Psoriasis Treat Reduces Side Effects

A new treatment that directly targets parts of the immune system responsible for the skin condition psoriasis will be available on the Pharmaceutical Benefits Scheme (PBS) from next week.
About 17,000 Australians have chronic plague psoriasis and as well as suffering unsightly skin, many experience anxiety and depression.
The new class of drugs, known as biological agents, produce fewer side effects because they have a more targeted effect.
Dr Stephen Shumack, from the College of Dermatologists, says the treatment will bring relief to thousands of sufferers.
"They change the way the immune system works or they alter or reduce some aspect of the immune function," he said.
"It's done in a much more targeted way than some of the agents we currently use such as steroids which have a blanket suppression of the immune system."
Dr Shumack says those with the disease can suffer psychologically.
"There's a lot of social isolation amongst sufferers of severe psoriasis," he said.
"They have trouble getting jobs they have trouble keeping jobs, they have a lot of time off work, they don't interact socially, they don't go out, they usually have trouble meeting partners."

Psoriasis Gene Identified

A common genetic variation in an immune system gene may help explain why some people are more likely to develop psoriasis than others.
Researchers say it's the first gene to be linked to the skin disease, and the discovery could lead to more effective treatments for psoriasis with fewer side effects.
Psoriasis is a common and chronic disease that causes patches of itchy, scaly, and often inflamed skin. The symptoms can vary from mildly irritating to potentially disfiguring and affect about 2% of Americans. Psoriasis can also develop into psoriatic arthritis, which can be painful and debilitating.
Drugs used to treat psoriasis target the irregular immune system response that is thought to trigger the disease. These drugs counter this immune response but can leave the body more susceptible to infection.
By finding the specific gene that triggers the disease, researchers say more targeted psoriasis treatments could be developed.
"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," says researcher James T. Elder, MD, PhD, professor of dermatology and radiation oncology at the University of Michigan Medical School, in a news release.
Psoriasis Gene Found
In the study, published in the American Journal of Human Genetics, researchers isolated the gene PSORS1 (for psoriasis susceptibility 1) as a major player in psoriasis susceptibility from among a field of several genes that regulate how the immune system fights off infection.
Researchers say the gene's role in triggering psoriasis was demonstrated in 2,723 people from 678 families in which at least one family member had the skin disease.
But having the gene isn't enough to cause the disease.
"For every individual with psoriasis who carries the PSORS1 gene, there are 10 other people with the gene who don't get psoriasis," says Elder.
"It's as if you are pushing a shopping cart down the aisle at the grocery store and putting genes in your cart," Elder explains. "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," says Elder. In some cases, that trigger may be infection, such as strep throat.
Researchers say the next step is to identify the other inherited genes that may play a role in psoriasis in order to develop better treatments for the skin disease.

Psoriasis Facts

Researchers may not always know the best way to treat psoriasis but they do agree on these facts on psoriasis:

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.

Psoriasis: Not Just A Cosmetic Issue

Psoriasis is more than a cosmetic issue. "This disease is common, chronic, and costly, both in monetary terms and in quality of life," says Jonathan Wilkin, M.D., director of the Food and Drug Administration's Division of Dermatologic and Dental Drug Products.
More than 5 million Americans have psoriasis, and they spend between $1.6 billion and $3.2 billion each year to treat the disease, according to the National Psoriasis Foundation (NPF). Between 150,000 and 260,000 new cases are diagnosed each year, including 20,000 in children younger than 10.
"Psoriasis can be painful and can be profoundly disruptive to a person's life," says Jill Lindstrom, M.D., an FDA dermatologist. "People who don't have it don't understand how burdensome the disease can be. There is constant shedding of scales. There can be functional impairment, itching, and pain." And health complications, such as arthritis, accompany some cases.
There is no cure for psoriasis, but a broad range of treatments is available to reduce the symptoms, clear up the skin, and send the disease into remission. FDA-approved treatments range from creams rubbed into the skin, to lasers that aim ultraviolet rays at the skin, to the newest treatments--injectable drugs made from living cells

Raptiva Appears Safe For Three Years of Continuous Use

Efalizumab (Raptiva) appears to be safe for up to 3 years of continuous weekly therapy for chronic moderate to severe plaque psoriasis, researchers reported here at the 64th Annual Meeting of the American Academy of Dermatology."
The point of this study is to look at safety," said Alice Gottlieb, MD, Director, University of Medicine and Dentistry of New Jersey -- Robert Wood Johnson Medical School Clinical Research Center, New Brunswick, New Jersey, United States, in a poster discussion session on March 6th."We saw flu-like symptoms in the first 12 weeks of treatment that are typical of this therapy, and they tend to diminish over time," she noted."
There does not seem to be a signal of increased internal malignancy, increased arthritis events, increased adverse events related to psoriasis or increased cardiac events over the 60 weeks in the retrospective look at the data," she reported.
Efalizumab is a T-cell inhibitor approved by the FDA for the treatment of moderate to severe psoriasis.Many traditional systemic psoriasis agents are useful only for short-term therapy because of concerns about organ toxicity and teratogenicity. To evaluate the safety profile of efalizumab over extended therapy periods, Dr. Gottlieb and colleagues looked retrospectively the results from two studies that addressed the safety of efalizumab, one at 15 months and the other at 3 years.Patient populations were similar in both studies. For the combined population of the studies, the mean duration of psoriasis was 18.1 years, with a range of 0-68 years. The mean Psoriasis Area and Severity Index (PASI) at enrollment was 19.2 with a range of 9.6 to 63.6. The mean percent Body Surface Area Affected (BSA) was 28.7% with a range of 10% to 90%.
The most frequently observed adverse events included acute-type adverse events, specifically, headache, fever, chills, nausea and myalgia occurring within 48 hours of efalizumab injection."No new common adverse events appeared during the extended therapy periods," the authors reported.
Serious adverse events occurred in 2.3% to 3.3% of the patients during each 12-week exposure. With the exception that serious adverse events related to skin occurred at a rate of 1.1% during 37-48 weeks of exposure, the incidence of each serious event was not greater than 1%.The incidence of selected adverse events (arthritis, infection, malignancy, psoriasis) within any 12-week treatment period was similar to that seen in shorter individual clinical trials.
This is the largest compilation of psoriasis patients studied out to 60 weeks for any biologic therapy, according to the researchers."This combined analysis of more than 1000 patients further demonstrates that extended exposure to efalizumab for up to 15 months appears to be well tolerated by patients with moderate to severe chronic plaque psoriasis."
The study was supported by Genentech, Inc.

Living with Guttate Psoriasis

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.

Topical Therapies Show Promise In Treating Psoriasis

Psoriasis, a chronic skin condition characterized by thick, red, scaly patches that itch and bleed, not only makes the activities of daily life difficult, but also can affect a person's emotional well being. Psoriasis affects more than 4.5 million adults in theUnited States with a large percentage of those patients living with mild or localized psoriasis, which in no way lessens the burden of this challenging skin condition. While new biologic treatments are available for patients with severe psoriasis, those with less severe psoriasis rely on topical therapies to manage their disease. In addition, some topical therapies that are approved for treating other skin conditions may be effective for the treatmentof less severe psoriasis.

Speaking today at the 64th Annual Meeting of the American Academy ofDermatology, dermatologist Linda Stein Gold, M.D., director of dermatology clinical research at the Henry Ford Health System in West Bloomfield, Mich., spoke about myths and misconceptions about the use of topical corticosteroids and some new topical treatment options for psoriasis.

"Topical treatments, such as corticosteroids, are considered the first line of treatment," said Dr. Stein Gold. "With the emergence of several new therapies, more people with psoriasis are experiencing substantial improvements and reporting a greatly enhanced quality of life."