Treating Psoriasis

Treatment of psoriasis is determined by the location, severity and history of psoriasis in each individual. There is no one method of treatment, for each person with psoriasis may respond differently. One main objective of treatment is to slow down the more rapid than usual growth rate of the skin cells. The rapid growth rate of skin cells causes the red, scaly psoriasis patches. The underlying cause of this increased skin growth is not yet known.
For patients with minimal psoriasis, therapy is limited to topical medications that are drugs applied to the skin.
For patients with moderate to widespread psoriasis, topical treatments are often combined with ultraviolet light therapy. Either sunlight or artificial ultraviolet light therapy can be used. If topical and ultraviolet light therapy are not effective, or are not practical, systemic or oral medications can be used. These may be combined with ultraviolet light therapy, the so-called photo-chemotherapy or PUVA therapy.
In severe cases and unresponsive cases of psoriasis, there are oral medications that slow down the growth rate of skin which are helpful. These drugs can have significant side effects and have to be used with the proper safeguard and caution. Even these strong drugs do not cure psoriasis but only help to control the disease.

Psoriasis Symptoms May Be the Tip of the Iceberg

International Psoriasis Council Issues a 'call to action' Following a Collaborative Consensus Meeting to Review Implications for Clinical Practice
World Psoriasis Day will have a more poignant focus this year as the International Psoriasis Council (IPC) issues a 'call to action' to medical experts to elevate psoriasis on the public health agenda by undertaking a more thorough therapeutic approach. Recommendations include the need to review current guidelines to ensure a more holistic approach to the management of psoriasis, taking into account the many potential co-morbidities, to prevent this significant health burden escalating. It is essential that physicians are vigilant about monitoring patients for signs of co-morbid conditions and are educated on all the therapeutic options available.
These recommendations come following a collaborative Consensus Meeting convened by the IPC held at the 15th European Academy of Dermatology and Venereology (EADV) Congress earlier this month. Multi-disciplinary medical professionals from around the globe reviewed the inflammatory nature of psoriasis and how it might be linked to co-morbid conditions such as obesity, cardiovascular disease (including hypertension, and myocardial infarction), type II diabetes and liver disease.
Dr Bruce Strober, assistant professor in the department of dermatology at New York University School of Medicine, commented, "Mounting data suggest that psoriasis is a component of an inflammatory state that nurtures significant co-morbidities. It is likely that in some patients both psoriasis and obesity are co-dependent manifestations of an underlying dysfunctional pathophysiologic state. It is important that the overall management of psoriasis is significantly improved to ensure that patients are diagnosed early, appropriately treated and regularly monitored for signs of co-morbidity."
Among the data presented at the meeting was a statistical study of over 10,000 patients in clinical trials conducted over the past 5 years, showing that psoriasis patients are more likely to have body mass index (BMI) measurements in the overweight and obese ranges than members of the general population. Building on this point, Dr Gerald Krueger of the University of Utah presented a study which indicated that psoriasis and obesity are endpoints of a shared etiology in which one may promote the other.
Important data indicating an increased risk of cardiovascular disease was presented for the first time at the meeting. A large study by Dr Joel Gelfand of the University of Pennsylvania, recently published in the Journal of the American Medical Association, highlighted that psoriasis may be an independent risk factor for heart attack, particularly in young individuals with severe disease. Patients in their 40s with severe psoriasis were more than twice as likely to suffer a heart attack than people without the skin disease. Dr Gelfand's findings also shed light on potential health risks for overweight psoriasis patients. These data are supported by a case-control study presented at the meeting showing that twice the number of psoriasis patients (60%) had coronary artery calcification than non-psoriasis patients (30%).
Other studies presented at the meeting indicated that patients suffer from their skin disease much more than previously understood. One trial showed that almost half of 1,000 psoriasis patients tested were likely to be clinically depressed, and another demonstrated an increased tendency to use alcohol and tobacco among psoriasis patients.
The consensus group agreed there is overwhelmingly sufficient data supporting the linkage of psoriasis to increased co-morbid risk and to mandate future investigations funded by both government and industry. Professor Wolfram Sterry, a board member of IPC who chaired the consensus meeting concluded, "Psoriasis is a serious condition in its own right that is exacerbated by its association with co-morbidities. It is essential that physicians understand the severity of the disease and all its manifestations and integrate therapy in a way that provides a treatment that is as broad as possible to cover all the ongoing pathogenetic events."
Asked about the outlook for the future, Dr Menter, President of IPC is optimistic: "The hope is that now that we understand better the systemic inflammatory nature of psoriasis, we can work closely with our colleagues in medicine and research to improve the general health of our psoriasis patients by using the full spectrum of medications, including the new biologic agents."
Drs. Sterry, Menter, and Strober are currently working on a paper that will summarise the consensus of the IPC meeting, investigate the relationship between psoriasis and co-morbidities, discuss important areas for research on these issues, and issue recommendations for clinical management of psoriasis patients at risk of developing co-morbid conditions. For now it is important that everyone touched by psoriasis recognises the severity of the condition and the profound lifelong impact it has on health.
About IPC
The International Psoriasis Council (IPC) is a global non-profit organization dedicated to advancing psoriasis research and treatment by providing a forum for education, collaboration, and innovation among physicians, researchers, and other professionals interested in psoriasis.

Psoriasis Increases the Risk for Myocardial Infarction

Psoriasis appears to be an independent risk factor for myocardial infarction, especially for younger patients with severe disease, researchers reported.
Action Points
Encourage psoriasis patients to aggressively control their modifiable cardiovascular risk factors.
Younger patients, 30 to 40 years old, with severe psoriasis had almost twice the risk of an MI compared with similar patients without psoriasis. By contrast, 60-year-old patients with severe disease had only a 36% increased MI risk, reported Joel Gelfand, M.D., of the University of Pennsylvania here, and colleagues in the Oct. 11 issue of the Journal of the American Medical Association.
These findings came from a prospective, population-based cohort study in the United Kingdom comparing 556,995 controls and 127,139 patients with mild psoriasis and 3,837 with severe disease, in which the researchers controlled for major cardiovascular risk factors. The data have been used widely in epidemiological studies.
Psoriasis has been associated with cardiovascular diseases in the past, but has been studied only in hospital-based studies that did not control for major cardiovascular risk factors. Thus it has not been clear whether psoriasis itself or comorbidities and behavior associated with the disease explain the association, said Dr. Gelfand and colleagues.
The data were collected from 1988 to 2002 by more than 500 British general practitioners as part of the patient's medical record and stored in a general practice database. Each patient was matched with up to five controls who were randomly selected during similar time periods from the same practices. Patients were 20 to 90 years old, and the mean follow-up was 5.4 years.
Patients with psoriasis were more likely to be men and to be older. They were classified as severe if they ever received systemic therapy (usually methotrexate). Adjustments were made for hypertension, diabetes, history of myocardial infarction, hyperlipidemia, age, sex, smoking, and body mass index, all more common in psoriasis patients.
Patients with severe psoriasis had a higher rate of MI compared with controls The MI rate was 2% in the control population, 1.8% among the mild psoriasis patients and 2.9% among those with severe psoriasis.
The incidence per 1,000 person-years for severe psoriasis was 5.13 (CI, 4.22-6.17), and for mild psoriasis, it was 4.04 (CI, 3.88-4.21). By contrast, for controls, the heart attack incidence was 3.58 (CI 3.52-3.65).
Patients with psoriasis had an increased adjusted relative risk for MI that varied by age. For example, the researchers said, for a 30-year-old patient with mild or severe psoriasis, the adjusted relative risk of having an MI was 1.29 (CI 1.14-1.46), and 3.10 (CI, 1.98-4.86) respectively. However, for a 60-year-old with mild or severe psoriasis, the adjusted relative risk of an MI was only 1.08 (CI, 1.03-1.13) and 1.36 (CI, 1.13-1.64), respectively.
A series of sensitivity analyses found no evidence of confounding by traditional cardiovascular risk factors. In addition, results were similar when analysis excluded MIs occurring in the first six months of follow-up to ensure capture of incident, not prevalent, MI. Other analyses found the relative MI risk for psoriasis patients persisted in a model that included a composite endpoint of MI or death due to any cause, the researchers reported.
The reason for the higher risk of MI among younger patients may relate to the fact that psoriasis is a heterogeneous disease. For example, the researchers wrote, it has been hypothesized that persons with disease onset before age 40 have more severe disease and a stronger association with human leukocyte antigen than patients with later-onset disease. Higher immune activity in psoriasis may be related to a higher risk of MI.
It is also possible, the researchers said, that there may be a survivorship effect, in that after decades of psoriasis, patients predisposed to MI would be less likely to available since they may have died.
In discussing the study's limitations, the researchers mentioned the fact that there may have been unknown or unmeasured confounding variables, such as obesity, stress, and smoking. However, in this study, they said, they did not find any association with body mass index for those patients (61%) for whom the information was recorded.
Additionally, because the researchers defined severe psoriasis on the basis of a history of systemic therapies, it was not possible to differentiate between the impact of psoriasis severity and systemic therapy on the risk of MI. However, they said, the findings in the severe group were robust to sensitivity analysis that excluded patients treated with drugs such as methotrexate and cyclosporine.
The results, the researchers said, add to growing evidence linking T-helper cell type 1 diseases to atherosclerosis and coronary artery disease. In fact, they said, psoriasis is the most prevalent TH1 autoimmune disease.
Other TH1 diseases, such as rheumatoid arthritis, have also been shown to be an independent risk factor for acute MI and multi-vessel coronary artery disease. The exact mechanism by which these diseases predispose a patient to cardiovascular disease is unclear, but may be due to common immunological pathways that function abnormally, the researchers said.
Furthermore, they noted, the link between MI and psoriasis may be mediated by other factors beyond inflammation, such as psychological stress, sedentary lifestyle, or possibly poor compliance with management of cardiovascular risk factors.
"Our findings are novel," Dr. Gelfand's team wrote, and therefore it is important that additional studies be performed to confirm these results and determine their therapeutic implications. The authors stressed studying the impact of clinical markers, such as body surface area for psoriasis, as well as biomarkers of systemic inflammation, such as C-reactive protein.
"In the meantime," Dr. Gelfand said, "as part of good medical care, patients with psoriasis should be encouraged to aggressively address their modifiable cardiovascular risk factors."
Dr Gelfand reported receiving grant support (unrestricted grants to the Trustees of the University of Pennsylvania) from Biogen Idec, Amgen, Astellis, and Centocor. He reports consulting agreements with Genentech, Novartis, Warner-Chilcott, AMGEN, Wyeth, Biogen Idec, and Centocor.
Coauthor David Margolis, M.D., Ph.D., has received grant support (unrestricted grant to the Trustees of the University of Pennsylvania) from Biogen Idec; he is also on the data and safety monitoring boards for Abbott, Biogen Idec (which is now Astellis), and Centocor, companies with studies investigating potential treatments for psoriasis.