Monthly Archives: April 2022

Physical activity can help improve psoriasis flares and increase periods of remission. Activity may further reduce the risk of developing other illnesses, such as heart disease and diabetes.

Physical activity offers many health benefits, especially for people with psoriasis. It can help them maintain a moderate weight and reduce the risk of developing certain diseases, such as heart disease and type 2 diabetes.

However, the sweat, heat, and stress of working out may also trigger or aggravate psoriasis symptoms. Pain and fatigue are also common issues that make it challenging for people with psoriasis to exercise.

This article discusses how exercise can help with psoriasis and provides tips for effective and safe activities for people with psoriasis.

Psoriasis affects approximately 3.2% of the United States population and about 23% of the worlds population.

Further research suggests that psoriasis occurs in 3.6% of white people, 1.9% of African American people, and 1.6% of Hispanic people.

This condition occurs equally among males and females.

It is an autoimmune skin condition that causes crusty, flaky patches called plaques to occur on the skins surface. These plaques may appear red on light skin and purple or violet on darker skin.

Psoriasis plaques can appear anywhere but commonly occur as small patches on:

Learn more about the signs and symptoms of psoriasis here.

A person may alternate between periods of active disease, called a flare, and periods of inactivity or remission. Symptoms can range from mild to severe, depending on the type of psoriasis a person has.

A person with psoriasis is also at an increased risk of arthritis, depression, diabetes, and heart disease.

Specific triggers can cause symptoms to appear or worsen. These vary from person to person but include:

Learn more about psoriasis in our dedicated hub.

The National Psoriasis Foundation recommends that people with psoriasis do at least 30 minutes of moderate exercise plus strength training at least five times a week.

A 2018 study found that intense physical activity might help decrease the prevalence of psoriasis. It also indicated that exercise may also benefit a persons mental health linked to the diagnosis of psoriasis and the impact on quality of life.

Another 2018 study found that diet and exercise effectively combat oxidative stressors and improve disease severity in people with psoriasis.

Obesity is a common cardiovascular risk factor in psoriatic disease. People with psoriasis may have low physical activity levels, which puts them at risk of having a stroke.

Research suggests exercise can help reduce weight and improve the severity of psoriasis in people with overweight.

A 2020 study showed that people with psoriasis tend to avoid exercise because they are concerned about:

A person should speak with their doctor or dermatologist to explore exercise options suitable for their skin needs.

Below are some tips to ensure a safe and effective workout.

As a general rule, avoid activities that cause flares or pain. Low impact, low intensity workouts, such as a stroll or a leisurely bike ride, might be more suitable.

Excessive sweating can trigger symptoms. People should avoid hot yoga and other exercises that cause excessive sweating. Inverse psoriasis is a form of psoriasis that occurs in areas where the skin folds, and sweat is a trigger that aggravates symptoms.

Some people experience stress as a result of having psoriasis, and, in turn, stress often aggravates this condition.

Doing too much exercise or performing cardio or higher intensity workouts may trigger the bodys stress response.

Higher-intensity workouts do not suit everyone, as excessive exercise can aggravate symptoms. However, people who manage their symptoms well may be able to tolerate more rigorous exercises, such as running and high intensity interval training (HIIT).

People with psoriatic arthritis, a potential complication of psoriasis, should avoid high impact exercises that put too much stress on weakened joints. Instead, they can opt for low impact activities, such as swimming and cycling.

Learn about the exercises for psoriatic arthritis here.

Tight clothing can worsen skin sensitivity, irritate the skin, and aggravate psoriasis patches during workouts.

Loose, breathable clothing and moisture-wicking fabrics help pull moisture away and allow it to evaporate fast.

Learn more about the best clothing for workouts here.

Warming up before exercise is crucial to prepare the muscles and reduce stiffness to avoid injuries. In the same way, finish activities with a proper cool-down, like some light stretching or a slow-paced walk.

Read more about the benefits of stretching.

Aim for consistency and frequency rather than duration. Physical activity may include taking the stairs instead of the elevator and walking to run errands.

If a person feels stiff or tense, they may switch their workouts and focus on a range of motion and flexibility exercises.

Learn more about stretching and flexibility here.

Working out may cause a person to sweat and lose skin moisture. A person should replenish lost fluids with proper hydration, which can help the skin stay moisturized and prevent flares in people with psoriasis.

Learn about the benefits of staying hydrated here.

If a person does not feel confident in a gym or a flare hinders their performance, they can exercise at home. There are plenty of workout videos online, including strength training, yoga, and core workouts.

Learn about the best home workouts here.

A person considering exercising for the first time could discuss options with a doctor or healthcare professional. They may be able to offer advice about what to avoid or recommend an assessment with a physical therapist.

Learn more about physical therapy here.

Aside from exercise, other alternative treatments can help manage psoriasis.

Learn more about home remedies for psoriasis here.

Psoriasis is a lifelong condition. While it has no cure, treatments and lifestyle changes, such as exercise and diet, can reduce symptoms and improve quality of life.

Psoriasis puts people at risk of other diseases that can affect their health and quality of life, including stroke, obesity, and cardiovascular diseases.

Many factors can hinder a person with psoriasis from exercising. However, not doing so can cause them to miss out on the health benefits that working out can offer.

Exercising improves a persons physical and mental health and can also reduce flares and the risk of developing other health conditions associated with psoriasis.

At the same time, a person should be mindful about how they exercise, know what to avoid, and what to do when an exercise leads to a flare.

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Exercise and psoriasis: Links and more - Medical News Today

This transcript has been edited for clarity.

Elaine Husni, MD, MPH: Welcome to this Medscape InDiscussion episode six. We're going to talk about emerging and novel therapeutics in the treatment of psoriatic arthritis. I'm particularly excited today because we have Dr Ana-Maria Orbai, who's both a friend and colleague. She is an assistant professor of medicine in the division of rheumatology at the Johns Hopkins University School of Medicine. And she also directs the psoriatic arthritis program at her institution. It is definitely a treat to have her here and to talk about some really interesting new therapeutics in psoriatic arthritis. Before I begin, I'd love to ask Ana-Maria, do you recall one of any of your first experiences with a psoriatic arthritis patient and what made you interested to become an expert in this field?

Ana-Maria Orbai, MD, MHS: First of all, thank you, Dr Husni, for the generous introduction. It's my pleasure to be here. Yes, of course I recall starting with psoriatic arthritis. We didn't have much in the beginning. We were still following in the footsteps in terms of both the framework for evaluating our patients as well as the therapy choices. Since then, the clinical data have expanded. We have a lot of new therapeutics. We have head-to-head trials, so there are many more treatment choices than before, and there is the possibility of adapting the treatment to the patient's own presentation and psoriatic disease phenotype. It's a very exciting time for psoriatic disease.

Husni: I agree. I remember when you and I were going to these meetings national meetings there'd be these huge exhibits for rheumatoid arthritis (RA) and these little exhibits for psoriatic arthritis. And now we're on equal footing. It's fun to see how it's exploded. I wanted to start off with a case if that is okay with you. He's a 46-year-old construction worker. He had longstanding psoriasis, using topicals for a long time. He had an episode of dactylitis in his second toe, and he was placed on methotrexate. Unfortunately, he didn't really like the way that it made him feel so he's really been on and off of methotrexate throughout the year or two. But luckily, his dactylitis did subside after a while. A few months later, he did have some worsening skin, mostly pretty classic plaque psoriasis, on his extensor surfaces his elbows and knees. He was started on a tumor necrosis factor (TNF) inhibitor and noticed that his skin really cleared up and that it was doing pretty well. That takes us to about 6 months before his visit with me. Why he went to see me is that he found it really difficult because he has to wear these special shoes at work these construction shoes and he's noticed a lot of pain by his heel to the point where it was really difficult for him to bend down. He was really having a hard time at work. His current rheumatologist did some x-rays and some bloodwork and said that everything was pretty normal. So he was getting a little frustrated and he wanted to see if there's anything better than adalimumab, which he was on for his psoriatic arthritis, or if there was something else going on. But he just really was quite debilitated at work. So I wanted to talk to you to see how you might approach this particular patient in terms of whether or not he should stay on and be more compliant with the methotrexate along with the adalimumab. Would you consider switching and maybe talking about some of the emerging treatments that may be better in a patient like this?

Orbai: Very interesting case for sure. A common scenario in our clinics is where patients may do well initially, or the disease may be controlled for them to continue on their current therapy. But then new symptoms emerge. In your case, it sounds like it's the lower extremities. We're hearing about pain, wearing boots, standing at work. So I am thinking, without examining the patient, just imagining and thinking: It either could be arthritis, MTPs, tarsus, ankles, subtalar joint, or with heel pain, plantar fascia pain, right? Could this be enthesitis or could these be combined? It's very common for our treatments to lose efficacy over time. It sounds like he's been on this treatment for 1 year. It's not uncommon for it to lose efficacy, especially since methotrexate was on and off. This could be one case where antidrug antibodies could have been developed, and that's why the biologic no longer works. Or maybe the psoriatic arthritis just figured another way to become active, going around adalimumab. I would definitely look into switching the medication fronts for this patient, also considering the patient's preference. It sounds like he's not very enthusiastic about continuing methotrexate in the first place, so maybe we should work with that as well and think, What else do we have in our toolkit? The first mechanism of action that comes to mind and for which we have head-to-head trials with adalimumab, would be interleukin (IL)-17 inhibition. While we have used this and we're familiar with this mechanism of action first for several years now, we have an emerging IL-17 pathway inhibitor, which is a dual inhibitor of IL-17A and -F, bimekizumab. We've all seen it, the phase 2b trial results with bimekizumab, and we're awaiting the phase 3 results. This pathway would definitely be of consideration.

Husni: I agree with you. A common scenario is where somebody does really well on a biologic and the expectations are here, right? When they start to have that waxing and waning course or any new symptoms and you elegantly pointed out that enthesitis could be playing a huge role because we are not seeing lots of changes on x-ray over time or bloodwork. Yet, he's having interference for some of his work and daily activities, which really makes us wonder about some of these other manifestations of psoriatic arthritis, such as enthesitis, as you brought up. This is where some of these new treatments for me become really interesting because now we're no longer just looking at general efficacy for psoriatic arthritis. We are really raising the bar and looking at different manifestations clinical presentations of the disease. I would love to hear a little bit more on some of these early studies on bimekizumab. What is your conclusion to some of these early trials?

Orbai: We could start with the psoriasis trials where we've seen much higher efficacy with inhibiting the dual pathway, and I am very hopeful that we can expect the same augmented effect in in the psoriatic musculoskeletal disease as well. I am very much looking forward to the phase 3 trial results. From the phase 2b trial, we saw that on the ACR 50 outcome, about 50% of the patients achieved this higher bar of efficacy. We also noted that although the primary outcome was selected at 12 weeks in this phase 2b trial, there was evidence that the magnitude of responses increased over time through weeks 16 and 20 of therapy. I think that's very exciting. For enthesitis, many of the results in the phase 2b trial were exploratory simply due to sample size and looking at multiple doses. For enthesitis, improvement in the MASES enthesitis score, were numerically higher than placebo, which is very encouraging. It does make sense that an IL-17 inhibitor would work better for enthesitis because we know that enthesitis is mediated through the IL-23 and IL-17 axes. I definitely look forward to seeing outcomes specifically on enthesitis with this new mechanism of action.

Husni: I agree. The ability to have outcome measures now, whether its MASES scores, has really elevated the way that we look at trials coming because I'm not just looking at joint and skin count now, I'm curious about dactylitis, enthesitis, axial involvement, and the ability for certain subsets of these therapeutics to work on some manifestations and not others. I do find enthesitis to be a little bit harder overall because the physical exam sometimes is difficult. Then, in addition, trying to understand the different outcome measures that they're using for enthesitis and whether or not this would be good in our patients. But nonetheless, so happy to see data coming out in head-to-head trials. I'm really looking forward to phase 3 and getting some more information on this drug. I really think that it'll make some difference in our field and I'm excited that new options are still coming out. The next issue I wanted to talk about are oral agents that you and I are familiar with from RA but yet are getting approved in psoriatic arthritis, and those are the JAK inhibitors. As you know, we probably have some more initial comfort in the RA world as they were approved their first. But now, we're seeing some safety challenges. I'd love to hear how you think about the JAK inhibitors in psoriatic arthritis.

Orbai: Indeed, safety is very important; in the psoriatic program, we have it lined up right with efficacy. I always talk to my patients about the balance being on just enough medicine to get us to the treatment goals while staying safe. That could be one medicine or a combination, depending on how active the psoriatic disease is. But safety is an important discussion with the recent data on JAK inhibitors. We know that in Europe, there's the recommendation to not prescribe these drugs to people older than age 65 because of the concern for risk for infection, heart disease, and thrombosis. Data from the safety studies taught us about increased risk. Interestingly, with the JAK inhibitor mechanism compared with the TNF inhibitor mechanism, which I think is very relevant for practice, there is an increased risk for heart disease as well as cancer. Clinicians were prepared to notice this increased risk on the basis of our knowledge of the mechanism of action. I don't think it's that surprising to us. To see those data, though, is very important and helps us put the mechanism of action in the context of our clinic. We have patients of different ages with different risk, and I think it's very, very important to tailor therapies to each of our patients. For example, I would agree that maybe in patients with certain comorbidities, you'd have to think twice about prescribing a JAK inhibitor, right? Somebody with a history of deep vein thrombosis (DVT) or with known cardiovascular disease that frequently happens in psoriatic arthritis probably should not be on a JAK inhibitor unless we had no other choice. If we had to do that, then I would definitely tighten the monitoring and the management of the additional risk factors. Somebody who may be a cancer survivor, obviously we wouldn't challenge with that mechanism of action, and we have other options which I would prioritize first.

Husni: Those are really interesting points. The initial enthusiasm was that this was oral, and there was some mindset that oral is always safer than injections. At least that's how some of my patients have been looking at this. The excitement at the beginning was the method of taking this and allowing more freedom for these patients. But then the labeling change really gave us pause to say, "Okay, maybe there are subsets that should avoid JAK inhibitors." We also saw such great efficacy, as I'm sure you did in RA. I don't think I was ready to let it go completely. But in my practice now, I probably reserve it for the younger age group, and in the older than 50-55 age group, I tend not to use the JAK inhibitors as freely as I probably did before some of these safety concerns. This past American College of Rheumatology (ACR) meeting had some really interesting new data that were really trying to quantify this risk rather than just saying risk/no risk. So, I think there's more to come. I don't think I'm ready to give up, but I have taken a pause, like you said, in these certain, more vulnerable groups. But I do think having an oral option that does work for the joints is really exciting because that's sometimes where I find some of the newer mechanisms fall in the joint space, and I am looking for something.

Orbai: We don't know everything about these drugs. For example, I'll tell you about a case of a 30-year-old man with psoriatic arthritis. He had comorbid irritable bowel disease (IBD) and he was bed-bound because of arthritis of the hips, and in between infections and his flares, there was no question about hip replacement. I completely ran out of medications in his case, and then we decided: Well, you are on DVT prophylaxis because you're pretty much bedbound let's try a JAK inhibitor. And that was what basically got him out of bed. And now he's exercising. Things are not perfect, but we have MRIs that have shown that his synovitis in his hips improved. So there's definitely a nuance in how people respond to these therapies and what's driving the disease at target tissue level. As long as we learn how to use these drugs and subset our patients, then we can manage the risks. The problem is when we have to go blindly with recommending first-line, second-line, third-line the one-size-fits-all approach won't work. And that's what our problem is because we try to have a pattern that will suit everyone, and that's just not real life.

Husni: It's not just the science, but it's the art of medicine, right? Even though the science tells us this is all approved for psoriatic arthritis and efficacious, we know that it's still the art of delivering these meds in the right patients at the right time.

Last but not least, I do have to talk about the IL-23 inhibitors because they obviously have been around in the psoriasis space, and they've been very comfortable with them. We now have the first IL-23 approved, guselkumab, for psoriatic arthritis. I just recently heard of risankizumab being approved for psoriatic arthritis. It is exciting that data are coming out with the joints. I'd love to hear your take on whether you've been using a lot of IL-23 inhibitors and when to use them in patients with psoriatic arthritis.

Orbai: I have been and it's so exciting to now have two because insurance coverages are so different. Having two choices allows us to cover more patients if these drugs are needed. IL-23s are very convenient in terms of dosing. It's very attractive to have a loading dose 4 weeks apart and then maintenance treatment with an injection that patients get every 8 or every 12 weeks. So great dosing flexibility. I'm trying to start them early on. Maybe I just diagnosed a patient with psoriatic arthritis. Maybe we just started methotrexate and we're weighing whether we go up on the methotrexate or whether we start something else. When patients are in the moderate, low disease activity level after my first intervention, adding an IL-23 inhibitor to their baseline methotrexate, for example, makes me less worried for risk for infection. This could be an easy add-on that I'm trying to implement earlier on in clinic, and I've had good results with this strategy and patients like the convenience of this injection. Not to mention that some patients come back and tell me, "Doctor, the next day or 2 days after this injection, my skin stopped itching." It's nice to have an initial effect which gives the patients optimism that the rest of the goals will be achieved. So it's very exciting to have these.

Husni: I couldn't agree more that in addition to getting excited about new classes, we have some unmet needs to learn how to really get better at giving this to the right patient at the right time. I always look forward to seeing you at our meetings, and I'm sorry that we haven't been able to see each other in person, but it's really nice to have you on this podcast. I would love to ask you the same question that I ask everybody who joins me. Are you up for that? If you were cooking in your kitchen, what are the first three ingredients for a successful treatment for patients with psoriatic arthritis?

Orbai: My first is aligning with the patient's goals. Our patients walk into our office. They need help with concerns. They are concerned that this is never going to go away. That they are never going to be able to get their real life back. Or maybe they are concerned to go on a drug that may have all these serious side effects trying to assess what's bothering them the most. What's their most important goal and fear it's very important. And then once we're aligned, the rest of the ingredients: having the specialty center, which allows me to consult with other specialists like dermatologists, colleagues in cardiology, colleagues in the Inflammatory Bowel Disease Center, which are common conditions and comorbidities that our patients come with. Having that framework of a specialized center is very helpful because I can lean on my colleagues with cases that are more complicated. The third ingredient is making sure that we have the discussion with the patient that this is a long journey that we're embarking on: It's going to involve monitoring and assessing whether we are at treatment target, and it's a team approach. We will always adjust the plan and are working together in getting them where they want to be.

Husni: Well, thanks to Ana-Maria, those are really great pearls of wisdom. It was really a joy to have you. Thank you for taking time out to talk with us.

Orbai: Thank you. My pleasure.

2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis

EULAR Recommendations for the Management of Psoriatic Arthritis With Pharmacological Therapies: 2019 Update

Treatment Guidelines in Psoriatic Arthritis

Bimekizumab in Patients with Active Psoriatic Arthritis: Results From a 48-Week, Randomised, Double-Blind, Placebo-Controlled, Dose-Ranging Phase 2b Trial

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Episode 6: Emerging and Novel Therapeutics in the Management of PsA - Medscape

Novan, Inc.

Live moderated video webcast with members of the Novan management team on Tuesday, April 26th at 2:00 PM ET

DURHAM, N.C., April 20, 2022 (GLOBE NEWSWIRE) -- Novan, Inc. (the Company or Novan) (Nasdaq: NOVN), today announced it will participate in the Virtual Investor Innovation in Dermatology Spotlight event on Tuesday, April 26, 2022, at 2:00 PM ET.

For the event, Paula Brown Stafford, President and Chief Executive Officer of Novan. will be joined by John A. Donofrio, Novans Executive Vice President and Chief Operating Officer. The event will spotlight Novans newly acquired portfolio of commercial medical dermatology products and its proprietary nitric oxide-based technology platform, NITRICIL, which has the potential to generate new, innovative treatments for multiple dermatological indications.

Novan recently announced its acquisition of EPI Health, a growing specialty dermatology company that has launched and markets innovative prescription therapies to dermatologists to improve the quality of life of patients. As a result, Novan now has a well-established product portfolio that addresses patient needs across psoriasis, rosacea, dermatosis and acne.

Novans innovative and clinically proven NITRICIL technology leverages nitric oxides (NO) naturally occurring antimicrobial and immunomodulatory effects to develop potential new therapies for unmet medical needs across multiple therapeutic areas. NITRICIL stores the gaseous NO species on large polymers, which allows nitric oxide to be applied as timed-release chemical entities. This technology allows the Company to control the level of nitric oxide storage, the rate of release, and the molecule size for targeted delivery. This targeted technology with anti-microbial and anti-inflammatory properties has the potential to address a number of skin diseases. The combined organization now has the capability to take potential treatments from bench to bedside through research and development, production, market access and commercialization to deliver therapies that meet unmet needs in dermatology and ultimately benefit patients.

Story continues

A live video webcast of the spotlight event will be available on the Events page of the Investors section of the Companys website (novan.com). A webcast replay will be available two hours following the live presentation and will be accessible for 90 days.

About Novan

Novan, Inc. is a specialty dermatology company focused on researching, developing and marketing innovative therapeutic products for skin diseases. Through our acquisition of EPI Health, we sell products for psoriasis, rosacea, dermatosis and acne. Our goal is to deliver safe and efficacious therapies where there are unmet medical needs. We are developing SB206 (berdazimer gel 10.3%) as a topical prescription gel for the treatment of viral skin infections, with a current focus on molluscum contagiosum. We have a pipeline of product candidates using our proprietary nitric oxide-based technology platform, NITRICIL, to generate new treatments for multiple indications.

Forward-Looking Statements

Any statements contained in this press release that do not describe historical facts may constitute forward-looking statements as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements may be identified by words such as believe, expect, target, anticipate, may, plan, potential, will, and similar expressions, and are based on the Companys current beliefs and expectations. These forward-looking statements include, but are not limited to, statements related to the Companys pharmaceutical development of nitric oxide-releasing product candidates, such as berdazimer 10.3% gel (SB206) for molluscum contagiosum, and the potential benefits of berdazimer 10.3% gel, if approved, and the Companys ability to realize the benefits of the EPI Health acquisition, including potential synergies and the ability to commercialize the product portfolio acquired through the EPI Health acquisition. Forward-looking statements are subject to a number of risks and uncertainties that could cause actual results to differ materially from the Companys expectations, including, but not limited to, risks related to the EPI Health acquisition, including the risk that the EPI Health acquisition disrupts current plans and operations, the ability to recognize the anticipated benefits of the proposed business combination, which may be affected by, among other things, competition, the ability of management to integrate the combined companys business and operation, and the ability of the parties to retain its key employees, and costs related to the EPI Health acquisition; risks related to the regulatory approval process, which is lengthy, time-consuming and inherently unpredictable, including the risk that the FDA will not agree with the Companys approach to a potential NDA submission, that the Companys product candidates may not be approved or that additional studies may be required for approval or other delays may occur, that the Company may not have sufficient quantities of drug substance and/or drug product to support regulatory submissions and that the Company may not obtain funding sufficient to complete the regulatory or development process; the Companys limited experience as a company in obtaining regulatory approvals and commercializing pharmaceutical products; risks and uncertainties in the Companys ongoing or future product development activities and preclinical studies, which may not prove successful in demonstrating proof-of concept, or may show adverse toxicological findings, and even if successful may not necessarily predict that subsequent clinical trials will show the requisite safety and efficacy of the Companys product candidates; any operational or other disruptions as a result of the COVID-19 pandemic; the Companys ability to obtain additional funding or enter into strategic or other business relationships necessary or useful for the further development or commercialization of the Companys product candidates; the Companys reliance on arrangements with third parties to support its operations and its development, manufacturing and commercialization efforts and the risk that such parties will not successfully carry out their contractual duties or meet expected deadlines; and other risks and uncertainties described in the Companys annual report filed with the Securities and Exchange Commission on Form 10-K for the twelve months ended December 31, 2021, and in the Companys subsequent filings with the Securities and Exchange Commission. Such forward-looking statements speak only as of the date of this press release, and Novan disclaims any intent or obligation to update these forward-looking statements to reflect events or circumstances after the date of such statements, except as may be required by law.

INVESTOR AND MEDIA CONTACT:

Jenene Thomas JTC Team, LLC833-475-8247NOVN@jtcir.com

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Novan to Participate in the Virtual Investor Innovation in Dermatology Spotlight Event - Yahoo Finance

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Understand new developments in science, health and technology, each week. Subscribe to The Conversations science newsletter.]

Link:
What is that rash? Genetic fingerprints can help doctors diagnose and treat skin conditions more effectively - The Conversation Indonesia

When I started my first full-time job after graduating college, I was surprised at the toll my 9-to-5 took on my body. I thought I would choose a desk job and that would be it. I was wrong! The long hours, repetitive movements, and even the commute ran me ragged. In my first few months of working, life was an endless cycle of work, sleep, repeat. Fatigue and burning pain from PsA made it impossible to do much else.

Over the years, I had to learn ways to make my office job easier on my body. It took a lot of trial and error, but eventually, I figured out what worked.

Half the battle of going to work is the commute; at the end of the day, you may not have energy for much else when combined with PsA fatigue.

One positive thing the pandemic has brought is the opportunity to work from home. If it's an option, I highly recommend you take it. I've been working remotely for two years now, and it's improved my quality of life since I can preserve my limited energy by avoiding traffic.

5 Tips For People With Psoriatic Arthritis From People With Psoriatic Arthritis

Of course, there are some jobs that can't be done from home. If you have a long commute, consider carpooling or taking public transportation. My office is in the city, and I take the commuter train when I must go in. I love being able to rest, relax, and catch up on my reading while someone else takes over the driving.

Whether youre on your feet all day or sitting at a desk, wearing good-quality, comfortable shoes is a must. I get blisters easily due to joint swelling, even if I'm sitting all day. So, instead of flats or heels, I wear booties to work when I go into the office. They still look professional but are much more comfortable.

Choose shoes with soft, shock-absorbent materials if you're standing all day. PsA can often cause heel and foot tenderness, which can worsen when standing on hard surfaces. I prefer shoes with a chunky foam or cork sole, as they are excellent shock absorbers. Rubber and plastic can be heavy and too firm.

If you must wear work boots, which usually have a rubber base and steel toes, try adding inserts for cushioning. Cork, foam, and gel inserts are great choices. And bring a change of shoes for commuting.

You never know when a joint may get irritated, so I always keep my favorite arthritis supplies nearby. In my desk, I have a drawer full of my preferred pain medications like nonsteroidal anti-inflammatory drugs (NSAIDs), topical pain relievers, and disposable heat packs the type with adhesives that attach to your body. I've found them helpful to take the edge off. I also like to keep compression gloves, sleeves, and socks on hand, which help me deal with swelling and pain. They can be a lifesaver to slip on during a long day.

I've heard time and time again that motion is lotion. Moving can help keep your joints from getting too stiff and painful. I was surprised by how painful working a sedentary job can be, and I constantly have to make an effort to stretch and get up for frequent walks.

Even people working physical jobs need the opportunity to stretch. Repetitive movements and standing on your feet for too long can irritate your joints. During my past employment and vocational training, I took a moment every half hour or so to stretch, and it made a big difference in how I felt.

It's a highly personal decision to reveal your diagnosis to your employer. Some people are worried that disclosing their condition may lead to bias in the workplace. I have worried about being seen as incapable at past jobs and have chosen to keep my diagnosis private.

I can't tell you the best option for your situation. I bring it up if I know my employer can make a reasonable accommodation that helps me complete my work. The few times I've chosen to reveal my condition have often brought positive changes, such as being able to work from home more frequently or allowing me to commute during off-hours. My supervisors were happy to grant these accommodations since they helped me work more efficiently and improved my work quality. You don't know what they can offer until you start the conversation!

It's not easy to work with PsA, but it can be possible. People today have more options when it comes to making the workplace work for you. Working from home, flexible hours, and other arrangements can make a career possible. It just takes some preparation and thinking outside the box.

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Managing Psoriatic Arthritis at Work | Psoriatic Arthritis and Your Career - Healthgrades

People with atopic dermatitis, commonly known as eczema, may find that inflammation of the skin is just one of the health conditions theyre living with.

Dermatologists have been aware of an association between eczema and other health concerns. Now, after evaluating data from numerous studies, the American Academy of Dermatology (AAD) has produced an official guideline, which was released at the beginning of the year.

The analysis, published in the Journal of the American Academy of Dermatology in January, found strong evidence tying atopic dermatitis in adults to a number of diseases and conditions, including hay fever, asthma, and food allergies; alopecia (sudden hair loss) and chronic urticaria (hives); osteoporosis; mental health disorders like depression; and skin infections.

When it comes to substance abuse disorder, ADHD (attention deficit hyperactivity disorder), and metabolic syndrome (a group of five conditions that can lead to heart disease, diabetes, stroke, and other health problems), study authors identified some evidence linking these issues to eczema.

The report also suggested a link between atopic dermatitis and various cardiovascular issues, but this association was considered to be small. Evidence supporting a link between eczema and autism spectrum disorders, heart attack, and stroke was inconclusive.

The lead author of the guideline,Dawn Davis, MD,a dermatologist at the Mayo Clinic, calls the AAD guideline groundbreaking because its the first paper of its kind to give a comprehensive review of how eczema may be related to these other physical and mental problems.

We are realizing more and more that inflammatory skin disease such as atopic dermatitis and psoriasis are not only skin conditions, but rather affect the entire person, says Dr. Davis. So we need to practice whole-person care. This guideline is created to empower patients, and to empower the medical community to help patients better address their skin needs.

For decades, dermatologists have recognized a connection between eczema and other atopic and allergic conditions. (The word atopic itself indicates an association with allergies.) MedlinePlus says that up to 60 percent of people with atopic dermatitis develop asthma or hay fever (allergic rhinitis) later in life, and up to 30 percent have food allergies.

Eczema can often signal the beginning of a progression of allergic diseases known as atopic march or allergic march. After people develop eczema, a typical pattern is for them to develop food allergies, followed by hay fever and then asthma.

This new AAD guideline found that about a quarter of adults with eczema had asthma, and they were three times more likely to have this inflammation of the airways than the general population.

The research also spotlighted evidence suggesting that asthma in children ages 7 to 11 was linked to a more persistent type of eczema. Targeted biologic therapies such as dupilumab (Dupixent) demonstrated a potential benefit for both severe atopic dermatitis and asthma.

Dupilumab has been approved for asthma and eczema because both of these diseases kind of work through the same pathway and cause inflammation, says Karan Lal, MD,the committee chair for the Society for Pediatric Dermatology. Its possible if were treating eczema with dupilumab at a very early age, we may prevent [children] from developing clinical signs of asthma.

When it comes to food allergies, researchers estimated that just over 1 in 10 individuals with eczema were likely to have this condition. While the researchers were unclear as to what the implications may be, they pointed out that patients often ask whether food allergies are a trigger for their eczema and whether they should seek out testing for food allergies.

The AAD team observed a consistent link between allergic rhinitis (hay fever) and eczema but little data showing a relationship to allergic conjunctivitis (inflammation of eye tissue) and eosinophilic esophagitis (inflammation of the esophagus).

We always suspected and knew in practice that asthma, food allergies, and other atopic diseases such as allergic rhinoconjunctivitis were more common in patients with eczema, but now we have research data to support those conclusions, says Davis.

Davis stressed that the study confirmed that certain skin diseases are more common in atopic dermatitis patients, such as alopecia areata an autoimmune disease in which the immune system attacks hair follicles, causing sudden hair loss that often results in bald patches on the head and that can affect the hair on other parts of the body as well.

The guideline presented data demonstrating a strong association between eczema and the autoimmune condition chronic urticaria (hives).

Overall, if you have eczema, youre 2.5 times more likely to have an autoimmune condition, according to the new guideline.

An analysis that pooled four studies, including 11,244 adults with eczema and 149,713 people without the condition, found that individuals with eczema faced double the odds of self-reported or clinician-diagnosed depression. In addition, researchers found that eczema patients were more likely to consider suicide, but evidence linking the condition to actual death by suicide was weak.

As to why these patients may be more apt than the general public to have mental health issues, the AAD panel believes that itching, poor sleep, and decreased quality of life overall may play an extensive role.

Although some research made a connection between substance abuse and eczema, evidence was limited about any tie between the skin condition and alcohol use or cigarette smoking.

Davis and her collaborators underscored that ADHD and autism spectrum disorders are better studied in children rather than adults, and these connections will be explored more in depth in an upcoming pediatric guideline.

Atopic disease patients have increased levels of blood proteins connected with cardiovascular risk.

Because systematic inflammation is an established risk factor for cardiovascular disease, its possible that treatments that manage inflammatory skin diseases like eczema could decrease the likelihood of heart problems, according to the guideline.

But in general, the research found only a slight link between eczema and hypertension, peripheral and coronary artery disease, congestive heart failure, and events such as myocardial infarction and cardiovascular death.

The data suggested a small association between eczema and obesity and dyslipidemia (an imbalance of lipids such as cholesterol). Still, pooled facts from eight cross-sectional studies revealed that eczema patients were 36 percent more likely to be obese and 13 percent more likely to have high cholesterol than the general population.

The guideline authors pointed out that atopic dermatitis may actually have an inverse relationship with diabetes, with some research suggesting that individuals have a lower risk of diabetes overall and type 2 diabetes specifically. Based on data analyzed in this paper, however, Davis emphasized that patients with eczema may face a greater likelihood of metabolic syndrome as a whole.

Davis and her team highlighted an investigation demonstrating an increased risk of osteoporosis among those with eczema, and a separate study showed a heightened likelihood of bone fracture. For those with severe atopic dermatitis, the possibility of fracture due to osteoporosis was even greater.

Investigators noted that more research is needed to understand the mechanisms behind this association, but some explanations suggest that chronic systemic inflammation may have a negative effect on bone metabolism, leading to increased bone loss.

The connection between eczema and staphylococcal skin infections is well known. The guideline spotlights a study from the United Kingdom indicating that herpes superinfection is twice as common among those with eczema. Other data suggested cutaneous infections, bacterial skin infections, and eczema herpeticum (a painful, blistering rash caused by the herpes simplex virus) are all more likely to occur among people with eczema.

While Golara Honari, MD, a dermatologist with Stanford Medicine, sees the value in raising awareness about eczemas link to other diseases, she believes patients and doctors need to interpret these correlations with caution.

We need to learn more about these conditions in relation to atopic disease, says Dr. Honari, using cardiovascular disease as an example. There are other common skin diseases for example, psoriasis that have really solid evidence for increased risk of cardiovascular disease, but for atopic dermatitis, that evidence is still not very solid.

Were putting together associations, but we have to be careful, because I don't think these associations necessarily lead to clinical correlations, adds Dr. Lal. Do the results in the guideline mean that for patients that come in, I have to screen all my patients for metabolic syndrome because they have a diagnosis of eczema? It doesn't really work like that.

Overall, Davis and her colleagues view the new guideline as a tool to educate and empower and not induce fear.

When we know certain diseases are interrelated, then we can work on monitoring for those diseases and screening for them, and we can work on lifestyle modification factors that can alter the risk of a disease course, she says.

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Eczema Linked to Potential for Other Health Problems - Everyday Health

Photo: Drazen Zigic (Shutterstock)

There is a uniquely American phenomenon anyone living in or visiting the states is familiar with: A commercial full of happy, smiling people appears on television. A narrator declares that a brand-name drug is changing the lives of people with, say, psoriasis. A faster voice runs down a list of potential side effects of the drug while the actors keep smiling and laughing, maybe dancing (for some reason). The narrator returns with a clear directive: Talk to your doctor today about [the medication].

The thing is, though, that talking to your doctor about medication can be kind of fraught, especially if you plop down in the exam room with a brand name you heard on TV, but no real clue what its all about. Is that how this is supposed to work? Theyre the one with years worth of education and experience, after all. Is it OK for you to suggest to them that you want medication?

It is OK, but there are no guarantees youll get the medication. That might be OK, too. Lets go over how you can talk to your doctor about medication options.

If you are having symptoms and did your own research, you might worry that a doctor will be dismissive of you if you bring up your interest in medication, since youre not, well, a doctor. To be clear, they might bedoctors are human and bias in healthcare is definitely a thingbut there is no reason you shouldnt advocate for yourself. You might not be a medical expert, but you are the expert on your own body.

Dr. Yoni Freedhoff, associate professor of family medicine at the University of Ottawa, said hes noticed patients can be cautious about suggesting to doctors that they have a medication that they think they should be on or theyd like to try. That can come from negative experiences with healthcare providers in the past or a feeling of sheepishness about coming out and saying they think they need medication.

Dr. Joseph Thomas, a hospitalist in New York, agreed that there certainly is some hesitancy at times because they dont want to come off as pushy, like theyre being demanding ... but I think if patients are curious or if they have questions, if theres something they would like to ask about being started on, then yes, absolutely bring that up.

The bottom line, Freedhoff said, is this: If a person has a desire to discuss something with their doctor, regardless of what that thing is, ideally, they should be able to have that discussion with their doctor. A doctors job is pretty straightforward. Our job is to inform people about their treatment options and the risks and ramifications of doing things and not doing things, but never to judge people on the treatment they decide for themselves.

The doctors job is to listen to your concerns and answer your questions, so you have every right to share them.

Did anyone ever tell you, God answers all our prayers, just not always with a yes? Doctors can be kind of like that (but theyre not God). They dont get to make executive decisions about your treatment andalso unlike Godthey are available for follow-up questions when they give you a no.

There will definitely be times where people will bring up medications that are not necessarily appropriate, Freedhoff said. Youre not a doctor, so you might not know that a certain medication wont work for your symptoms or isnt advisable at this point in your treatment. You might not realize you dont meet the clinical criteria for a certain prescription or your insurance wont cover it. Thats fine; youre not the doctor here, so how could you know? The doctors job in this situation is to explain all of that to you. A good doctor, Freedhoff said, would be able to explain thathopefully in a way that doesnt upset the patient.

If the doctor says you dont meet the clinical criteria, ask why not and ask about what options exist that you do qualify for. Freedhoff recommended asking what criteria are utilized in determining a medications appropriateness, for instance, and Thomas pointed out that a doctor might have insight they can share about your particular tolerances. At the heart of any visit to the clinic are your health, your body, and your life. You should feel empowered to ask as many questions as it takes until you have a solid understanding of your treatment.

Were not saying you should hop from doctor to doctor until you find someone who agrees with your self-diagnosis, but you can absolutely consult someone else, provided there are doctors in your area who are available to you.

Seeking a new doctor could be a solution to a number of problems beyond the fact that your current one isnt prescribing a certain medication. As Freedhoff said, If you have a doctor and you do not feel comfortable bringing up a discussion around medication or treatment options, that should be a sign that you need to either discuss your relationship with your doctor and discuss the fact that you dont feel comfortable, try to explore why, and get past that, or get a new doctor.

Thomas added, Ive unfortunately heard too many stories of patients kind of being dismissed by their doctors, [saying things like] Oh, thats why you shouldnt go to Dr. Google and that sort of thing. That happens, and its a thing I think myself and other folks in my profession should discourage. If people are bringing up these questions, its usually because they want to be engaged in their own health and they want to do the best they can to be better and to feel better.

See? There are doctors out there who want to talk and listen. You should feel confident in sharing the truth about your symptoms and what youre going through, no matter what treatment option you decide on. If a doctor is dismissive, wont answer your questions, or shows any signs of bias, you should always feel free to look elsewhere.

All of that being said, have reasonable expectations here. In an instance where youre being treated poorly or a doctor is being very dismissive, sure, push back and advocate for yourself, but use your judgment. If a doctor is telling you youre not a candidate for something and seems willing to have ongoing conversations about what could work for you, hear them out.

Is there bias in healthcare? No question, said Freedhoff, but there will be times a drug just doesnt work for you, and that wont be due to bias. Respecting the fact that there are clinical criteria for prescription medications is worthwhile.

Remember that, as weve established, doctors arent Godbut they do have training and insights most patients dont. Thomas pointed out, for example, that while the media raised significant awareness of monoclonal antibodies as part of a treatment for COVID-19, patients may not realize those dont work as well on the latest variants. There is a lot you can find out through your own investigations, and while you should feel empowered to bring all of that up, be open to learning new things from doctors, who have more expertise here than the average journalist or marketing person.

Its worth having these discussions because medical care, at this point, is a team effort between doctor and patient, he said. Its not the paternalistic relationship that it once was decades ago. So, it cant hurt to ask.

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Is It Ever Worth Asking Your Doctor About a Medication You Saw on TV? - Lifehacker