Monthly Archives: April 2021

Psoriasis is a skin condition that can cause areas of skin to become flushed, inflamed, and flaky.

The appearance of psoriatic lesions may cause a person to feel anxious, depressed, or embarrassed. However, resources are available that may help people manage these conditions.

Scientists do not fully understand the link between psoriasis and anxiety or depression. However, some research has suggested that psoriasis and mental health conditions are strongly linked.

In one study, researchers found that several factors, including a persons age at psoriasis onset, can directly affect social anxiety and depression.

They found that people who developed psoriasis before the age of 18 years experienced social anxiety related to feelings of stigmatization.

They also found that people who developed psoriasis after the age of 18 years developed social anxiety related to feelings of their appearance affecting their self-worth.

Social anxiety disorder is a type of anxiety disorder. A person with social anxiety and psoriasis may not want to spend as much time with friends or family due to possible feelings of embarrassment or shame.

According to the National Institute of Mental Health, social anxiety can cause a person to:

There is also a strong link between stress and psoriasis.

The American Psychological Association (APA) describes a fine line between stress and anxiety.

Both cause similar symptoms, but stress is typically a response to a trigger, such as overworking or having exposure to conflict. On the other hand, anxiety is associated with long-term worry over situations with no obvious triggers related to a specific situation.

Some research has suggested that perceived stress does not affect the severity of psoriasis symptoms. However, the researchers noted that stress can increase the level of perceived impact on a persons daily life. They also stated that people who associated psoriasis with psychological factors such as stress were more likely to be anxious.

The National Psoriasis Foundation states that stress can affect the severity of psoriasis symptoms and make itchiness worse. As a result, it recommends that individuals manage stress as part of their overall treatment plan.

Having psoriasis can cause a person to develop anxiety.

The APA defines anxiety as persistent and excessive worries that continue and do not go away even with no stressor causing the worry.

Anxiety affects people in several ways. It may lead to:

For example, a person with psoriasis may avoid going to a social gathering because they believe that others may make fun of them or find their psoriasis gross.

By avoiding social gatherings, the person may feel more alone and could develop symptoms of depression due to social isolation.

Psoriasis is a condition independent of stress or anxiety. However, stress or anxiety can trigger or worsen psoriasis symptoms.

One study has suggested that anxiety and psoriasis have a cyclical relationship. This means that psoriasis can cause anxiety and that anxiety can cause the symptoms of psoriasis to worsen.

As a result, a person with both conditions may notice symptoms of psoriasis during a period of stress or anxiety.

The Psoriasis and Psoriatic Arthritis Alliance provides several strategies to help a person deal with general anxiety and social anxiety. These include taking steps such as:

A person can also ask a doctor about mental health services. They may recommend a psychologist or psychiatrist to help the person cope with stress and anxiety related to psoriasis.

The National Psoriasis Foundation offers a service called One to One. It connects people with psoriasis to mentors who can help them learn to cope with the condition. This may be helpful for people who feel that they do not have anyone to relate to.

Psoriasis is linked to several mental health conditions, including anxiety, stress, and depression. Some evidence has suggested that anxiety and stress can trigger psoriasis flares and that psoriasis flares can trigger anxiety or stress.

A person with psoriasis should work with a healthcare professional to develop effective mental health treatments so that they can live their life without fear of social stigmatization or negative judgment.

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Psoriasis and social anxiety: What is the link? - Medical News Today

Living with a chronic condition can be stressful. Thats especially true of any visible condition, like psoriasis.

Psoriasis is an autoimmune disease that causes inflammation in the body and red, scaly, itchy patches on the skin. Often, these patches are in visible places like the knees, elbows, and scalp.

While theres no cure for psoriasis, treatments can prevent skin flares and relieve related stress.

The connection between stress and psoriasis is complex, and it goes both ways. Stress is a known trigger of psoriasis flares. And people who develop these patches may stress about the way psoriasis makes them look and feel.

Could stress actually cause psoriasis? In and of itself, stress is not going to be something that causes psoriasis to develop out of the blue, says Evan Rieder, MD, assistant professor of Dermatology at NYU Langone Health.

He adds, But it could cause a flare of the disease in someone who is already genetically predisposed to having psoriasis.

Researchers have discovered more than 80 genes linked to psoriasis. When your relatives have this condition, youre more likely to get it. If both of your parents have it, your risk is 75 percent. If only one parent has it, your risk is 15 percent.

Exactly why stress causes flares, researchers dont know. People with psoriasis seem to have a problem with the hypothalamic-pituitary-adrenal (HPA) axis, the system that controls their bodys reaction to stress.

They have lower levels of the stress hormone cortisol, which normally helps tame inflammation. So when they are under stress, inflammation starts, and psoriasis flares up.

The stress of living with psoriasis can escalate this process and make symptoms even worse. Psoriasis patches are itchy and cause discomfort. There is also a stigma from having plaques on your skin.

People you meet might react to the redness by making comments or by shrinking away from touching you. You can imagine what that does to someones self-esteem, Rieder says.

One effective way to manage stress is with relaxation techniques such as meditation and deep breathing. Exercise is also a good stress reliever, and its great for boosting self-esteem.

Hypnosis and biofeedback are other techniques to help ease stress. It takes regular practice of relaxation techniques for them to be effective.

Self-advocacy is important when it comes to managing psoriasis, according to Rieder. Your dermatologist may focus only on your skin and not ask questions about your mental health.

People with psoriasis can get depression and anxiety, and it doesnt necessarily correlate with whats going on with their skin. Their skin can look clear, he says.

In addition to seeing your dermatologist, he recommends talking to a therapist. Focus on whatever is getting in the way of you being able to live your best life, he says.

You might want to consider seeing a therapist who has experience working with people with psoriasis or other chronic conditions.

A support group is a place where you can connect with other people who have psoriasis, and learn from their experiences. I think they can be very helpful, Rieder says. Unless youre living with the condition, its very hard to truly empathize.

Support groups are held in places like hospitals, community centers, and churches. Youll also find them online. The best place to start looking for a support group is through an organization like the National Psoriasis Foundation.

It may be hard to talk to people about your psoriasis, even those closest to you. But starting the conversation can help the people that love you most give you the support you need.

For people in your outer circle, your explanation can be brief and to the point. Say something like, Its not infectious and you cant get it from me, Rieder suggests.

Be more open and honest with friends and family. Help them understand what its like for you to live with this disease. Once they understand, they can be better allies.

Having clearer skin can go a long way toward emotional improvement. When youre less stressed about your skin, you may find you get fewer flares.

At least one psoriasis treatment biologic drugs serves double duty. Biologics are genetically engineered medications that target certain molecules in the body involved in causing inflammation, helping your immune system to operate properly.

In the case of psoriasis, these medications help relieve depression and improve quality of life while they clear the skin.

You have many options for treating psoriasis. The treatment dermatologists usually try first is a topical steroid, which slows cell production and brings down inflammation in your skin. Other, nonsteroidal topicals include anthralin, synthetic vitamin D3, and vitamin A.

Phototherapy exposes your skin to UV light to stop skin cells from growing. You can get this treatment at your doctors office or at home.

Systemic (body-wide) treatments such as biologics, methotrexate, and cyclosporine stop your immune system from causing inflammation in your skin. You may get one of these treatments if your psoriasis is severe or it doesnt respond to topical treatments.

The key to getting on the right treatment is to find a doctor you trust. Make sure you see a board certified dermatologist and get the best recommendations, Rieder says.

Psoriasis is a difficult condition to live with, but theres never been a better time to live with psoriasis. We can get people clear or almost clear in the majority of cases.

These treatments can really improve peoples quality of life and the way that they feel, he adds.

Stress and psoriasis are closely linked. Youre more likely to have flare-ups when youre stressed, and psoriasis can increase your stress levels.

Seeing a dermatologist and getting on the right treatment can lead to clearer skin and less stress. A counselor or other mental health provider will help you manage the emotional symptoms of psoriasis while your treatment goes to work.

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Stress and Psoriasis: What's the Link? - Healthline

Several research articles have shown a positive association between psoriasis and thyroid diseases, including Hashimotos thyroiditis (hypothyroidism) and Graves disease (hyperthyroidism), but the limited number of studies do not provide a complete explanation to prove this association, according to a review study published in Cureus.

This review study included 45 articles that featured psoriasis, hypothyroidism, thyroid function tests, propylthiouracil, and psoriatic arthritis as inclusion keywords. Medical Subject Headings keywords psoriasis, hypothyroidism, and autoimmunity were also imputed into PubMed to identify the relevant articles for review.

A total of 39 of the 45 articles included in this review study demonstrated a positive association between psoriasis and thyroid diseases, although 6 articles found no association.

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In 5 articles, researchers showed that thyroid hormones had an effect on the development of psoriasis. Other articles demonstrated that genetic, immunological, and inflammation were involved in the associations. Reactive oxygen species-related pathogenesis was also reported in 2 articles. In 5 articles, there were reports of positive thyroid peroxidase antibodies, thyroglobulin antibodies, and Hashimotos thyroiditis ultrasound features in patients with psoriasis.

Marked improvement was observed in psoriatic skin lesions following thyroidectomy in 2 articles. In addition, the investigators of this review found that first-line propylthiouracil for hyperthyroidism reportedly clears psoriatic lesions, according to findings in 6 articles. Propylthiouracil did not appear to induce clinical hypothyroidism or lead to any serious adverse effects. The researchers of this review study suggest propylthiouracil could be prescribed as an alternative therapy for patients with psoriasis due to its side effects compared with existing psoriasis treatments that are typically toxic and expensive.

The investigators also noted that a higher prevalence of the association between psoriasis and thyroid diseases in women was reported in some of the articles. However, some articles found no sex preference involved in the prevalence of the association.

Limitations of this study included the small number of articles available for review as well as the lack of a pooled meta-analysis of the data.

The investigators concluded that additional studies are required to establish a connection between these diseases because these findings have a significant impact on both the clinical and research sides.

Eapi S, Chowdhury R, Lawal OS, Mathur N, Malik BH. Etiological association between psoriasis and thyroid diseases. Cureus. 2021;13(1):e12653. Published 2021 Jan 12. doi:10.7759/cureus.12653

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Is There an Association Between Psoriasis and Thyroid Disease? - Dermatology Advisor

Learning about the relationship between diet and inflammation helped me make long-term changes and have fewer flare-ups.

After suffering from early-onset arthritis and thick, scaly, itchy patches of skin on my hands for years, some recent unexplained changes in my fingernails led me to request a referral to a rheumatologist.

X-rays and bloodwork confirmed my suspicions I have psoriatic arthritis (PsA).

While my 20-year search for an answer was over, the fight to reduce the inflammation causing my pain was just beginning.

I knew from experience that sugar was a trigger for my joint pain, and for years Id eaten a healthy Mediterranean diet.

But were there other foods that might be contributing to the sudden flare-ups that I experienced?

After reading about the success of others who had tried Whole30, a popular elimination diet, I decided it was worth finding out.

Whole30 isnt a weight loss diet. Its a short-term eating program, created by Melissa Hartwig Urban in 2009, to help people change their relationship with food and determine whether specific foods may be negatively impacting their health.

For 30 days, the following foods are off-limits:

Whats left is whole foods that come from an animal or plant, such as meat, fish, fruit, vegetables, healthy fats like olive oil, and herbs and spices.

After youve been on the plan for a full 30 days comes the reintroduction period. One food is reintroduced at a time, allowing several days to pass between eating the food and reintroducing another food.

This is intended to give your body time to let you know if that particular food causes any unwanted symptoms.

Whole30 is very restrictive, so it isnt recommended as a long-term diet. And while there arent any scientific studies touting health benefits of the Whole30 program, it is similar to though stricter than the popular paleo diet, which has some research to back it up.

To be safe, I asked my provider if she recommended the program, and she gave me the green light to get started.

I decided to take the program one step further and removed nightshades from my diet. Nightshades, including tomatoes and peppers, are packed full of nutrition but I suspected they were triggering some of my joint pain.

There is no scientific evidence that nightshades increase inflammation, but some people do find that their joints hurt more when they eat them.

I found the program fairly easy to follow, as long as I cooked most of my own food. The easiest meals were breakfast and lunch.

I eat the same thing almost every morning: eggs, spinach, and avocado. If I added a sweet potato and some extra olive oil, I was satisfied for 4 hours.

Lunch for me is usually a simple salad, or fruit, prosciutto, and olives, or both. As long as the dressing was on-plan, this was still a good option.

My favorite time hack involved preparing extra food for dinner that I could repurpose the next day for lunch.

I found dinner to be the most challenging meal. Since I was no longer eating nightshades, I reworked some of my favorite recipes. I found a wonderful nightshade-free taco seasoning recipe online that made Mexican night possible.

Since I didnt want to cook every single night for a month, I needed to find a takeout restaurant that could accommodate my restrictions.

A local Mediterranean restaurant listed their ingredients online, and I was able to get a meal that was Whole30 compliant. Having this option available felt like a life saver.

Snacks are generally discouraged on the Whole30 program, but as long as the snack is just a smaller version of a meal, its allowed. On-plan turkey slices and mayo layered with lettuce and sprouts became my go-to afternoon pick-me-up.

After being on the program for about a week, I noticed I wasnt in as much pain.

On the other hand, about halfway through the month, I had a moment of weakness. I ate a bite of white potato and some takeout food that had been seasoned with red pepper flakes.

By the time I went to bed that night, I had developed full-body joint pain. These foods are nightshades, so I was pretty sure Id identified one of my triggers.

After getting back on track and completing the 30 days, my pain had improved so much that I cut my anti-inflammatory medication back to once a week.

I saw my rheumatologist while I was completing the Whole30 program to discuss whether I would need another medication for psoriatic arthritis. I told him that I had cut back on my NSAID and that the rough patches on my skin had smoothed out and were no longer cracked and peeling.

My doctor knew that I was doing a Whole30 round and credited my improved symptoms to the elimination of inflammatory foods. He also said I was doing so well that I didnt need to go on medication.

To kick off the reintroduction phase of the program, I had a glass of wine on day 31 with dinner. While it didnt trigger any pain, it also wasnt the feel-good end-of-day solace I remembered.

Next I added sourdough bread and a small amount of sugar in the form of honey. Again, I found I didnt enjoy them as much as I used to. And the joint pain was back.

The last food I officially reintroduced was spicy pepper seasonings and spices, like red pepper flakes. Maybe I didnt need to test nightshades again, but I love spicy foods. And yes, I had a flare-up of full-body joint pain.

At this point, I went off plan. I had already identified a few foods that were causing me pain, and it was time for a break from all the restrictions. But I felt so good after finishing my first Whole30 that I knew I would go through the program again.

The reintroduction phase not only cemented my belief that some foods cause inflammation in my body, but also that my relationship with certain foods was built on habit, rather than need or joy.

I have hereditary high cholesterol and find it hard to keep my numbers in a good range. At the end of my Whole30 round, my total cholesterol was down 60 points and my triglycerides were finally within normal range.

While weight loss wasnt my goal, I was thrilled to discover that Id lost 5 pounds. My clothes were fitting looser and I felt lighter.

The no snacking rule made it easier to fall asleep at night, and I had more energy in the evenings.

As a short-term eating program designed to reset both the body and the mind, I feel the Whole30 program was a success.

It also worked very well as an elimination diet. I felt less pain and had more energy by the end of the Whole30 program.

If you want to explore the Whole30 program, I recommend reading over the official website and having a conversation with your doctor to make sure the program is appropriate for your situation.

Cindy Blye is a nurse and health writer/journalist in North Carolina. Her works have appeared in various nursing blogs and online health news websites. Shes passionate about helping people live a healthier and more energetic life. When she isnt writing, you can find her gardening, cooking, hiking, biking, reading, or eating dark chocolate.

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I Tried the Whole30 for Psoriatic Arthritis and This Is What Happened - Healthline

LONG BEACH, Calif. & BASEL, Switzerland--(BUSINESS WIRE)--Dermavant Sciences, a clinical-stage biopharmaceutical company dedicated to developing and commercializing innovative therapeutics in immuno-dermatology, today announced that two abstracts from Dermavants two pivotal Phase 3 trials for tapinarof for the treatment of psoriasis in adults, PSOARING 1 and PSOARING 2, will be presented during the upcoming American Academy of Dermatology Virtual Meeting Experience 2021 (AAD VMX 2021), on April 23-25, 2021.

Tapinarof is being developed as a novel, once-daily therapeutic aryl hydrocarbon receptor modulating agent (TAMA), cosmetically elegant, steroid-free topical cream for the treatment of plaque psoriasis and atopic dermatitis.

The following posters will be viewable on the conference platform for the entirety of the conference:

Title: Tapinarof Cream 1% Once Daily for Plaque Psoriasis: Secondary Efficacy Outcomes from Two Pivotal Phase 3 Trials

This poster contains secondary efficacy outcomes, including Physician Global Assessment (PGA) scores, percent body surface area (%BSA) affected, and 90% reduction in Psoriasis Area and Severity Index (PASI90) an endpoint more commonly used to assess systemic agents.

Authors: Linda Stein Gold, MD; Andrew Blauvelt, MD, MBA; April Armstrong, MD, MPH; Seemal R. Desai, MD; Howard Sofen, MD; Lawrence J. Green, MD; Stephen K. Tyring, MD, PhD; Laura K. Ferris, MD, PhD; Philip M. Brown, MD, JD; David S. Rubenstein, MD, PhD; Stephen C. Piscitelli, PharmD; Anna M. Tallman, PharmD; Leon Kircik, MD

Title: Tapinarof Cream 1% Once Daily for Plaque Psoriasis: Patient-reported Outcomes from Two Pivotal Phase 3 Trials

This poster contains patient-reported outcomes data, including itch and quality of life measurements.

Authors: Robert Bissonnette, MD; Bruce Strober, MD, PhD; Mark Lebwohl, MD; Jerry Bagel, MD; James Del Rosso, DO; Joseph F. Merola, MD, MMSc; Neal Bhatia, MD; Paul Yamauchi, MD, PhD; Philip M. Brown, MD, JD; David S. Rubenstein, MD, PhD; Anna M. Tallman, PharmD; Stephen C. Piscitelli, PharmD

About Dermavants Phase 3 Program for Tapinarof in Psoriasis

Dermavants pivotal Phase 3 clinical program for tapinarof in adult plaque psoriasis consists of PSOARING 1 (NCT03956355) and PSOARING 2 (NCT03983980), as well as PSOARING 3 (NCT04053387), the ongoing long-term safety study.

PSOARING 1 and PSOARING 2, which collectively enrolled 1,025 patients, were two identically designed, multi-center, randomized, vehicle-controlled, double-blind, parallel group studies conducted in North America that evaluated the safety and efficacy of tapinarof cream, 1% dosed once daily (QD) for 12 weeks versus vehicle QD in adult patients aged 18-75 years diagnosed with plaque psoriasis. The primary endpoint of both studies was a PGA score of clear (0) or almost clear (1) with a minimum 2-grade improvement from baseline at Week 12.

PSOARING 3 is a long-term, open-label, extension study to evaluate the safety and efficacy of tapinarof cream, 1% for the treatment of plaque psoriasis in adults. Subjects in the study had previously completed treatment with tapinarof or vehicle in either the PSOARING 1 or PSOARING 2 Phase 3 pivotal efficacy and safety studies. PSOARING 3 consists of up to 40 weeks of tapinarof cream, 1%, and a 4-week safety follow-up period. As such, subjects who received drug during PSOARING 1 and PSOARING 2, completed PSOARING 3 having received treatment with tapinarof cream for up to 52 weeks. Greater than 90% of eligible patients who completed PSOARING 1 and PSOARING 2 enrolled in PSOARING 3.

About Psoriasis

Psoriasis is a chronic, systemic, inflammatory skin disease characterized by red patches and plaques with silvery scales on the skin. Psoriasis affects approximately 8 million people in the United States and 125 million worldwide.

Psoriasis can begin at any age, but typically has two peaks of onset, the first at age 20 to 30 years and the second at age 50 to 60 years. People with psoriasis are at an increased risk of developing other chronic and serious health conditions. Comorbidities include psoriatic arthritis, inflammatory bowel disease, hypertension, diabetes, obesity, and depression. Psoriasis has a significant impact on quality of life and on psychological health.

About Dermavant

Dermavant Sciences, a subsidiary of Roivant Sciences, is a clinical-stage biopharmaceutical company dedicated to developing and commercializing innovative therapeutics in immuno-dermatology. Dermavants focus is to develop therapies that have the potential to address high unmet medical needs while driving greater efficiency in research and clinical development. The companys robust medical dermatology pipeline includes both late-stage and earlier-stage-development product candidates the company believes could address important immuno-dermatological conditions, including psoriasis, atopic dermatitis, vitiligo, primary focal hyperhidrosis, and acne. Dermavant is developing its lead product candidate, tapinarof (DMVT-505), as a novel therapeutic aryl hydrocarbon receptor modulating agent (TAMA) topical cream for the treatment of plaque psoriasis and atopic dermatitis, which affect approximately 8 million and 26 million people in the United States, respectively. The company reported positive Phase 3 results for tapinarof cream in adult patients with plaque psoriasis. For more information, please visit http://www.dermavant.com, and follow us on Twitter (@dermavant) and LinkedIn (Dermavant Sciences).

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Dermavant Announces Tapinarof Data Presentations at the AAD VMX 2021 - Business Wire

This article was originally published here

Am J Clin Dermatol. 2021 Apr 16. doi: 10.1007/s40257-021-00603-w. Online ahead of print.

ABSTRACT

The emergence of data from clinical trials of biologics, the approval of new biologics, and our improved understanding of psoriasis pathogenesis have increased the therapeutic possibilities for the treatment of moderate-to-severe psoriasis. Biologics currently approved for the treatment of psoriasis include tumor necrosis factor inhibitors, interleukin (IL)-17 inhibitors, ustekinumab (an IL-12/23 inhibitor), and IL-23 inhibitors. Data from clinical trials and studies of the safety and efficacy of biologics provide essential information for the personalization of patient care. We discuss the benefits and disadvantages of biologics as a first-line treatment choice, update treatment recommendations according to current evidence, and propose psoriasis treatment algorithms. Our discussion includes the following comorbid conditions: psoriatic arthritis, multiple sclerosis, congestive heart failure, inflammatory bowel disease, hepatitis B, nonmelanoma skin cancer, lymphoma, and latent tuberculosis. We make evidence-based treatment recommendations for special populations, including pediatric patients, patients with coronavirus 2019 (COVID-19), and pregnant and breastfeeding patients with psoriasis. Ultimately, individualized recommendations that consider patient preferences, disease severity, comorbid conditions, and additional risk factors should be offered to patients and updated as new trial data emerges.

PMID:33861409 | DOI:10.1007/s40257-021-00603-w

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Biologic Treatment Algorithms for Moderate-to-Severe Psoriasis with Comorbid Conditions and Special Populations: A Review - DocWire News

This article was originally published here

Int J Clin Pharmacol Ther. 2021 Apr 16. doi: 10.5414/CP203906. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the relative effectiveness and safety of doses of secukinumab and guselkumab in patients with active psoriatic arthritis (PsA).

MATERIALS AND METHODS: A Bayesian network meta-analysis was performed incorporating data from randomized controlled trials (RCTs) to evaluate the effectiveness and safety of secukinumab 150 mg, secukinumab 300 mg, and guselkumab 100 mg every 4 weeks (Q4W) and guselkumab every 8 weeks (Q8W).

RESULTS: Six RCTs, including 2,385 patients, fulfilled the inclusion criteria. The surface under the cumulative ranking curve (SUCRA) revealed that secukinumab 300 mg had the highest probability of reaching a 20% American College of Rheumatology (ACR20) response rate, followed by secukinumab 150 mg, guselkumab 100 mg Q4W, guselkumab 100 mg Q8W, and placebo. The ACR50 response rate revealed the same distribution pattern as the ACR20 response rate. The SUCRA rating, dependent on the psoriasis area and severity index of at least 75% (PASI75) response rate, showed that guselkumab 100 mg Q4W had the highest possibility of achieving the PASi75 response, followed by guselkumab 100 mg Q8W, secukinumab 300 mg, secukinumab 150 mg, and placebo. Safety analyses focused on serious adverse events (SAEs), adverse events (AEs), and withdrawals attributable to AEs that did not have statistically relevant variation in the respective intervention categories.

CONCLUSION: Based on the ACR20 and ACR50 response rates, secukinumab 300 mg had the strongest response effectiveness, whereas guselkumab 100 mg Q4W was the most effective treatment strategy for PsA based on PASI75. However, there was little disparity between the treatment options with regard to SAEs.

PMID:33860750 | DOI:10.5414/CP203906

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Relative efficacy and safety of secukinumab and guselkumab for the treatment of active psoriatic arthritis: A network meta-analysis - DocWire News