Monthly Archives: January 2022

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

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

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

There are five distinct types of psoriasis:

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

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

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

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

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

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

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

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

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

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

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

Here is the original post:
Psoriasis - Melbourne, FL Dermatologist

What is psoriasis?

Psoriasis is a chronic skin condition that occurs when the skin cells are replaced too rapidly. Normally, it takes about a month for new skin cells to migrate from the lower layers of skin to the skins surface, and as new cells reach the surface, old, worn-out cells are shed, creating a continual replacement process that supports healthy skin. In psoriasis, this replacement cycle process is sped up, with new skin cells migrating to the surface in just a few days instead of a month. As the skin cells near the surface, they create a backlog of unshed surface cells, forming large patches of thick, scaly skin called plaques. Although the specific underlying cause of psoriasis isnt known, research indicates the condition is related to an immune disorder that interferes with the normal skin replenishment cycle. Psoriasis plaques can be unsightly and embarrassing, but the disease is not contagious, which means it cannot be spread from one person to another.

Psoriasis is usually identifiable by the recurrent plaques of scaly, itchy skin that develop. These plaques can appear red or pink with a silvery or whitish sheen. Plaques tend to occur most commonly around the elbows and knees, but they can occur elsewhere as well. Other symptoms include:

Some people develop psoriatic arthritis, a painful condition that causes aching in the joints and joint stiffness. The best way to know for sure if you have psoriasis is to have an evaluation by a skilled dermatologist who can diagnose the condition with a physical exam, sometimes accompanied by a biopsy to rule out other conditions.

To date, there is no cure for psoriasis, but there are several treatments that can help reduce flare-ups and help keep symptoms under control. Prescription-strength topical medications and oral medications are effective in helping many patients manage their symptoms, and some patients benefit from phototherapy that uses precise measured doses of light to reduce scaly, itchy plaques.

Continued here:
Psoriasis Specialist - Melbourne, FL & Titusville, FL ...

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

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

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

There are five distinct types of psoriasis:

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

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

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

Mild to moderate psoriasis can generally be treated at home using a combination of twokey strategies: over-the-counter medications andprescription topical treatments.

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

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

Treatments for moderate to severe psoriasis include prescription medications and biologics.

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

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

More here:
Psoriasis - Kissimmee & Windermere, FL Dermatologists ...

Transcript:

Lakshi Aldredge, MSN, ANP-BC, DCNP: Weve covered a lot. We talked about topical treatments, we touched on phototherapy, we talked about the oral treatments, and then the different class of biologic agents, including the TNF [tumor necrosis factor]alpha inhibitors, IL-17s and the IL-23s. Thats whats exciting: theres even more research thats happening in the field of psoriasis, and there are new agents coming into the field. Can you talk a little about whats coming down the pipeline?

Matthew Brunner, MHS, PA-C, DFAAPA: Im really excited. First, we have just seen such an explosion of immunology, knowledge, education, and therapeutics in the last 20 years. And that knowledge and advancements continuing. There are new classes of immunologic agents called tyrosine kinase inhibitors [TKIs], and theyre hopefully going to be entering the fray very soon. Theyre going to offer another modality and an oral agent that patients will be able to take, hopefully with more convenient dosing options and good safety. Well see all that come to fruition.

Then theres this topical therapeutic aryl hydrocarbon receptor modulating agents that are being studied in both psoriasis and atopic dermatitis. And we may see those in both topical and systemic iterations down the road. The future has never been brighter to be a psoriasis patient. I tell my patients all the time, its never great to have psoriasis, but youve never lived at a better time to have psoriasis. Every time I see them back in a future visit, the same holds true because new agents are comingnew targets, to help them manage their conditionare being brought to market. Its really exciting. What do you think about the future?

Lakshi Aldredge, MSN, ANP-BC, DCNP: You said it very well. Its such a great time to be in the field of psoriasis management because there continues to be such activity and research. We have very passionate researchers who are really looking to find a cure. In the meantime, finding all these targets that help improve the skin, help improve the joints. There new agents coming out, but its also important to understand that, for example, with the IL-23s, there are new indications being studied. Right now, many of the IL-23s are indicated for moderate to severe psoriasis in adult patients. Were going to see clinical trials that are being completed currently in adolescents and in pediatrics. Thats something that we can look forward to. Also, we can look forward to data that are going to be coming shortly about psoriatic arthritis and the use of IL-23 inhibitors in psoriatic arthritis disease. Thats going to be very promising as well.

You said it perfectly: the future has never looked brighter for our patients with psoriasis. As we move toward the goal of clear or near-clear skin and also looking at them holistically, helping prevent the development or worsening of those other comorbiditiessuch as metabolic syndrome, psychosocial disease, and cardiovascular riskall these treatment modalities can help us help our patients with psoriasis to live long and healthy, happy, successful lives. Thats our role as NPs [nurse practitioners] and PAs [physician assistants] in dermatology. Its a very exciting time.

Matthew Brunner, MHS, PA-C, DFAAPA: Thank you for joining me today. This has been really a fun conversation. Hopefully its been educational for those of you watching. Thank you for watching HCPLive Peers & Perspectives. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peers & Perspectives and other great content right in your in-box.

Transcript edited for clarity.

Go here to see the original:
Anticipated Developments in the Field of Plaque Psoriasis - MD Magazine

Psoriasis, a common autoimmune disorder that impacts over a million South Africans,1 is often misunderstood to be a simple skin disorder. This couldnt be further from the truthpsoriasis is a serious chronic disorder that negatively impacts the overall health of a person, and can present with serious co-morbidities such as heart, lung and kidney problems.2

Unlike other chronic diseases, psoriasis is visible to other people. This makes the disease even more complicated and debilitating, as many patients also suffer with mental health challenges such as anxiety, depression, poor self-esteem and relationship challenges. A recent study found that one third of adults living with psoriasis said that the disease interferes with their love life.3

Sharon* was just seven years old when she had a severe case of chicken pox that left 90% of her body inflamed with painful burning scales. After a visit to a dermatologist, Sharon was diagnosed with psoriasis and has lived with this debilitating skin disease for over thirty years. This is Sharons story.

When my symptoms of psoriasis started, there werent many treatment options available and over the years, I tried a myriad of creams and UVA light therapies. Unfortunately, nothing helped me achieve clear skin, said Sharon. My life was filled with burning, itchy and embarrassing skin, at times I felt trapped alone at home. Those rare times that I did venture out, I hid my skin under layers of clothes.

My psychological pain and anguish were worse than the pain of my skin, added Sharon. At that time, my doctors didnt seem to consider my emotional suffering and the impact psoriasis had on my whole life. It all became so unbearable that I went to the darkest places of my mind and considered ending my life.

namtipStudio/shutterstock

Shortly after I considered suicide, I had a heart-to-heart with my doctor, who prescribed a biologic treatment, said Sharon. Initially, I didnt have much hope, until I saw the difference it made to my skin. For the first time in years, I felt comfortable to wear sleeveless clothing and go out without covering up. I was overcome by joy!

In addition to the right medication, lifestyle changes can also make a difference.

Its important to get the right treatment for your condition. Psoriasis patients are urged to motivate and pressurise their medical aid to cover the cost of treatment as it is a chronic and debilitating disease. In addition, it is your constitutional right to access healthcare.

Psoriasis impacts people in different ways, and requires individual treatment, says Dr Noufal Raboobee, a dermatologist based in Durban South Africa. While each patient requires a unique treatment plan, whats critical is that they find the right treatment plan to achieve clear skin, and do so before the disease escalates and causes additional health co-morbidities. Everyone deserves to live a fulfilled life without pain and shame.

If you, or a loved one is experiencing dry, painful, scaly skin that just wont heal, or any other symptoms of psoriasis, talk to a dermatologist. You can also learn more about psoriasis by visiting the #MoreThanSkinDeep page on Facebook. Remember, psoriasis can be treated and clear skin is achievable and its your right to get the treatment you need to live a healthy, fulfilled life.

*Name of patient has been changed for privacy reasons.

Read more:
Living With Psoriasis. A Sufferer Shares Her Thoughts - Longevity LIVE - Longevity LIVE

Patients with psoriasis exhibited superior efficacy outcomes when treated with ultraviolet (UV)-based phototherapy plus other adjuvant therapies vs UV monotherapy, with similar safety profiles shown for both approaches.

The efficacy of ultraviolet (UV)-based phototherapy for psoriasis may be improved when combined with other adjuvant therapies, according to study findings published last week in Annals of Medicine.

Beyond the use of systemic therapies such as oral retinoids or biologics, UV-based phototherapy with UVB or psoralen UVA (PUVA) has been shown to be a well-established and generally effective therapeutic option for the treatment of psoriasis. Moreover, researchers said that although systemic and biological treatments are strongly recommended for severe and diffuse skin diseases, these medications can cause systemic adverse effects and immunosuppression.

These UV-based phototherapies, along with their combination with other treatments, are thought to be effective treatments for many patients with psoriasis, leading to an urgent demand for comparative studies of efficacy referring to clinical decision-making, they noted.

Seeking to compare the clinical efficacy and safety profile of different UV-based phototherapies in the treatment of psoriasis, the investigators conducted a meta-analysis of randomized controlled trials registered in the PubMed, Cochrane Library, Scopus, and Embase databases.

UV-based therapies were assessed as a monotherapy or in combination with various drugs and remedies, including systematic treatments, skin lubricants, vitamins, and vitamin derivatives in the treatment of moderate to severe psoriasis. Five phototherapy strategies were identified and analyzed:

The primary outcome for assessing effectiveness and safety was Psoriasis Area and Severity Index (PASI) 75 response (75% or more reduction in PASI score from baseline) and withdrawal due to adverse events, in which effects were ranked and calculated by surface under the cumulative ranking analysis (SUCRA).

In the meta-analysis, 32 studies involving 2120 patients with psoriasis (mean age, 41.5 years; 61.6% male) were included. Compared with monotherapy of PUVA and UVB, PASI 75 response was significantly higher in those treated with cPUVA (risk ratio [RR], 1.39; 95% CI, 1.00-1.94) and cUVB (RR, 1.27; 95% CI, 1.03-1.57), respectively. Moreover, PUVA combined with vitamin D and its derivatives ranked highest concerning clinical effect and safety (clusterank value = 7393.2).

Regarding safety, no significant difference was reported for withdrawal due to adverse events or incidence of erythema. The relatively safest strategy was cPUVA, particularly PUVA combined with calcium/vitamin D derivatives (RR, 0.98; 95% CI, 0.30-3.17; SUCRA = 80.8%).

cPUVA and cUVB, especially combined with calcium/vitamin D derivatives, are both safe and effective treatments for psoriasis and have the potential for the first choice in the treatment of moderate to severe psoriasis, concluded the researchers. However, more high-quality trials are necessary for confirming our findings.

Reference

Li Y, Cao Z, Guo J, et al. Assessment of efficacy and safety of UV-based therapy for psoriasis: a network meta-analysis of randomized controlled trials. Ann Med. Published online January 6, 2022. doi:10.1080/07853890.2021.2022187

Continued here:
Adjuvant Ultraviolet-Based Therapy More Effective vs Monotherapy in Psoriasis - AJMC.com Managed Markets Network

This article was originally published here

Clin Rev Allergy Immunol. 2022 Jan 18. doi: 10.1007/s12016-021-08914-w. Online ahead of print.

ABSTRACT

Psoriatic arthritis (PsA) is a chronic inflammatory condition characterized by psoriasis, synovitis, enthesitis, spondylitis, and the possible association with other extra-articular manifestations and comorbidities. It is a multifaceted and systemic disorder sustained by complex pathogenesis, combining aspects of autoinflammation and autoimmunity. Features of PsA autoinflammation include the role of biomechanical stress in the onset and/or exacerbation of the disease; the evidence of involvement of the innate immune response mediators in the skin, peripheral blood and synovial tissue; an equal gender distribution; the clinical course which may encounter periods of prolonged remission and overlapping features with autoinflammatory syndromes. Conversely, the role of autoimmunity is evoked by the association with class I major histocompatibility complex alleles, the polyarticular pattern of the disease which sometimes resembles rheumatoid arthritis and the presence of serum autoantibodies. Genetics also provide important insights into the pathogenesis of PsA, particularly related to class I HLA being associated with psoriasis and PsA. In this review, we provide a comprehensive review of the pathogenesis, genetics and clinical features of PsA that endorse the mixed nature of a disorder at the crossroads of autoinflammation and autoimmunity.

PMID:35040085 | DOI:10.1007/s12016-021-08914-w

Continued here:
The Conundrum of Psoriatic Arthritis: a Pathogenetic and Clinical Pattern at the Midpoint of Autoinflammation and Autoimmunity - DocWire News