Treatment of psoriasis – UpToDate

Literature review current through: Jun 2017. | This topic last updated: Jun 28, 2017.

INTRODUCTIONPsoriasis is a common chronic skin disorder typically characterized by erythematous papules and plaques with a silver scale, although other presentations occur. Most cases are not severe enough to affect general health and are treated in the outpatient setting. Rare life-threatening presentations can occur that require intensive inpatient management.

This topic reviews the treatment of psoriatic skin disease. The epidemiology, clinical manifestations, and diagnosis of psoriatic skin disease are discussed in detail separately, as are psoriatic arthritis and the management of psoriasis in pregnant women and special populations. (See “Epidemiology, clinical manifestations, and diagnosis of psoriasis” and “Treatment of psoriatic arthritis” and “Pathogenesis of psoriatic arthritis” and “Clinical manifestations and diagnosis of psoriatic arthritis” and “Management of psoriasis in pregnancy” and “Treatment selection for moderate to severe plaque psoriasis in special populations”.)

APPROACHPsoriasis is a chronic disease that can have a significant effect on quality of life. Therefore, management of psoriasis involves addressing both psychosocial and physical aspects of the disease.

Numerous topical and systemic therapies are available for the treatment of the cutaneous manifestations of psoriasis. Treatment modalities are chosen on the basis of disease severity, relevant comorbidities, patient preference (including cost and convenience), efficacy, and evaluation of individual patient response [1]. Although medication safety plays an important role in treatment selection, this must be balanced by the risk of undertreatment of psoriasis, leading to inadequate clinical improvement and patient dissatisfaction [2,3].

Psychosocial aspectsPsoriasis can be a frustrating disease for the patient and the provider. The clinician needs to be empathetic and spend adequate time with the patient. It may be helpful for the clinician to touch the patient when appropriate to communicate physically that the skin disorder is neither repulsive nor contagious.

Clinicians should lay out reasonable aims of treatment, making it clear to the patient that the primary goal of treatment is control of the disease. Although treatment can provide patients with high degrees of disease improvement, there is no cure for psoriasis.

Educating the patient about psoriasis is important and referral to an organization such as the National Psoriasis Foundation (www.psoriasis.org) is often helpful.

Psoriasis may affect patients’ perceptions of themselves and this can potentially initiate or exacerbate psychological disorders such as depression [4,5]. Patients with limited skin disease may still have significant psychosocial disability [6]. Some patients with psoriasis may benefit from counseling and/or treatment with psychoactive medications.

Choice of therapyFor most patients, the initial decision point around therapy will be between topical and systemic therapy. However, even patients on systemic therapy will likely continue to need some topical agents. Topical therapy may provide symptomatic relief, minimize required doses of systemic medications, and may even be psychologically cathartic for some patients.

For purposes of treatment planning, patients may be grouped into mild-to-moderate and moderate-to-severe disease categories. Limited, or mild-to-moderate, skin disease can often be managed with topical agents, while patients with moderate-to-severe disease may need phototherapy or systemic therapy. The location of the disease and the presence of psoriatic arthritis also affect the choice of therapy. Psoriasis of the hand, foot, or face can be debilitating functionally or socially and may deserve a more aggressive treatment approach. The treatment of psoriatic arthritis is discussed separately. (See “Treatment of psoriatic arthritis”.)

Moderate-to-severe psoriasis is typically defined as involvement of more than 5 to 10 percent of the body surface area (the entire palmar surface, including fingers, of one hand is approximately 1 percent of the body surface area [7]) or involvement of the face, palm or sole, or disease that is otherwise disabling. Patients with more than 5 to 10 percent body surface area affected are generally candidates for phototherapy or systemic therapy, since application of topical agents to a large area is not usually practical or acceptable for most patients. Attempts to treat extensive disease with topical agents are often met with failure, can add cost, and lead to frustration in the patient-clinician relationship.

There is ample evidence of efficacy of the newer systemic therapies (“biologics”); however, cost is a major consideration with these agents. Established therapies such as methotrexate and phototherapy continue to play a role in the management of moderate to severe plaque psoriasis. (See ‘Biologic agents’ below.)

The management of patients with extensive or recalcitrant disease is a challenge even for experienced dermatologists. However, the availability of biologic medications has reduced the challenge considerably.

The concept that many patients with psoriasis in the United States do not receive sufficient treatment to control the disease is suggested by an analysis of surveys performed by the National Psoriasis Foundation between 2003 and 2011 [2]. Among the 5604 survey respondents with psoriasis, 52 percent expressed dissatisfaction with their treatment. Many patients received no treatment, including 37 to 49 percent of respondents with mild psoriasis, 24 to 36 percent of respondents with moderate psoriasis, and 9 to 30 percent of respondents with severe psoriasis. Further studies will be useful for clarifying the reasons for these observations and for determining the value of interventions to increase the accessibility of treatment.

Widespread pustular disease requires aggressive treatment, which may include hospitalization. Therapeutic approaches to generalized pustular psoriasis and psoriatic arthritis are discussed separately. (See “Pustular psoriasis: Management” and “Treatment of psoriatic arthritis”.)

Mild-to-moderate diseaseLimited plaque psoriasis responds well to topical corticosteroids and emollients. Alternatives include vitamin D analogs, such as calcipotriene and calcitriol, tar, and topical retinoids (tazarotene). For facial or intertriginous areas, topical tacrolimus or pimecrolimus may be used as alternatives or as corticosteroid sparing agents, though improvement may not be as rapid. Localized phototherapy is another option for recalcitrant disease.

Combinations of potent topical corticosteroids (table 1) and either calcipotriene, calcitriol, tazarotene, or UVB phototherapy are commonly prescribed by dermatologists. Calcipotriene in combination with Class I topical corticosteroids is highly effective for short-term control. Calcipotriene alone can then be used continuously and the combination with potent corticosteroids used intermittently (on weekends) for maintenance. A combination product containing calcipotriene and betamethasone dipropionate is available for this use. With proper adherence, considerable improvement with topical therapies may be seen in as little as one week, though several weeks may be required to demonstrate full benefits.

Because adherence to topical treatment can be a major hurdle, keeping the treatment regimen simple and using treatment vehicles that the patient finds acceptable is often beneficial [8].

Severe diseaseSevere psoriasis requires phototherapy or systemic therapies such as retinoids, methotrexate, cyclosporine, apremilast, or biologic immune modifying agents. Biologic agents used in the treatment of psoriasis include the anti-TNF agents adalimumab, etanercept, and infliximab, the anti-interleukin (IL)-12/23 antibody ustekinumab, and the anti-IL-17 antibody secukinumab. Improvement usually occurs within weeks. Patients with severe psoriasis generally require care by a dermatologist.

Intertriginous psoriasisIntertriginous (inverse) psoriasis should be treated with class VI and VII low potency corticosteroids (table 1) due to an increased risk of corticosteroid-induced cutaneous atrophy in the intertriginous areas. Topical calcipotriene or calcitriol and the topical calcineurin inhibitors tacrolimus or pimecrolimus are additional first-line treatments [9,10]. These agents may be used alone or in combination with topical corticosteroids as corticosteroid sparing agents for long term maintenance therapy. Calcipotriene, tacrolimus, and pimecrolimus are more expensive options than topical corticosteroids. Some concerns have been raised about the safety of the calcineurin inhibitors (see ‘Calcineurin inhibitors’ below and “Epidemiology, clinical manifestations, and diagnosis of psoriasis”, section on ‘Inverse psoriasis’).

Scalp psoriasisThe presence of hair on the scalp can make topical treatment of psoriasis challenging because patients may find certain products messy or difficult to apply. Recognizing the patient’s preference for a drug vehicle may help to improve adherence to therapy. For many patients, lotion, solution, gel, foam, or spray vehicles are preferable to thicker creams or ointments.

Topical corticosteroids are the primary topical agents used for psoriasis on the scalp [11]. Support for the use of these agents is evident in a systematic review of randomized trials that found that very potent or potent topical corticosteroids are more effective treatments for scalp psoriasis than topical vitamin D analogs [12]. Combining a corticosteroid and vitamin D analog may offer additional benefit; in the systematic review, combination treatment with a potent topical corticosteroid and a vitamin D analog appeared slightly more effective than potent topical corticosteroid monotherapy. However, in clinical practice, complicating the treatment regimen with more than one topical product may reduce the likelihood of consistent adherence to the treatment regimen. Thus, we usually prescribe a topical corticosteroid alone as initial therapy. Commercial betamethasone dipropionate-calcipotriene combination products are available, but are more expensive than most topical corticosteroid preparations.

Other topical therapies used for psoriasis (eg, tazarotene, coal tar shampoo, anthralin) and intralesional corticosteroid injections also may be beneficial for scalp involvement, though data on efficacy specifically in scalp disease are limited [11]. Salicylic acid can be a helpful adjunctive treatment because of its keratolytic effect. Phototherapy (eg, excimer laser) and systemic agents are additional treatment options for patients who cannot achieve sufficient improvement with topical agents [11].

Guttate psoriasisThe management of guttate psoriasis is reviewed separately. (See “Guttate psoriasis”, section on ‘Treatment’.)

Generalized pustular psoriasisThe management of generalized pustular psoriasis is reviewed separately. (See “Pustular psoriasis: Management”.)

Localized pustular psoriasisLocalized pustular psoriasis (palms and soles) is difficult to treat. Approaches include potent topical corticosteroids and topical bath psoralen plus UVA phototherapy (PUVA). (See “Psoralen plus ultraviolet A (PUVA) photochemotherapy”.)

Data are limited on the use of systemic retinoids for localized pustular psoriasis. However, these drugs appear to be particularly effective in the treatment of pustular psoriasis, and we consider them first line therapy. Acitretin is the retinoid that is used most often for this indication. Acitretin is a potent teratogen and should not be used in women who might become pregnant. Pregnancy is contraindicated for three years following acitretin therapy. (See ‘Retinoids’ below.)

Nail psoriasisAlthough nail involvement alone is uncommon, many patients with psoriasis have disease that involves the nails. The management of nail psoriasis is reviewed in detail separately. (See “Nail psoriasis”, section on ‘Treatment’.)

Erythrodermic psoriasisThere is no high quality evidence to support specific recommendations for the management of erythrodermic psoriasis. Based upon data from open-label or retrospective studies and case reports, a panel of experts suggested that patients with severe, unstable disease should be treated with cyclosporine or infliximab due to the rapid onset and high efficacy of these agents [13]. Patients with less acute disease can be treated with acitretin or methotrexate as first-line agents. The panel advised against the use of systemic glucocorticoids due to the perceived potential for these drugs to induce a flare of psoriasis upon withdrawal of therapy. (See ‘Systemic therapies’ below.)

Data are limited on the efficacy of biologic agents other than infliximab for the treatment of erythrodermic psoriasis. Etanercept was effective in an open-label study of 10 patients [14], and case reports have documented successful treatment with adalimumab and ustekinumab [15,16].

In general, patients with erythrodermic psoriasis should be cared for by a dermatologist and may require hospitalization and/or combinations of systemic treatments. Topical therapies, such as mid-potency topical corticosteroids, emollients, wet dressings, and oatmeal baths can be used in concordance with systemic treatment to manage symptoms [13]. Long-term maintenance therapy for psoriasis is required.

ChildrenThe immediate and long-term adverse effects of therapies for psoriasis are of particular concern in the pediatric population. Many agents used in the treatment of adult psoriasis have also been used for children [17]. However, high quality studies on the efficacy and safety of therapies for psoriasis in children are limited. Guidelines for the treatment of children based upon the available evidence have been published [18].

Special populationsThe treatment of psoriasis in pregnant women and patients with hepatitis B, hepatitis C, human immunodeficiency virus infection, latent tuberculosis, or malignancy is reviewed separately. (See “Treatment selection for moderate to severe plaque psoriasis in special populations” and “Management of psoriasis in pregnancy”.)

ReferralReferral to a dermatologist should be considered in the following settings:

Confirmation of the diagnosis is needed.

The response to treatment is inadequate as measured by the clinician, patient, or both.

There is significant impact on quality of life.

The primary care clinician is not familiar with the treatment modality recommended such as PUVA, phototherapy, or immunosuppressive medications.

The patient has widespread severe disease.

In cases of psoriatic arthritis, referral and/or collaboration with a rheumatologist is indicated. (See “Treatment of psoriatic arthritis”.)

TOPICAL THERAPIESPatient adherence may be the largest barrier to treatment success with topical therapies [8]; early patient follow-up (within a week of initiating treatment) may improve adherence. Published guidelines for the treatment of psoriasis with topical therapies are available [19].

EmollientsHydration and emollients are valuable and inexpensive adjuncts to psoriasis treatment. Keeping psoriatic skin soft and moist minimizes the symptoms of itching and tenderness. Additionally, maintaining proper skin hydration can help prevent irritation and thus the potential for subsequent Koebnerization (development of new psoriatic lesions at sites of trauma).

The most effective are ointments such as petroleum jelly or thick creams, especially when applied immediately after a hydrating bath or shower.

CorticosteroidsTopical corticosteroids remain the mainstay of topical psoriasis treatment despite the development of newer agents [20]. The mechanism of action of corticosteroids in psoriasis is not fully understood. Corticosteroids exert antiinflammatory, antiproliferative, and immunosuppressive actions by affecting gene transcription.

The inherent potency of a topical corticosteroid is frequently reported using a I to VII scale based on vasoconstrictive assays (table 1). Although ointments are sometimes thought to be inherently more effective because of their occlusive properties, this is not uniformly correct. In practice, the efficacy/potency of a topical corticosteroid is dependent on many factors including skin type, plaque thickness, and, perhaps most importantly, compliance.

To minimize adverse effects and maximize compliance, the site of application needs to be considered in choosing the appropriately potent corticosteroid:

On the scalp or in the external ear canal, potent corticosteroids in a solution or foam vehicle (eg, fluocinonide 0.05% or clobetasol propionate 0.05%) are frequently indicated. Clobetasol 0.05% shampoo or spray can also be used for scalp involvement.

On the face and intertriginous areas, a low potency cream (eg, hydrocortisone 1%) is often sufficient.

For thick plaques on extensor surfaces, potent preparations (eg, betamethasone 0.05% or clobetasol propionate 0.05%) are often required.

The typical regimen consists of twice daily application of topical corticosteroids. Most patients will show a rapid decrease in inflammation with such therapy, but complete normalization of skin or lasting remission is unpredictable.

Topical corticosteroids generally can be continued as long as the patient has thick active lesions. Skin atrophy from topical corticosteroids usually is not a problem unless the medication is continuously applied after the skin has returned to normal thickness. Once clinical improvement occurs, the frequency of application should be reduced [19]. For patients in whom lesions recur quickly, topical corticosteroids can be applied intermittently (such as on weekends only) to maintain improvement. The addition of non-corticosteroid topical treatments can also facilitate the avoidance of long-term daily topical corticosteroids. (See ‘Mild-to-moderate disease’ above.)

The risks of cutaneous and systemic side effects associated with chronic topical corticosteroid use are increased with high potency formulations. Data support limiting the continuous application of Class I topical corticosteroids to two to four weeks; thus, close clinician supervision should be employed if longer treatment durations are required (table 1) [19]. Data are less clear regarding treatment durations for less potent topical corticosteroids. Side effects of topical corticosteroids, including the potential for suppression of the hypothalamic axis, are discussed separately. (See “Pharmacologic use of glucocorticoids” and “General principles of dermatologic therapy and topical corticosteroid use”.)

The cost of topical corticosteroids varies widely. The price of a 60 gram tube of a potent corticosteroid brand name product can be hundreds of dollars. There are generic preparations in each potency class that have reduced the cost somewhat, though generic prices in the United States are rising [21]. Examples of available generics include, in order of increasing potency, hydrocortisone 1%, triamcinolone 0.1%, fluocinonide 0.05%, betamethasone dipropionate 0.05%, and clobetasol 0.05%.

Different formulations have been developed in an effort to enhance the delivery of topical corticosteroids. Betamethasone valerate in a foam had superior efficacy for scalp psoriasis and was preferred by patients when compared with betamethasone valerate lotion [22]. The foam becomes a liquid on contact with skin and is also well tolerated by patients with trunk and extremity psoriasis [23]. A clobetasol propionate spray is also available; like foams, sprays are easy to apply to large areas [24]. The main advantage of these newer preparations is likely greater patient acceptance, which may translate into greater adherence; the main disadvantage is cost.

Topical vitamin D analogsTopical vitamin D analogs for the treatment of psoriasis include calcipotriene (calcipotriol), calcitriol, and tacalcitol. Although topical vitamin D analogs are effective as monotherapy for some patients, a systematic review found that combination therapy with a topical corticosteroid is more effective than either treatment alone [25].

Until 2009, calcipotriene was the only topical vitamin D analog available in the United States. Calcipotriene is obtainable as a cream, solution, ointment, or foam, or as a combination ointment, suspension, or foam with betamethasone dipropionate. Topical calcitriol ointment has been prescribed in Europe for years, and is now available in the United States. When compared with calcipotriene, calcitriol appears to induce less irritation in sensitive areas of the skin (eg, skin folds) [26].

CalcipotrieneCalcipotriene (calcipotriol) is an established therapy in psoriasis. The precise mechanism is not clear, but a major effect is the hypoproliferative effect on keratinocytes [27]. An immune modulating effect has been postulated for calcipotriene, but has not been shown to be significant in psoriasis to date [28].

In a systematic review of randomized controlled trials, calcipotriene was at least as effective as potent topical corticosteroids, calcitriol, short contact dithranol, tacalcitol, coal tar and combined coal tar 5%, allantoin 2%, and hydrocortisone 0.5% [29]. Only potent topical corticosteroids appeared to have comparable efficacy at eight weeks. Skin irritation is the main adverse event associated with calcipotriene.

Combined use of calcipotriene and superpotent corticosteroids has demonstrated increased clinical response and tolerance in clinical trials compared with either agent used alone [30-32]. One regimen employed daily use of both calcipotriene ointment and halobetasol ointment for two weeks, followed by weekend use of the halobetasol ointment and weekday use of calcipotriene [30]. This regimen produced six-month remission maintenance in 76 percent compared with 40 percent with weekend halobetasol alone. A similar regimen with calcipotriene ointment and clobetasol propionate foam also appears to be effective [33].

In addition, a randomized trial found that a preparation that combines calcipotriene with betamethasone dipropionate (0.064%) was effective with once daily usage, and more effective than once daily therapy with either betamethasone or calcipotriene [34]; this combination preparation typically costs more than $400 for a 60 g tube. Patients who use topical corticosteroids in combination with calcipotriene must be monitored for adverse effects as with corticosteroid monotherapy. (See ‘Corticosteroids’ above.)

Thus, topical calcipotriene may be used as an alternative or adjunct to topical corticosteroid therapy. It is applied twice daily when used as monotherapy. No controlled trials guide how best to use topical corticosteroids in conjunction with calcipotriene. Once daily use of each may be adequate. Acidic products can inactivate topical calcipotriene, and some topical corticosteroids may be acidic. A reasonable approach to combination therapy is to have patients apply topical calcipotriene and topical corticosteroids each once daily at different times of day.

Other than skin irritation, side effects of topical calcipotriene are usually minimal; the risk of hypercalcemia is low when the drug is used appropriately [35]. However, topical calcipotriene is more expensive than many generic potent corticosteroids.

CalcitriolThe mechanism of action of calcitriol is thought to be similar to that of calcipotriene and involves the drug’s ability to inhibit keratinocyte proliferation and stimulate keratinocyte differentiation [36]. In addition, calcitriol inhibits T-cell proliferation and other inflammatory mediators [36]. In two randomized trials with a total of 839 patients with mild to moderate plaque psoriasis, calcitriol 3 mcg/g ointment was more effective than vehicle [37]. At the end of the study periods (up to eight weeks), 39.6 and 32.7 percent of the calcitriol groups versus 21.2 and 12 percent of the vehicle groups exhibited at least marked global improvement.

In a systematic review, calcipotriene and calcitriol were equally effective [25]. However, on sensitive areas of the skin, calcitriol appears to be less irritating than calcipotriene. An intraindividual randomized trial of 75 patients compared treatment with calcitriol 3 mcg/g ointment to calcipotriene 50 mcg/g ointment for mild to moderate psoriasis on facial, hairline, retroauricular, and flexural areas [26]. Perilesional erythema, perilesional edema, and stinging or burning sensations were significantly lower in the areas treated with calcitriol. A 52-week open-label study of the safety of calcitriol ointment did not reveal an adverse effect on calcium homeostasis [38].

Similar to calcipotriene, calcitriol ointment is more expensive than many generic potent topical corticosteroids. The drug is applied twice daily.

TarThe use of tar is a time-honored modality for treating psoriasis, although newer (and less messy) treatment options have reduced its popularity. The precise mechanism of action of tar is not known; it has an apparent antiproliferative effect.

Tar can be helpful as an adjunct to topical corticosteroids. There are no commercially available corticosteroid/tar combinations. Tar products are available without a prescription in the form of shampoos, creams, lotions, ointments, and oils. Newer products include a solution and a foam. Some patients may prefer the less messy formulations.

Tar can also be compounded into creams and ointments. A commonly used compound is 2% or 3% crude coal tar in triamcinolone cream 0.1% applied twice daily to individual plaques. An alternative is 4 to 10% LCD (liquor carbonis detergens, a tar distillate) in triamcinolone cream or ointment, used similarly. A preparation of 1% tar in a fatty-acid based lotion may be superior to conventional 5% tar products [39] and appears to have efficacy similar to that of calcipotriene [40].

Topical tar preparations, including shampoos, creams, and other preparations, can be used once daily. Patients should be warned that tar products have the potential to stain hair, skin, and clothing. It may help to use them at night and wear inexpensive night clothes (eg, old pajamas) as they tend to be messy. Patients may also find the odor of tar products unpleasant.

For shampoos, the emphasis should be on making sure the product reaches the scalp. Tar shampoo should be left in place for 5 to 10 minutes before rinsing it out.

TazaroteneTazarotene is a topical retinoid that was safe and effective in two randomized, vehicle-controlled trials that included 1303 patients with psoriasis [41]. The 0.1% cream was somewhat more effective than 0.05% cream, but with a slightly higher rate of local side effects. Another study found that once daily administration of tazarotene gel, 0.05% or 0.1%, compared favorably with the twice daily administration of topical fluocinonide 0.05% [42]. Absorption of tazarotene was minimal over the 12-week course of the study, suggesting that systemic toxicity is unlikely during long-term therapy. A small uncontrolled study of short contact tazarotene found that a 20 minute application followed by washing appeared to be less irritating than traditional use, and seemed to have similar efficacy [43]. Irritation limits use of tazarotene by itself; the irritation is reduced by concomitant treatment with a topical corticosteroid [44].

Calcineurin inhibitorsTopical tacrolimus 0.1% and pimecrolimus 1% are effective in the treatment of psoriasis [45-48]. Facial and intertriginous areas may be well suited to these treatments, which can allow patients to avoid chronic topical corticosteroid use:

An eight-week randomized trial in 167 patients ages 16 and older found that twice daily treatment to intertriginous and facial lesions with tacrolimus 0.1% ointment resulted in more patients achieving clearance of lesions or excellent improvement compared with placebo (65 versus 32 percent) [49].

An eight-week randomized trial in 57 adults with moderate to severe inverse psoriasis found that twice daily treatment with pimecrolimus 1% cream resulted in more patients clearing or almost clearing lesions compared with placebo (71 versus 21 percent) [50].

Topical tacrolimus and pimecrolimus are generally well tolerated when used to treat facial and intertriginous psoriasis [49,50]. However, corticosteroid therapy may be more effective, at least compared with pimecrolimus. This was suggested in a four-week randomized trial in 80 patients with intertriginous psoriasis that compared various therapies applied once daily [51]. Betamethasone valerate 0.1% was more effective than pimecrolimus 1%.

In 2005, the US Food and Drug Administration (FDA) issued an alert about a possible link between topical tacrolimus and pimecrolimus and cases of lymphoma and skin cancer in children and adults [52], and in 2006 placed a “black box” warning on the prescribing information for these medications [53]. No definite causal relationship has been established; however, the FDA recommended that these agents only be used as second line agents for atopic dermatitis. Subsequent studies have not, however, found evidence of an increased risk of lymphoma [54,55]. (See “Treatment of atopic dermatitis (eczema)”, section on ‘Topical calcineurin inhibitors’.)

AnthralinTopical anthralin (also known as dithranol) is an effective treatment for psoriasis that has been utilized since the early 20th century [56-58]. The mechanism of action of anthralin in psoriasis is not well understood, but may involve antiinflammatory effects and normalization of keratinocyte differentiation [19].

Skin irritation is an expected side effect of anthralin that can limit the use of this therapy. This side effect and the ability of anthralin to cause permanent red-brown stains on clothing and temporary staining of skin have contributed to a decline in the use of anthralin therapy.

In order to minimize irritation, anthralin treatment is usually prescribed as a short-contact regimen that is titrated according to patient tolerance. For example, treatment may begin with concentrations as low as 0.1% or 0.25% applied for 10 to 20 minutes per day, with weekly step-wise increases in duration to reach a total contact time up to one hour [59]. Then, weekly, serial increases in the concentration of anthralin can be performed (eg, 0.5, 1, and 2%) based upon patient tolerance and lesion response.

In the United States, anthralin is commercially marketed only as a 1% or 1.2% cream or a 1% shampoo. Thus, in the outpatient setting in the United States, the initial treatment regimen often consists of 1% or 1.2% anthralin applied for 5 to 10 minutes per day. Subsequently, the application time is titrated up to 20 to 30 minutes as tolerated.

Application to surrounding unaffected skin should be avoided to minimize irritation. For patients with well-defined plaques, petrolatum or zinc oxide may be applied to the surrounding skin as a protectant prior to application. After the desired contact period has elapsed, anthralin should be washed off the treated area [19].

Benefit from anthralin therapy is often evident within the first few weeks of therapy. When administered by patients in the outpatient setting, anthralin is less effective than topical vitamin D or potent topical corticosteroid therapy [25,60,61].

ULTRAVIOLET LIGHTUltraviolet (UV) irradiation has long been recognized as beneficial for the control of psoriatic skin lesions. As an example, patients often notice improvement in skin lesions during the summer months. UV radiation may act via antiproliferative effects (slowing keratinization) and anti-inflammatory effects (inducing apoptosis of pathogenic T-cells in psoriatic plaques). In choosing UV therapy, consideration must be given to the potential for UV radiation to accelerate photodamage and increase the risk of cutaneous malignancy.

Phototherapy and photochemotherapy require the supervision of a dermatologist trained in these treatment modalities. The American Academy of Dermatology has provided guidelines for the treatment of psoriasis with ultraviolet light [62]. Despite high efficacy and safety, the use of office-based phototherapy has declined in the United States because of administrative issues and the development of new systemic medications [63].

ModalitiesTherapeutic doses of ultraviolet light can be administered in several ways:

Ultraviolet B (UVB) radiation (290 to 320 nm) is used in patients with extensive disease, alone or in combination with topical tar. The mechanism of action of UVB is likely through its immunomodulatory effects [64]. Patients receive near-erythema-inducing doses of UVB at least three times weekly until remission is achieved, after which a maintenance regimen is usually recommended to prolong the remission.

Narrow band UVB (311 nm) is an alternative to standard (broadband- 290 to 320 nm) UVB in the treatment of psoriasis. Suberythemogenic doses of narrow band UVB are more effective than broadband UVB in clearing plaque psoriasis [65]. Apoptosis of T cells is also more common with 311 nm than with broadband UVB.

Photochemotherapy (PUVA) involves treatment with either oral or bath psoralen followed by ultraviolet A (UVA) radiation (320 to 400 nm) under strict medical supervision. UVA penetrates deeper into the dermis than UVB and does not have the latter’s potential for burning the skin. A number of possible mechanisms have been postulated to explain PUVA’s effects [66]. With oral PUVA, patients ingest the photosensitizing drug, 8-methoxypsoralen, followed within two hours by exposure to UVA; this sequence is performed three times weekly in increasing doses until remission, then twice or once weekly as a maintenance dose. With bath PUVA, the psoralen capsules are dissolved in water, and affected skin (hands, feet, or total body) is soaked for 15 to 30 minutes prior to UVA exposure. There are few data on the comparative efficacy of oral and bath PUVA for psoriasis. A small open randomized trial of 74 patients with moderate to severe psoriasis did not find a significant difference in efficacy between the two treatments [67]. Additional studies are necessary to confirm this finding.

Some patients take psoralen prior to coming into the office or clinic for PUVA. Increased photosensitivity is typically present starting one hour after an oral dose and resolves after eight hours. Pre and post treatment photoprotection (eg, hat, sunscreen, sun protective goggles) are critical in preventing serious burn injury to the skin and eyes from being outside. (See “Psoralen plus ultraviolet A (PUVA) photochemotherapy”.)

Pretreatment emollients have long been thought to improve results with UVB. However, while thin oils do not impede UV penetration, emollient creams can actually inhibit the penetration of the UV and should not be applied before treatment [68]. Gentle removal of plaques by bathing does help prior to UV exposure.

Uncertainty remains about the comparative efficacy of UVB phototherapy and PUVA photochemotherapy for plaque psoriasis. Randomized trials comparing the efficacy of narrowband UVB to PUVA have yielded inconsistent findings [69]. The convenience of not needing to administer a psoralen prior to treatment is a favorable feature of UVB phototherapy.

Home phototherapyAn alternative to office-based phototherapy is the use of a home ultraviolet B (UVB) phototherapy unit prescribed by the treating clinician [70]. This option may be preferred by patients who are not in close proximity to an office-based phototherapy center, whose schedules do not permit frequent office visits, or for whom the costs of in-office treatment exceed those of a home phototherapy unit. Home units cost about $3000, but may prove cost-effective in the long term, particularly when compared with biologic therapies. Insurance coverage of these units varies.

For some dermatologists, uncertainty regarding the safety of home units has led to a reluctance to prescribe them. Some have expressed concern for the potential for improper or excessive usage of these devices [71]. In contrast, a randomized trial of 196 subjects found that narrowband UVB administered via home units was as safe and effective as office-based treatments [71]. Home phototherapy units that are equipped with electronic controls that allow only a prescribed number of treatments are available and may help to mitigate clinician concerns.

Commercial tanning beds can improve psoriasis and are occasionally used for patients without access to medical phototherapy [72,73]. However, data are limited on this mode of treatment, and clinicians and patients should be cognizant that there is significant variability in the UV output of tanning beds [74].

Excimer laserAnother development in ultraviolet therapy for psoriasis involves use of a high energy 308 nm excimer laser. The laser allows treatment of only involved skin; thus, considerably higher doses of UVB can be administered to psoriatic plaques at a given treatment compared with traditional phototherapy. Uncontrolled trials suggest that laser therapy results in faster responses than conventional phototherapy [75,76]. As an example, one study of excimer laser therapy involved 124 patients with stable mild to moderate plaque psoriasis, of whom 80 completed the entire protocol [75]. Treatments were scheduled twice weekly. After 10 or fewer treatments, 84 and 50 percent of patients achieved the outcomes of 75 percent or better and 90 percent or better clearing of plaques, respectively. This number of treatments was far fewer than that typically required of phototherapy (25 or more). Side effects of laser therapy included erythema and blistering; these were generally well tolerated, and no patient discontinued therapy because of adverse effects.

A common sequela of excimer laser therapy is the induction of UV-induced hyperpigmentation (tanning) in treated areas, which can be cosmetically distressing for some patients. Hyperpigmentation resolves after the discontinuation of treatment.

Like 311 nm UVB, the excimer laser represents a therapeutic advance toward specific wavelength therapies for psoriasis. While both the excimer laser and narrow band UVB are approved for use in psoriasis, inconsistencies in third party coverage for these treatments limit their utilization.

Cancer riskA concern with PUVA is an increased risk of nonmelanoma skin cancer and melanoma. Ongoing monitoring is indicated in patients who have received prolonged courses of PUVA. In general, phototherapy is contraindicated in patients with a history of melanoma or extensive nonmelanoma skin cancer. (See “Psoralen plus ultraviolet A (PUVA) photochemotherapy”, section on ‘Skin cancer’.)

Folate deficiencyFolate deficiency has been associated with health disorders such as neural tube defects in fetuses of affected pregnant women, anemia, and hyperhomocysteinemia (a risk factor for cardiovascular disease). In an in vitro study, exposure of plasma to UVA led to a 30 to 50 percent decrease in the serum folate level within 60 minutes [77]. However, folate deficiency secondary to UVA exposure has not been proven to occur in vivo. In a small randomized trial of healthy subjects, no difference in serum folate levels was identified between subjects irradiated with UVA for six sessions and untreated subjects [78]. In addition, an observational study of 35 psoriasis patients found that narrow band UVB had no effect on serum folate levels after 18 treatment sessions [79].

The rest is here:

Treatment of psoriasis – UpToDate

Psoriasis treatment in skin of color – ModernMedicine

Dr. AlexisWhen it comes to treating psoriasis in non-white patients, there is a paucity of data on differences in epidemiology, clinical presentation and approaches to treatment.

Although psoriasis appears to have a lower prevalence in non-white racial ethnic groups, including African Americans, it is by no means an uncommon or rare disease, says Andrew Alexis, M.D., chair of the department of dermatology and director of the Skin of Color Center at Mount Sinai St. Lukes and Mount Sinai West in New York City. He spoke on psoriasis at the Skin of Color Seminar Series (SOCSS) in New York City in May.

In fact, a recent study found a 1.9% prevalence rate of psoriasis in African Americans.

This is much more common than previously reported, Dr. Alexis tells Dermatology Times.

The clinical presentation of psoriasis in darker skinned individuals can vary, based primarily on the visual appearance. For example, because of the background melanin pigmentation, the erythema may look more violaceous, hyperpigmented or dark brown or gray, Dr. Alexis says. Therefore, one has to train the eye to detect psoriasis-related erythema in darker skin types.

Diagnostic pearls

Clues of psoriasis include the quality of the scale, the anatomic distribution and associated features.

There are scenarios, though, where a biopsy is needed to confirm the diagnosis of psoriasis.

I find this is more frequent in darker skin types, Dr. Alexis says.

For instance, patients with skin type VI may present with violaceous, gray, or hyperchromic scaly plaques without appreciable erythema.

In these patients, it may be difficult to distinguish the psoriasis from lichen planus, cutaneous T-cell lymphoma or sarcoidosis in some cases, Dr. Alexis says.

Therapeutic insights

For treatment, a few studies have looked at potential racial ethnic differences in safety and efficacy.

Once such study1 found comparable safety measures and efficacy outcome measures for the injectable TNF antagonist, etanercept (Enbrel, Amgen) Dr. Alexis says.

However, in the above study from the Journal of Drugs in Dermatology in 2011, racial/ethnic differences in quality-of-life impact were observed. As measured by the Dermatology Quality of Life Index (DLQI), baseline quality of life was actually worse in African American and Hispanic/Latino patients compared to Caucasians, Dr. Alexis says.

More recently, Dr. Alexis was co-author of a poster at this years SOCSS that evaluated the safety and efficacy of the recently approved biologic agent brodalumab (Siliq, Valeant), for which there was no significant racial or ethnic differences in safety or efficacy.2

Studies like this are important to understand whether there are any potential differences in safety and efficacy, particularly with biologics that are so specific in their target, Dr. Alexis says. Fortunately, we have not seen any significant differences with the studies that have been conducted thus far.

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Psoriasis treatment in skin of color – ModernMedicine

Psoriasis and Eczema: What’s the Difference? – Beliefnet

Orrling and Tomer S/Wikimedia Commons

Dry, itchy, and painful skin can be due to a wide range of skin conditions. Two of the most popular conditions thought are psoriasis and eczema. These two conditions can appear very similar and make it tough to distinguish a difference. Both conditions cause red, itchy skin but have different causes and treatments.

Eczema is a skin condition that can be caused by a number of factors including environmental factors, allergens, family history and bacteria exposure. On the other hand, psoriasis is a condition that occurs when a persons immune system triggers skin cells to grow faster than they should. Instead of the dead skin cells coming off the skin, they build up. In addition, psoriasis can cause joint stiffness as well as swelling.

Both of the conditions can keep the skin from appearing smooth and healthy. There is only one type of eczema, and five types of psoriasis. However, the most common form of psoriasis is plaque psoriasis, which is the form that most clearly resembles eczema. While its rare that a person will have both of the conditions at once, it is possible.

Due to the buildup of psoriasis plaques, the skin will have thick, red and scaly patches that are well-defined. These may be silvery in color and are raised up high. The skin will be thicker and more inflamed than if it was eczema.

Eczema is different with the patches being red or brown-gray in color. There will be rough, leathery patches of skin. Sometimes the areas will appear as small raised bumps. These bumps may have a crust-like layer that causes them to leak fluid when broken.

Eczema is known to cause very intense itching that usually worsens at night. When a person scratches the skin, the results can be swollen, sensitive and even raw skin. However, while psoriasis can cause itching it typically is only mild. There instead may be a sting or a burn feeling.

Eczema is more common in children than adults, and tends to subside at about age 5 or 6 according to the Nemours Foundation. However, some young people may have flare-ups during puberty.

Psoriasis typically develops between the ages of 15 and 35, and babies rarely have the condition. The American Academy of Dermatology estimate that 1 percent of children have psoriasis while 10 percent of children have eczema.

Eczema appears most commonly on part of your body that bend, including your inner elbow or behind the knee. Babies will sometimes get it on their chin, cheeks, scalp, and similar.

Psoriasis can appear on the nails, which is rare for eczema. In addition patches of psoriasis can show up on elbows, knees, the scalp, lower back, palms of hands, soles of feet, eyelids, ears, mouth and lips.

Both psoriasis and eczema share some triggers, such as stress and infection. Its important to avoid things that will irritate the skin, such as certain soaps, detergents and disinfectants. Since allergens can set off eczema, its also important to avoid things like dust, pets, pollen and mold if necessary.

Psoriasis can also get flare-ups when the skin is injured, for example by vaccinations, sunburn and scratches. Medications such as lithium or drugs for malaria are also known to bring on psoriasis symptoms. Talk with your doctor about how to avoid these triggers.

Mild-to-moderate psoriasis treatments include over-the-counter corticosteroids that work by reducing inflammation and itching. Moderate-to-severe psoriasis can be treated with stronger medications available by prescription.

Eczema has no cure. Keeping the skin clean, moisturized and dry can help relieve symptoms. If avoidance of triggers and at-home treatments dont work, a doctor can prescribe stronger creams.

Psoriasis and eczema arent the only types of skin conditions that resemble each other. Examples of other skin conditions that are commonly misdiagnosed include athletes foot, contact dermatitis, shingles, hives, rosacea and seborrheic dermatitis. If you are unsure of what is causing your skin issues, monitor the area closely and go see a doctor.

Psoriasis has been linked to serious health conditions including diabetes, heart disease and depression. Eczema doesnt have serious links. However you may have someone else in your family with eczema, or have asthma or hay fever.

Regardless of the skin condition, its important to speak to a doctor about treatment options and ways to find relief for the problem. Keep a log of your symptoms and try to identify the triggers that make it worse. This will help in pinpointing if you have eczema or psoriasis.

Continued here:

Psoriasis and Eczema: What’s the Difference? – Beliefnet

8 Holistic Ways to Heal Psoriasis – Beliefnet


Psoriasis is an inflammatory disease that causes raised, red, scaly patches to appear on the skin. It typically affects the outside of elbows, knees or the scalp, thought it can appear anywhere. It can be itchy, burn and sting, which can leave patients in discomfort. There are many treatments out there for psoriasis, however there is no cure.

Those with psoriasis struggle to find treatment plans that work best for them. Finding relief from the skin condition can be hard, but many have found great success in using various at-home, herbal remedies. These natural options provide a way to reduce redness, and relieve pain, itching and burning. Try these different options out to see what could possibly work for you.

To help relieve scalp itch, apple cider vinegar may be a great way to go. You can buy a bottle of apple cider vinegar at your local grocery store and apply it to your scalp several times a week. Some people feel a burning sensation, so try diluting the vinegar with water on a 1-to-1 ratio to prevent this from happening. Others have found rinsing the solution once it has dried also helps to prevent irritation. If this works for you, you will see results within a few weeks. However, if your scalp is cracked or bleeding you will want to skip this remedy. The vinegar will only further irritate your skin.

If you have psoriasis throughout your body, a warm bath filled with Dead Sea salts or Epsom salts will help. Try adding a quarter cup of salt to bathwater and soak for about 15 minutes. Be sure to apply moisturizer once you are done to help keep skin hydrated. The soak should help alleviate the itching and burning of scaly plaques.

Aloe plant gel is known to be helpful for sunburns, and it can help with psoriasis too. Gel from the plant can be applied to the skin up to three times daily and research shows that it can help reduce redness and scaling associated with psoriasis. If not using an actual aloe plant, look for medicated creams that contain at least 0.5 percent aloe. Please note, however, that taking aloe in tablet form shows no benefit and can be dangerous.

This has been a solution to psoriasis for centuries and many report it has great benefits, despite there not being scientific evidence to support the use of it. Tea tree oil comes from the leaves of the tea tree plant which grows in Australia. When applied to the skin, this treatment is said to help remove dry, dead cells. Many people find using shampoos with tea tree oil helps best. Be careful, though, as many are allergic to it.

One of natures best skin soothers, many individuals with psoriasis report finding relief with the help of oats. Try applying an oat past or taking a bath in oats to relieve itchy skin and reduce redness.

Turmeric is an herb that is frequently studied for its powerful anti-inflammatory and antioxidant properties. You can take turmeric concentrated in pill or supplement form or if you like curries, adding it liberally to your food. The FDA considers 1.5 to 3.0 grams of turmeric per day to be safe. However, we suggest that you consult with a naturopathic practitioner for help in determining the correct amount for you.

One of the best things you can do for your psoriasis is to modify your diet. Fresh fruit and vegetables are filled with disease-fighting antioxidants. When you have psoriasis, its important to maintain a healthy weight so that your medication will be more effective. In addition, research suggests that psoriasis patients are at an increased risk for heart disease and stroke. Keeping fruits and veggies around will help to lower this risk.

Drinking plenty of water is also an important diet choice for those with psoriasis. Drinking water helps to keep your skin hydrated and prevent it from getting too dry. In addition, using a humidifier is a good home remedy that will keep your skin moist, especially in winter.

Studies have also shown that people who have celiac disease may be at a higher risk for psoriasis, in part because gluten can cause inflammation. Even if you dont have celiac, a gluten-free diet may work for you.

Many find that stress is a huge trigger for their psoriasis symptoms. To help combat this, pick activities you enjoy that are known to have stress-reducing properties. Yoga is a great way to relieve built up anxiety and stress. Devote 20 minutes a day to yoga exercise, which involve some mediation as well as breathing, stretching, and strengthening movements. Yoga also helps to relieve the pain and itch of psoriasis plaques while improving your range of motion if you have psoriatic arthritis. Another stress-reducing activity would be getting a massage. Clinical trials have shown massage therapy may be beneficial in treating chronic pain, which often accompanies psoriasis and psoriatic arthritis.

It can be tough to find the treatment plan that works for you. Psoriasis can be a stubborn disease, but it does not have to run your life. Try out these natural, at-home remedies to fight the irritation and itchiness of psoriasis.

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8 Holistic Ways to Heal Psoriasis – Beliefnet

Lilly’s catch-up act in psoriasis is working, but now it has to catch up in cancer – FiercePharma

Eli Lilly has been playing catch-up in the psoriasis market ever since it launched its drug to treat the condition, Taltz, last spring into a crowded field dominated by Novartis Cosentyx. But if second-quarter results are any indication, Lilly is proving to be a formidable competitor.

Sales of Taltz skyrocketed 618% year-over-year to $138.7 million, which handily beat the consensus analyst estimate of $122 million. Other new medications also outperformed, including diabetes treatments Jardiance, up 157% to $103.2 million, and Trulicity, which rose 139% to $480.2 million.

All told, Lillys revenues jumped 8% to $5.8 billion during the second quarter. The companys non-GAAP net income was up 30% to $1.2 billion (95 cents a share). Analysts had been boosting their sales forecasts over the last month but were still pleasantly surprised, having expected $5.6 billion in sales.

RELATED: Top 15 pharma companies by 2016 revenue14. Eli Lilly

Net-net, todays earnings update is good news, wrote Leerink analyst Seamus Fernandez in a morning note to investors. He did add, however, that the pressure will be on Lilly to continue delivering standout results to justify its stock price, which is up 15% for the year.

Towards that end, Lillys executives spent much of the conference call after the earnings release telling investors how it plans to be competitive in the red-hot market for cancer drugs. The company has charted some successes in oncologynotably Cyramza to treat gastric cancer, which was up 27% during the quarter to $186.3 million. But Levi Garraway, Lillys new senior vice president of global development and medical affairs, acknowledged during the call that Lilly would need to prioritize many more medicines that change the standard of care in cancer if its to compete in new treatment modes like immuno-oncology and mutation-specific tumor targeting.

Much of the companys new strategy will hinge on testing patients in clinical trials for mutations and other molecular characteristics that will boost the chances of success and help overcome treatment resistance in targeted patient populations. So Lilly is prioritizing seven oncology drugs in its pipeline, including prexasertib, a CHK1 inhibitor being tested in high-grade ovarian cancer. In early trials, 35% of patients with a particular BRCA mutation responded to the experimental drug, Garraway said.

Together, these assets have the potential to be foundational agents or to anchor foundational regimens, Garraway said during the call. Lilly intends to test many of its oncology drugs in combination with other cancer drugs that are in trials or already marketed, he added. We remain excited about the quality of our compounds but believe that the optimal development path will be best implemented in partnership with external entities that have specific or niche biological expertise, he said. Lilly also intends to aggressively pursue acquisitions of early-stage immuno-oncology assets, executives said.

RELATED: New diabetes meds push Lilly to earnings beat but pipeline worries abound

The pressure on Lilly to continue to drive innovations out of its pipeline is only intensified by patent losses on key blockbusters. Strattera to treat ADHD, for example, was down 17% for the quarter to $186.6 million. Lillys $1.5 billion ED blockbuster Cialis scored a bit of a reprieve last week, reaching a settlement that will extend its patent through September of next year. But the product is showing its age: Sales were flat at $627 million, driven largely by price increases, the company said.

Lillys pipeline challenge has been highlighted recently by beleaguered baricitinib, its much anticipated JAK inhibitor to treat rheumatoid arthritis, which was handed a surprise complete response letter from the FDA in April. In a separate announcementtoday, the company said it would take a minimum of 18 months to address the FDAs concerns. The agency has suggested a new clinical trial would be necessary to prove that the risk/benefit profile is acceptable, according to Lilly.

The delay was surprising to some analysts, including Tim Anderson of Bernstein, who declared in a note to investors that Lillys management recently indicated it was hopeful a resubmission might occur in early 2018not happening!

Lilly CEO Dave Ricks said the company remains committed to baricitinib, even after one analyst pointed out that the rheumatoid arthritis field is already crowded with entrenched players. When will the company just give up, she wondered?

Ricks replied that Lilly is a long way from giving up. After discussions with the FDA, the company has clarity on what the FDAs point of view is. Its just not our point of view, he conceded. But give up? Not a chance, he said. Its definitely disappointing but were committed.

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Lilly’s catch-up act in psoriasis is working, but now it has to catch up in cancer – FiercePharma

Olympic Swimmer Dara Torres Offers Advice to People With Psoriasis – TeenVogue.com

This story was published on The Mighty by Erin Migdol , a platform for people facing health challenges to share their stories and connect.

For many people with psoriasis , a flare-up means going outside in shorts or a swimsuit seems out of the question. But take it from five-time Olympic swimmer Dara Torres, whos been forced to confront this dilemma over and over since her diagnosis with psoriasis 25 years ago you can show off your beach body in the summer, and you should if you want to.

Torres, 50, is advocating for psoriatic disease this summer as part of the sponsored [Show More of You](http://www.showmoreofyou.com( campaign. She told The Mighty she first began noticing red, itchy patches while she was training for her third Olympics, the 1992 games in Barcelona. I was in a swimsuit and everyone could see everything, she said. I was embarrassed by it and put lotion on it and thought it would go away, but it got worse.

She was soon diagnosed with plaque psoriasis, which flares up when she gets stressed. Back then, she said people werent as educated about psoriasis and psoriatic diseases as they are today, and she felt self-conscious knowing it could flare when she was stressed about an upcoming meet.

No one had [the] nerve to come up and say anything. But you can tell when people are looking at you, and I felt like people were looking at me. Back then, people thought they would get it, Torres said. People thought if they touched me and it hit their skin they would get it or if they were in the pool with me, then they would get it, too.

But those misconceptions simply arent true psoriasis is not contagious and is actually common (approximately 7.5 million Americans have psoriasis, and up to 30 percent of those may also eventually develop psoriatic arthritis ). Its also treatable with the help of a dermatologist.

Thats why Torres is partnering with Celgenes Show More of You campaign, which seeks to raise awareness of psoriatic disease and show people with psoriasis they can still be their true selves this summer. Torres said she became more confident in her body when she realized, as she says, my business suit is my swimsuit.

I couldnt not be confident, I had to follow my dreams and continue swimming. I couldnt not go to the Olympics because I had psoriasis, Torres said.

And she has a message for others who might feel embarrassed or ashamed of their psoriasis this summer: talk with a dermatologist about treatment options, and get out there.

[The campaign] is sharing other people with psoriasis stories and saying hey, its OK. We want to give them confidence to know that they can go out show more of you is really a great name, Torres said. Everyone in the world knows bodies come in all shapes and sizes and you shouldnt be discriminated against for that.

Related: When a Hairdresser Refused to Cut My Hair Because I Have Psoriasis

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Olympic Swimmer Dara Torres Offers Advice to People With Psoriasis – TeenVogue.com

EU approves LEO Pharma’s psoriasis biologic – PharmaTimes

A new treatment option has been approved in the European Union for patients with psoriasis, paving the way for access to a novel approach for those with moderate-to-severe forms of the disease who are candidates for systemic therapy.

LEO Pharmas Kyntheum (brodalumab) is a novel biologic and the first and only psoriasis treatment to target the L-17 receptor.

By binding to this specific receptor on the cells of the skin, brodalumab blocks the biological activity of several pro-inflammatory IL-17 cytokines involved in plaque formation, offering a different mechanism of action to all other psoriasis biologics currently available, which target free inflammatory mediators.

In the clinical trials, 37-44 percent of patients treated with the drug achieved complete skin clearance (PASI 100) at week 12, compared with 19-22 percent with ustekinumab, with high levels of skin clearance sustained with continuous brodalumab treatment through week 52.

The most common adverse events linked to the drug were arthralgia (joint pain), nasopharyngitis (inflammation of the nose and pharynx), headache, and upper respiratory tract infection, LEO noted.

Kyntheums approval is an important milestone for nearly two million people living with psoriasis in the UK, a quarter of whom will have, or may develop, a moderate or severe form of the disease, said Professor Richard Warren, consultant dermatologist, North West, Salford Royal NHS Foundation Trust.

Despite recent advances in treatment, there are still some patients who cannot achieve the complete, sustained skin clearance they desire. Brodalumab with its differentiated mode of action represents a valuable treatment option, one I believe will be welcomed in the field of dermatology.

EU clearance follows that in US where the drug was approved under the brand name Siliq, but with a boxed warning on suicide and a restricted prescriber programme. Valeant holds US rights to the drug.

Nearly 1.8 million people live with psoriasis in the UK, and 25 percent of them can develop a moderate or severe form of the disease.

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EU approves LEO Pharma’s psoriasis biologic – PharmaTimes

Cyndi Lauper showcases backstage psoriasis woes in Novartis’ new … – FiercePharma

Cyndi Lauper is back to star in another round of Novartis psoriasis marketing.

The ’80s pop music icon, who in 2015 partnered with the Swiss pharma giant and the National Psoriasis Foundation on a disease-awareness push, appears with two other real-life patients in Novartis latest Cosentyx spot.

RELATED:Novartis goes ’80s with Cyndi Lauper-led psoriasis campaign

It was tough getting out there on stage, she narrates, as the camera shows her in her dressing room, trying to disguise her psoriasis with spray makeupand failing. The commercial weaves Laupers story with those of two other patients, shown struggling withunwanted attention aspeople around them stare at the red, flaky skin patches caused by the disease.

But the video spot takes a triumphant turn after Lauper declares that I found something that worked and keeps on working.

Never give up, she urges viewers, adding, clear skin can last as she rocks out on stage and then walks into a crowd of adoring fans.

RELATED:Novartis bolsters its home-turf advantage in psoriasis with Cosentyx DTC push

The new work is part of Novartis See Me campaign, which the company launched last year to play well with this patient base and further grow the brand, as then-pharma chief David Epstein told investors on an early 2016 conference call.

The new spot comes in the face of some new competition. Since the Basel-based drugmaker rolled out its first DTC effort in psoriasis, Eli Lillys Taltz, Valeants Siliq and, most recently, Johnson & Johnsons Tremfya have arrived on the next-gen psoriasis scene. Those rivals didn’t stop Cosentyx from cracking the blockbuster barrier, though; it racked up $1.13 billion worldwide in 2016.

And asJohnson & Johnson execs recently reassured their own investors, theres still plenty of market share to go around. We believe it’s only about 25% to 30% of the patients in that category [who] are actually on some of the newer agents, CEO Alex Gorsky said. So that in and of itselfrepresents a significant opportunity.

More here:

Cyndi Lauper showcases backstage psoriasis woes in Novartis’ new … – FiercePharma

Leo Pharma gets EC nod for psoriasis treatment Kyntheum – Pharmaceutical Business Review

PBR Staff Writer Published 21 July 2017

AstraZenecas subsidiary MedImmune announced that its partner Leo Pharma has secured approval from the European Commission (EC) for its Kyntheum (brodalumab) to treat moderate-to-severe plaque psoriasis.

The approval allows to market Kyntheum in all 28 European Union (EU) member countries, as well as Iceland, Liechtenstein and Norway.

Kyntheum is a new biologic medicine developed to treat moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy. It is claimed to be the only biologic that selectively targets the IL-17 receptor subunit A.

It effectively blocks the biological activity of several pro-inflammatory IL-17 cytokines, by binding to the receptor with high affinity.

Psoriasis is a chronic and immune-mediated inflammatory skin disease affecting around 125 million people across the globe, including about 14 million Europeans.

In July 2016, AstraZeneca entered into an agreement with Leo Pharma to develop and commercialise Kyntheum in Europe.

Outside of Europe, Valeant Pharmaceuticals had secured commercial rights for brodalumab except in Japan and certain other Asian countries, where the rights are held by Kyowa Hakko Kirin.

Currently, brodalumab was approved in the US and Japan for adult patients with moderate-to-severe plaque psoriasis who are candidates for systemic therapy.

The psoriasis clinical trials program for Kyntheum included three clinical trials, comprising of Amagine-1 with 661 patients, Amagine-2 with 1831 patients and Amagine-3 with 1881 patients.

According to AstraZeneca, data from the three randomized and controlled Amagine clinical trials determined Kyntheum was well tolerated with an acceptable safety profile.

Leo Pharma president and CEO Gitte Pugholm Aabo said: Those most affected by psoriasis often feel controlled by their condition, the stigma it brings, and the diverse complications associated with it.

We hope that the EU approval of Kyntheumwill help many more people to regain control, and live lives unrestricted by psoriasis, while our role is to support them throughout their journey to clear skin.

Image: Head office of the European Commission. Photo: courtesy of Amio Cajander.

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Leo Pharma gets EC nod for psoriasis treatment Kyntheum – Pharmaceutical Business Review

European approval for LEO Pharma’s in-licensed psoriasis drug … – The Pharma Letter (registration)

Kyntheum (brodalumab), a new biologic medicine developed for the treatment of moderate-to-severe plaque

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European approval for LEO Pharma’s in-licensed psoriasis drug … – The Pharma Letter (registration)

Could Cannabis Be Used Medically To Treat Psoriasis? – CannaTech.news

Cannabis is proving to be an effective treatment for a wide number of medical conditions including Crohns disease, glaucoma, and chemotherapy-induced nausea

There is also mounting evidence that cannabis has a profound effect on the immune system. Which leads us to our next question: Is cannabis an effective treatment for psoriasis?

What is psoriasis?

Psoriasis is an autoimmune disorder in which your immune system mistakenly identifies a foreign invader within your body and produces white blood cells in response. These cells, known as T cells, then proceed to attack your bodys healthy cells.

The condition is characterized by red, itchy patches of skin caused by the buildup of immature T cells on the skins surface. Areas of the body most commonly affected are the back of the forearms, shins, around the navel, and the scalp.

Somewhere between 10 to 20 percent of people who have psoriasis will go on to develop psoriatic arthritis, a form of chronic inflammatory arthritis that causes painful swelling and stiffness of the joints. If left untreated, it can even lead to permanent joint damage.

Psoriasis is thought to be a genetic condition that is triggered by environmental factors. Scientists have found 25 different genes that increase a persons likelihood of developing psoriasis, but it is stress that seems to induce most outbreaks. Many patients also report the worsening of symptoms when chronic infections are present, as well as when there is a dramatic change in the season and climate.

Psoriasis and mental health

The numerous uncomfortable symptoms of psoriasis such as pain, fatigue, and sleeplessness can have a profound toll on the mental health of sufferers, as one can imagine.

Up to 60 percent of psoriasis patients report significant psychiatric symptoms, according to the National Psoriasis Foundation. The organization also notes that those who suffer from psoriasis are at an increased risk for depression, anxiety, and suicide.

Cannabis as a psoriasis treatment

While psoriasis isnt curable, there are a number of useful treatments that can help patients to manage their symptoms. These include several different drug and light therapies, although some have serious side effects and others become less effective as patients build up a resistance to them.

In light of the physical and emotional strain of psoriasis, new treatment options are very much in need. Given the wealth of recent research on cannabis and its effectiveness in treating a wide variety of conditions, it is now being explored as a possible treatment optionfor psoriasis.

In order to access the value of cannabis in the treatment of psoriasis, research has focused on a number of different aspects of the disease.

Slowing cell growth

Some studies, such as this one, show that cannabis may be useful in slowing the rapid growth of keratinocytes, which are the immature skin cells that psoriasis patients produce. The authors of the above study go on to state that their results support a potential role for cannabinoids in the treatment of psoriasis.

Pain relief

Cannabis is a common intervention for sufferers of pain it may even be more effective than opioids in controlling acute and neuropathic pain. This paper suggests cannabis may also have the ability to reduce chronic pain and postoperative pain.

Suppressing the immune response

Although much more research is needed, there are some studies which point to cannabis being an effective immunomodulator that can diminish the immune response. This can reduce the severity of inflammation associated with some conditions, including autoimmune disorders like psoriasis. This paper, published in Nature Reviews. Immunology, gives credence to the wealth of information that indicates cannabis to be an effective immunosuppressant and anti-inflammatory agent.

While most of this research has focused on the oral application of cannabis, many psoriasis patients also us cannabis oil topically, reporting that it helps controls the irritation and proliferation of speed irritations whilst reduces inflammation.

Future research

Due to the fact that cannabis is still classed as a Schedule I substance under the United States Controlled Substances Act, research into its therapeutic uses has been restricted. However, the recent relaxation of a number of state laws, along with widespread mainstream attention on cannabis, has seen more important research initiated.

The next few years are extremely exciting in relation to the medicinal uses of cannabis and, as the above evidence points to, it may well become a valuable agent in the treatment of autoimmune disorders such as psoriasis.

[Featured image credit-The Cannabis Reporter]

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Could Cannabis Be Used Medically To Treat Psoriasis? – CannaTech.news

AstraZeneca’s Kyntheum OK’d in EU for plaque psoriasis – Seeking Alpha

The European Commission approves AstraZeneca’s (NYSE:AZN) Kyntheum (brodalumab) for the treatment of moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy.

Brodalumab is a biologic that selectively targets the interleukin-17 (IL-17) receptor subunit A, located on skin cells. Other interleukin inhibitors target free inflammatory mediators.

LEO Pharma has exclusive commercialization rights in Europe. Valeant Pharmaceuticals has global commercial rights ex-Europe except Japan and certain other Asian countries where Kyowa Hakko Kirin Co. owns the rights.

Brodalumab is marketed in the U.S. by Valeant under the brand name Siliq.

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AstraZeneca’s Kyntheum OK’d in EU for plaque psoriasis – Seeking Alpha

FDA Approves Tremfya for Moderate to Severe Plaque Psoriasis – P&T Community

FDA Approves Tremfya for Moderate to Severe Plaque Psoriasis
P&T Community
The FDA has approved guselkumab (Tremfya, Janssen Biotech) for the treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy. Tremfya is the first approved biologic therapy that selectively

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FDA Approves Tremfya for Moderate to Severe Plaque Psoriasis – P&T Community

J&J’s New Psoriasis Drug Approved by FDA – Drug Discovery & Development

Like many other conditions, a one-size-fits-all therapy does not apply to patients with plaque psoriasis. Now, there is another treatment option for those not responding to current available therapies.

Janssen Biotech, Inc., a division of Johnson & Johnson, has announced U.S. FDA approval of guselkumab (Tremfya) for the treatment of moderate to severe plaque psoriasis.

Approval comes after an expedited regulatory review following application of an FDA Priority Review Voucher. Its the first drug approved that selectively blocks interleukin (IL)-23, a cytokine thought to play a role in the disease.

The treatment is administered as a 100 mg subcutaneous injection every eight weeks, following two starter doses at weeks 0 and 4. It is indicated for adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

Regulators made the approval based on results from Phase III clinical studies that included more than 2,000 patients. The VOYAGE 1, VOYAGE 2, and NAVIGATE studies showed 7 out of ten patients receiving the treatment achieved at least 90 percent improvement in skin clearance at week 16.

The VOYAGE 1 AND VOYAGE 2 trials tested guselkumab against placebo and adalimumab (Humira).

Patients receiving guselkumab experienced significant improvement in skin clearance and greater improvement in symptoms of plaque psoriasis including itch, pain, stinging, burning and skin tightness when compared with placebo at week 16.

In a head-to-head analysis against adalimumab, more than seven out of ten patients treated with guselkumab reported at least 90 percent clearer skin at week 24 compared with more than four out of ten patients treated with adalimumab.

NAVIGATE findings demonstrated the effectiveness of guselkumab in patients who had an inadequate response to treatment with J&Js IL-12 and IL-23 antagonist ustekinumab (Stelara). At week 28, 31 percent of guselkumab-treated patients were considered cleared or almost cleared versus 14 percent of ustekinumab-treated patients 12 weeks after randomization to continue ustekinumab or transition to guselkumab.

Tremfya represents a significant milestone in the treatment of moderate to severe plaque psoriasis as evidenced by the proven skin clearance demonstrated in the majority of study patients receiving this IL-23specific therapy at week 16 and up to week 48,” said Andrew Blauvelt, M.D., M.B.A., President of Oregon Medical Research Center, and study investigator in the companys announcement. “We continue to make progress in understanding the science of psoriasis and the important role IL-23 plays in the pathogenesis of this disease, which is another reason why today’s approval of Tremfya is exciting, both as a researcher and a practicing dermatologist.”

“The approval of new and effective treatment options is always welcome news for the plaque psoriasis patient community, as not all patients respond similarly to currently available treatments,” said Michael Siegel, Ph.D., Vice President of Research Programs for the National Psoriasis Foundation in a statement from Janssen. “For the more than one million Americans living with moderate to severe plaque psoriasis, the approval of Tremfya is a meaningful addition and offers physicians and patients an effective new, first-in-class therapy that selectively inhibits IL-23.”

There is an ongoing Phase III study evaluating guselkumab as a treatment for active psoriatic arthritis and a Phase III trial evaluating efficacy compared to secukinumab (Cosentyx) for moderate to severe plaque psoriasis.

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J&J’s New Psoriasis Drug Approved by FDA – Drug Discovery & Development

A dermatologist reveals the best way to deal with scalp psoriasis – Netdoctor

Scalp psoriasis is a common skin disorder that causes raised, reddish, scaly patches on the scalp and can extend beyond the hairline onto the forehead, the back of the neck and around the ears. It can vary from being very mild and unnoticeable, with slight fine scaling, or very severe with thick crusted plaques covering the entire scalp.

Dr Conal Perrett, dermatologist and founder of the Devonshire Clinic and one of London Medical Concierge’s network of doctors, answers your questions on scalp psoriasis.


As with other types of psoriasis, we don’t know what causes it and ongoing research is being done to try and identify why it occurs. Doctors believe it comes from a deficiency within the immune system that causes skin cells to grow too quickly and build up into patches. You may be more likely to get scalp psoriasis if it runs in your family.

Scalp psoriasis is not contagious but it is incredibly uncomfortable, itchy and can cause confidence issues in many people.

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Symptoms of mild scalp psoriasis may include only a light fine scaling. Whereas, moderate or severe scalp psoriasis symptoms can include:

Sometimes it can be difficult to distinguish between dandruff and scalp psoriasis as they both have similar symptoms. You may be able to tell by the thickness and colour of the flakes but if you are in any doubt and think your dandruff may indicate scalp psoriasis scaling then I would advise speaking with your GP.

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There are many treatment options, such as lotions, creams and shampoos, which can help scalp psoriasis and often a combination approach using a number of different treatments may be required until the symptoms have settled. It is important to remember to treat scalp psoriasis even if you experience hair loss, as the hair will grow back once the inflammation settles.

Treatments can be time-consuming so I would recommend choosing one that suits your lifestyle and carrying out extensive treatments over the weekend. Remember to treat psoriasis daily when it is active. It can take at least eight weeks until you are able to gain adequate control of the plaques, whichever treatment you choose to use.

Once you have achieved clearance, it is important to maintain the improvement, and this can usually be done with regular use of a tar shampoo and or by moisturising the scalp occasionally with an oil or emollient. If you have no success in controlling your scalp psoriasis, ask your GP to refer you to a specialist.

Visit http://www.londonmedicalconcierge.com for more information on how you can get quick access to an appointment with a leading dermatologist to discuss any skin concerns.

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A dermatologist reveals the best way to deal with scalp psoriasis – Netdoctor

Psoriasis: FDA approves guselkumab – European Biotechnology

The Food and Drug Administration has granted US market approval to Janssen Biotech/MorphoSys IL23 blocker guselkumab (Temfya) as therapy for moderate to severe psoriasis.

The authorisation triggered an milestone payment from Janssen Biotech, Inc. to MorphoSys AG (Martinsried, Germany), which had discovered and licenced the first ever approved IL23-blocking antibody to treat moderate to severe plaque psoriasis to the US company. The approval of the immunosuppressive antibody, which will be sold under the tradename Tremfya, comes after an expedited regulatory review following application of an FDA Priority Review Voucher.

In the pivotal studies VOYAGE 1 and VOYAGE 2, the subcutanously administered antibody proved to be superior to standard of care (adalimumab) in PASI 90 after 16-48 weeks of treatment. Improvements were also demonstrated in psoriasis involving the scalp and in symptoms of plaque psoriasis including itch, pain, stinging, burning and skin tightness at week 16. MorphoSys announced its partner Janssen will commence marketing of the drug in Q3/2017.

Psoriasis is a chronic skin disorder characterised by epidermal hyperproliferation and dermal inflammation that vary in severity. It affects about 23% of the global population, making it one of the most prevalent autoimmune diseases worldwide, and can be associated with other inflammatory conditions, such as psoriatic arthritis, inflammatory bowel disease and coronary artery disease.

GlobalData estimates the psoriasis market to grow from currently US$7.5bn to US$13.3bn by 2024. GlobalDatas analyst Nikhilesh Sanyal predicts that recently approved immunosuppressive antibody drugs such as guselkumab or Eli Lillys IL-17 blocker ixekizumab annual sales might exceed US$1bn. However, the psoriasis market is crowded, with other biologics such as Sun Pharmas IL23p19 blocker tildrakizumab and AstraZeneca/Valeants (NYSE: VRX) brodalumab, which, however, had been linked to suicidal thoughts. Furthermore, outgoing patent protection for J&Js infliximab, Abbvies adalimumab, and Amgens etanercept has triggered development of several biosimilars, which may come with a significant pricing advantage.

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Psoriasis: FDA approves guselkumab – European Biotechnology

People with psoriasis will have new treatment option instead of Humira – Chicago Sun-Times

People with psoriasis will have a new treatment option for the itchy, sometimes painful condition, after the federal Food and Drug Administration approved a new psoriasis drug.

The FDA approved Tremfya for treatment of moderate to severe plaque psoriasis.

Johnson & Johnson said that, in one patient study, about seven in 10 patients getting Tremfya had clear or nearly clear skin after 24 weeks of treatment.

That compares with about four in 10 patients receiving rival AbbVies Humira, which treats several immune disorders and is the worlds top-selling drug. AbbVie is based in North Chicago.

The drug, which has the chemical name guselkumab, will cost $9,684 per dose, or about $58,100 per year, without insurance. Thats comparable to Humira, which costs about $59,200 a year.

Tremfya, which is injected every eight weeks, can cause infections and other serious side effects. Because it suppresses part of the immune system, it can increase the risk of developing tuberculosis and some types of cancer.

More than 7.5 million Americans are estimated to have psoriasis, a chronic inflammatory condition in which overproduction of skin cells causes raised red lesions called plaques, along with frequent pain, itching and burning sensations. Tremfya was able to both clear up lesions and help relieve those symptoms.

Johnson & Johnson, based in New Brunswick, New Jersey, sells other immune disorder treatment such as Remicade and Stelara for conditions including Crohns disease, ulcerative colitis and rheumatoid arthritis.

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People with psoriasis will have new treatment option instead of Humira – Chicago Sun-Times

Psoriasis- What You Need To Know – Reports Healthcare

Psoriasis is unpredictable, infuriating and among the most perplex skin disorders. It is a condition in which your skin cells start multiplying at a rate ten times faster than the normal one. When the underlying cells skin cells move towards the surface of the skin and die, they cause red plaques all over the skin due to their sheer volume.

About 7.5 million people are said to get affected by psoriasis in America. Not only does this disease harm the skin, it can also result in several other complications such as psoriatic arthritis, inflammatory bowel disease, diabetes type 2 and cardiovascular problems. Therefore, it is important to know the manifestations and diagnosis of psoriasis in order to deal with this irritating skin disease as fast as possible.

What Happens In Psoriasis

As mentioned before, psoriasis occurs when the skin production process is sped up. In a typical individual, it takes a month for the skin cells to grow in the skin, rise to the surface and fall off eventually.

In people with psoriasis, this process is sped up to a few days only. This means that the skin cells are not given enough time to fall off in a normal way. An overproduction of these cells occurs which causes the development of plaques in them.

Scales are usually seen in the body of such patients. The most common areas where they can be seen are elbows, joints and knees. Scales can also grow on other parts of the body such as neck, hands, scalp, feet and face.

Less commonly, psoriasis can also be seen attacking the mouth, nails and the area surrounding the genitals.

Causes Of Psoriasis

Scientists have categorized the reasons for psoriasis according to the two key factors- the immune system and the genetic makeup.

Immune System

Psoriasis is an autoimmune disease in which the body starts attacking its own cells. In this disease, the white blood cells or the T cells present in your blood start harming the skin cells.

In a normal individual, white blood cells are designated to destroy all the bacteria that make their way into your body and to fight them before they start spreading infection. These cells mistakenly start targeting the normal skin cells leading to overdriving of their production. New skin cells are quickly generated and start piling up on the surface of the skin.

Plaques are formed that are normally surrounded by inflammation in this case.

Genetic Makeup

The genetic makeup of a certain individual also makes him more vulnerable to developing psoriasis. If any one of your immediate family members is suffering from a skin disease, you are more prone to acquire psoriasis as well. However, only 2 to 3 percent of the people suffer from psoriasis due to genetic setup is quite less.

Is Psoriasis Transmissible?

Psoriasis is not generally contagious and the patient is unable to transmit this disease to the people surrounding him. Even if you come in direct contact with a psoriatic lesion, you will not acquire it.

Signs And Symptoms Of Psoriasis

The symptoms of this skin disorder can vary from person to person. However, the most commonly seen manifestations are mentioned below:

Treatment Options For Psoriasis

In general, psoriasis is untreatable. Medications can be prescribed to decrease the scales, slow down the growth cycle of skin cells and to reduce inflammation.

Several ointments and creams are given to be applied on the infected area. These topical treatments may include the use of topical retinoids, topical corticosteroids, salicylic acid and vitamin D analogues.

Systemic treatments are given to people who have moderate to severe form of psoriasis and do not respond to the topical treatment. The commonly prescribed medicine groups are biologics, cyclosporine and retinoids.

This treatment regimen involves the use of ultraviolet light or even the natural light to stop overactive T cells in the body. Symptoms of psoriasis are said to be reduced using UVA and UVB light.


Psoriasis- What You Need To Know – Reports Healthcare

FDA clears Philips’ light therapy wearable for mild psoriasis … – FierceBiotech

Philips scored FDA clearance for its wearable light therapy device for the treatment of psoriasis. The rechargeable device delivers blue LED light to the skin in a drug-free approach that controls the symptoms of mild psoriasis.

Characterized by patches of thick, red inflamed skin covered with scales, psoriasis occurs when skin cells quickly rise to the surface, where they build up before they mature. The chronic disease affects more than 6.7 million adults in the U.S., according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Philips launched the first-generation BlueControl system in Germany, the Netherlands and the U.K. in October 2014. The following year, the company earned a CE mark for the devices follow-up, which was introduced in additional markets, including Denmark, Finland, Sweden and Poland. The FDA has cleared it as a prescription device for home use.

RELATED: MetrioPharm advances psoriasis drug after phase 2 readout

A patient secures the BlueControl device on the affected body part using adjustable straps. The blue light triggers natural processes in the skin that ease the symptoms of psoriasis, which include redness and scaling. Specifically, it slows down the accelerated production of skin cells that results in plaques.

In addition to light therapy, psoriasis is commonly treated with pharmaceuticals. Topical treatments such as ointments or creams containing corticosteroids work well for some patients, but some patients with severe psoriasis may need medications that are taken orally or by injection. These include immune suppressants and drugs that interfere with specific immune system functions that cause the overproduction of skin cells.

RELATED: J&J’s Tremfya gets its go-ahead to fight Novartis, Lilly in psoriasis. Can it stand out?

Patients who take immune-suppressing drugs are at higher risk of infection. Using light therapy alone, or in combination with medicationwhich allows a lower dose of eachis an attractive way to reduce thisrisk.

Now, Philips plans to engage with dermatologists and patient support groups in the U.S., with eyes on commercial launch early next year.

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FDA clears Philips’ light therapy wearable for mild psoriasis … – FierceBiotech