Monthly Archives: September 2021

In mid-August, the Centers for Disease Control and Prevention (CDC)recommended that people who have compromised immune systems get an additional dose of the COVID-19 vaccine.

This includes people who have received organ transplants or are undergoing cancer treatment, as well as some individuals with chronic health conditions who are taking drugs that can suppress their immune response, raising their risk of serious, prolonged COVID-19.

If you have psoriasis and are taking an immunosuppressive medication, such as high-dose steroids or a biologic, you may wonder what the new vaccine guidance means for you and when, how, or even if, you should get a booster shot.

Here are some answers to your most pressing questions, with insights from two leading psoriasis experts.

RELATED: Coronavirus Alert: The Latest News, Data, and Expert Insight on the COVID-19 Pandemic

Anyone with psoriatic disease who is being treated with immune-modulating drugs and has already received two doses of a COVID-19 vaccine from Pfizer-BioNTech or Moderna is eligible for a third dose, says Joel Gelfand, MD, the cochair of the National Psoriasis Foundation and a professor of dermatology and epidemiology at the University of Pennsylvania Perelman School of Medicine in Philadelphia.

Among those patients, Dr. Gelfand believes the following are most likely to benefit from a third shot:

Right now, psoriasis patients and other immune-compromised people who received the Johnson & Johnson (J&J) single-dose vaccine are not eligible for a booster shot.

Since the J&J vaccine has only been available since March 2021, the CDC is waiting for more data before making a recommendation about additional doses for people who are immune-compromised, as well as for the general population.

Preliminary data released by J&J on August 25 suggest that a booster shot could be highly protective.

RELATED: Living With Psoriasis During the Pandemic Can Have a Side Effect: Chronic Guilt

You should talk to the physician you see for psoriasis treatment to [get their input] and determine if you are on an immunosuppressive medication prior to getting the booster shot, saysLisa Zaba, MD, PhD, a clinical associate professor of dermatology at Stanford University School of Medicine in Palo Alto, California.

You dont need a prescription or a doctors note to get a third shot, but you should bring your vaccination card. The dose will be the same as the first and second shot, and the side effects should be similar, says the CDC.

If possible, yes, says Gelfand. The CDC is recommending that people get the same vaccine they received for their first two shots, so if you are already inoculated with either Pfizer or Moderna, you should get the same for your third shot.

If that isnt feasible, or you dont know which vaccine your received for your first two doses, the agency says you should get your additional dose with either the Pfizer or Moderna vaccine.

For people who are immune-compromised or taking immune-suppressing medications, its recommended that they wait at least 28 days after they had the second dose before getting a booster, says Zaba.

Not necessarily, says Gelfand. Of the treatments commonly used for psoriasis, only methotrexate has been found to result in modest reductions in antibody response to the mRNA [messenger RNA] vaccines [from Pfizer and Moderna]. And the clinical significance of this finding is not known.

Gelfand also notes that the U.S. Food and Drug Administration (FDA) authorized expanded use of two-dose Pfizer and Moderna vaccines on the basis of data from patients who received an organ transplant and, as a result, were significantly immunosuppressed.

Research has shown that these patients were not able to mount a significant immune response to the initial two-dose vaccine and that a third dose could help increase the amount of protective antibodies in their blood.

RELATED: Study Finds That People on Methotrexate Mount a Weaker Immune Response to a COVID-19 Vaccine

Its very important to talk to your doctor before making any changes in your psoriasis medication, says Gelfand.

He notes that patients taking methotrexate with well-controlled disease may in consultation with their doctors consider pausing their medication for two weeks after getting the booster.

While this approach may improve antibody response, its not known if it will result in any meaningful benefit in terms of the risk of contracting COVID-19 or developing severe disease, he says.

Because the effects of pausing methotrexate after getting a COVID-19 vaccine arent yet known, people with psoriasis who paused their medication after the first two COVID-19 vaccine doses should still consider getting a third shot, says Zaba.

A third dose will likely provide you with better protection, but how much better is not yet clear, says Zaba.

Some studies have found that people who were severely immunocompromised and had virtually no protection from the Pfizer or Moderna vaccine had an improved antibody response after a third shot of the same vaccine, says the CDC.

Right now, we dont know if a third or booster shot has clinically meaningfully benefits [for psoriasis patients on immunosuppressive medication], says Gelfand. But given the emergence of the Delta variant, which is much more transmissible than previous variants, its likely that booster vaccines will be necessary and helpful.

Even after receiving a third dose of the vaccine, youll need to take extra precautions to avoid exposure to COVID-19, such as wearing a mask (especially inside) and avoiding crowds.

To reduce your odds of exposure, its also important that your family members and other close contacts get vaccinated.

If they are already immunized, they too will be eligible for a third shot beginning on September 20. Thats when the federal government is planning to roll out boosters for all Americans who received their second vaccine dose at least eight months prior.

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Psoriasis and COVID-19 Vaccine Boosters - Everyday Health

A game-changing treatment for moderate to severe psoriasis could become available on the NHS within four weeks after being approved by the UK drugs regulator.

The Medicines and Healthcare Products Regulatory (MHRA) has given the go-ahead for Bimekizumab to be used for adults with moderate to severe plaque psoriasis.

The regulator authorised the drug after a major trial found it effectively cured 62 per cent of moderate to severe cases of the disease.

The breakthrough has the potential to transform the lives of hundreds of thousands of people in the UK, who frequently feel physically uncomfortable and self-conscious because of their condition.

Psoriasis is a skin disease that affects more than 1.3 million people in the UK, causing red, itchy scaly patches, most commonly on the knees, elbows, trunk and scalp.

It is a common, long-term disease with no cure. About 200,000 people in the UK have a moderate to severe form of the disease.

We have witnessed first-hand the mental strength and resilience need to live with this condition and look forward to making this new treatment option available to patients, said Claire Brading, managing director UK and Ireland at UCB, the Belgium pharma company that developed the drug.

Doctors have welcomed the development.

Psoriasis impacts every part of the lives of people living with the condition, from work to relationships, said Professor Richard Warren, consultant dermatologist at Salford Royal NHS Foundation Trust.

Bimekizumab has shown strong results in head-to-head trials with higher rates of skin clearance achieved versus some of the most prescribed therapies, a key outcome for patients. Its a highly effective option for patients suffering from moderate to severe plaque psoriasis, he said.

Existing treatments have improved the lives of thousands of people but these only work for a minority of patients and the effect often wears off after a year or so and symptoms return.

But trials of bimekizumab sold under the brand name Bimzelx show it is working well after two to three years and the researchers are confident that, for the vast majority of those patients who benefit, the effect will last for as long as it is needed, over many years.

As such, while its not a cure as it will come back if the treatment is stopped it completely removes the symptoms while the drug is taken, for the 62 per cent of patients it works for.

The new drug is initially given through an injection that is self-administered once a month to begin with and then every two months after 16 weeks.

Psoriasis is caused when an overactive immune system causes skin cells to grow too quickly. The drug works by dampening down its activity.

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Psoriasis treatment: effective new medicine available on NHS within weeks - iNews

Courtesy of Lauren Scholl

Chicago-area resident Lauren Scholl, 33, was diagnosed with psoriatic arthritis four years ago. Heres her story.

About five years ago, I started experiencing extreme pain in my feet. I was a competitive ballroom-dance instructor and professional dancer at the time, and I just assumed the pain was because I was constantly on my feet at work. But this pain was tough to work around.

I had intense stiffness in my feet, and my toes could not flexthere was no range of motion at all. I couldnt even get into a lunge position or kneel and put my toes on the ground because they just wouldnt move that way. When I walked, it felt like my feet had bruises all over them, even though they looked fine from the outside.

I was shockedI was just 28 at the time. Could arthritis really affect me at such a young age?

I finally decided it was time to see a podiatrist. He took X-rays of my legs and feet and spotted specific arthritis patterns in my toes. I was shockedI was just 28 at the time. Could arthritis really affect me at such a young age?

I was referred to a rheumatologist, who ran blood work, examined my X-rays, and asked about my personal and family history, taking careful note of the fact that autoimmune diseases run in my family. Eventually I was given a diagnosis: I had psoriatic arthritis.

I didnt know it at the time, but psoriatic arthritis is a chronic inflammatory disease that causes swelling in the joints. It usually happens in conjunction with psoriasis, a chronic skin condition that causes itchy, scaly patches of irritated skin. I had been diagnosed with psoriasis about five years prior, which helped my doctor make the connection.

By the end of the day, I was physically and emotionally exhausted from fighting through agony.

The initial medication I was put on didnt work well for me. I suddenly developed depression, which I had never had in my life. I didnt even know how to identify it when it first showed up, but eventually I realized that the way I was feeling wasnt normal. So my doctor switched my medication after six months.

It didnt help that I was also struggling a lot at work as a dance instructor because of the pain. I tried to ignore it, but by the end of the day, I was physically, mentally, and emotionally exhausted from fighting through so much agony. On top of that, I got pregnant. The extra stress of pregnancy on my expanding and changing body made things that much harder.

Around this same time, I was introduced to an online arthritis support organization called CreakyJoints, where I met people who helped me deal with my illness. They also helped me make tweaks to my everyday lifestyle. I learned to track my symptoms to identify triggers; eliminate certain foods from my diet that contained sugar, gluten, and dairy; and schedule my work days and social calendar around the times I was least symptomatic, to minimize the pain as best as I could.

Unfortunately with my condition, I experienced discomfort both when I was active and when I was at rest. I took a lot of over-the-counter (OTC) anti-inflammatories and I tried ice, heat, and any type of OTC topical cream that stood a chance of making me feel better. But the pain persevered, and it started spreading to other areas of my body, like my knees and shoulders. Each day was a struggle, but I loved dance so much and it was the one thing I didnt want to give it up. I remember giving myself daily pep talks about how I could get through this and tough it out, even though it was becoming increasingly clear that I couldnt.

Finally, my body was not able to handle it anymore. I decided to leave dance. I was devastateddance was a part of my identitybut I had to make a change. I couldn't take the intense daily agony.

I found a way to work around my illness that was holding me back.

I was a stay-at-home mom for a bit, but I learned that just wasnt for me. I felt like I had more to share with the world, and I wanted to continue to pursue my career. I realized that what I loved most about performing was being activeand I wasnt going to let psoriatic arthritis take that away from me. So I decided to get my personal training certification, and later went on to become a certified nutrition coach, too. I now train clients full-time and in person, and help others that I cant see in person through comprehensive fitness and nutrition online coaching.

Courtesy of Lauren Scholl

Personal training is a way for me to continue to be active, and its more manageable than constantly demonstrating dance moves (or doing them in competitions). For example, if I need to sit on a bench while Im working, I can sit on a bench. That wasnt an option when I was teaching people to danceI would need to physically dance with someone to teach them the steps. Now I use my words a bit more than my body to help people get to where they need to be. Ive found a way to work around an illness that was holding me back, and I try to instill that in the people I work with now, too. You may get injured or experience another roadblock along your journey, but that doesnt mean you have to stop exercising or working toward your goalsyou just have to get creative and find ways around it.

Im still battling my illness. I have good days and bad days. And Im still trying to find the right medication or combination of medications that can get my inflammation markers down. But overall, Im trying to find the right balance of living my life to the fullest while minimizing my pain, and Im hopeful that Ill be able to do just that.

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I Never Thought Arthritis Would Derail My Career. Here's What I Wish I Had Known. - ELLE.com

AbbVies megablockbuster Rinvoq ambition suffered a blow thanks to an updated safety warning and treatment restriction from the FDA. But pharma watchers have different opinions on just how significant the impact will be on AbbVie's JAK inhibitor.

In an announcement Wednesday, the FDA is revising Rinvoqs boxed warning to include information about increased risks of serious heart-related events, cancer, blood clots and death. The agency is also limiting the drugs use to patients whove tried but failed on at least one TNF inhibitor. Pfizer's Xeljanz and Eli Lilly's Olumiant, both also JAK inhibitors, were hit with the same limitations.

If Rinvoq is only used in second or later lines, it could mean a $1 billion to $3 billion reduction from AbbVies $8 billion 2025 sales estimate for the drug, SVB Leerink Geoffrey Porges wrote in a Wednesday note to investors. For his part, Bernstein analyst Ronny Gal reined in his 2030 sales projection for Rinvoq to $11.2 billion from the previous $17.2 billion.

To Porges, the updated safety language, which stemmed from findings from a postmarketing study by Pfizers fellow JAK inhibitor Xeljanz, wasnt too surprising. But he didnt foresee the post-TNF restriction.

Still, as Porges, Evercore ISI analyst Josh Schimmer and Piper Sandler analyst Christopher Raymond noted in their separate analyses, doctors are already reserving JAK inhibitors for arthritis patients who failed on TNF inhibitor out of a sense of abundant caution for safety and also due to payer restrictions.

RELATED: JAK inhibitors from Pfizer, AbbVie and Lilly hit with dreaded FDA heart safety, cancer warnings

As Schimmer pointed out, the majority of current and projected Rinvoq use is indeed in the post-TNF inhibitor treatment setting. A recent survey of 100 high-volume U.S. rheumatologists that Piper Sandler conducted with Spherix Global Insights showed that only 14% of patients are getting Rinvoq as prior to TNF inhibitors. And a large number of physicians are avoiding JAKs for patients with high or moderate blood clot risks.

Rinvoq is currently approved to treat moderate to severe rheumatoid arthritis after failure on methotrexate. Its label before the FDA update already included a boxed warning on blood clots, lymphoma and other malignancies and serious infections.

While Porges said Rinvoqs U.S. potential is almost certainly reduced, he still thinks its feasible that the drug can get to the $3.5 billion to $4.5 billion U.S. sales required for AbbVie to hit its $8 billion worldwide goal. If the U.S. market turns out to be more challenging, AbbVie could turn to Europe, where Rinvoq just won a go-ahead in atopic dermatitis without safety pushback from the European Medicines Agency, Porges suggested.

For its part, AbbVie is seeking FDA's blessing to expand Rinvoq into atopic dermatitis, psoriatic arthritis and ankylosing spondylitis plus expects a potential filing in ulcerative colitis. But because the FDA is now pushing Rinvoqs use behind TNF in all approved indications, earlier use for those diseases are off the table, Porges said.

RELATED: AbbVie's big Rinvoq ambitionsand the larger JAK classface even more uncertainty with latest FDA delays

But Gal is less optimistic. The Bernstein analyst now sees higher risks that the JAK inhibitor class may not win FDA approvals in less severe dermatological diseases such as atopic dermatitis and psoriasis. Besides Rinvoq, Xeljanz and Olumiant are also awaiting FDA decisions on their atopic dermatitis filings.

He sees a bigger problem than just the anti-TNFs. In other indications that Rinvoqs eyeing, Gal suspected that the FDA will likely also sequence it behind other classes of drugs such as Johnson & Johnsons IL-23 inhibitor Stelara, Sanofis IL-4/13 inhibitor Dupixent and even S1P modulators such as Bristol Myers Squibbs Zeposia.

It may also be that FDA will choose to prevent or further curtail use of the JAK inhibitors in disease conditions where the risk-reward is lower, Gal wrote in a note Wednesday.

By comparison, Piper Sandlers Raymond maintained his 2025 sales estimate for Rinvoq at $8.13 billion. In rheumatoid arthritis, Raymond viewed the label revisions as affecting Rinvoq on the margin. As for eczema, he has long been putting Rinvoqs future use to be after Dupixent.

RELATED: AbbVie's Rinvoq marches toward blockbuster ulcerative colitis nod even as JAK delays drag on

AbbVie has an option to dig itself out of the safety mess. As the FDA acknowledged, Rinvoq and Olumiant were dragged into the same safety warning and use limitation because they share similar mechanisms as Xeljanz. AbbVie could therefore conduct a large postmarketing study for Rinvoq, similar to the Pfizer trial, to prove its case to the FDA.

While the Xeljanz trial took seven years to complete, Gal suggested five years would be a reasonable estimate for a similar Rinvoq trial. Porges pointed out the study needs to show definite proof of the absence of harm to be able to reverse the troublesome labeling. Porges expects AbbVie wont decide on whether to run such a trial until early 2022.

AbbVie did not respond to a request for comment.

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FDA's new JAK safety restrictions spell trouble for AbbVie's Rinvoq, but to what extent? - FiercePharma

Pityriasis rosea is a skin condition that causes a Christmas tree rash. It starts with one patch, known as the mother patch, and branches out with smaller daughter patches on other parts of the body.

Although the rash will go away on its own with time, some people turn to medication, topical treatments, and dietary changes in an attempt to improve their symptoms (1, 2).

This article explores whether any diet, supplements, or other treatments can help treat pityriasis rosea.

Pityriasis rosea is a skin condition. It causes scaly, oval-shaped rashes that begin on the stomach, back, or chest and branch out onto the neck, arms, and legs (1, 2).

Its considered a self-limiting condition, meaning that it goes away on its own. It typically lasts 68 weeks, though it can last longer in some people (1, 2).

In most cases, the rash does not return once it has gone away, although one small study estimated that around 25% of people will experience recurrence (3).

Some, but not all, people with pityriasis rosea experience mild itching. Other symptoms of the condition are fatigue, nausea, headaches, fever, and sore throat. These symptoms can occur before or at the same time as the rash (2).

Sometimes, pityriasis rosea is mistaken for other skin conditions such as psoriasis, eczema, or ringworm. Your doctor may order blood tests to rule out other conditions before confirming a pityriasis rosea diagnosis.

The cause of pityriasis rosea is not known. Some speculate that it could be associated with a viral infection because it has been shown to spread through communities (2).

Anyone can get pityriasis rosea, but its most common between the ages of 10 and 35 and in those who are pregnant (2, 4).

Pityriasis rosea in pregnancy may be linked to miscarriage, especially during the first 15 weeks, although this correlation is not confirmed (1).

Because the rash goes away on its own with time, treatment is typically focused on symptom relief. Medical treatment can include antihistamines, topical steroids, and light therapy, all of which aim to reduce the intensity of itching (1).

Pityriasis rosea is a skin condition associated with a rash that can be itchy. The rash goes away on its own, often after 68 weeks, and treatment typically focuses on symptom relief.

No research directly supports the idea that dietary changes can help manage pityriasis rosea.

Still, some people believe that eating an anti-inflammatory diet might improve itching. An anti-inflammatory diet is high in foods that provide antioxidants, beneficial compounds that help prevent oxidative stress in your body (5).

Because pityriasis rosea is thought to be associated with increased oxidative stress, eating a diet high in antioxidants theoretically makes sense. However, there is currently no research supporting this idea (5).

Similarly, some people believe that the Autoimmune Protocol a diet that aims to lower inflammation could reduce pityriasis rosea symptoms (6).

In theory, a diet that decreases inflammation in your body might help manage the itching associated with the condition. However, no research supports this idea.

Current research doesnt suggest that any specific dietary changes can treat pityriasis rosea. Still, some people theorize that anti-inflammatory or antioxidant-rich diets might help relieve itching.

Pityriasis rosea usually goes away on its own, without requiring treatment. Still, certain supplements, topical treatments, medications, and lifestyle changes may offer some relief for those who experience irritated, itchy skin.

No strong evidence indicates that any supplements could help treat pityriasis rosea. However, certain supplements may relieve itchy skin in general.

Research suggests that vitamin D may relieve skin itch associated with eczema, a condition that makes skin red and itchy. One study found that taking 1,5001,600 IU of vitamin D per day reduced the severity of the symptoms (7, 8).

Fish oil is another supplement that has been shown to benefit the skin. One study in rats found that a daily fish oil supplement relieved itchiness associated with dry skin (9, 10).

Taking turmeric as a supplement and applying it topically may also help relieve itchy skin thanks to turmerics anti-inflammatory and antioxidant properties (11, 12, 13).

Lastly, animal studies have found that compounds in bilberry may relieve itchy skin (14).

Keep in mind that although these potential anti-itch benefits of vitamin D, fish oil, turmeric, and bilberry are promising, more research in humans is still needed.

Further, these supplements have not been studied specifically in relation to pityriasis rosea. If youre experiencing itchy skin from the rash, its best to talk with your doctor to see if any of these supplements are worth a try.

Certain topical treatments may relieve some of the itching caused by pityriasis rosea.

Hydrocortisone is a cream that reduces your skins immune response to relieve itching, swelling, and redness. However, its not recommended for long-term use, so its a good idea to check with your doctor if youre interested in trying it (15).

Another option is calamine lotion. It contains zinc oxide, an essential mineral that can help with itching. It does so by decreasing the effects of histamine, a compound thats part of your bodys immune response and is associated with symptoms like itching (16).

Applying aloe vera may also cool and calm itchy skin. You can find bottled aloe vera in stores or use the gel from a fresh aloe vera leaf. When looking for aloe vera products, check out the ingredients and choose one that has aloe vera listed first (17).

Interestingly, oatmeal has been found to have antioxidant and anti-inflammatory properties that may soothe irritated skin. Simply add 12 cups of oats to a bath and soak for 1520 minutes. You can also look for lotions containing oatmeal to enjoy its benefits (18, 19).

While these topical remedies may provide some relief, they wont treat the condition. Further, even though theyre generally considered safe, its best to talk with your doctor before trying them, especially if youre pregnant or breastfeeding.

Your doctor may be able to prescribe a stronger topical treatment if none of these over-the-counter options do the trick.

Over-the-counter antihistamines like diphenhydramine (Benadryl) and cetirizine (Zyrtec) can relieve itching by blocking the effects of histamine. Keep in mind, though, that some types may make you sleepy (20, 21).

Acyclovir, a drug often used to treat chickenpox, may also help those with pityriasis rosea. In fact, research has found that it may reduce skin redness, relieve symptoms, and even reduce the duration of rash (22, 23, 24).

A type of anti-inflammatory medications known as corticosteroids may also improve symptoms, although they are recommended only for severe or lingering cases of the condition. One study found that relapse rate was higher in those who were treated with a corticosteroid (25).

Some lifestyle factors may affect your skin, especially if youre dealing with a rash.

Try to avoid hot temperatures, as they can cause sweating, which might irritate your rash. Hot baths and showers and perfume-containing soaps and lotions may also cause irritation.

Because symptoms such as fatigue, nausea, fever, and sore throat can occur before or at the same time as the rash, be sure to get plenty of rest, stay hydrated, and check in with your doctor to make sure youre staying healthy.

Although pityriasis rosea cant be cured, certain medications, topical treatments, supplements, and lifestyle changes may reduce your symptoms.

There is currently no research to suggest that dietary changes can help treat or manage pityriasis rosea.

However, remedies such as antihistamines and topical treatments can help relieve itchy, irritated skin. And avoiding hot temperatures may help you avoid further irritating your skin.

Its best to talk with your doctor to find out which options may work best for you especially if youre pregnant or breastfeeding.

Remember, the rash usually goes away on its own without treatment.

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Pityriasis Rosea and Diet: Is There a Connection? - Healthline