Ultraviolet Therapy For Psoriasis

Most people with psoriasis know that spending time in the sun can help clear up their skin. That's because the sun is the most common source of ultraviolet light. Ultraviolet A light primarily causes the skin to tan, while ultraviolet B light causes tanning and sunburns. Lamps that produce both types of light are sometimes used to treat moderate or severe cases of psoriasis.

Psoralen Plus Ultraviolet A
On its own, ultraviolet A does not have a significant effect on psoriasis. The medication psoralen makes the skin respond to ultraviolet A. Psoralen plus ultraviolet A (PUVA), also called photochemotherapy, involves a combination of the medication psoralen and ultraviolet A rays.
Therefore, the first step in a PUVA treatment is to either ingest psoralen pills two hours before the treatment or apply it by painting it on or soaking in a tub of water that contains psoralen about 15 minutes before the light treatment.
Light treatments last between 30 seconds and several minutes. Most people require treatments two or three times a week for a total of 20 or 30 treatments to clear the skin. After that, many people require maintenance treatments. For some people, one treatment a month is enough; others may need more frequent maintenance.
PUVA appears to be effective in 85 to 90 percent of patients. The treatment is especially helpful for people with stable plaque psoriasis, guttate psoriasis, which causes droplet-shaped lesions instead of larger patches of psoriasis, and psoriasis on the hands and feet.
The side effects of PUVA include nausea (from the oral medication), itching and skin redness. Long-term use of PUVA increases the risk of skin cancer. The treatment also can cause freckling, skin aging and cataracts. The increased risk of cataracts can be avoided if patients wear eye protection for 12 to 25 hours after ingesting psoralen.

Ultraviolet B
Ultraviolet B therapy involves coating the skin with an emollient such as mineral oil or petroleum jelly, and then exposing the skin to UVB light for brief periods, sometimes just a few seconds. Occasionally, medicated lotions, like anthralin-salicylic acid paste or pills, like retinoids, are used in combination with UVB therapy.
There are two types of UVB therapy: broadband and narrowband. Broadband therapy, which has been available for more than 80 years, involves a wide spectrum of UVB wavelengths. Patients require three to five treatments a week. Narrowband therapy is newer and involves a narrow band of UVB wavelengths. It is more effective than broadband treatment, requiring two to three treatments a week.
The skin usually clears up after about 15 to 25 treatments. Maintenance treatments, perhaps two a week, begin as soon as lesions reappear.
Although UVB treatment is less effective than PUVA, it has fewer side effects and is less likely to cause skin cancer.

Questions to ask your doctor:
1. How many treatments will I need?
2. Are there any lotions or medications I should avoid before treatments?
3. Will I need special screening for skin cancer after treatment?

Advitech Tries to Bring Psoriasis Product to Market

Advitech is embroiled in discussions with potential partners to bring its XP-828L product to market, targeting sufferers of mild to moderate psoriasis and other inflammatory diseases.The Canadian biotech has spent the past year conducting clinical trials to support the safety and efficacy of its sweet whey-derived ingredient, to give it more weight with both dermatologists and natural product suppliers.
It now says it has signed confidentiality agreements and met with companies from the United States, Europe and Asia, and has been contacted by a number of companies interested in distributing the product.
Advitech's immediate aim is to sign an agreement in principle with its first marketing partner before 2005 is out.
At the beginning of this month, Advitech announced positive results of a preclinical study into XP-828P for inflammatory bowel diseases like Crohn's disease and autoimmune colitis, conducted in collaboration with Patrice Poubelle at the Centre de Recherche du Centre Hospitalier de l'Université Laval. The in vivo studies using two animal models indicated statistically-significant improvements of several clinical parameters, and showed a dose-dependent effect, said the company.
“These results confirm the potential of our XP-828L platform in the development of additional applications for chronic inflammatory diseases,”said president and CEO Renaud Beauchesne.
“Our strategy at this time consists in identifying the best possible partner for continuing the development of this application, and for bringing it to market. Discussions are already under way to develop a partnership for this application.”
However the company's net loss continued to deepen in 3Q 2005, to C$528,100 compared to C$446,100 for the same period of last year. Operating expenses increased two percent to C$617,300, while total revenues plummeted from C$160,200 to C$89,200.
Advitech said it is “currently reviewing options to ensure continuous funding of its activities”. One thing is apparent, however: the bioactive ingredient Lactium, for which Advitech sells to the US market under a 1999 agreement with Ingredia, is not performing as a cash cow.
Although the company indicated earlier this year that it plans to continue with this venture, the failure of resale activities to meet expectations and no new distribution agreements for the US market is causing it to reconsider.
“The company will be reassessing the status of such activities in the future and may decide not to renew its distribution agreement for this product,” it said.

A Film About Psoriasis

"People judge us on the basis of our skin — our whole culture is based on cosmetics, lotions, creams and all that," said Finkelstein, of Oakland, Calif. "With (psoriasis), there's a whole layer of psychosocial problems, feelings of embarrassment, of shame, of ultimately feeling isolated."
But these days, Finkelstein, a filmmaker, has cast off the shy persona and is sharing his story with a new documentary, "My Skin's on Fire: Living With Psoriasis." DVDs of the film can be ordered for free at www.beyondpsoriasis.com.
He said now is an ideal time to shed light on the skin disease that affects more than 5 million people because, thanks to new medications, it's no longer a disease that needs to remain hopelessly hidden.
Rather than treating the disease topically, a new class of drugs known as "biologics" and "immuno-supressants" target the internal cause — an immune system on overdrive, which leads to the visible pile-up of inflamed skin cells. Inflammation normally protects the body, but too much of it is harmful.
"Here, really in the last 2 to 3 years, they've changed the disease of psoriasis. For many years it was considered an inflammatory skin disease. Now it's known as an 'immune-mediated disease,'" he says. "They've been able to pinpoint some of the mechanisms that misfire in the immune system."
But as Finkelstein's film shows, living with psoriasis is often far more than just a bothersome condition. Its obvious symptoms — flaky, red skin — can be a tremendous mental burden as well.
In the film, Finkelstein follows the typical trajectory of dealing with psoriasis. First, small patches of flaky skin crop up, usually when a person is a young adult. Then comes the diagnosis of psoriasis. The person may feel confused, wondering where they got such a disease, but a bit of questioning often reveals that it runs in the family — a trait kept hidden from most family members. Then, the person goes through a long trial of different treatments, many of which don't work.
Thankfully, that last step has been shortened by the advent of biologic drugs, said Dr. Alan Menter, a clinical professor of dermatology at the University of Texas Southwestern Medical School in Dallas and founder of the International Psoriasis Council.
Menter, who was interviewed for Finkelstein's film, said it accurately portrays the emotional burden of the disease.
For example, when patients first come to him for medical help, they often are overweight and depressed, Menter said. Most newly-diagnosed patients are young adults.
"For example, you take a 25-year-old, standing in the mirror seeing these crusted patches all over his or her body. They're trying to go out and get a date and it's crushing. They can hide it with clothing but that can't hide it from themselves or when they relationship starts becoming intimate," he said.
But Menter and Finkelstein are both optimistic that this will be less of a problem in the coming years, as more people are treated with medicines that truly help quell the disease.
"Right now I think there are something like 40 new drugs," Finkelstein said. "The future looks very bright for all of us who have suffered for so many years. I think it's a very good time to be talking about psoriasis."

EAR PSORIASIS

Psoriasis is commonly found in the ears too. In this case it can appear as dry scales in the ear canal. It also occurs behind the ear so this area has to be checked to look for the plaques if the diagnosis of psoriasis is considered. The image shows some dryness of the skin in the ear, with some scaling, which is characteristic of psoriasis.

Junior Psoriatic Arthritis

Juvenile psoriatic arthritis can be tricky to diagnose. While psoriasis is a common skin condition, associated primarily with a chronic rash all over the, only about 12 to 14 percent of people with psoriasis will develop related arthritis.CausesGenetic and environmental factors play a strong role in the development of psoriatic arthritis. A family history of psoriasis is linked to many children with juvenile psoriatic arthritis, as well as a family history of other forms of spondyloarthropathy. There is little relationship between the severity of a rash and the risk of getting juvenile psoriatic arthritis, however.NOTE: In some people with juvenile psoriatic arthritis, the arthritis shows up before the rash. In these cases, diagnosis can be so difficult that it may take up to 10 years to be certain of a definite diagnosis.Signs and Symptoms
Pitting or thickening and yellowing of the fingernails and toenails
A small round scaly patch on the scalp, belly button or buttocks
Joint problems in large joints, such as the hip and sacroiliac joints
Joint problems can occur on just one side or in the same joints on both sides of the body
Swelling of entire fingers or toes, making them resemble sausages (dactylitis)
Eye inflammation occurs in 10 to 20 percent of children
NOTE: Children with juvenile psoriatic arthritis should be examined by an eye specialist (ophthalmologist) annually to check for eye problems.Long-term Concerns
Damage to the eyes or other eye problems
Decreased range of motion of a joint
Shortening or lengthening of a limb or digit
Damaged cartilage and/or enlargement of a joint
NOTE: Many children have no long-term consequences of having juvenile psoriatic arthritis. Your child may have none, one or several of the concerns listed above, but you should be on the lookout for any or all of them

Statistics on Psoriasis

The numbers tell the story about psoriasis and psoriatic arthritis.

About 2.1 percent of the U.S. population has psoriasis

More than 4.5 million adults in the United States have been diagnosed with psoriasis

Often appears between the ages of 15 and 35, but can develop at any age.Some infants have psoriasis, although this is considered rare

Three percent to 10 percent of the body affected by psoriasis is considered to be a moderate case. More than 10 percent is considered severe. The palm of the hand equals 1 percent of the skin. However, the severity of psoriasis is also measured by how psoriasis affects a person's quality of life. Psoriasis can have a serious impact even if it involves a small area, such as the palms of the hands or soles of the feet.

About 30 percent of people with psoriasis have cases that are considered moderate to severe (generally meaning it covers more than 3 percent of their body)

More than 1.5 million Americans have moderate to severe psoriasis

Severe types of psoriasis can compromise the skin's ability to control body temperature and prevent infections

Psoriasis' impact on the quality of life
75 percent of people with moderate to severe psoriasis report that their disease has a moderate to large impact on their everyday lives:
26 percent alter their normal daily activities
21 percent stop their normal daily activities
40 percent say their psoriasis affects their clothing choices (avoiding dark colors, covering up arms and legs)
36 percent say it affects how they sleep
36 percent report bathing more than normal(based on results of National Psoriasis Foundation 2001 Benchmark Survey on Psoriasis and Psoriatic Arthritis)

Psoriasis may disqualify a person from serving in the U.S. military

About 1 million people in the U.S. population have psoriatic arthritis; that equals about 0.5 percent of the country

Between 10 percent and 30 percent of people with psoriasis develop psoriatic arthritis
Psoriatic arthritis usually develops between the ages of 30 and 50, but it can develop at any time

Generally psoriasis appears before the psoriatic arthritis, but it can develop without the characteristic skin lesions

There are five types of psoriatic arthritis

Psoriasis patients make nearly 2.4 million visits to dermatologists each year
Overall costs of treating psoriasis may exceed $3 billion annually
150,000 to 260,000 cases of psoriasis are diagnosed each year

If one parent has psoriasis, children have a 10 percent to 25 percent chance of developing psoriasis
If both parents have psoriasis, children have a 50 percent chance

Psoriasis affects an estimated 1 percent to 3 percent of the world's population

ARTHRITIS DRUG FOUND HELPFUL FOR PSORIASIS

A drug for rheumatoid arthritis can relieve the suffering of patients with moderate to severe psoriasis for a year, researchers said on Friday.
They found that infliximab, which is marketed under the name Remicade by Johnson & Johnson in the United States and by Schering-Plough Corp in other markets, improved symptoms of the chronic skin condition that affects 2 percent of the population in western countries.
"This is the first study to show that the very rapid and dramatic improvement that you see with psoriasis can, in the majority of patients, be maintained over at least the medium term -- over the course of a year," said Professor Christopher Griffiths, of the University of Manchester in England.
Previous trials have only looked into the impact of the drug on psoriasis over a short period of about 12 weeks.
The study published in The Lancet medical journal also showed patients saw a significant improvement in one of the most disturbing features of psoriasis: nail disease.
"Up until now it has been extremely difficult to treat," Griffiths told Reuters.
He and his colleagues compared the effects of the intravenous treatment to a placebo, or dummy drug, on 378 patients with the illness.
Each patient was given three intravenous infusions of the drug or a placebo over six weeks and then every 8 weeks for nearly a year. After less than 3 months on the treatment, 80 percent of the patients showed at least a 75 percent improvement, compared to 3 percent in the placebo group.
By the end of the trial, the drug completely cleared the skin condition in a quarter of patients but no one in the placebo group had the same result.
"Some of the patients were improved to the extent that they had no psoriasis and there was no impairment of their quality of life. So this is the best result you could possibly aim for with a treatment for psoriasis," said Griffiths.
"Compared with the other available treatments, it does work extremely effectively and extremely quickly."
The scientists said none of the patients given the drug had any serious side effects. But they stressed that the treatment is not a cure. It is likely patients would have to be on a long-term maintenance programme.
Psoriasis, an immune mediated disease, can develop at any age but it occurs most commonly before the age of 40. Psoriasis patches can also show up on the fingernails and toenails. About 15 percent of patients also suffer from arthritis linked to the condition.
European regulators recently approved infliximab for the treatment of psoriasis but the drug has not yet been approved for the skin condition in the United States.
The drug is also used as a treatment for Crohn's disease, an inflammatory bowel condition.

Psoriasis Triggers

Psoriasis triggersPsoriasis is not contagious—no one can "catch" it from another person. Because of their genes, certain people are more likely to develop it, but a "trigger" is usually necessary to make psoriasis appear. These triggers may include emotional stress, injury to the skin, some types of infection and reaction to certain drugs.
StressStress is a proven trigger in some people. It can cause psoriasis to flare for the first time or aggravate existing psoriasis.
Relaxation and stress reduction may help people with psoriasis. For example, not only does relaxation help lower stress levels, but also it gives people a feeling of control. These techniques, however, seem to work best with traditional medical treatments, instead of using the techniques alone.
How can people cope with stress?
Cope with the stigma: A stigma—a characteristic that other people think of as negative—can erode a person's self-esteem. Low self-esteem can lead to stress, and possibly a worsening of psoriasis. One way to overcome the stigma, however, is to understand how and why it occurs.
Hypnosis: This relaxation technique may help people who are using other treatments. For example, one study found that people who listen to meditation-based relaxation tapes while they are using light therapy may clear faster than those who don't listen to the tapes.
Injury to skinSometimes psoriasis appears in areas of the skin that have been injured or traumatized. This is called the "Koebner phenomenon." Vaccinations, sunburns and scratches can all trigger a Koebner (KEB-ner) response. The Koebner response can be treated if it is caught early enough. For example, people receiving a vaccination may be at risk for the Koebner response, but the physician can bring it under control if the psoriasis occurs at the injection site.
MedicineCertain medications are associated with triggering psoriasis.
Lithium: Used to treat manic depression and other psychiatric disorders. Lithium aggravates psoriasis in about half of those with psoriasis who take it. However, people can ask their physicians about alternatives to lithium.
Antimalarials: Quinacrine, chloroquine and hydroxychloroquine may cause a flare of psoriasis, usually two to three weeks after the drug is taken. Hydroxychloroquine has the lowest incidence of side effects.
Inderal: This high blood pressure medication worsens psoriasis in about 25 percent to 30 percent of patients with psoriasis who take it. It is not known if all high blood pressure (beta blocker) medications worsen psoriasis, but they may have that potential. Sometimes other medications can be substituted.
Quinidine: This heart medication has been reported to worsen some cases of psoriasis.
Indomethacin: This drug is used to treat arthritis. It is a nonsteroidal anti-inflammatory drug. It has worsened some cases of psoriasis. Other anti-inflammatories usually can be substituted. Indomethacin's negative effects are usually minimal when it is taken properly. Its side effects are usually outweighed by its benefits in psoriatic arthritis.
What are some other triggers?Allergies: Although unproven, some people suspect that allergies trigger their psoriasis.
Diet: Although unproven, changing the diet has helped some people improve their psoriasis or avoid flares.
Strep infection: May trigger guttate psoriasis.
Weather: May make skin drier and more susceptible to a psoriasis outbreak.

Psoriasis: The 2000 Year Old Itch

The first mention of the disease we now know as psoriasis was by the Greek physician Hippocrates, who lived between 460 and 377 BC. Psoriasis appeared again in the first century AD in the writings of a Roman author named Cornelius Celsus. He described it as a variation of impetigo. In the late 1700s, the English dermatologist Robert Willan recognized psoriasis as its own condition. But it wasn't until 1841 that the condition was given the name "psoriasis" by Viennese dermatologist Ferdinand Hebra; he was also the first to describe the picture of psoriasis we have today. The word was derived from the Greek word "psora" meaning "to itch."

The Origin of the Term Psoriasis

Psoriasis was first given that name in complete differentiation from other skin conditions by the Austrian dermatologist Ferdinand von Hebra in 1841, although there are what are believed to be descriptions of the disease in sources going back to ancient Roman and possibly even biblical times.

Psoriasis Home Care

Skin care at home can help control psoriasis. Skin care and treatment may include using creams or lotions, pills, baths or soaks, and ultraviolet (UV) light. Skin care for psoriasis includes the following:
Take care of your skin and keep it moist and lubricated.
Gently soften and remove psoriasis crusts by putting cream on the crusts and then peeling the loose crusts off. Removing crusts may help creams and lotions to be absorbed in the skin. However, this should be done very carefully so that the skin is not irritated.
Follow instructions for skin products and prescribed medications. It may take a period of trial and error until you know which skin products or procedures work best for you. For mild symptoms of psoriasis, various nonprescription medications, such as aloe vera, may be soothing.
Follow your schedule for sunlight or ultraviolet light treatments.
Seek information or counseling from your doctor. Psoriasis day care centers may be available in limited locations. To find a center near you, ask your doctor or contact the National Psoriasis Foundation at www.psoriasis.org.
For more information on caring for your skin, see:
Skin care for psoriasis.
Other helpful suggestions to control psoriasis include:
Protecting your skin. Treat all infections promptly, and try to avoid skin injuries and irritation.
Taking care of your scalp. When you have psoriasis on your scalp, treat your scalp, not your hair.
Trimming your nails. Keeping your nails trimmed may prevent the spread or flare-ups of psoriasis.
Being careful in the sun. Although short periods of sun exposure reduce psoriasis in most people, too much sun exposure can damage the skin and cause skin cancer. In addition, sunburns can trigger flares of psoriasis.
Being aware of possible medication reactions. Certain medications can trigger psoriasis or make symptoms worse.
Studies have not found any "psoriasis diet" that can cure or improve the condition, despite claims over the years. Try to eat a balanced, low-fat diet and maintain a healthy weight.