepsis).
Cyclosporine can damage the kidneys, methotrexate puts the liver and lungs at risk, and phototherapy can cause skin cancer. To reduce these risks, doctors often put patients on "rotational therapy." "The thought is by moving from one therapy to another therapy over time, the risk to any individual organ is reduced," says Lindstrom.
"We also try to choose a drug with an appropriate benefit-risk ratio," she says. For mild psoriasis, a topical steroid may be appropriate. For more severe disease, where it becomes impractical to apply topicals over a large surface area several times a day, a patient may need a systemic treatment.
Most of the highly effective treatments for psoriasis affect the immune system in some way. For steroid drugs, which have been around for more than 50 years, the risks are well known. But less is known about the long-term side effects of newer drugs, such as the biologics. The safety and side effects of biologics and other immune-suppressing drugs to treat psoriasis continue to be monitored by drug manufacturers and the FDA.
For many people, dealing with the emotional impact of psoriasis can be as challenging as treating the disease.
Bird says that mothers have pulled their children away from her on the subway, and some people, horrified by her skin lesions, have asked her if she has AIDS. As her disease has evolved over 30 years, so has Bird's way of dealing with these reactions. In her teens, she'd tell people she had leprosy just for the shock value, she says. Today, Bird is open about the disease but still relies on her defiant attitude to "steel myself for the experience" of going to the beach. "I love to swim," she says. But Bird knows that without covering herself up in a public place, she "runs the risk of people just rubbernecking."
"When I'm feeling forgiving, I try to ignore them," she says, "but when I'm angry, I think 'didn't your mother teach you not to stare?'"
Bird advises others with psoriasis to find out what works best for them to cope with the emotional effects of the disease. Going to therapy has helped her, she says. So has leading a support group for psoriasis sufferers. "It's important for people to work on their emotional well-being," says Bird, "however they choose--whether it's meditation, yoga, or putting on long pants and going out dancing."
Researchers continue to look for reasons why immune cells overreact and what genes may be responsible for psoriasis, hoping to find better treatments, and eventually a cure. Psoriasis research is aided by the visibility of the symptoms on the skin.
"You can see the disease," says Leonardi. "You don't have to do invasive testing to see the effects of therapy." Psoriasis research has a "tremendous spillover into other fields besides dermatology," he adds. "There is a huge need for drugs to suppress the immune system without the side effects."
Multiple sclerosis, Crohn's disease, rheumatoid arthritis, and type 1 diabetes are just a few of the diseases that may also benefit from psoriasis research.

The Guttate Psoriasis Picture

Guttate psoriasis is characterized by small red dots (or drops) of psoriasis. Guttate is derived from the Latin word gutta meaning "drop." It often appears on the trunk, arms and legs. The lesions may have some scale. Guttate psoriasis frequently appears suddenly following a streptococcal infection or viral upper respiratory infections. There are also other events that can precipitate an attack of guttate psoriasis: tonsillitis, a cold, chicken pox, immunizations, physical trauma, psychological stress, illness, and the administration of anti-malarial drugs. Guttate psoriasis is many small patches of psoriasis, all over the body, and often happens after a throat infection. Guttate Psoriasis most often affects children and young adults. It appears as small, red bumps-the size of drops of water-on the skin. It usually appears suddenly, often several weeks after an infection such as strep throat.

Biotech Sells Psoriasis Treatment Amevive To Japanese Drug Maker

Biotech company Biogen Idec Inc. said Monday it agreed to sell the worldwide rights of Amevive, a psoriasis treatment, to the U.S. arm of Japanese drug maker Astellas Pharma Inc., for $60 million.
A Biogen spokesman said the deal also includes undisclosed royalty payments.
Biogen said it will continue to manufacture Amevive, a biologic anti-inflammatory compound, and supply it to Astellas. Biogen added it expects the transaction to close as early as mid-April.

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