Psoriatic disease is an autoimmune disorder that involves inflammation throughout your body. Its also an umbrella term for two conditions: psoriasis and psoriatic arthritis (PsA).

Psoriasis generally affects the skin and causes plaques or lesions to appear. PsA primarily affects the joints, causing pain and stiffness. People with psoriatic disease may also experience issues with other organs and tissues, and they have a higher chance of developing heart disease or diabetes.

About 30 percent of people living with psoriasis also develop PsA. You may develop PsA without having psoriasis, but its not common.

When treating PsA, a person will often have a team of doctors and specialists. This team typically includes a dermatologist and a rheumatologist. When these healthcare professionals work together, diagnosis and treatment practices may be more effective.

Dermatologists often work with people living with psoriasis. With around 30 percent of people living with psoriasis later developing PsA, dermatologists are often the first to recognize PsA symptoms in their patients.

If youre already living with psoriasis and working with a dermatologist, theyll likely ask you about symptoms related to PsA. If they identify PsA, they can start to administer treatment specifically for PsA.

Early treatment is important to help prevent arthritis from getting worse and causing joint damage. About 40 to 60 percent of people living with PsA will develop joint deformity, which leads to reduced quality of life.

Rheumatologists specialize in diseases that affect the joints and muscles. A rheumatologist can provide an initial diagnosis of PsA or develop a treatment plan following a dermatologists diagnosis.

A rheumatologist can help you develop a comprehensive treatment plan that works for your needs. They will often be the doctor you see for managing your medication, reporting any issues, and other aspects of your PsA care.

Diagnosing PsA can be difficult, but its important to diagnose the condition as soon as possible for more successful treatment outcomes. Early treatment can help prevent permanent joint damage.

The best results may occur when the rheumatologists and dermatologists work together to diagnose the condition. According to a 2021 study, close collaboration between the two doctors can help speed up the diagnosis of PsA.

Diagnosis typically involves ruling out other conditions, which can be difficult because PsA has overlapping symptoms with other types of arthritis. Currently, theres no standard practice for diagnosing PsA.

Symptoms a dermatologist or rheumatologist may look for when diagnosing PsA include:

According to a 2021 study conducted in China, one factor that affects a rheumatologists ability to diagnose PsA effectively is whether they work full time or part time. These findings may not apply the same way in the United States, but they provide helpful insight into the need for rheumatologists to have experience with and be involved in the diagnosis.

Psoriasis often presents before PsA. Due to the likelihood of comorbidity of the two conditions, your dermatologist may be more open to a PsA diagnosis if you have psoriasis and develop joint pain.

Treatment outcomes for PsA may also improve when a rheumatologist and dermatologist work together.

Often, treatments for psoriasis and PsA overlap. This means some of the systemic treatments used to treat one can also help treat the other. Systemic treatments can include biologics and oral medications.

When working with both doctors, a person with PsA will need to communicate which treatment each doctor provides. A dermatologist may work by prescribing skin care treatments, while the rheumatologist may work more on treating the overall disease and joint pain.

Treatments for psoriatic disease include:

Systemic medications often help for PsA, because they target overall inflammation. Your rheumatologist may recommend additional treatment, such as pain medications like nonsteroidal anti-inflammatory drugs (NSAIDs).

When a person with PsA seeks care from both a dermatologist and rheumatologist working together, a diagnosis may come earlier, and treatment outcomes may improve. Earlier diagnosis can help slow disease progression and help prevent joint damage.

Dermatologists often work with people living with psoriasis, and rheumatologists specialize in diseases affecting the joints and muscles. About 30 percent of people living with psoriasis develop PsA.

Speak with your doctors about whether working together would help in developing a comprehensive treatment plan and improving your PsA.

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Treating PsA: How a Rheumatologist and Dermatologist Work Together - Healthline

Introduction

Apremilast, a phosphodiesterase 4 (PDE-4) inhibitor, has demonstrated clinical benefits in the management of psoriasis not only in randomized controlled trials (RCTs), ESTEEM 1 and 2 but also in real-world studies.1,2 The inhibition of PDE-4 is associated with an increase in intracellular cAMP levels, and subsequently modulates inflammatory responses, and thus helps in maintaining a balanced immune system.35 While apremilast is proven to be safe and well tolerated, it may cause a few temporary and mild to moderate adverse events (AEs) such as gastrointestinal upset, nausea, muscle pain and headache during the initiation of the therapy.6 These side effects are linked to cAMP levels which are decreased in psoriasis. Because of higher incidence of AEs, dose titration of apremilast is recommended at the initiation of therapy over a period of one week. However, despite the initial dose titration many patients develop AEs, leading to discontinuation of therapy in real-world practice.7

Although several interventions are well demonstrated for the management of AEs, sometimes dose adjustment and discontinuation of the therapy may be required.7,8 Recently published Indian papers on apremilast also highlighted a slowdown of titration in the initial period.9,10 Owing to this, for reduction in AEs and better compliance by patients, many dermatologists in India further slow down titration therapy up to 24 weeks, but studies regarding the safety of apremilast in different titration methods are lacking. The objective of this clinical study is to evaluate the safety and effectiveness of different dose titration methods of apremilast as initiation therapy in the management of patients with plaque psoriasis.

Adult patients (18 years of age) of either gender and diagnosed with chronic plaque psoriasis were included in the study. Patients with history of anti-psoriatic medications in any form within 2 weeks and use of biologics within 1224 weeks were excluded. Additionally, patients with any significant medical illness such as diabetes or cardiac disease, immunocompromised conditions, sexually transmitted diseases, etc. that would have prevented study participation, and female patients who were pregnant or lactating were excluded from the study as per the investigators discretion.

The study was conducted in compliance with the protocol approved by the Ethics Committee (Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane). Written informed consent was obtained from all the patients prior to participation in the study. This study was registered with a clinical trial registry (CTRI/2020/04/024631). This study was performed in accordance with Good Clinical Practices and the Declaration of Helsinki 1996.

This was an open-label, randomized, prospective, comparative, three-arm, and single-center study. The objective of this study was to study the initial adverse effect profile associated with apremilast titration dose and its effectiveness in each group. Patients were randomized by simple randomization technique into three groups. Group I received apremilast 30 mg twice a day after standard titration for the first 6 days. Group II received all tablets in a starter pack as once a day (OD) for 13 days, followed by apremilast 30 mg twice a day. Group III received two starter packs as 8 tablets of apremilast 10 mg OD for 8 days, followed by 20 mg OD for the next 8 days, and 30 mg OD for the next 10 days; thus totaling 26 days followed by apremilast 30 mg twice a day (Figure 1). All the patients were prescribed moisturizer only along with apremilast with antihistamines if needed. The total duration of the therapy in all groups was 16 weeks.

Figure 1 Apremilast titration methods.

Abbreviation: mg; milligram.

The primary objective of the study was to compare the percentage of patients presenting with adverse events (AEs) and the number of patients discontinuing treatment due to AEs in each group. The secondary objective was to compare the effectiveness of apremilast in each group.

A safety analysis was performed on a full analysis set (SAF), (i.e., those patients who have received at least one dose of apremilast and completed at least one post-baseline follow-up visit). The effectiveness analyses were performed on the intent-to-treat set (ITT), (i.e., those patients who have received at least one dose of apremilast and had at least one post baseline efficacy assessment).

Results were presented as mean scores, and the groups were compared using one-way ANOVA with Tukey HSD test and Fishers exact test. The level of significance was set at p <0.05. The difference in the proportion of patients with a change in mean scores (based on improvement criteria), was analysed using the chi-square test. Data were analysed using the IBM SPSS (Statistical Package for Social Sciences) statistics version 20.

Of the 128 patients enrolled in this study, all (100%) were included in the SAF, and 95 patients (74.22%) were included in the ITT. Thirty-three patients (25.78%) were lost to follow-up before the first effectiveness assessment visit (Figure 2).

Figure 2 Study Design.

There were 38 patients in Group I, 46 patients in Group II and 44 patients in Group III. Male predominance was seen in all groups with a mean (SD) age of 43.58 (9.78) in Group I, 42.53 (10.73) in Group II and 38.7 (12.5) years in Group III, respectively (Table 1). All the baseline characteristics under SAF are noted in Table 1. Patient distribution was homogeneous in all groups.

Table 1 Baseline Demographic Characteristics for Full Analysis Set (SAF)

Safety outcomes in all groups are summarized in Table 2. In Group I, 50% reported AEs, 41.3% reported AEs in Group II whereas 25% reported AEs in Group III. There was statistical difference (p <0.05) between Group I and III but no statistical difference was noted between Groups II and III. Nausea was the most common AE reported in all groups, followed by gastrointestinal upset and headache. Though all the groups experienced AEs, the maximum number of AEs were seen in Group I in first week only (74.19%) compared with other groups whereas in Groups II and III, 24.32% and 42.85% patients reported AEs in first week. In subsequent weeks, there was reduction in occurrence of AEs in all groups, as shown in Table 2. Most of the AEs occurred at the dose of apremilast 30 mg. As a result, 4 patients (10.53%) of the patients discontinued the therapy in Group I, 3 patients (6.52%) in Group II and 1 patient (2.27%) in Group III (Table 2). There was no significant statistical difference between any groups in terms of discontinuation of apremilast.

Table 2 Details of Adverse Events in All Groups

All ITT patients were included in the treatment response group. There were 35 patients in Group I, 33 patients in Group II and 27 patients in Group III. All the baseline characteristics under ITT are noted in Table 3. Patient distribution was homogeneous in all groups.

Table 3 Baseline Demographic Characteristics for Intention to Treat (ITT)

At week 10, in Group I, 10 patients (28.5%) and 5 patients (14.5%) achieved Psoriasis Area and Severity Index (PASI) 50 and 75 respectively while in Group II, 12 (36.3%) and 6 patients (18.1%) achieved PASI 50 and 75 respectively. In Group III, PASI 50 was achieved in 8 patients (29.6%) and PASI 75 in 2 patients (7.4%). At week 16, 14 (40%), 6 (18.1%) and 7 (26%) patients achieved PASI 50 and 11 (31.43%), 14 (42.4%), 9 patients (33.3%) achieved PASI 75 in Groups I, II and III respectively (Figure 3). On intergroup comparison, there was no statistically significant difference between any groups.

Figure 3 Effectiveness evaluation in all groups for PASI.

Abbreviation: PASI; Psoriasis area and severity index.

There was a significant statistical difference between the baseline and the end of treatment in all groups in terms of improvement of all mean scores such as mean PASI, mean body surface area (BSA) and mean symptoms scores (p <0.05) as shown in Figures 4 and 5, but on intergroup comparison, there was no statistical significant difference, as shown in Table 4.

Table 4 Clinical Response at Week 10 and Week 16

Figure 4 Improvement in mean PASI and BSA scores at week 10 and week 16.

Abbreviations: PASI; Psoriasis area and severity index, BSA; body surface area.

Figure 5 Improvement in mean scores at week 10 and week 16.

All the landmark clinical trials1,2 and real-world studies11 have examined the safety and effectiveness of apremilast for a complete duration of therapy but this study has examined safety during the titration of therapy. Apremilast is a PDE-4 inhibitor and the inhibition of PDE-4 is associated with an increase in intracellular cAMP levels, which subsequently modulate the inflammatory responses, and thus help in maintaining balance of the immune system.35 It has been found that the cAMP-specific PDE-4 is highly expressed in some specific organs such as the gastrointestinal tract, the musculoskeletal system, the brain and the skin,1214 and hence adverse effects associated with these systems that are observed with apremilast are accredited to PDE-4 inhibition.13,15,16 Moreover, it has been found that patients with inflammatory diseases express higher levels of PDE-4 than healthy individuals.13,17 Hence, in such patients, more attention is required to minimize AEs with maintaining the balance of efficacy.

In earlier studies where apremilast dosing began at the full dose, more AEs were reported than Phase II studies, where apremilast titration was done over a period of 6 days. Hence initial dose titration is recommended to lower the AEs.18,19 But, despite titration, a high number of AEs were reported from landmark trials and real-world studies, leading to the discontinuation of the drug.11

In our study, 50%, 41.3% and 25% of the patients reported 1 AE in Groups I, II and III, respectively which was statistically significant. This is in line with recently published real-world studies on titration suggesting that a further slowdown of titration led to a lesser rate of AEs.10 Moreover, recently published papers on apremilast also pointed towards a slower titration in the initial period.9,20 Additionally, patients in Group I experienced the maximum number of AEs in the first week compared with other groups. The incidence of AEs in subsequent weeks was reduced in all groups. This suggests that further slowdown of titration helps in reducing the AEs associated with apremilast. Nausea was the most commonly reported AE in our study, unlike the other study on titration where GI upset was the most commonly reported. As reported by Giembycz et al., nausea and emesis were among the commonest adverse effects of PDE-4 inhibitors due to the expression of PDE-4 in the central nervous system.21

Additionally, the percentage of patients discontinuing apremilast was reported as lower compared with other studies, though this was not significant. This could be due to a smaller sample size. But the trend of lower AEs with a slowdown of titration was reported as significant. Additionally, though these AEs were mild to moderate in nature and resolved with the continuation of the drug, most of the AEs occurred in the initial 2 weeks of dosing.

In terms of effectiveness, 31.43%, 42.4% and 33.3% of the patients achieved PASI 75 at the end of 16 weeks in Groups I, II and III, respectively. This is in line with landmark clinical studies on apremilast.1,2 But as mentioned above, there was no statistical difference between any of the groups suggesting that even further slowdown of titration at the initiation of therapy did not affect the efficacy of apremilast. As per a recently published report from India, a minimum of 24 weeks of therapy was recommended by experts for better efficacy.9 Effectiveness was also statistically significant at week 16 from baseline in all groups in the mean score of PASI, BSA and symptoms score suggesting that all titration methods were equally effective.

To the best of our knowledge, the present study is the first prospective, randomized and comparative realworld experience of safety and effectiveness of apremilast with three different titration methods. This study provides evidence that in patients who are intolerant to apremilast titration in the initial period, further slowdown of titration is an effective strategy. This strategy will not only help in reducing adverse effects but also help in the reduction of the discontinuation of apremilast therapy. Moreover, this strategy may help in improving compliance by patients. Additionally, clinical efficacy was also well documented with the further slowdown of titration. The clinical implication is that apremilast should be titrated gradually and tailored according to the patients tolerance, especially in patients who do not tolerate standard dose titration. There were some limitations such as small sample size and only one center being involved in the study.

In conclusion, the slow titration of apremilast is associated with lesser occurrence of AEs, and hence, fewer chances of discontinuation of the treatment. Additionally, in terms of effectiveness, there was no statistical difference between any groups in terms of PASI and BSA improvement. Hence, it can be concluded that slower titration is a useful strategy for reducing AEs but at the same time maintaining the efficacy of apremilast.

The datasets are available only on request due to privacy/ ethical restrictions, and can be requested from [emailprotected]

Dr Dhiraj Dhoot, Dr Namrata Mahadkar and Dr Hanmant Barkate are employees of Glenmark Pharmaceuticals Ltd. The other authors report no conflicts of interest in this work.

1. Papp K, Reich K, Leonardi CL, et al. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: results of a Phase III, randomized, controlled trial (efficacy and safety trial evaluating the effects of apremilast in psoriasis [ESTEEM] 1). J Am Acad Dermatol. 2015;73(1):3749. doi:10.1016/j.jaad.2015.03.049

2. Paul C, Cather J, Gooderham M, et al. Efficacy and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with moderate-to-severe plaque psoriasis over 52 weeks: a phase III, randomized controlled trial (ESTEEM 2). Br J Dermatol. 2015;173(6):13871399. doi:10.1111/bjd.14164

3. Schafer P. Apremilast mechanism of action and application to psoriasis and psoriatic arthritis. Biochem Pharmacol. 2012;83(12):15831590. doi:10.1016/j.bcp.2012.01.001

4. Schafer PH, Parton A, Capone L, et al. Apremilast is a selective PDE4 inhibitor with regulatory effects on innate immunity. Cell Signal. 2014;26(9):20162029. doi:10.1016/j.cellsig.2014.05.014

5. Maurice DH, Ke H, Ahmad F, Wang Y, Chung J, Manganiello VC. Advances in targeting cyclic nucleotide phosphodiesterases. Nat Rev Drug Discov. 2014;13(4):290314. doi:10.1038/nrd4228

6. Dattola A, Del Duca E, Saraceno R, Gramiccia T, Bianchi L. Safety evaluation of apremilast for the treatment of psoriasis. Expert Opin Drug Saf. 2017;16(3):381385. doi:10.1080/14740338.2017.1288714

7. Daudn Tello E, Alonso Surez J, Beltrn Cataln E, et al. Multidisciplinary management of the adverse effects of apremilast. Manejo de los efectos adversos de apremilast desde un abordaje multidisciplinar. Actas Dermosifiliogr. 2021;112(2):134141. doi:10.1016/j.ad.2020.08.007

8. Langley A, Beecker J. Management of common side effects of apremilast. J Cutan Med Surg. 2018;22(4):415421. doi:10.1177/1203475417748886

9. Rajagopalan M, Dogra S, Saraswat A, Varma S, Banodkar P. the use of apremilast in psoriasis: an Indian perspective on real-world scenarios. Psoriasis. 2021;11:109122. doi:10.2147/PTT.S320810

10. De A, Sarda A, Dhoot D, Barkate H. Apremilast titration: real-world Indian experience. Clin Dermatol Rev. 2021;5(2):183186.

11. Parasramani S, Thomas J, Budamakuntla L, Dhoot D, Barkate H. Real-world experience on the effectiveness and tolerability of apremilast in patients with plaque psoriasis in India. Indian J Drugs Dermatol. 2019;5(2):8388.

12. Chiricozzi A, Caposiena D, Garofalo V, Cannizzaro MV, Chimenti S, Saraceno R. A new therapeutic for the treatment of moderate-to-severe plaque psoriasis: apremilast. Expert Rev Clin Immunol. 2016;12(3):237249. doi:10.1586/1744666X.2016.1134319

13. Li H, Zuo J, Tang W. Phosphodiesterase-4 inhibitors for the treatment of inflammatory diseases. Front Pharmacol. 2018;9:1048. doi:10.3389/fphar.2018.01048

14. Halpin DM. ABCD of the phosphodiesterase family: interaction and differential activity in COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(4):543561. doi:10.2147/COPD.S1761

15. Dyke HJ, Montana JG. Update on the therapeutic potential of PDE4 inhibitors. Expert Opin Investig Drugs. 2002;11(1):113. doi:10.1517/13543784.11.1.1

16. Dietsch GN, Dipalma CR, Eyre RJ, et al. Characterization of the inflammatory response to a highly selective PDE4 inhibitor in the rat and the identification of biomarkers that correlate with toxicity. Toxicol Pathol. 2006;34(1):3951. doi:10.1080/01926230500385549

17. Schafer PH, Truzzi F, Parton A, et al. Phosphodiesterase 4 in inflammatory diseases: effects of apremilast in psoriatic blood and in dermal myofibroblasts through the PDE4/CD271 complex. Cell Signal. 2016;28(7):753763. doi:10.1016/j.cellsig.2016.01.007

18. Busa S, Kavanaugh A. Drug safety evaluation of apremilast for treating psoriatic arthritis. Expert Opin Drug Saf. 2015;14(6):979985. doi:10.1517/14740338.2015.1031743

19. Young M, Roebuck HL. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor: a novel treatment option for nurse practitioners treating patients with psoriatic disease. J Am Assoc Nurse Pract. 2016;28(12):683695. doi:10.1002/2327-6924.12428

20. Carrascosa JM, Belinchn I, Rivera R, Ara M, Bustinduy M, Herranz P. The use of apremilast in psoriasis: a Delphi Study. Estudio Delphi para el uso de apremilast en la psoriasis. Actas Dermosifiliogr. 2020;111(2):115134. doi:10.1016/j.ad.2019.07.005

21. Giembycz MA. Phosphodiesterase 4 inhibitors and the treatment of asthma: where are we now and where do we go from here? Drugs. 2000;59(2):193212. doi:10.2165/00003495-200059020-00004

Excerpt from:

Safety and effectiveness of Apremilast in plaque psoriasis | PTT - Dove Medical Press

Rashes can be thought of as a dysfunctional community of skin cells. Your skin harbors dozens of distinct cell types, including those that form blood vessels, nerves and the local immune system of the skin. For decades, clinicians have largely been diagnosing rashes by eye. While examining the physical appearance of a skin sample under a microscope may work for more obvious skin conditions, many rashes can be difficult to distinguish from one another.

At the molecular level, however, the differences between rashes become more clear.

Scientists have long known that molecular abnormalities in skin cells cause the redness and scaliness seen in conditions like psoriasis and eczema. While almost all the various cell types in your skin can release chemicals that worsen inflammation, which ones leads to rash formation remains a mystery and may vary from patient to patient.

But molecular testing of skin rashes isnt a common practice because of technological limitations. Using a new approach, my colleagues and I were able to analyze the genetic profiles of skin rashes and quantitatively diagnose their root causes.

Traditional genetic analyses work by averaging out the activity of thousands of genes across millions of cells.

Genetically testing tissue samples is standard practice for conditions like cancer. Clinicians collect and analyze tumor biopsies from patients to determine a particular cancers unique molecular characteristics. This genetic fingerprint helps oncologists predict whether a cancer will spread or which treatments might work best. Cancer cells lend themselves to this form of testing because they often grow into recognizable masses that make them easy to isolate and analyze.

But skin is a complex mixture of cells. Collapsing these unique cell communities into a single group may obscure genetic signatures essential to diagnosis.

Recent technological advances called single-cell RNA sequencing, however, have enabled scientists to preserve the identity of each type of cell that lives in the skin. Instead of averaging the genetic signatures across all cell types in bulk, single-cell RNA sequencing analyses allow each cell to preserve its unique characteristics.

Using this approach, my colleagues and I isolated over 158,000 immune cells from the skin samples of 31 patients. We measured the activity of about 1,000 genes from each of those cells to create detailed molecular fingerprints for each patient. By analyzing these fingerprints, we were able to pinpoint the genetic abnormalities unique to the immune cells residing in each rash type. This allowed us to quantitatively diagnose otherwise visually ambiguous rashes.

We also observed that some patients had treatment responses consistent with what we expected with our predicted diagnoses. This suggests that our concept could viably be expanded for further testing.

To make our approach available to clinicians and scientists, we developed an open source web database called RashX that contains the genetic fingerprints of different rashes. This database will allow clinicians to compare the genetic profile of their patients rashes to similar profiles in our database. A closely matching genetic fingerprint might yield clues as to what caused their patients rash and lead to potential treatment avenues.

The rapid development of drugs that target the immune system in recent years has inundated doctors with difficult treatment decisions for individual patients. For example, while certain drugs that act on the immune system are known to work well for conditions like psoriasis or eczema, many patients have atypical rashes that cant be precisely diagnosed.

An open source database like ours could help enable clinicians to profile and diagnose these rashes, providing a stepping stone to choose a suitable treatment.

Furthermore, chronic inflammatory diseases that affect organs other than the skin share similar genetic abnormalities. Lab tests that can illuminate the root causes of skin diseases can likely be expanded to many other conditions.

Our RashX project initially focused on just two very common types of rashes, psoriasis and eczema. It is unknown whether other types of rashes will have similar genetic profiles to psoriasis and eczema or instead have their own unique fingerprints. It is also unclear which parts of the fingerprint would best predict drug response.

But RashX is a living web resource that will grow more useful as more scientists collaborate and contribute new data. Our lab is also working to simplify the process of developing genetic profiles of rashes to make participating in this area of research more accessible for clinics around the world. With more data, we believe that projects like RashX will make precision testing for rashes an essential next step in diagnosis and treatment.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Originally posted here:

What is that rash? - ASBMB Today

Probiotic skin care involves using products that contain live microorganisms to improve the health of the skin. The idea behind this is that it helps maintain a beneficial balance of microbes, helping to reduce the symptoms of skin conditions.

Research on the effectiveness and safety of probiotics in skin care is very preliminary. Early studies indicate that oral probiotics may help with some health conditions, which has led scientists to study whether they may also be useful as a topical treatment.

However, some scientists argue that doctors do not yet understand the skin microbiome well enough to safely use topical probiotics as a skin treatment. The Food and Drug Administration (FDA) also does not regulate topical probiotics.

This article discusses probiotic skin care and the research supporting its use. It also examines potential risks and suggests other factors to consider when shopping for skin care products.

Probiotics are live microorganisms that are beneficial to human health. Probiotic skin care involves applying these microbes topically in the form of products such as creams or treatments.

The concept of probiotics dates back to 1900, when Louis Pasteur discovered them as the source of fermentation in foods such as yogurt. In the human body, probiotics make up part of the microbiome, which is the collection of microorganisms that naturally inhabit the digestive tract, skin, and other parts of the body.

The microbiome contains a huge variety of species. Some of these microbes are beneficial, while others can be pathogenic, or disease-causing. An imbalance in the amount of good and bad microbes is known as dysbiosis.

According to a 2019 study, the composition of the skin microbiome in healthy skin differs from the composition of the microbiome in diseased skin. Research from 2021 also reports that dysbiosis within the skin microbiome can result in the emergence and worsening of skin conditions.

Because of this, scientists and cosmetic companies have become increasingly interested in how probiotics might restore balance to the skin microbiome.

Some common species of probiotics that people may find in skin products include:

Almost any skin care product can contain them, including:

However, it is important to note that while many products may list microbes on their ingredients label, it is not always possible to know whether or not these microbes are alive.

Many companies use preservatives in their products to prolong their shelf life and ensure they are safe to use. Preservatives work by killing bacteria. This means that, in many cases, the probiotics may be inactivated.

A 2021 review looked at the body of research exploring the use of topical probiotics in skin care. Although some studies suggest these may have benefits, research is still in its early stages. Most research on probiotics focuses on oral probiotics.

People with atopic dermatitis (AD), or atopic eczema, have a higher amount of the bacteria Staphylococcus aureus in their skin microbiome, according to a 2017 study.

The authors of the study tested the effects of applying the probiotic Lactobacillus johnsonii to the skin of 31 participants with AD. Analysis of the data indicated that it reduced the number of S. aureus and decreased AD symptoms.

Older research from 2003 investigated the effect of S. thermophilus on AD. After a 2-week application period involving 11 participants, the results suggested that the probiotic reduced redness, scaling, and itching.

A 2016 study reviewed the effects of probiotics on the skin in clinical trials and animal experiments. The results indicated that their benefits include:

This may mean probiotics can reduce some of the visible signs of aging, such as sun damage. However, more research is necessary.

Some studies suggest that topical probiotics may promote wound healing, but the results vary significantly.

Older research from 2005 evaluated the effect of the probiotic Lactobacillus plantarum on preventing infections in wounds. After investigating it in test tubes and in mice, the authors concluded that it might inhibit infection development and improve tissue repair.

More large-scale human trials are necessary to see if it affects people the same way.

A 2020 paper states that topical probiotics may help address a loss of microbial diversity that previous research has found in people with acne. They may also reduce levels of Cutibacterium acnes on the skin, which is a type of bacteria that lives in hair follicles and is strongly associated with acne.

However, at the moment, this is only a theory. There are currently no randomized controlled trials that prove probiotic skin care targets C. acnes.

Data on probiotic treatment of psoriasis is limited, but studies investigating oral probiotics for the condition show promise. Authors of research from 2019 listed psoriasis as a skin condition that they believe oral and topical probiotics may help.

A 2019 review analyzed six clinical trials to explore the safety of topical probiotic treatment for AD. It found no significant side effects.

However, as with other types of skin care, there is always a risk that some people will have hypersensitivity or allergies to the ingredients. This may cause:

If this occurs, or the product burns or stings, a person should wash it off and stop using it.

Even though the probiotics in skin care may not be alive due to preservatives, it is difficult to know for sure. For this reason, people with compromised immune systems should avoid topical products that may contain live cultures, as well as probiotic foods and supplements.

It is important to note that experts are still learning about the skin microbiome. A 2021 paper argues that because scientists do not have sufficient knowledge, using topical probiotics could have unforeseen consequences.

Some species, or groups of species, may be capable of damaging the skin microbiome rather than helping it.

Microbes do not affect the body in isolation. Communities of microbes can have different effects when they coexist. Because this ecosystem is complex and differs from person to person, disruption can be potentially harmful.

The authors of a 2021 study urge scientists to conduct more research to understand how the microbiome as a whole interacts with human health, rather than only looking at individual microbes.

It is also difficult for cosmetic companies to create products that still contain live microbes due to the need to keep the product sanitary using preservatives.

An alternative approach could be to use prebiotics in skin care instead. These are ingredients that feed the beneficial bacteria that already live on the skin. This requires no live cultures to be present in the product and does not introduce new species.

If a person decides to try probiotic skin care, they can do so by following these tips:

Probiotic skin care involves using probiotic-containing products to try to alleviate certain skin conditions or improve its appearance. Some species of probiotics that people may find on skin product labels include S. thermophilus, Lactococcus, and Lactobacillus.

The FDA does not regulate probiotic skin care, so there is currently no recommendation on which types of probiotics are beneficial to the skin and little way of knowing if the probiotics in a product are alive.

Limited studies that examine specific species have suggested topical probiotics may be well-tolerated by many, but more research is necessary to fully understand if they could treat skin conditions and, if so, which species work best.

It is possible that probiotics could cause negative effects if they disrupt someones skin microbiome. People may want to ask a dermatologist for advice on the best products to suit their skin, particularly if they have a condition such as AD or acne.

Learn more about creating a dermatologist-recommended skin care routine here.

See more here:

Does probiotic skin care work? Products, uses, and more - Medical News Today

You have swollen, painful joints. It might be a sign of psoriatic arthritis. But you dont have the telltale skin rash that signals psoriasis. Could you have one condition without the other?

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Psoriasis and psoriatic arthritis are related conditions, but they dont always strike at the same time, says rheumatologist Ivana Parody, MD.

Heres what to know about psoriasis and psoriatic arthritis and how they fit together.

Psoriatic arthritis is an autoimmune disease. It occurs when your bodys immune system attacks its own tissues. The disease causes pain and swelling in your joints and the places where tendons and ligaments attach to bones. It can develop at any age, but most people experience their first symptoms between ages 35 and 55.

So, where does the skin come into play? Psoriasis is an autoimmune disease that affects your skin. It causes red, itchy, inflamed patches of skin that can be covered with silvery scales.

Psoriasis is common on the elbows, knees and scalp but can show up just about anywhere on your body. Most people with psoriasis never get psoriatic arthritis. But about 30% of people with psoriasis do develop the disease.

Its possible, but not very common, says Dr. Parody. Most people develop psoriasis first. Psoriatic arthritis typically emerges about seven to 10 years later.

Thats not always the case, however. A small number of people have joint pain first, and the skin disease appears later. Its even possible that a person with psoriatic arthritis will never have any skin symptoms. But that doesnt happen often. When it does, there is usually a family history of psoriasis, Dr. Parody says.

Psoriatic arthritis can cause different symptoms from person to person. But there are several common symptoms:

Experts arent sure what causes psoriatic arthritis. They suspect a combination of genes and environmental factors is to blame.

Unfortunately, no single test can identify psoriatic arthritis. Its usually easier for a doctor to diagnose you if you have psoriasis, as the two diseases often tag team.

Whether or not your skin is involved, your doctor will consider several factors to make a diagnosis. These include:

If you have painful, swollen joints and other symptoms, start with your primary care doctor, says Dr. Parody. They may refer you to a rheumatologist, who specializes in diagnosing and treating arthritis and other diseases that affect the joints, muscles and bones.

Some psoriatic arthritis treatments will also help calm skin symptoms. But if you have bothersome psoriasis symptoms, it can be helpful to see a dermatologist, too (an expert in skin conditions).

Some people with psoriatic arthritis have mild symptoms. They may be able to control pain and swelling with over-the-counter anti-inflammatory drugs.

People with advanced disease usually need prescription medications. These drugs can relieve symptoms and prevent permanent joint damage. They include:

Besides medications, there are things you can do to help relieve pain and protect your joints:

Theres no cure for psoriasis or psoriatic arthritis, but you can manage both with treatment. And new medications come out every year, says Dr. Parody. By working with your doctor, you can develop a plan to protect your joints and keep doing the things you love.

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Can You Have Psoriatic Arthritis Without Psoriasis? - Health Essentials from Cleveland Clinic

This article was originally published here

PLoS One. 2021 Dec 9;16(12):e0259852. doi: 10.1371/journal.pone.0259852. eCollection 2021.

ABSTRACT

This study aimed to investigate the perceived threat, mental health outcomes, behavior changes, and associated predictors among psoriasis patients during the COVID-19 pandemic. The COVID-19 has been known to increase the health risks of patients with psoriasis owing to patients immune dysregulation, comorbidities, and immunosuppressive drug use. A total of 423 psoriasis patients not infected with COVID-19 was recruited from the Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Chang Gung Memorial Hospital, and China Medical University Hospital from May 2020 to July 2020. A self-administered questionnaire was used to evaluate the perceived threat, mental health, and psychological impact on psoriasis patients using the Perceived COVID-19-Related Risk Scale score for Psoriasis (PCRSP), depression, anxiety, insomnia, and stress-associated symptoms (DAISS) scales, and Impact of Event Scale-Revised (IES-R), respectively. Over 94% of 423 patients with psoriasis perceived threat to be 1 due to COVID-19; 18% of the patients experienced psychological symptoms more frequently 1, and 22% perceived psychological impact during the pandemic to be 1. Multivariable linear regression showed that the higher psoriasis severity and comorbidities were significantly associated with higher PCRSP, DAISS, and IES-R scores. The requirement for a prolonged prescription and canceling or deferring clinic visits for psoriasis treatment among patients are the two most common healthcare-seeking behavior changes during the COVID-19 pandemic. Psoriasis patients who perceived a higher COVID-19 threat were more likely to require a prolonged prescription and have their clinic visits canceled or deferred. Surveillance of the psychological consequences in psoriasis patients due to COVID-19 must be implemented to avoid psychological consequences and inappropriate treatment delays or withdrawal.

PMID:34882690 | DOI:10.1371/journal.pone.0259852

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Perception of the threat, mental health burden, and healthcare-seeking behavior change among psoriasis patients during the COVID-19 pandemic - DocWire...

A method to shed unprecedented views into skin diseases: that was the goal when the INNODERM project was launched in 2016 under the leadership of the Technical University of Munich (TUM). It has yielded a novel imaging modality that can see deeper and with higher discrimination beneath the skin surface than any competing method today. The project has now been chosen as the winner of the European Commissions 2021 ECS Innovation Award, writes TUM in a press release.

Raster scan optoacoustic mesoscopy RSOM for short is the name of the pioneering imaging technology developed as part of the EU-funded INNODERM project. With an RSOM scanner, it becomes possible to capture very detailed vascular and cellular structures under the skin surface and precisely analyse changes of the skin. This is important, for example, in following the progression of diseases like psoriasis, eczema or melanoma. This was not possible with previous approaches like visual inspection, optical imaging or ultrasonography, as they do not provide sufficient contrast or depth penetration to obtain comparable information. The RSOM scanner has been used to image the extent of melanomas with unprecedented detail under the skin surface and quantify treatment efficacy associated with psoriasis, offering more objective and accurate observations that could enable doctors to determine if treatments are taking effect.

An international team headed by Vasilis Ntziachristos,Professor of Biological Imagingat TUM and Director of the Institute for Biological and Medical Imaging at Helmholtz Munich, spent five years refining and developing the technology. The project, which has involved research institutions as well as partners in industry, has generated more than 20 scientific papers. When INNODERM first began, the RSOM required a large laboratory installation to operate. In the meantime, however, the team has squeezed the technology into a portable scanner around the size of a medical ultrasound device. It is now being used for research purposes at several university hospitals around the world. Certification for use in physicians practices and hospital clinics is expected by the end of 2022.

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At the European Forum for Electronic Components and Systems (EFECS), a major congress of the European electronics industry, INNODERM received the ECS Innovation Award. The award is presented annually by the European Commission and the European Health and Digital Executive Agency (HaDEA) in recognition of innovative projects funded under the EU research and innovation program Horizon 2020. The jury praised the technological progress made by INNODERM and was impressed by the projects progress in developing the scanner into a commercial device by INNODERM partner iThera Medical GmbH. INNODERM received 3.8 million euros in funding through Horizon 2020.

Optoacoustic imaging, which fuels RSOM, is a modality that is intensively studied by Prof. Ntziachristos team in more than 15 years. Put simply, light pulses illuminate and are absorbed by tissue and converted to ultrasound waves, which are then detected by sensors and mathematically converted into images. Since each molecule absorbs and responds uniquely to different colors of light, the technique can be used to study anatomical and biochemical features of tissue. This makes RSOM capable of resolving details like microvascular, tissue oxygenation concentrations, endothelial function and other pathophysiological processes. This is all without the need to use contrast agents and ionizing radiation, making the method extremely safe and non-invasive for patients.

A follow-up project to INNODERM began in 2020. Also funded by the EU, the WINTHER project aims to improve RSOM technology while continuing to miniaturize the equipment. Along with skin diseases, the new scanner will be suitable for detecting and monitoring cardiovascular conditions and diabetes. OPTOMICS, an international EU project launched in 2021, also headed by Prof. Ntziachristos, is studying how RSOM data can be combined with multi-omics measurements to lead to a digital twin used for prognosis and treatment planning for type-2 diabetes.

Also interesting: Scientists search for the cause of your wrinkles with Chanel

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Seeing deeper through skin - Innovation Origins

Diagnosis

Your doctor will ask questions about your health and examine your skin, scalp and nails. Your doctor might take a small sample of skin (biopsy) for examination under a microscope. This helps determine the type of psoriasis and rule out other disorders.

Psoriasis treatments aim to stop skin cells from growing so quickly and to remove scales. Options include creams and ointments (topical therapy), light therapy (phototherapy), and oral or injected medication.

Which treatments you use depends on how severe the psoriasis is and how responsive it has been to previous treatment. You might need to try different drugs or a combination of treatments before you find an approach that works for you. Usually, however, the disease returns.

Corticosteroids. These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They are available as ointments, creams, lotions, gels, foams, sprays and shampoos. Mild corticosteroid ointments (hydrocortisone) are usually recommended for sensitive areas, such as your face or skin folds, and for treating widespread patches. Topical corticosteroids might be applied once a day during flares, and on alternate days or weekends only to maintain remission.

Your doctor may prescribe a stronger corticosteroid cream or ointment triamcinolone (Acetonide, Trianex), clobetasol (Temovate) for smaller, less-sensitive or tougher-to-treat areas.

Long-term use or overuse of strong corticosteroids can thin the skin. Over time, topical corticosteroids may stop working.

Retinoids. Tazarotene (Tazorac, Avage) is available as a gel and cream and applied once or twice daily. The most common side effects are skin irritation and increased sensitivity to light.

Tazarotene isn't recommended when you're pregnant or breast-feeding or if you intend to become pregnant.

Calcineurin inhibitors. Calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel) reduce inflammation and plaque buildup. They can be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.

Calcineurin inhibitors are not recommended when you're pregnant or breast-feeding or if you intend to become pregnant. This drug is also not intended for long-term use because of a potential increased risk of skin cancer and lymphoma.

Coal tar. Coal tar reduces scaling, itching and inflammation. It's available over-the-counter or by prescription in various forms, such as shampoo, cream and oil. These products can irritate the skin. They're also messy, stain clothing and bedding, and can have a strong odor.

Coal tar treatment isn't recommended for women who are pregnant or breast-feeding.

Light therapy is a first-line treatment for moderate to severe psoriasis, either alone or in combination with medications. It involves exposing the skin to controlled amounts of natural or artificial light. Repeated treatments are necessary. Talk with your doctor about whether home phototherapy is an option for you.

Psoralen plus ultraviolet A (PUVA). This treatment involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.

This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. Short-term side effects include nausea, headache, burning and itching. Long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma.

If you have moderate to severe psoriasis or other treatments haven't worked, your doctor may prescribe oral or injected (systemic) drugs. Because of the potential for severe side effects, some of these medications are used for only brief periods and might be alternated with other treatments.

Methotrexate. Usually administered weekly as a single oral dose, methotrexate (Trexall) decreases the production of skin cells and suppresses inflammation. It's less effective than adalimumab (Humira) and infliximab (Remicade). It might cause upset stomach, loss of appetite and fatigue. People taking methotrexate long term need ongoing testing to monitor their blood counts and liver function.

Men and women should stop taking methotrexate at least three months before attempting to conceive. This drug is not recommended when you're breast-feeding.

Cyclosporine. Taken orally for severe psoriasis, cyclosporine (Neoral) suppresses the immune system. It's similar to methotrexate in effectiveness but cannot be used continuously for more than a year. Like other immunosuppressant drugs, cyclosporine increases your risk of infection and other health problems, including cancer. People taking cyclosporine need ongoing monitoring of their blood pressure and kidney function.

These drugs are not recommended when you're pregnant, breast-feeding or if you intend to become pregnant.

Biologics. These drugs, usually administered by injection, alter the immune system in a way that disrupts the disease cycle and improves symptoms and signs of disease within weeks. Several of these drugs are approved for the treatment of moderate to severe psoriasis in people who haven't responded to first-line therapies. The therapeutic options are rapidly expanding. Examples include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), ustekinumab (Stelara), secukinumab (Cosentyx) and ixekizumab (Taltz). These types of drugs are expensive and may or may not be covered by health insurance plans.

Biologics must be used with caution because they carry the risk of suppressing your immune system in ways that increase your risk of serious infections. In particular, people taking these treatments must be screened for tuberculosis.

Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments topical creams and ultraviolet light therapy (phototherapy) in people with typical skin lesions (plaques) and then progress to stronger ones only if necessary. People with pustular or erythrodermic psoriasis or associated arthritis usually need systemic therapy from the beginning of treatment. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.

A number of alternative therapies claim to ease the symptoms of psoriasis, including special diets, creams, dietary supplements and herbs. None have definitively been proved effective. But some alternative therapies are deemed generally safe and might reduce itching and scaling in people with mild to moderate psoriasis. Other alternative therapies are useful in avoiding triggers, such as stress.

If you're considering dietary supplements or other alternative therapy to ease the symptoms of psoriasis, consult your doctor. He or she can help you weigh the pros and cons of specific alternative therapies.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Try these self-care measures to better manage your psoriasis and feel your best:

Coping with psoriasis can be a challenge, especially if the affected skin covers a large area of your body or is visible to other people. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden.

Here are some ways to help you cope and to feel more in control:

You'll likely first see your family doctor or a general practitioner. In some cases, you may be referred directly to a specialist in skin diseases (dermatologist).

Here's some information to help you prepare for your appointment and to know what to expect from your doctor.

Make a list of the following:

For psoriasis, some basic questions you might ask your doctor include:

Your doctor is likely to ask you several questions, such as:

Read more:

Psoriasis - Diagnosis and treatment - Mayo Clinic

Alwan, W., and F.O. Nestle. "Pathogenesis and Treatment of Psoriasis: Exploiting Pathophysiological Pathways for Precision Medicine." Clin Exp Rheumatol 33 (Suppl. 93): S2-S6.

Arndt, Kenneth A., eds., et al. "Topical Therapies for Psoriasis." Seminars in Cutaneous Medicine and Surgery 35.2S Mar. 2016: S35-S46.

Benhadou, Fairda, Dillon Mintoff, and Vronique del Marmol. "Psoriasis: Keratinocytes or Immune Cells -- Which Is the Trigger?" Dermatology Dec. 19, 2018.

Conrad, Curdin, Michel Gilliet. "Psoriasis: From Pathogenesis to Targeted Therapies." Clinical Reviews in Allergy & Immunology Jan. 18, 2015.

Dowlatshahi, E.A., E.A.M van der Voort, L.R. Arends, and T. Nijsten. "Markers of Systemic Inflammation in Psoriasis: A Systematic Review and Meta-Analysis." British Journal of Dermatology 169.2 Aug. 2013: 266-282.

Georgescu, Simona-Roxana, et al. "Advances in Understanding the Immunological Pathways in Psoriasis." International Journal of Molecular Sciences 20.739 Feb. 10, 2019: 2-17.

Greb, Jacqueline E., et al. "Psoriasis." Nature Reviews Disease Primers 2 (2016): 1-17.

Kaushik, Shivani B., and Mark G. Lebwohl. "Review of Safety and Efficacy of Approved Systemic Psoriasis Therapies." International Journal of Dermatology 2018.

National Psoriasis Foundation. "Systemic Treatments: Biologics and Oral Treatments." 1-25.

Ogawa, Eisaku, Yuki Sato, Akane Minagawa, and Ryuhei Okuyama. "Pathogenesis of Psoriasis and Development of Treatment." The Journal of Dermatology 2017: 1-9.

Stiff, Katherine M., Katelyn R. Glines, Caroline L. Porter, Abigail Cline & StevenR. Feldman. "Current pharmacological treatment guidelines for psoriasis and psoriaticarthritis." Expert Review of Clinical Pharmacology (2018).

Villaseor-Park, Jennifer, David Wheeler, and Lisa Grandinetti. "Psoriasis: Evolving Treatment for a Complex Disease." Cleveland Clinic Journal of Medicine 79.6 June 2012: 413-423.

Woo, Yu Ri, Dae Ho Cho, and Hyun Jeong Park. "Molecular Mechanisms and Management of a Cutaneous Inflammatory Disorder: Psoriasis." International Journal of Molecular Sciences 18 Dec. 11, 2017: 1-26.

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Psoriasis Treatment, Symptoms, Causes, Types & Diet

What is psoriasis?

Psoriasis is a chronic autoimmune condition that causes the rapid buildup of skin cells. This buildup of cells causes scaling on the skins surface.

Inflammation and redness around the scales is fairly common. Typical psoriatic scales are whitish-silver and develop in thick, red patches. Sometimes, these patches will crack and bleed.

Psoriasis is the result of a sped-up skin production process. Typically, skin cells grow deep in the skin and slowly rise to the surface. Eventually, they fall off. The typical life cycle of a skin cell is one month.

In people with psoriasis, this production process may occur in just a few days. Because of this, skin cells dont have time to fall off. This rapid overproduction leads to the buildup of skin cells.

Scales typically develop on joints, such elbows and knees. They may develop anywhere on the body, including the:

Less common types of psoriasis affect the nails, the mouth, and the area around genitals.

According to one study, around 7.4 million Americans have psoriasis. Its commonly associated with several other conditions, including:

There are five types of psoriasis:

Plaque psoriasis is the most common type of psoriasis.

The American Academy of Dermatology (AAD) estimates that about 80 percent of people with the condition have plaque psoriasis. It causes red, inflamed patches that cover areas of the skin. These patches are often covered with whitish-silver scales or plaques. These plaques are commonly found on the elbows, knees, and scalp.

Guttate psoriasis is common in childhood. This type of psoriasis causes small pink spots. The most common sites for guttate psoriasis include the torso, arms, and legs. These spots are rarely thick or raised like plaque psoriasis.

Pustular psoriasis is more common in adults. It causes white, pus-filled blisters and broad areas of red, inflamed skin. Pustular psoriasis is typically localized to smaller areas of the body, such as the hands or feet, but it can be widespread.

Inverse psoriasis causes bright areas of red, shiny, inflamed skin. Patches of inverse psoriasis develop under armpits or breasts, in the groin, or around skinfolds in the genitals.

Erythrodermic psoriasis is a severe and very rare type of psoriasis.

This form often covers large sections of the body at once. The skin almost appears sunburned. Scales that develop often slough off in large sections or sheets. Its not uncommon for a person with this type of psoriasis to run a fever or become very ill.

This type can be life-threatening, so individuals should see a doctor immediately.

Check out pictures of the different types of psoriasis.

Psoriasis symptoms differ from person to person and depend on the type of psoriasis. Areas of psoriasis can be as small as a few flakes on the scalp or elbow, or cover the majority of the body.

The most common symptoms of plaque psoriasis include:

Not every person will experience all of these symptoms. Some people will experience entirely different symptoms if they have a less common type of psoriasis.

Most people with psoriasis go through cycles of symptoms. The condition may cause severe symptoms for a few days or weeks, and then the symptoms may clear up and be almost unnoticeable. Then, in a few weeks or if made worse by a common psoriasis trigger, the condition may flare up again. Sometimes, symptoms of psoriasis disappear completely.

When you have no active signs of the condition, you may be in remission. That doesnt mean psoriasis wont come back, but for now youre symptom-free.

Doctors are unclear as to what causes psoriasis. However, thanks to decades of research, they have a general idea of two key factors: genetics and the immune system.

Psoriasis is an autoimmune condition. Autoimmune conditions are the result of the body attacking itself. In the case of psoriasis, white blood cells known as T cells mistakenly attack the skin cells.

In a typical body, white blood cells are deployed to attack and destroy invading bacteria and fight infections. This mistaken attack causes the skin cell production process to go into overdrive. The sped-up skin cell production causes new skin cells to develop too quickly. They are pushed to the skins surface, where they pile up.

This results in the plaques that are most commonly associated with psoriasis. The attacks on the skin cells also cause red, inflamed areas of skin to develop.

Some people inherit genes that make them more likely to develop psoriasis. If you have an immediate family member with the skin condition, your risk for developing psoriasis is higher. However, the percentage of people who have psoriasis and a genetic predisposition is small. Approximately 2 to 3 percent of people with the gene develop the condition, according to the National Psoriasis Foundation (NPF).

Read more about the causes of psoriasis.

Two tests or examinations may be necessary to diagnose psoriasis.

Most doctors are able to make a diagnosis with a simple physical exam. Symptoms of psoriasis are typically evident and easy to distinguish from other conditions that may cause similar symptoms.

During this exam, be sure to show your doctor all areas of concern. In addition, let your doctor know if any family members have the condition.

If the symptoms are unclear or if your doctor wants to confirm their suspected diagnosis, they may take a small sample of skin. This is known as a biopsy.

The skin will be sent to a lab, where itll be examined under a microscope. The examination can diagnose the type of psoriasis you have. It can also rule out other possible disorders or infections.

Most biopsies are done in your doctors office the day of your appointment. Your doctor will likely inject a local numbing medication to make the biopsy less painful. They will then send the biopsy to a lab for analysis.

When the results return, your doctor may request an appointment to discuss the findings and treatment options with you.

External triggers may start a new bout of psoriasis. These triggers arent the same for everyone. They may also change over time for you.

The most common triggers for psoriasis include:

Unusually high stress may trigger a flare-up. If you learn to reduce and manage your stress, you can reduce and possibly prevent flare-ups.

Heavy alcohol use can trigger psoriasis flare-ups. If you excessively use alcohol, psoriasis outbreaks may be more frequent. Reducing alcohol consumption is smart for more than just your skin too. Your doctor can help you form a plan to quit drinking if you need help.

An accident, cut, or scrape may trigger a flare-up. Shots, vaccines, and sunburns can also trigger a new outbreak.

Some medications are considered psoriasis triggers. These medications include:

Psoriasis is caused, at least in part, by the immune system mistakenly attacking healthy skin cells. If youre sick or battling an infection, your immune system will go into overdrive to fight the infection. This might start another psoriasis flare-up. Strep throat is a common trigger.

Here are 10 more psoriasis triggers you can avoid.

Psoriasis has no cure. Treatments aim to reduce inflammation and scales, slow the growth of skin cells, and remove plaques. Psoriasis treatments fall into three categories:

Creams and ointments applied directly to the skin can be helpful for reducing mild to moderate psoriasis.

Topical psoriasis treatments include:

People with moderate to severe psoriasis, and those who havent responded well to other treatment types, may need to use oral or injected medications. Many of these medications have severe side effects. Doctors usually prescribe them for short periods of time.

These medications include:

This psoriasis treatment uses ultraviolet (UV) or natural light. Sunlight kills the overactive white blood cells that are attacking healthy skin cells and causing the rapid cell growth. Both UVA and UVB light may be helpful in reducing symptoms of mild to moderate psoriasis.

Most people with moderate to severe psoriasis will benefit from a combination of treatments. This type of therapy uses more than one of the treatment types to reduce symptoms. Some people may use the same treatment their entire lives. Others may need to change treatments occasionally if their skin stops responding to what theyre using.

Learn more about your treatment options for psoriasis.

If you have moderate to severe psoriasis or if psoriasis stops responding to other treatments your doctor may consider an oral or injected medication.

The most common oral and injected medications used to treat psoriasis include:

This class of medications alters your immune system and prevents interactions between your immune system and inflammatory pathways. These medications are injected or given through intravenous (IV) infusion.

Retinoids reduce skin cell production. Once you stop using them, symptoms of psoriasis will likely return. Side effects include hair loss and lip inflammation.

People who are pregnant or may become pregnant within the next three years shouldnt take retinoids because of the risk of possible birth defects.

Cyclosporine (Sandimmune) prevents the immune systems response. This can ease symptoms of psoriasis. It also means you have a weakened immune system, so you may become sick more easily. Side effects include kidney problems and high blood pressure.

Like cyclosporine, methotrexate suppresses the immune system. It may cause fewer side effects when used in low doses. It can cause serious side effects in the long term. Serious side effects include liver damage and reduced production of red and white blood cells.

Learn more about the oral medications used to treat psoriasis.

Food cant cure or even treat psoriasis, but eating better might reduce your symptoms. These five lifestyle changes may help ease symptoms of psoriasis and reduce flare-ups:

If youre overweight, losing weight may reduce the conditions severity. Losing weight may also make treatments more effective. Its unclear how weight interacts with psoriasis, so even if your symptoms remain unchanged, losing weight is still good for your overall health.

Reduce your intake of saturated fats. These are found in animal products like meats and dairy. Increase your intake of lean proteins that contain omega-3 fatty acids, such as salmon, sardines, and shrimp. Plant sources of omega-3s include walnuts, flax seeds, and soybeans.

Psoriasis causes inflammation. Certain foods cause inflammation too. Avoiding those foods might improve symptoms. These foods include:

Alcohol consumption can increase your risks of a flare-up. Cut back or quit entirely. If you have a problem with your alcohol use, your doctor can help you form a treatment plan.

Some doctors prefer a vitamin-rich diet to vitamins in pill form. However, even the healthiest eater may need help getting adequate nutrients. Ask your doctor if you should be taking any vitamins as a supplement to your diet.

Learn more about your dietary options.

Life with psoriasis can be challenging, but with the right approach, you can reduce flare-ups and live a healthy, fulfilling life. These three areas will help you cope in the short- and long-term:

Losing weight and maintaining a healthy diet can go a long way toward helping ease and reduce symptoms of psoriasis. This includes eating a diet rich in omega-3 fatty acids, whole grains, and plants. You should also limit foods that may increase your inflammation. These foods include refined sugars, dairy products, and processed foods.

There is anecdotal evidence that eating nightshade fruits and vegetables can trigger psoriasis symptoms. Nightshade fruits and vegetables include tomatoes as well as white potatoes, eggplants, and pepper-derived foods like paprika and cayenne pepper (but not black pepper, which comes from a different plant altogether).

Stress is a well-established trigger for psoriasis. Learning to manage and cope with stress may help you reduce flare-ups and ease symptoms. Try the following to reduce your stress:

People with psoriasis are more likely to experience depression and self-esteem issues. You may feel less confident when new spots appear. Talking with family members about how psoriasis affects you may be difficult. The constant cycle of the condition may be frustrating too.

All of these emotional issues are valid. Its important you find a resource for handling them. This may include speaking with a professional mental health expert or joining a group for people with psoriasis.

Learn more about living with psoriasis.

Between 30 and 33 percent of people with psoriasis will receive a diagnosis of psoriatic arthritis, according to recent clinical guidelines from the AAD and the NPF.

This type of arthritis causes swelling, pain, and inflammation in affected joints. Its commonly mistaken for rheumatoid arthritis or gout. The presence of inflamed, red areas of skin with plaques usually distinguishes this type of arthritis from others.

Psoriatic arthritis is a chronic condition. Like psoriasis, the symptoms of psoriatic arthritis may come and go, alternating between flare-ups and remission. Psoriatic arthritis can also be continuous, with constant symptoms and issues.

This condition typically affects joints in the fingers or toes. It may also affect your lower back, wrists, knees, or ankles.

Most people who develop psoriatic arthritis have psoriasis. However, its possible to develop the joint condition without having a psoriasis diagnosis. Most people who receive an arthritis diagnosis without having psoriasis have a family member who does have the skin condition.

Treatments for psoriatic arthritis may successfully ease symptoms, relieve pain, and improve joint mobility. As with psoriasis, losing weight, maintaining a healthy diet, and avoiding triggers may also help reduce psoriatic arthritis flare-ups. An early diagnosis and treatment plan can reduce the likelihood of severe complications, including joint damage.

Learn more about psoriatic arthritis.

Around 7.4 million people in the United States have psoriasis.

Psoriasis may begin at any age, but most diagnoses occur in adulthood. The average age of onset is between 15 to 35 years old. According to the World Health Organization (WHO), some studies estimate that about 75 percent of psoriasis cases are diagnosed before age 46. A second peak period of diagnoses can occur in the late 50s and early 60s.

According to WHO, males and females are affected equally. White people are affected disproportionately. People of color make up a very small proportion of psoriasis diagnoses.

Having a family member with the condition increases your risk for developing psoriasis. However, many people with the condition have no family history at all. Some people with a family history wont develop psoriasis.

Around one-third of people with psoriasis will be diagnosed with psoriatic arthritis. In addition, people with psoriasis are more likely to develop conditions such as:

Though the data isnt complete, research suggests cases of psoriasis are becoming more common. Whether thats because people are developing the skin condition or doctors are just getting better at diagnosing is unclear.

Check out more statistics about psoriasis.

The rest is here:

Psoriasis: Causes, Triggers, Treatment, and More

Psoriasis is a common and commonly misunderstood disorder. Its not simply itchy, dry skin; according to the National Psoriasis Foundation (NPF), its caused by an immune-system dysfunction that brings on inflammation. Normally, a persons skin cells grow and shed in about a month, but for a person with psoriasis, that process is sped up, taking only about 3 or 4 days, and the result is a build-up of skin cells causing scales and plaque. About 8 million Americans deal with its discomfort every day, says the NPF.

Psoriasis is not curable, but thankfully its very treatable, says Mona Gohara, MD, associate clinical professor of dermatology at the Yale School of Medicine. Theres no need to endure the psychological or physical discomfort that may come along with this conditionseek treatment for it. There are a range of possible treatments, from topical creams and lotions to prescription oral medications. If you start at the bottom of therapeutic pyramid with creams, this may be enough to quell the irritation, says Dr. Gohara.

Some creams and lotions that can ease the dryness and itch are available over the counter; with others, youll need a prescription from a doctor. It takes a bit of trial and error to find what topical treatment may work best for you. Here, some guidance to the most common types of creams and lotions for psoriasis.

This is the active ingredient (approved by the FDA for treating psoriasis) in treatments that can help banish scales by softening them and making the outer layer of skin shed. You can find salicylic acid in many forms (not just lotions/creams/ointments, but also foams, soaps, gels, patches, and more). These treatments are designed to work in combo with others, because getting rid of the scales can help other treatments do their work more efficiently. If its a strong version, salicylic acid can irritate the skin and make hair more likely to break off, and that can lead to temporary hair loss, says the NPF.

The NPF says that these are the most frequently used treatments for psoriasis. Theyre designed to quell inflammation and pump the brakes on the growth of skin cells (this helps sidestep the buildup that produces scales). Steroid treatments come in different strengths; mild ones are available over the counter (OTC) and stronger types require a prescription. Generally, the stronger ones are needed for elbows, knees, and other hard to treat areas. These are powerful meds with potential side effects (thin skin, broken blood vessels, and more) and should be used carefully under a medical doctor's supervision. Also,the use of topical steroids on brown skin can create lightening, which may take time to repigment, says Dr. Gohara. Its always important to apply steroids directly on, not all around, lesions or areas of concern.

The NPF advises not to use a topical steroid for longer than three weeks without consulting a doctor, as well as to avoid stopping the use of one suddenly because that can cause a flare-up of your psoriasis. Another reason to use these under the care of a physician: Topical steroids can be absorbed via the skin and have an impact on internal organs when used for a long period of time or over a wide area of skin.

These prescription treatments also come in various forms not just creams, lotions and ointments, but also gels, foams, and more. In some medications, vitamin D is combined with a steroid. Like other treatments, meds with vitamin D slow down the pace of your skin cells' growth. (Depending on the specific medication, side effects can include skin irritation, stinging, burning, itching or excessive calcium in the urine.) One advantage of vitamin D creams is they dont run the risk of causing skin atrophy a very real side effect of chronic topical steroid use, says Dr. Gohara. But they can be more irritating. Generally, systemic side effects are rare, yet hypercalcemia is a theoretical risk, and your doctor may opt to have you get blood tests.

Vitamin A treatments

A topical retinoid, vitamin A is the active ingredient in prescription medication that comes in the form of a cream, gel, or foam. It also works by slowing the growth of skin cells. When using it, the plaques of psoriasis may turn bright red before clearing up. Side effects here also include skin irritation; the medication increases the risk of sunburn as well, so its critical to use sunscreen to protect your skin when using these meds.

Coal tar

This ingredient is found in different strengths in various treatment forms, including shampoo. It can be found in OTC products in its weaker strength and by prescription for stronger versions. Like other products, coal tar slows the growth of skin cells, but it can be stinky and irritating, and can stain your bedding and clothes (as well as blond hair).

Heres one of the challenging things about treating psoriasis: Your body can build up a tolerance to a certain medications, so something that seemed magical in its ability to bring you relief could suddenly stop working. On the other hand, a treatment that didnt work for you years ago could suddenly work wonders.

Thats why trial and error is a necessary part of psoriasis treatment. Finding the right treatment for psoriasis is much like finding the right partner. It may take some 'dating' until the right one finally comes along, says Dr. Gohara. Some may work for a bit, but then efficacy fizzles. Topical steroids are the most common culprit of this phenomenon, although it may happen with other topical or systemic medication as well.

According to the National Psoriasis Foundation, its key to moisturize daily it can lessen the itchy redness. They recommend that you use fragrance-free products and soaps that moisturize rather than dry you out, skip the way-hot shower (keep it lukewarm), and rub on moisturizer right after showering. The NPF recommends these OTC creams, based on information theyve heard from dermatologists while emphasizing that none of them are stand-ins for treatment from a healthcare provider. Still, theyre all deeply moisturizing and may improve some pesky symptoms such as flaking and itching:

Anti-Itch Concentrated Lotion with Calamine and Triple Oat Complex

This creamhas anti-inflammatory and antioxidant ingredients.

Moisturizing Cream for Psoriasis

CeraVe developed this with dermatologists to moisturize skin and rebuilt the skin barrier.

Hydra Therapy, Itch Defense Moisturizer

A shea butter lotion, it's designed to be used right after a shower.

Psoriasis Medicated Treatment Gel

$43.98

This gelhas salicylic acid to work on scales, itching, and dryness.

Skin Calming Intensive Itch Relief Lotion

With menthol and oatmeal, the lotion is especially good for nighttime itching, according to the manufacturer.

Ultimate Multi-Symptom Psoriasis Relief Cream

$28.82

A soothing cream with salicylic acid and a bunch of moisturizers.

Intense Skin Repair Body Lotion

Lubridermamazon.com

The manufacturer says this deeply moisturizing lotion lasts for 24 hours to help repair skin.

Medicated Moisturizing Psoriasis Cream

A salicylic acid cream that also contains aloe and shea butter.

This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. You may be able to find more information about this and similar content at piano.io

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The Best Creams for Psoriasis - Over-the-Counter and ...

Psoriasis is a skin condition that creates red patches of skin with white, flaky scales. It most commonly occurs on the elbows, knees and trunk, but can appear anywhere on the body. The first episode usually strikes between the ages of 15 and 35. It is a chronic condition that will then cycle through flare-ups and remissions throughout the rest of the patient's life. Psoriasis affects as many as 7.5 million people in the United States. About 20,000 children under age 10 have been diagnosed with psoriasis.

In normal skin, skin cells live for about 28 days and then are shed from the outermost layer of the skin. With psoriasis, the immune system sends a faulty signal which speeds up the growth cycle of skin cells. Skin cells mature in a matter of 3 to 6 days. The pace is so rapid that the body is unable to shed the dead cells, and patches of raised red skin covered by scaly, white flakes form on the skin.

Psoriasis is a genetic disease (it runs in families), but is not contagious. There is no known cure or method of prevention. Treatment aims to minimize the symptoms and speed healing.

There are five distinct types of psoriasis:

People who have psoriasis are at greater risk for contracting other health problems, such as heart disease, inflammatory bowel disease and diabetes. It has also been linked to a higher incidence of cardiovascular disease, hypertension, cancer, depression, obesity and other immune-related conditions.

Psoriasis triggers are specific to each person. Some common triggers include stress, injury to the skin, medication allergies, diet and weather.

Psoriasis is classified as Mild to Moderate when it covers 3% to 10% of the body and Moderate to Severe when it covers more than 10% of the body. The severity of the disease impacts the choice of treatments.

Mild to moderate psoriasis can generally be treated at home using a combination of three key strategies: over-the-counter medications, prescription topical treatments and light therapy/phototherapy.

The U.S. Food and Drug Administration has approved of two active ingredients for the treatment of psoriasis: salicylic acid, which works by causing the outer layer to shed, and coal tar, which slows the rapid growth of cells. Other over-the-counter treatments include:

Prescription topicals focus on slowing down the growth of skin cells and reducing any inflammation. They include:

Controlled exposure of skin to ultraviolet light has been a successful treatment for some forms of psoriasis. Three primary light sources are used:

Treatments for moderate to severe psoriasis include prescription medications, biologics and light therapy/phototherapy.

Oral medications. This includes acitretin, cyclosporine and methotrexate. Your doctor will recommend the best oral medication based on the location, type and severity of your condition.

Biologics. A new classification of injectable drugs, biologics are designed to suppress the immune system. These tend to be very expensive and have many side effects, so they are generally reserved for the most severe cases.

Light Therapy/Phototherapy. Controlled exposure of skin to ultraviolet light has been a successful treatment for some forms of psoriasis. Two primary light sources are used:

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Psoriasis - Melbourne, FL Dermatologist

Researchers in China documented 2 cases of refractory erythrodermic psoriasis (EP) effectively treated with secukinumab, a fully humanized immunoglobulin (IgG)1k monoclonal antibody that neutralizes interleukin (IL)-17A. After 4 weeks of a standard treatment regimen, patients demonstrated a 75% reduction in the Psoriasis Area and Severity Index score (PASI).

Although secukinumab has been shown to result in rapid and sustained improvements of plaque psoriasis symptoms, clinical data on the treatment of EP with the drug are scarce. The condition, which accounts for 1% to 2.25% of all psoriatic cases, impacts over 80% of the body surface area (BSA) and usually occurs in patients with poor control of existing psoriasis.

Both patients included in the case series (1 male, 1 female) presented with severe EP and were resistant to treatment with acitretin or methotrexate. The male patient also presented with cirrhosis while the female patient had iridocyclitis. Both individuals continued with secukinumab for at least 32 weeks and no adverse reactions were observed during follow-up.

The 50-year-old female patient originally presented with plaque psoriasis lesions at age 26. Her erythroderma was initially relieved under oral acitretin but soon gradually thickened and spread to the whole body, authors wrote. In July of 2019 she presented to a dermatology clinic with extensive erythroderma (100% BSA) and a PASI score of 40.

Following once weekly treatment of 300 mg of secukinumab subcutaneously between weeks 0 through 4, and 300 mg every 4 weeks, the patients PASI score and BSA decreased to 9.8% and 40.45%, respectively, at week 4. By week 12, she achieved a 90% reduction in PASI score with no adverse events, while at 32 weeks she remained free of relapse and adverse events.

Similarly, a 46-year-old man who was diagnosed with plaque psoriasis during adolescence achieved initial alleviation using oral acitretin treatment at age 38. In May 2019, the drug exhibited decreased efficacy and the patient was admitted in July 2019 with extensive erythroderma (PASI 28, BSA 80%). The patient also exhibited signs of early cirrhosis caused by the drug and other factors, though tests revealed normal liver and kidney function.

At weeks 0,1,2,3, and 4 the male patient injected 300 mg of secukinumab, followed by a 300 mg dose once every 4 weeks. At week 4, the patients PASI score and BSA decreased to 7.6 and 29.6%, respectively. Results were sustained without any side effects after 40 weeks.

National Psoriasis Foundation guidelines, updated in 2010, recommend cyclosporine or infliximab as first-line therapy for unstable cases of EP and acitretin or methotrexate for patients who present with less acute disease.

However, traditional treatments, including acitretin, cyclosporine, methotrexate, and supportive symptomatic treatment, often have limited efficacy and adverse effects, which do not meet the expectations of patients, authors wrote.

Because patients in China typically use traditional Chinese medicine for initial treatment, individuals have often already developed moderate or severe psoriasis by the time they seek professional help.

As noted with other biologic drugs, the metabolism of secukinumab is not affected by renal function, and hemodialysis does not seem to affect its plasma concentration, researchers said.

Future clinical trials with large samples ought to be carried out to support findings while personalized plans based on patient characteristics to ensure retention rates and reduce adverse reactions are warranted.

Secukinumab may be a viable, rapid treatment option for patients with EP who experience failure of multiple therapies, authors concluded.

Reference

Liu L, Jin X, Sun C, and Xia J. two cases of refractory erythrodermic psoriasis effectively treated with secukinumab and a review of the literature. Dermatol Ther. Published online February 2, 2021. doi:10.1111/dth.14825

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Researchers Report 2 Cases of Erythrodermic Psoriasis Effectively Treated With Secukinumab - AJMC.com Managed Markets Network

GPP is a chronic-relapsing and potentially life-threatening disorder and is considered a phenotype of pustular psoriasis. It presents with multiple coalescing sterile pustules on erythematous skin; patients may also have fever, malaise, high white blood cell counts, and elevated C-reactive protein (CRP). It can also appear as arthritis, acute respiratory distress syndrome, cholestasis, and neutrophilic cholangitis. Because it is so rare, data from larger, high-quality clinical studies are not available, the authors wrote.

Researchers analyzed medical records from January 2005 to May 2019 containing information about 201 treatment series from 86 patients with GPP. Those who had exclusive treatment with systemic glucocorticoids or phototherapy were excluded, as were patients with 1 prior course of treatment with anakinra but who then switched to secukinumab; or with brodalumab who then switched to ustekinumab.

Overall, 65.1% of the patients were female, with an average age of 51.2 years when GPP began; they had a mean disease duration of 8.7 years. Laboratory results from their first visit to a medical center showed elevated CRP in just over 75% of the patients; 62.4% had leukocytosis; 38.1% had an electrolyte imbalance; other patients had hypocalcemia, hypo- or hyperkalemia, or hyponatremia.

Additional characteristics stemming from flare-related complications that indicated the severity of the disease included:

Additionally, nearly 13% of the patients needed admission to an intensive care unit or other intensive care due to a GPP flare; 74.1% of patients had evidence of disease at the time of their last visit.

Patients had received an average 2.3 systemic therapies for GPP. Psoriatic vulgaris was diagnosed in 50.0% and psoriatic arthritis in 17.4% of the patients.

Overall, an excellent response was reached in 41.3% of all treatment courses, and a partial response was seen in 31.4%. Nonresponse occurred in 27.3% of treatment courses.

Biological treatment was significantly more effective than nonbiological therapies, with biologics seeing an excellent response in 47.4% of treatment series compared with 35.9% of nonbiologics (P = .02). Overall, the median drug survival was 14 months (36 months for biologics vs 6 months for nonbiologics; P <.001).

Inhibitors of interleukins 17A and 23 showed particularly strong efficacy and drug survival, the researchers said, and should be considered earlier in the course of the disease. They noted that in Japan, guidelines on GPP recommend biologics and antitumor necrosis factor agents for GPP; in Germany, corticosteroids and acitretin are the only licensed drugs for GPP.

The crude probability of drug survival was highest for secukinumab (HR of drug discontinuation compared with acitretin, 0.22), followed by ixekizumab and ustekinumab (HR, 0.38 each).

This study is one of the larger case series adding to the growing evidence on treatment of GPP and, to our knowledge, is the first in-depth analysis of drug survival in GPP in a real-life setting, the researchers wrote.

Reference

Kromer C, Loewe E, Schaarschmidt ML, et al. Drug survival in the treatment of generalized pustular psoriasis: a retrospective multicenter study. Dermatol Ther. Published online January 26, 2021. doi:10.1111/dth.14814

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Rare, Severe Type of Psoriasis Merits Biologic Consideration, Researchers Say - AJMC.com Managed Markets Network

Raynauds syndrome, also known as Raynauds phenomenon, is a condition that affects body extremities such as the fingers.

In response to a trigger like cold air or emotional stress, blood vessels become narrow and normal circulation is cut off. This can make your fingers very pale or blue, tingly, or numb. Raynauds can also sometimes affect other areas like your toes, nose, and ears.

Raynauds syndrome has been associated with certain autoimmune diseases.

Psoriatic arthritis (PsA) is a chronic, inflammatory autoimmune condition. It affects the joints and surrounding areas where the bone connects to ligaments and tendons. It can occur at any age but often develops between ages 30 and 50.

If you have PsA, you may be wondering if you should be looking out for signs of Raynauds syndrome. Read on for more information about the two conditions.

While PsA is a type of autoimmune disease, research supporting a direct correlation between PsA and Raynauds is limited. Theres not much evidence to show that the two conditions are related.

However, its possible to have both conditions.

If you experience symptoms of cold intolerance and color changes of your fingers or toes, a rheumatologist can perform tests to determine whether or not those symptoms are consistent with Raynauds.

This diagnostic process may include:

Certain factors can increase your chance of developing Raynauds phenomenon. They include:

Raynauds syndrome has been linked to another inflammatory type of arthritis called rheumatoid arthritis. Still, Raynauds is less common in rheumatoid arthritis compared with other types of rheumatic diseases, such as lupus.

Raynauds phenomenon is a type of vasculitis. The sudden narrowing of the arteries in your fingers or other extremities is called vasospasm, and it happens in response to triggers like cold and anxiety.

Over time, people who have been living with rheumatoid arthritis may develop vasculitis. Where rheumatoid arthritis affects the joints, vasculitis causes inflammation in the blood vessels. This affects blood flow to certain areas of your body.

Vasculitis can cause artery walls to become inflamed, which narrows the passage through which your blood travels.

PsA treatment depends on the frequency and severity of symptoms you experience. Mild, intermittent PsA symptoms can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, taken as needed.

More severe cases of PsA are treated with stronger medications like disease-modifying anti-rheumatic drugs (DMARDs) and biologics, or even surgery.

Treatment for Raynauds is different from PsA treatment and depends on the type. There are two types of Raynauds: primary and secondary.

Known as Raynauds disease, the primary form of Raynauds occurs without any associated medical conditions. Blood work is often normal with no indicators that anything is out of the ordinary.

Primary Raynauds can usually be managed with self-care measures. These include:

In some cases, Raynauds is the first sign that another underlying condition is present. Known as Raynauds syndrome or phenomenon, the secondary form of Raynauds is thought to occur as the result of an autoimmune-related condition, such as:

Secondary Raynauds is often more severe and can require more intervention to manage. It can cause pain and even result in complications like skin ulcers and gangrene. Its less common than primary Raynauds and usually occurs in people over 30 years of age.

Secondary Raynauds can benefit from lifestyle changes as well. However, its often most improved when the underlying condition is treated.

Other treatments specifically for Raynauds aim to prevent tissue damage like ulcers. These include:

PsA is an inflammatory, autoimmune type of arthritis that can accompany psoriasis. Raynauds phenomenon is a type of vasculitis, or narrowing of the blood vessels.

Both conditions are a result of an overactive immune system, which triggers inflammation in the body.

Research supporting a direct link between PsA and Raynauds is limited, but its possible to have both conditions. If you experience Raynauds symptoms, talk to your rheumatologist.

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Psoriatic Arthritis and Raynaud's Syndrome: The Link - Healthline

- The British Journal of Dermatology has publishedevidence of sustained efficacy in tildrakizumab responders and a favourable long-term safety profile with total tildrakizumab exposure of over 5400 patient-years through 5 years (256 weeks)[1]

- The full complete pooled dataset demonstrates long-term psoriasis control with tildrakizumab with a consistent long-term safety profile through 5 years (256 weeks)[1]

- This is the first and longest complete pooled dataset published in a medical journal on an anti-IL23p19 inhibitor

BARELONA, Spain, Feb. 9, 2021 /PRNewswire/ -- Almirall, S.A. (BME: ALM), a global biopharmaceutical company focused on skin health, announced today that the British Journal of Dermatology (BJD) has published a full 5-year pooled data analysis from two phase III clinical studies, reSURFACE 1 and reSURFACE 2 of Ilumetri (tildrakizumab), an IL-23p19 inhibitor for the treatment of moderate-to-severe plaque psoriasis, and can be found in the BJD online library. These data provide evidence of sustained efficacy in tildrakizumab responders and in patients switched from etanercept to tildrakizumab at week 28, and a favourable long-term safety profile with total tildrakizumab exposure of over 5400 patient-years. During this period, PASI and PGA response rates were maintained in a large proportion of patients[1]. This is the first and longest complete dataset published in a medical journal on an anti-IL23p19 inhibitor.

Long-term efficacy and safety: up to 5-year results from reSURFACE 1 and reSURFACE 2[1]

Results of the 5-year pooled data from reSURFACE 1 and reSURFACE 2demonstrated long-term control of psoriasis, with a large proportion of patients who responded at week 28 maintaining efficacy by both relative and absolute PASI. Absolute PASI <3 at week 244 for tildrakizumab 100mg and 200mg were 78.8% and 82.6% respectively. PGA 0/1 at week 244 for tildrakizumab 100mg and 200mg were 68.5% and 74.2%, respectively (multiple imputation for missing data). Results show a favourable long-term safety profile with a total tildrakizumab exposure of over 5400 patient-years. Both 100mg and 200mg doses weregenerally well tolerated with low rates of serious adverse events and adverse events of special interest through 5 years.

"In our study, patients who responded to tildrakizumab maintained a clinically significant response over 5 years. Control of psoriasis was sustained with a reassuring safety profile. This tildrakizumab study confirms the role that the IL23p19 class can play in achieving long term control for our psoriasis patients," stated Prof Diamant Thai, Director of the Comprehensive Centre for Inflammation Medicine at Lbeck University in Germany, the first author of the study.

Safety was further explored in different analyses examining incidence rates of severe infections, malignancies, and major adverse cardiovascular events, as well as overall safety in patients over 65 years of age. No new reported signals were found in any of the sub-groups.

About tildrakizumab[2]

Tildrakizumab is a humanized monoclonal antibody that targets the p19 subunit of interleukin-23 (IL-23) and inhibits the release of proinflammatory cytokines and chemokines with limited impact on the rest of the immune system. Indicated for the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy. Tildrakizumab demonstrated superiority vs placebo and etanercept in the phase 3 reSURFACE programme. Significantly more tildrakizumab patients achieved PASI 75 at Week 12 vs. placebo in both studies [re-SURFACE-1/2: 64%/61% (100 mg), 62%/66% (200 mg) vs 6%/6% (PBO), p<0.0001] and vs. etanercept [reSURFACE-2: 61% (100 mg, p=0.001), 66% (200 mg, p<0.0001) vs 48%]. Significantly more tildrakizumab patients achieved a PGA score of 'clear' or 'minimal', with 2-grade reduction from baseline at Week 12 in both studies vs. placebo [re-SURFACE-1/2: 58%/55% (100 mg), 59%/59% (200 mg) vs 7%/4% (PBO), p<0.0001], TIL 200 mg (59%, p=0.0031) and TIL 100 mg (55%, p=0.0663) vs. ETA (48%). The incidence of severe infections, malignancies, and major adverse cardiovascular events seen in the clinical trials were low and similar across treatment groups, with the most common AE being nasopharyngitis. Tildrakizumab was administered as 100 or 200 mg injection(s) at week 0 and 4 in the induction phase and then every 12 weeks thereafter for maintenance. DLQI 0/1 at week 12 was achieved by 42% of patients (n=309); by week 28 it was achieved by 52% of the patients (n=299) with patients reporting that psoriasis no longer affected their lives. By week 52, 64% of the responders at week 28 achieved DLQI 0/1 (n=113).

Almirall in-licensed Tildrakizumab from Sun Pharmaceutical Industries Ltd. (Sun Pharma) in July 2016. The agreement is for development and commercialization of tildrakizumab in Europe. So far, tildrakizumab has been launched in Germany, United Kingdom, Switzerland, Austria, Denmark, Spain, Italy and France.

References

1. Thai D, Piaserico S, Warren RB, et al. Five-year efficacy and safety of tildrakizumab in patients with moderate to severe psoriasis who respond at week 28: pooled analyses of two randomised phase 3 clinical trials (reSURFACE 1 and reSURFACE 2). Br J Dermatol. 2021 Feb 5. doi: 10.1111/bjd.19866.

2. IlumetriI (tildrakizumab) Summary of Product Characteristics.

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https://www.almirall.com/

SOURCE Almirall, S.A.

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Almirall announces a new publication in the British Journal of Dermatology of ILUMETRI (tildrakizumab) as the first anti-IL23p19 treatment for which...

Arthritis is a painful rheumatic condition that causes joint inflammation. There are many different types of arthritis that can affect the joints and other areas of the body and cause similar symptoms, such as pain, swelling, and stiffness.

There are more than 100 different types of arthritis. Some common types of arthritis include osteoarthritis (OA), rheumatoid arthritis (RA), and psoriatic arthritis (PsA).

Below, we explore these conditions, as well as other diseases that can present with arthritis. We also discuss potential treatment and when to seek medical guidance.

According to the Centers for Disease Control and Prevention (CDC), OA affects over 32.5 million adults in the United States.

Symptoms of OA include:

People often experience OA symptoms in the hips, hands, and knees.

The following increase the likelihood of developing OA:

Learn more about OA here.

RA is an autoimmune condition that causes painful swelling and inflammation in the joints. It typically affects the hands, wrists, and feet.

RA does not only affect joints. It can also cause problems in other organs of the body, including the heart, lungs, and eyes.

While some people experience a sustained progression of the disease, the intensity of symptoms usually comes and goes. Symptoms may include:

Another characteristic of RA is symmetrical involvement. This means pain and signs of inflammation occur on both sides of the body and in the same joints.

RA can cause lasting tissue damage, which can lead to:

Some people who have RA may also need assistance walking.

Some RA risk factors include:

Learn more about RA here.

PsA is an autoimmune condition.

Symptoms of PsA include:

PsA joint involvement is asymmetric, affecting different joints on either side of the body.

This type of arthritis can develop in people with a skin condition called psoriasis, which causes scaly, flushed, or silvery patches of skin. These patches can look different depending on a persons skin color.

Learn more about psoriasis on black skin here.

Researchers still do not fully understand what causes this form of arthritis. However, having a family history of PsA may increase a persons risk of developing this condition.

Learn more about PsA here.

Gout is a type of arthritis that causes painful swelling, often in a single joint at a time.

Symptoms of gout can flare up and go away quickly. They include:

Swelling is common in the big toe. Often, it also affects the knee or ankle joint.

A person may be at higher risk of developing gout if they:

Health conditions that may lead to gout include:

Gout may also occur due to metabolic syndrome, which is not a condition in itself. It refers to a number of characteristics, diseases, or habits that can make a person more likely to experience other health conditions, such as heart disease, stroke, or diabetes.

Learn more about gout here.

This chronic illness is an autoimmune condition that commonly affects females aged 1544 years.

Lupus is not a type of arthritis in itself. However, arthritis is one of the most common symptoms of this condition.

One symptom of lupus is the characteristic butterfly rash that can develop on the face. Other rashes can also develop on the arms, hands, and face. Rashes can worsen after sun exposure.

While symptoms may differ from person to person, they generally include:

Learn more about lupus here.

Juvenile arthritis, also known as childhood arthritis, affects children or even infants.

Symptoms of juvenile arthritis include:

There is no known cause of childhood arthritis. It appears to affect children regardless of race, age, or background.

Learn more about juvenile arthritis here.

Reaching a definitive diagnosis may take time, because many types of arthritis are similar or resemble other conditions.

Typically, a doctor will first check a persons medical and family history. They will also ask about symptoms and perform a physical exam. They may run tests such as:

Arthritis management depends on the type of arthritis. There are different forms of treatment available.

Medical treatment for arthritis may involve:

Surgery may not be necessary for everyone with arthritis. However, it can benefit certain complications of arthritis that result in malalignment of joints and functional limitations due to damaged joints. It can also help with intractable pain, which is when a person experiences pain that is difficult to treat or manage.

Common surgeries for arthritis include:

Physical therapy can be a great option for people with arthritis. It can help ease pain or increase activity.

Behavioral changes that can help with arthritis may include:

Some people find certain home remedies helpful in relieving pain and swelling from certain types of arthritis. These may include:

If a person has experienced joint symptoms that last more than 3 days, they should seek treatment from a healthcare professional.

Similarly, if a person has joint symptoms at different times within a month, they should also contact a doctor.

Medications and other treatments can help a person manage chronic symptoms, such as pain and swelling.

Pain will come and go with many types of arthritis. However, even if the pain resolves, a person should still seek treatment.

It is important to treat arthritis early. If left untreated, some types of arthritis may worsen over time and cause permanent disability.

Arthritis is a painful condition that causes joint inflammation.

Different types of arthritis can cause similar symptoms. It is vital to get the correct diagnosis, as it can help determine most effective treatment options.

The right treatment may also prevent future complications and help a person live a more active life.

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Common types of arthritis: Location, causes, treatment, and more - Medical News Today

Dr. Mikita

Our skin is one of our hardest working organs. It not only protects all the other organs in our bodies, and can repair itself, but it also regulates body temperature and detects and fights off infection. Healthy skin is an essential part of your overall health and wellness, yet most of us take our skin for granted, especially in the winter.

Winters

Effects

on Skin

Frequent hand washing and sanitizer use may already be taking a toll on your hands as the pandemic continues, but as temperatures and humidity levels continue to drop, other body parts can also get itchy, cracked, and irritated.

The harsh weather can strip the skins natural protective barrier, creating gaps in the outer most layer, allowing water to escape promoting dehydration and irritants to get in. The dry environment may be responsible for that uncontrollable itch, as the inflammatory response kicks in and releases histamines. It can exacerbate inflammatory skin diseases such as rosacea, eczema, ichthyosis, and psoriasis, which suffer an impaired barrier function.

Tips to Avoid a Painful

Season

If you are not prepared, the changes to your skin can make for a long winter. Knowing how your skin typically reacts to cold weather can help you create a routine ahead of time and keep your skin from reacting negatively to fall and winter.

Know Your Skin: As winter approaches, try to remember how your skin changed during past winters. Maybe your skin stayed the same as it did in the summer. This could be because of the routine you have in place. If your skin changed and became dryer than usual, this may mean you need to better prepare your skin for winter.

If you know your skin is prone to drying out from cold weather, a way to prepare your skin before and during the winter is to stick to short and warm showers. Long, hot showers can feel great after a cold day, but can strip your skin of important oils, leaving it dry.

Its All About Moisture: Find a good moisturizer and use it before the cold weather hits and throughout the cold weather season. A moisturizer does exactly what its name implies: moisturizes. Moisturizing your skin in preparation for the cold weather and during the winter can help your skin from becoming dried out. An oil-free moisturizer that contains glycerin is best to help keep skin hydrated.

Some Conditions Require Special Treatment: If you have eczema or psoriasis, you will have to do more than simply slather on extra lotion and drink more water.

In the case of eczema, your body overreacts to an external trigger, such as dust mites or perfumes in cosmetics and soaps. Eczema develops as itchy, red skin, often in areas where skin touches skin, such as in the bends of the arms or knees. If you have eczema, its important to use fragrance-free, hypoallergenic soap and moisturizers, as fragrances can cause allergies and further trigger itchiness and inflammation. One over-the-counter cream that may help provide relief from symptoms. You should also use scent-free hypoallergenic laundry detergent for the same reason. Certain fabrics, such as those made with wool, may be irritating to delicate skin as well.

In the case of psoriasis, a hyperactive immune response causes new skin cells to proliferate more quickly than old ones can be shed. The result is that cells pile up on top of each other, causing red patches with silvery scales. Psoriasis almost always requires prescription treatment because of the underlying autoimmune disease, but the best option varies depending on how much of the skin is impacted. Lack of sun exposure during winter months can also have an effect on psoriasis so your provider may consider phototherapy, a treatment that essentially involves using a light box to expose skin to controlled amounts of UV light in order to dampen inflammation.

Preparation Can Go a Long Way

Dry skin can make for an uncomfortable winter which is why preparation is key as we continue through the cold winter months. If youre having trouble managing your skin care, talk to a dermatologist. Your dermatologist can help you develop a routine and care plan to meet your skins unique needs. If youre experiencing severely dry or chapped skin, or if youve recently developed a rash thats not improving, talk to your doctor as these could be signs of a dermatologic condition or symptoms of more serious illness or allergic reaction.

Dr. Sabrina Mikita is a dermatologist with UPMC seeing patients at SH Dermatology located at 1205 Grampian Blvd., Suite 1A, Williamsport. For more information or to schedule an appointment, call 570-326-8060.

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Highmark, a Blue Cross Blue Shield-affiliated health insurer, will expand access to Freespira's digital therapeutic for PTSD, panic disorder, panic attacks and other panic symptoms.

In addition to bringing the treatment to members living in Pennsylvania, Delaware and West Virginia, the agreement will also provide remote coaching on how to use Freespirato those not already receiving support from a behavioral health professional, according to the announcement.

"We are pleased with the clinical and financial outcomes achieved for our health plan members through the use of Freespira," Demetrios C. Marousis, director of behavioral health at Highmark, said in a statement.

"This breakthrough, drug-free treatment has reduced the impact of symptoms associated with panic attacks, resulting in reduced use of medications and other healthcare costs for symptom management. Freespira adds value to our members' plans and helps us to create a remarkable health care experience, freeing people to be their best."

Barcelona-based biopharma company Almirall and New York-based Happify Health will be working together to develop an international version of Claro, a digital treatment that addresses the mental health of psoriasis patients. This product would be designed for psoriasis patients living in Spain, Italy, France and the U.K., and would be deployed later this year through the Almirall patient support program.

"Since mental health events act as stressors that can trigger psoriasis flare ups, Happify is excited to work with a European leader like Almirall in this condition to address the mental and physical health symptoms of these patients," Chris Wasden, head of digital therapeutics at Happify Health, said in a statement.

"Our digital therapeutic solution acts as a complement to Almirall's commitment to psoriasis patients to empower people with psoriasis to live full lives through meaningful behavior change. Together, we can help psoriasis patients, one patient at a time, and at scale."

Kaiser Permanente has signed a multi-year collaboration with Accenture and Microsoft to bring more of its digital ecosystem to the cloud. The healthcare provider said that the partnership will enable new capabilities for Kaiser Permanente members and clinicians alike for more personalized and accessible care.

This collaboration will help Kaiser Permanente better serve our members by providing our care teams with increased access to cloud-based services, which will enable them to deliver personalized digital experiences and make more data-informed decisions, Diane Comer, SVP and interim CIO for Kaiser Permanente, said in a statement.

Boehringer Ingelheim's representatives will be using air quality data from BreezoMeter when speaking with clinicians about their patients' respiratory health, the pharma company announced last week. By tapping both real-time and historical data, Boehringer would be able to help predict when and whether environmental stressors could exacerbate symptoms of asthma, COPD and other conditions, and thereby raise awareness among providers.

"We complement our commitment to developing innovative therapies by developing innovative digital solutions with the goal of supporting healthcare providers in managing chronic conditions, Jim Boushie, executive director of business transformation at Boehringer Ingelheim, said in a statement.

To improve respiratory health and treatment plans, we utilize BreezoMeters data to help expose the effects of high pollution and pollen. Their air quality analytics empower our teams and will continue to inform how we collaborate with physicians to improve patient outcomes.

Otsuka Pharmaceutical's Development & Commercialization arm has partnered with Spencer Health Solutions, the maker of an at-home medication adherence platform, to further evaluate and deploy direct-to-patient services through the device. In particular, the pharma company said it will be considering the device's medication adherence and patient engagement capabilities in upcoming traditional and decentralized clinical trials.

Our commitment to the democratization of clinical trials, patient engagement and leveraging technology to improve diversity and inclusion in clinical research helps drive our success at Otsuka, Dr. Christoph Koenen, EVP and chief medical officer at Otsuka Pharmaceutical Development & Commercialization, said in a statement.

The spencersmart hub will be an asset in our efforts to improve treatment plans for people living with challenging health conditions.

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Highmark expands access to Freespira's DTx, Almirall and Happify developing digital mental health program for European psoriasis patients and more...

Having lived through a global pandemic for going on a year now, weve learned a lot, like that face masks are important, toilet paper is a hot commodity, and the world of exotic animals is far wilder than we could have possibly imagined. And while all (*gestures wildly*) of that was going on, we still managed to learn a lot about skin care while social distancing at home as well.

As many of us used the time at home to recalibrate our beauty routines, we relied on some of our favorite dermatologists to help us do it properly. Over the course of the pandemic, Well+Good has published hundreds of stories about skin care, ranging from how to deal with maskne (a word none of us had ever even heard before 2020) to how to treat psoriasis with a $10, over-the-counter lotion. To find out which tips have made the biggest difference in our skin during this unusual year, keep on scrolling.

Cleansing oil is known to be one of the gentlest, most effective types of face wash that works for all skin types, but in order to reap its full benefits, youve got to use it properly. According to derms, you should start by applying it to dry skin, which will better help it pick up the makeup, dirt, and oil from your pores, massage it in circular motions, then rinse it off entirely with warm water (never cold, because it will solidify the oil) to ensure it gets off all the gunk.

Adult acne is very much a thing, which means that when youre trying to treat it, you also may be trying to treat fine lines and wrinkles. The fix, according to board-certified dermatologist Joshua Zeichner, MD, is to use a simple two-ingredient combo. You need to make sure that the acne products are in line with other aesthetic needs of the patients, he says. Thats where topical retinoids are really helpful, and ingredients like salicylic acid, because they both give exfoliating benefits, and skin brightening and evening benefits, and retinoids can also help to stimulate collagen production.

There are plenty of effective hydrating ingredients out there (in the video above, board-certified dermatologist Mona Gohara, MD, names five of them), but the one that unquestionably deserves a spot in any no-frills routine is glycerin. Humectants attract water to the skin, explains Dr. Gohara, adding that glycerin and other fan-fave hydrator hyaluronic acid both fall into this category. And glycerin is not only so great at drawing water into the skin, but its also super gentle, which is why youll see it in a ton of products. I personally think that glycerin is the one ingredient thats good for everyone. Its no bells and whistles, we know it works, and everybody should have it.

There are certain serumslike the Skinceuticals legendary vitamin C serumthat are worth spending big bucks on. But others? Not so much. According to Dr. Gohara, its A-okay to skimp on other spots in your routine. When it comes to splurging, think about antioxidants, retinol, and any specific skin concern that you may have, she says. But I definitely think a gentle cleanser, a sunscreen, or even a moisturizer are places where you can save. This way, you can save up for one whizzbang treatment that really works.

Toner is one of the skin-care worlds most confusing routine steps, and derms have differing opinions on whether you really need it or not. The trick to getting the most out of it? Only apply it to certain spots. If you feel like you need it, just use it on areas where you may need a little extra love on your skin, says Dr. Gohara. If you have dry patches, look for a hydrating toner with hyaluronic acid, like Vichy Puret Thermale ($18) and if youre oily in certain spots, use an exfoliating AHA-packed option, like Glossier Solution ($24)

Last year gave us a swift introduction to the trials and tribulations of maskne, but (thankfully) also taught us how to treat it. Wearing masks is essential, but so is taking care of your skin, because thats the barrier between us and whats happening in the outside world, says Dr. Gohara. So to whatever extent you can, keep it gentle and basic. She suggests using a hydrating cleanser, likeLa Roche-Posay Toleriane Hydrating Gentle Face Cleanser ($15) to keep your skin extra clean, then applying an emollient moisturizer like Vaseline($2) orCerave Healing Ointment ($10) to the bridge of your nose, around your ears, jawline, cheekbones, and anywhere else where the mask might be rubbing.

Dont pick your skin is the skin-care advice dermatologists dish out on the reg and that most of us constantly ignore. If you are going to go all-in on your blackheads (which, same), Dr. Gohara says theres only one right way to go about it. One of the most important ways to get rid of blackheads is to extract them out, says Dr. Gohara. Im not giving you the carte blanche to go at them with your nails, but I definitely think there are ways we need to extract blackheads. Shes a fan of using at-home comedone extractors, like this one, which are a whole lot safer for your skin than your own fingers.

Considering this year forced us to spend time away from our dermatologists offices, we had to find at-home solutions for the treatments we often rely on them on. And in the case of Botox, we turned to collagen-stimulating peptides to help keep our skin plump. Peptides are small amino acids, which are the building blocks of collagen, explains Dr. Gohara. Kind of like a grape is to wine, peptides are to collagen. They wake up the collagen, shake it up a little bit, so it knows it has to produce itself more. The result? Smoother, juicier skinno needles required.

2020 was the year that I learned that those little pimple-looking spots on my butt werent actually pimples at all. One of the most common things that my patients come in forwhich can be very distressingare pimple-like lesions on the butt. Or, buttne, says Dr Gohara. But in reality, it aint buttne at all. While the blemishes on your behind maylook like red, angry, inflamed zits, theyre actually something different entirely. These arent true pimplestheyre inflamed hair follicles, explains Dr. Gohara. To deal with them, she suggests using a 1.5 or two percent benzoyl peroxide wash in the shower, like Panoxyl Acne Foaming Wash ($9). If that doesnt work, it may be time to take a trip to the dermatologist for a more intense prescription treatment.

Treating psoriasis can be frustrating, but it doesnt have to be expensive. According to Dr. Gohara, the best OTC treatment will only run your $10. Her go-to?Eucerin Advanced Repair Lotion($10). It has a smidge of exfoliators in it, so its a nice compromise between total exfoliation and just moisturizing, she says. Its made with lactic acid, which will help to gently slough away flakes, andceramides, which work to strengthen your skin barrier. I think that would be a very nice choice for somebody who has psoriasis on their skin, says Dr. Gohara.

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