Symptoms of psoriasis (psoriasis treatment,)

Psoriasis Treatment

Although psoriasis may be almost unnoticeable in its early stages, patients often report an itching and/or burning sensation as the disease progresses.

This photo on the left shows itching (skin after itching) and bleeding spots thereafter, on psoriasis lesions. In this photo, the patient has scratched it profoundly to an extent that there are bleeding spots. (Click photo to enlarge.)

There are many variants and types of psoriasis. But usually the course follows like this: It starts with red small bumps on the skin that progress to bigger scaly patches. The condition is associated with lot of itching. As the scales accumulate, pink to deep red plaques with a white crust of silvery scales appear on the skin surface.

Although psoriasis may affect any area of the body, it is most commonly found on the scalp, elbows, knees, hands, feet, and genitals.

Types of psoriasis:

Psoriasis has many variants. The common ones are as follows:

• Plaque Psoriasis: Plaque psoriasis is the most common type of the disease and is characterized by raised, thickened patches of red skin covered with silvery-white scales. Its scientific name is psoriasis vulgaris.

• Pustular psoriasis is characterized by pus-like blisters. Attacks of pustular psoriasis may be triggered by medications, infections, emotional stress, or exposure to certain chemicals. Pustular psoriasis may affect either small or large areas of the body.

• Erythrodermic psoriasis characterized by intense redness and swelling of a large part of the skin surface, is often accompanied by itching or pain. Erythrodermic psoriasis may be precipitated by severe sunburn, use of oral steroids (such as cortisone), or a drug-related rash.

• Guttate psoriasis is characterized by small, drop-like lesions on the trunk, limbs, and scalp. Guttate psoriasis is most often triggered by bacterial infections (for example, Streptococcus).

• Inverse psoriasis is characterized by smooth red lesions in the folds of the skin like in the folds of the skin near the genitals, under the breasts, or in the armpits. Inverse psoriasis is related to increased sensitivity to friction and sweating and may be painful or itchy.

The Psoriatic Nail
About 50 percent of persons with active psoriasis have psoriatic changes in fingernails and/or toenails. In some instances psoriasis may occur only in the nails and nowhere else on the body. Nail changes in psoriasis fall into general categories that may occur singly or all together:

• The nail plate is deeply pitted or depressed
• The nail has a yellow to yellow-pink discoloration
• White areas appear under the nail plate. There may be reddened skin around the nail.
• The nail plate crumbles in yellowish patches (onychodystrophy)
• The nail may be entirely lost

Nail psoriasis is frequently associated with psoriatic arthritis
For the most part people with psoriasis can function normally. Sometimes people experience low self-esteem because psoriasis appears unsightly. Psoriasis is often misunderstood by the public, and this can make social interactions awkward. This may lead to emotional problems such as anxiety, anger, embarrassment, and depression.

By Dr Rajesh Shah

Psoriasis Treatment

There’s no cure for psoriasis, but there are treatments (psoriasis treatment)

Psoriasis Treatment

Psoriasis is a recurring, noncontagious skin disease that is characterized by raised, thickened patches of red skin covered with silvery-white scales.

It is estimated that 4.5 million adults in the U.S. have psoriasis.

Psoriasis derived its name from the Greek word meaning, “itch.” It results from an overproduction of skin cells leading to thickening of the skin and scaling. Any part of the body may be affected, but certain areas such as elbows, knees, fingernails, heels, face or scalp are common sites for psoriasis. More severe forms of the disease may affect large areas of the body such as the chest, back and legs.

Research suggests that psoriasis may be hereditary or that it may be the result of a gene mutation. The immune system is mistakenly “triggered,” causing new skin cells to form at a very fast rate. Skin cells move up to the skin surface every three to four days instead of the usual 28 to 30 days. The result is that skin cells build up, causing raised, red patches, which are cosmetically annoying and often very itchy. People often experience their first attack or subsequent flare-up if their skin is injured, such as being cut, scratched or severely sun-burned.

Psoriasis can worsen with stress, some medications, winter weather and infections.

Psoriasis therapy is customized to meet individual patient needs. Your age, how long you have had psoriasis, the extent of the disease and your response to past treatment will influence the course of therapy I recommend at any given time. Various treatments and combinations of treatments may be necessary before the psoriasis is under control. Prescription medications containing cortisone, salicylic acid, tar, anthralin or retinoids may be recommended alone or in combination with special ultraviolet light. These medications require careful adjustment according to patient response and lab-test results, often needed to monitor the safety of some treatments.

Photochemotherapy involves taking a medication known as “psoralen” by mouth followed by exposure to a special kind of ultraviolet light known as “UVA” or “long-wave” ultraviolet light in a series of treatments. The term, PUVA, is an acronym for Psoralen drug combined with Ultra-Violet A light therapy.

Among the newest agents for psoriasis that has not responded to other treatments are the “biologics,” medicines that act against naturally occurring cells or chemical messengers thought to promote psoriasis. They have substantial advantages over previously used systemic therapies in that they do not cause kidney or liver damage and have fewer risks and side effects than traditional therapies. Examples include alefacept (Amevive), etanercept (Enbrel), infliximab (Remicade) and efalizumab (Rap-tiva).

Biologic treatments tend to be expensive and require injections, but they appear to have a high degree of safety.

For most patients, psoriasis is a long-term condition. Although there is no cure, there are many effective treatments. Now, thanks to a surge in new treatment options developed over the last few years, patients have more hope than ever in finding a treatment that works for them.

Dr. John J. Jones Jr. is a board-certified dermatologist specializing in diseases of the skin, allergies and skin-cancer surgery, with offices in Thibodaux and Raceland. He also serves as associate professor of dermatologic surgery at Louisiana State University Medical Center in New Orleans.

By Dr. John Jones, Health columnist

Psoriasis Treatment

Indigo extract effective treatment for psoriasis (psoriasis treatment )

Psoriasis Treatment

Taiwanese investigators report that an ointment made from an extract of Indigo naturalis is effective in treatment-resistant plaque psoriasis -- and the treatment appears to be safe.

Indigo naturalis is a plant that is the source of a dark blue dye. The extract has been used for centuries in traditional Chinese medicine for the psoriasis treatment, the researchers explain in the Archives of Dermatology.

Forty-two patients with recalcitrant plaque psoriasis applied indigo naturalis ointment or vehicle (sham ointment) topically to two symmetrical psoriatic plaque lesions on each side of the body for 12 weeks.

Dr. Yin-Ku Lin of Chang Gung Memorial Hospital in Taoyuan, Taiwan, and colleagues report "significant reductions" in scores of scaling, rash, and induration with indigo naturalis ointment.

The mean sum of these scores was 6.3 with indigo naturalis ointment and 12.8 with the vehicle, and the percentage of the plaque area remaining was 38.5 percent after indigo naturalis treatment compared with 90 percent with the vehicle ointment. Thirty-one of 42 patients (74 percent) experienced clearance or near-clearance of psoriasis lesions with indigo naturalis ointment.

Lin's group reports that "severity was not a significant factor in predicting psoriasis treatment success."

They also point out that "the color and smell of indigo naturalis may affect compliance of the patients and the longer-term durability of the benefit simultaneously. The indigo naturalis ointment slightly stains the skin and clothing, which can be cleaned thoroughly by common detergents. Repeated application has no significant effect on skin color and will not change the skin appearance."

On the plus side, "Indigo naturalis ointment treatment has neither adverse effects, such as those found with corticosteroid treatment, nor other toxic effects based on our past 5 years of clinical observation. Furthermore, it costs much less in comparison with other topical agents," Lin and colleagues write. "We anticipate that indigo naturalis ointment can be an alternative or complementary therapy for psoriasis and believe it will be a great benefit to this large patient population."

SOURCE: Archives of Dermatology, November 2008.

Psoriasis Treatment

New Biologic Ustekinumab Receives Positive Opinion From European Regulatory Authority for the Treatment Psoriasis (Treatment Psoriasis)

Treatment Psoriasis

BEERSE, Belgium, November 21 /PRNewswire/ -- Janssen-Cilag announced today that ustekinumab, the first in a new class of biologics, has received a positive opinion for the treatment of moderate to severe plaque psoriasis from the European Committee for Medical Products for Human Use (CHMP). This positive opinion takes patients living with the physical and mental burdens of psoriasis a step closer towards a convenient new therapeutic option. The CHMP's positive opinion is now referred for final action to the European Commission.The CHMP recommended approval of ustekinumab is for adults who have failed to respond to, have a contraindication to, or are intolerant to other systemic therapies including ciclosporin, methotrexate and PUVA (a light sensitising medication, combined with exposure to ultraviolet light A).

This positive opinion is based on data from two large pivotal Phase 3 (PHOENIX 1 & 2), multi-centre, randomised, double blind, placebo controlled trials involving nearly 2,000 patients in whom the efficacy and tolerability of ustekinumab in the treatment of moderate to severe plaque psoriasis was evaluated.(1,2) More than two-thirds of patients achieved the primary endpoint of each pivotal study, at least 75% reduction in psoriasis using the Psoriasis and Severity Index (PASI 75) at week 12, after just two doses at weeks 0 and 4. Significant maintenance of PASI 75 response through at least one year in patients receiving maintenance therapy every 12 weeks was also demonstrated using a randomised withdrawal design in the first pivotal study (PHOENIX 1). Rates of serious adverse events, including serious infections, malignancies and cardiovascular events, were low and consistent with the expected background rates. The most common adverse events in Phase 3 clinical trials were arthralgia, cough, headache, injection site erythema, nasopharyngitis and upper respiratory tract infection.

About Psoriasis

Psoriasis is a chronic, immune-mediated inflammatory disease, which results from the over-production of skin cells resulting in their accumulation on the surface of the skin, which causes red, scaly plaques that may itch and bleed. It is estimated that three percent of the world's population has psoriasis.(3) Twenty to thirty percent of people with psoriasis have cases that are considered severe.(4)

About Ustekinumab

Ustekinumab is a new, human monoclonal antibody with a novel mechanism of action that targets the p40 sub-unit of cytokines interleukin-12 (IL-12) and interleukin-23 (IL-23), naturally occurring proteins that are important in regulating immune responses and that are thought to be associated with some immune-mediated inflammatory disorders, including plaque psoriasis. Ustekinumab is under regulatory review in the United States.

Centocor, Inc. developed ustekinumab and has exclusive marketing rights to the product in the United States. Janssen-Cilag companies have exclusive marketing rights in all countries outside of the United States.

References

(1) Leonardi CL, Kimball AB, Papp KA, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). The Lancet. 2008;371:1665-74

(2) Papp K, Langley RG, Lebwohl M, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). The Lancet. 2008;371:1675-84.

(3) International Federation of Psoriasis Associations. Profile of Psoriasis. Available at: http://www.ifpa-pso.org/t2.aspx?p=107478 Accessed on 10 November 2008

(4) Smith CH, Anstey AV, Barker JN, et al. British Association of Dermatologists guidelines for use of biological interventions in psoriasis 2005. Br J Dermatol. 2005;153(3

Treatment Psoriasis

Raptiva Gets Stronger Warning for Psoriasis Treatment (Psoriasis Treatment)

Psoriasis Treatment

The US Food and Drug Administration (FDA) has announced labeling changes that affect the popular psoriasis drug, efalizumab, marketed under the brand name, Raptiva. The updated label warning is the result of the increased risk of developing life-threatening infections when using this medication.

Only patients 18 and older who have moderate to severe plaque are approved to receive the drug, administered as a once-a-week injection that provides systemic, or whole body, psoriasispsoriasis treatment to control the painful and disfiguring skin disorder. In addition to a stronger warning labels, Genentech, Inc., San Francisco, makers of Raptiva, must submit a Risk Evaluation and Mitigation Strategy (REMS) to the FDA. The REMS must include a patient-directed Medication Guide and projected timetable for REMS assessment.

The FDA Office of Surveillance and Epidemiology received numerous reports describing serious infection in patients taking Raptiva, some of whom were hospitalized as a result of infection. In some cases, patients died.

The new label will carry research findings of studies involving juvenile mice, scientifically the age equivalent of a human between one and 14 years of age. These findings suggest the risk of permanent immune system

suppression when Raptiva is given repeatedly to this age group, evidence that further strengthens the FDA’s approval of this drug only for individuals 18 years of age or older.

As Raptiva suppresses the immune system to suppress psoriasis outbreaks, it also suppresses the entire body’s immune system. By weakening a patient’s natural defense mechanisms in systemic fashion, the risk of developing serious infection and malignancy is increased.

It is by jeopardizing the entire immune system that Raptiva leaves a patient more susceptible to bacterial sepsis, invasive fungal disease, progressive multifocal leukoencephalopathy (PML), viral meningitis, and similar opportunistic infections.

No patient should begin Raptiva therapy before getting all age-appropriate vaccinations and no further vaccinations should be administered during Raptiva therapy. Because the drug suppresses the immune system, the full strength of a vaccination may not be achieved.

Raptiva warning labels also describe the risk of certain potential adverse side effects and directions to both patient and physician should adverse reactions develop.

Source: FDA

Psoriasis Treatment