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Category Archives: Psoriasis

Psoriasis: Causes, Triggers, Treatment, and More

Posted: April 26, 2020 at 12:41 am

Psoriasis is a chronic autoimmune condition that causes the rapid buildup of skin cells. This buildup of cells causes scaling on the skins surface.

Inflammation and redness around the scales is fairly common. Typical psoriatic scales are whitish-silver and develop in thick, red patches. Sometimes, these patches will crack and bleed.

Psoriasis is the result of a sped-up skin production process. Typically, skin cells grow deep in the skin and slowly rise to the surface. Eventually, they fall off. The typical life cycle of a skin cell is one month.

In people with psoriasis, this production process may occur in just a few days. Because of this, skin cells dont have time to fall off. This rapid overproduction leads to the buildup of skin cells.

Scales typically develop on joints, such elbows and knees. They may develop anywhere on the body, including the:

Less common types of psoriasis affect the nails, the mouth, and the area around genitals.

According to one study, around 7.4 million Americans have psoriasis. Its commonly associated with several other conditions, including:

There are five types of psoriasis:

Plaque psoriasis is the most common type of psoriasis.

The American Academy of Dermatology (AAD) estimates that about 80 percent of people with the condition have plaque psoriasis. It causes red, inflamed patches that cover areas of the skin. These patches are often covered with whitish-silver scales or plaques. These plaques are commonly found on the elbows, knees, and scalp.

Guttate psoriasis is common in childhood. This type of psoriasis causes small pink spots. The most common sites for guttate psoriasis include the torso, arms, and legs. These spots are rarely thick or raised like plaque psoriasis.

Pustular psoriasis is more common in adults. It causes white, pus-filled blisters and broad areas of red, inflamed skin. Pustular psoriasis is typically localized to smaller areas of the body, such as the hands or feet, but it can be widespread.

Inverse psoriasis causes bright areas of red, shiny, inflamed skin. Patches of inverse psoriasis develop under armpits or breasts, in the groin, or around skinfolds in the genitals.

Erythrodermic psoriasis is a severe and very rare type of psoriasis.

This form often covers large sections of the body at once. The skin almost appears sunburned. Scales that develop often slough off in large sections or sheets. Its not uncommon for a person with this type of psoriasis to run a fever or become very ill.

This type can be life-threatening, so individuals should see a doctor immediately.

Check out pictures of the different types of psoriasis.

Psoriasis symptoms differ from person to person and depend on the type of psoriasis. Areas of psoriasis can be as small as a few flakes on the scalp or elbow, or cover the majority of the body.

The most common symptoms of plaque psoriasis include:

Not every person will experience all of these symptoms. Some people will experience entirely different symptoms if they have a less common type of psoriasis.

Most people with psoriasis go through cycles of symptoms. The condition may cause severe symptoms for a few days or weeks, and then the symptoms may clear up and be almost unnoticeable. Then, in a few weeks or if made worse by a common psoriasis trigger, the condition may flare up again. Sometimes, symptoms of psoriasis disappear completely.

When you have no active signs of the condition, you may be in remission. That doesnt mean psoriasis wont come back, but for now youre symptom-free.

Doctors are unclear as to what causes psoriasis. However, thanks to decades of research, they have a general idea of two key factors: genetics and the immune system.

Psoriasis is an autoimmune condition. Autoimmune conditions are the result of the body attacking itself. In the case of psoriasis, white blood cells known as T cells mistakenly attack the skin cells.

In a typical body, white blood cells are deployed to attack and destroy invading bacteria and fight infections. This mistaken attack causes the skin cell production process to go into overdrive. The sped-up skin cell production causes new skin cells to develop too quickly. They are pushed to the skins surface, where they pile up.

This results in the plaques that are most commonly associated with psoriasis. The attacks on the skin cells also cause red, inflamed areas of skin to develop.

Some people inherit genes that make them more likely to develop psoriasis. If you have an immediate family member with the skin condition, your risk for developing psoriasis is higher. However, the percentage of people who have psoriasis and a genetic predisposition is small. Approximately 2 to 3 percent of people with the gene develop the condition, according to the National Psoriasis Foundation (NPF).

Read more about the causes of psoriasis.

Two tests or examinations may be necessary to diagnose psoriasis.

Most doctors are able to make a diagnosis with a simple physical exam. Symptoms of psoriasis are typically evident and easy to distinguish from other conditions that may cause similar symptoms.

During this exam, be sure to show your doctor all areas of concern. In addition, let your doctor know if any family members have the condition.

If the symptoms are unclear or if your doctor wants to confirm their suspected diagnosis, they may take a small sample of skin. This is known as a biopsy.

The skin will be sent to a lab, where itll be examined under a microscope. The examination can diagnose the type of psoriasis you have. It can also rule out other possible disorders or infections.

Most biopsies are done in your doctors office the day of your appointment. Your doctor will likely inject a local numbing medication to make the biopsy less painful. They will then send the biopsy to a lab for analysis.

When the results return, your doctor may request an appointment to discuss the findings and treatment options with you.

External triggers may start a new bout of psoriasis. These triggers arent the same for everyone. They may also change over time for you.

The most common triggers for psoriasis include:

Unusually high stress may trigger a flare-up. If you learn to reduce and manage your stress, you can reduce and possibly prevent flare-ups.

Heavy alcohol use can trigger psoriasis flare-ups. If you excessively use alcohol, psoriasis outbreaks may be more frequent. Reducing alcohol consumption is smart for more than just your skin too. Your doctor can help you form a plan to quit drinking if you need help.

An accident, cut, or scrape may trigger a flare-up. Shots, vaccines, and sunburns can also trigger a new outbreak.

Some medications are considered psoriasis triggers. These medications include:

Psoriasis is caused, at least in part, by the immune system mistakenly attacking healthy skin cells. If youre sick or battling an infection, your immune system will go into overdrive to fight the infection. This might start another psoriasis flare-up. Strep throat is a common trigger.

Here are 10 more psoriasis triggers you can avoid.

Psoriasis has no cure. Treatments aim to reduce inflammation and scales, slow the growth of skin cells, and remove plaques. Psoriasis treatments fall into three categories:

Creams and ointments applied directly to the skin can be helpful for reducing mild to moderate psoriasis.

Topical psoriasis treatments include:

People with moderate to severe psoriasis, and those who havent responded well to other treatment types, may need to use oral or injected medications. Many of these medications have severe side effects. Doctors usually prescribe them for short periods of time.

These medications include:

This psoriasis treatment uses ultraviolet (UV) or natural light. Sunlight kills the overactive white blood cells that are attacking healthy skin cells and causing the rapid cell growth. Both UVA and UVB light may be helpful in reducing symptoms of mild to moderate psoriasis.

Most people with moderate to severe psoriasis will benefit from a combination of treatments. This type of therapy uses more than one of the treatment types to reduce symptoms. Some people may use the same treatment their entire lives. Others may need to change treatments occasionally if their skin stops responding to what theyre using.

Learn more about your treatment options for psoriasis.

If you have moderate to severe psoriasis or if psoriasis stops responding to other treatments your doctor may consider an oral or injected medication.

The most common oral and injected medications used to treat psoriasis include:

This class of medications alters your immune system and prevents interactions between your immune system and inflammatory pathways. These medications are injected or given through intravenous (IV) infusion.

Retinoids reduce skin cell production. Once you stop using them, symptoms of psoriasis will likely return. Side effects include hair loss and lip inflammation.

People who are pregnant or may become pregnant within the next three years shouldnt take retinoids because of the risk of possible birth defects.

Cyclosporine (Sandimmune) prevents the immune systems response. This can ease symptoms of psoriasis. It also means you have a weakened immune system, so you may become sick more easily. Side effects include kidney problems and high blood pressure.

Like cyclosporine, methotrexate suppresses the immune system. It may cause fewer side effects when used in low doses. It can cause serious side effects in the long term. Serious side effects include liver damage and reduced production of red and white blood cells.

Learn more about the oral medications used to treat psoriasis.

Food cant cure or even treat psoriasis, but eating better might reduce your symptoms. These five lifestyle changes may help ease symptoms of psoriasis and reduce flare-ups:

If youre overweight, losing weight may reduce the conditions severity. Losing weight may also make treatments more effective. Its unclear how weight interacts with psoriasis, so even if your symptoms remain unchanged, losing weight is still good for your overall health.

Reduce your intake of saturated fats. These are found in animal products like meats and dairy. Increase your intake of lean proteins that contain omega-3 fatty acids, such as salmon, sardines, and shrimp. Plant sources of omega-3s include walnuts, flax seeds, and soybeans.

Psoriasis causes inflammation. Certain foods cause inflammation too. Avoiding those foods might improve symptoms. These foods include:

Alcohol consumption can increase your risks of a flare-up. Cut back or quit entirely. If you have a problem with your alcohol use, your doctor can help you form a treatment plan.

Some doctors prefer a vitamin-rich diet to vitamins in pill form. However, even the healthiest eater may need help getting adequate nutrients. Ask your doctor if you should be taking any vitamins as a supplement to your diet.

Learn more about your dietary options.

Life with psoriasis can be challenging, but with the right approach, you can reduce flare-ups and live a healthy, fulfilling life. These three areas will help you cope in the short- and long-term:

Losing weight and maintaining a healthy diet can go a long way toward helping ease and reduce symptoms of psoriasis. This includes eating a diet rich in omega-3 fatty acids, whole grains, and plants. You should also limit foods that may increase your inflammation. These foods include refined sugars, dairy products, and processed foods.

There is anecdotal evidence that eating nightshade fruits and vegetables can trigger psoriasis symptoms. Nightshade fruits and vegetables include tomatoes as well as white potatoes, eggplants, and pepper-derived foods like paprika and cayenne pepper (but not black pepper, which comes from a different plant altogether).

Stress is a well-established trigger for psoriasis. Learning to manage and cope with stress may help you reduce flare-ups and ease symptoms. Try the following to reduce your stress:

People with psoriasis are more likely to experience depression and self-esteem issues. You may feel less confident when new spots appear. Talking with family members about how psoriasis affects you may be difficult. The constant cycle of the condition may be frustrating too.

All of these emotional issues are valid. Its important you find a resource for handling them. This may include speaking with a professional mental health expert or joining a group for people with psoriasis.

Learn more about living with psoriasis.

Between 30 and 33 percent of people with psoriasis will receive a diagnosis of psoriatic arthritis, according to recent clinical guidelines from the AAD and the NPF.

This type of arthritis causes swelling, pain, and inflammation in affected joints. Its commonly mistaken for rheumatoid arthritis or gout. The presence of inflamed, red areas of skin with plaques usually distinguishes this type of arthritis from others.

Psoriatic arthritis is a chronic condition. Like psoriasis, the symptoms of psoriatic arthritis may come and go, alternating between flare-ups and remission. Psoriatic arthritis can also be continuous, with constant symptoms and issues.

This condition typically affects joints in the fingers or toes. It may also affect your lower back, wrists, knees, or ankles.

Most people who develop psoriatic arthritis have psoriasis. However, its possible to develop the joint condition without having a psoriasis diagnosis. Most people who receive an arthritis diagnosis without having psoriasis have a family member who does have the skin condition.

Treatments for psoriatic arthritis may successfully ease symptoms, relieve pain, and improve joint mobility. As with psoriasis, losing weight, maintaining a healthy diet, and avoiding triggers may also help reduce psoriatic arthritis flare-ups. An early diagnosis and treatment plan can reduce the likelihood of severe complications, including joint damage.

Learn more about psoriatic arthritis.

Around 7.4 million people in the United States have psoriasis.

Psoriasis may begin at any age, but most diagnoses occur in adulthood. The average age of onset is between 15 to 35 years old. According to the World Health Organization (WHO), some studies estimate that about 75 percent of psoriasis cases are diagnosed before age 46. A second peak period of diagnoses can occur in the late 50s and early 60s.

According to WHO, males and females are affected equally. White people are affected disproportionately. People of color make up a very small proportion of psoriasis diagnoses.

Having a family member with the condition increases your risk for developing psoriasis. However, many people with the condition have no family history at all. Some people with a family history wont develop psoriasis.

Around one-third of people with psoriasis will be diagnosed with psoriatic arthritis. In addition, people with psoriasis are more likely to develop conditions such as:

Though the data isnt complete, research suggests cases of psoriasis are becoming more common. Whether thats because people are developing the skin condition or doctors are just getting better at diagnosing is unclear.

Check out more statistics about psoriasis.

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Psoriasis: Causes, Triggers, Treatment, and More

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Psoriasis – Diagnosis and treatment – Mayo Clinic

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Diagnosis

In most cases, diagnosis of psoriasis is fairly straightforward.

Psoriasis treatments reduce inflammation and clear the skin. Treatments can be divided into three main types: topical treatments, light therapy and systemic medications.

Used alone, creams and ointments that you apply to your skin can effectively treat mild to moderate psoriasis. When the disease is more severe, creams are likely to be combined with oral medications or light therapy. Topical psoriasis treatments include:

Topical corticosteroids. These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They reduce inflammation and relieve itching and may be used with other treatments.

Mild corticosteroid ointments are usually recommended for sensitive areas, such as your face or skin folds, and for treating widespread patches of damaged skin.

Your doctor may prescribe stronger corticosteroid ointment for smaller, less sensitive or tougher-to-treat areas.

Long-term use or overuse of strong corticosteroids can cause thinning of the skin. Topical corticosteroids may stop working over time. It's usually best to use topical corticosteroids as a short-term treatment during flares.

Topical retinoids. These are vitamin A derivatives that may decrease inflammation. The most common side effect is skin irritation. These medications may also increase sensitivity to sunlight, so while using the medication apply sunscreen before going outdoors.

The risk of birth defects is far lower for topical retinoids than for oral retinoids. But tazarotene (Tazorac, Avage) isn't recommended when you're pregnant or breast-feeding or if you intend to become pregnant.

Calcineurin inhibitors. Calcineurin inhibitors tacrolimus (Prograf) and pimecrolimus (Elidel) reduce inflammation and plaque buildup.

Calcineurin inhibitors are not recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma. They may be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.

Coal tar. Derived from coal, coal tar reduces scaling, itching and inflammation. Coal tar can irritate the skin. It's also messy, stains clothing and bedding, and has a strong odor.

Coal tar is available in over-the-counter shampoos, creams and oils. It's also available in higher concentrations by prescription. This treatment isn't recommended for women who are pregnant or breast-feeding.

This treatment uses natural or artificial ultraviolet light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight.

Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with medications.

Psoralen plus ultraviolet A (PUVA). This form of photochemotherapy involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.

This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. Short-term side effects include nausea, headache, burning and itching. Long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma.

If you have severe psoriasis or it's resistant to other types of treatment, your doctor may prescribe oral or injected drugs. This is known as systemic treatment. Because of severe side effects, some of these medications are used for only brief periods and may be alternated with other forms of treatment.

Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments topical creams and ultraviolet light therapy (phototherapy) in those patients with typical skin lesions (plaques) and then progress to stronger ones only if necessary. Patients with pustular or erythrodermic psoriasis or associated arthritis usually need systemic therapy from the beginning of treatment. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.

There are a number of new medications currently being researched that have the potential to improve psoriasis treatment. These treatments target different proteins that work with the immune system.

A number of alternative therapies claim to ease the symptoms of psoriasis, including special diets, creams, dietary supplements and herbs. None have definitively been proved effective. But some alternative therapies are deemed generally safe, and they may be helpful to some people in reducing signs and symptoms, such as itching and scaling. These treatments would be most appropriate for those with milder, plaque disease and not for those with pustules, erythroderma or arthritis.

If you're considering dietary supplements or other alternative therapy to ease the symptoms of psoriasis, consult your doctor. He or she can help you weigh the pros and cons of specific alternative therapies.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Although self-help measures won't cure psoriasis, they may help improve the appearance and feel of damaged skin. These measures may benefit you:

Coping with psoriasis can be a challenge, especially if the disease covers large areas of your body or is in places readily seen by other people, such as your face or hands. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden.

Here are some ways to help you cope and to feel more in control:

You'll likely first see your family doctor or a general practitioner. In some cases, you may be referred directly to a specialist in skin diseases (dermatologist).

Here's some information to help you prepare for your appointment and to know what to expect from your doctor.

Make a list of the following:

For psoriasis, some basic questions you might ask your doctor include:

Your doctor is likely to ask you several questions, such as:

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Psoriasis - Diagnosis and treatment - Mayo Clinic

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Meet the Scientists on the Frontlines of Psoriasis Research – HealthCentral.com

Posted: at 12:41 am

Editor's Note: This story is part of a new series on HealthCentral called "Get Your Ph.D.!", which is geared toward people who've got the basics of their condition down and want to up their expertise. Who's ready to go pro?!

If psoriasis had a street name, it would be known as Slim Shady. Not only does the exact cause of this condition baffle even the best of scientific minds (genetics and an overactive immune system are possible culprits, as are triggers like stress, skin trauma, and weight gain), but its characteristic itchy and painful lesions can crop up anywhere from head to toe. In the world of skin conditions, psoriasis is all kinds of sly.

While there are effective treatments available to manage symptoms and stop them from getting worseincluding topicals, ultraviolet light therapy, oral meds, and biologics, which target the immune systemthere is yet to be a foolproof, one-size-fits-all cure. Whats more, larger implications about the relationship between psoriasis and other diseases are still a question mark. Now, thanks to groundbreaking studies from some seriously smart researchers, there is new hope for a better understanding and treatment of the condition. We talked with three of these doctors to find out what theyre working on. Caution: Majorly impressive science ahead.

MEET THE EXPERT:

Title: Head of the Lab of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute (NHLBI)

Research: Exploring the link between psoriasis inflammation and heart disease

Skin health isnt usually among the conditions a cardiologist studies, let alone treats, but for Nehal N. Mehta, M.D., psoriasis plays a starring role in his research.

It started with a single patient. I met a 45-year-old physician who had been having recurrent heart attacks with no real risk factors, and when I examined him, I saw a patch of psoriasis on his right inner thigh that hed had since med school, Dr. Mehta says.

It could have been nothing, but then again, there were no other clues to go on. Dr. Mehta started wondering. On a hunch, he and his team began examining scans of people with psoriasis, and what they found was startling: The condition was not just skin deep. When you look at these images, theres inflammation everywherein the joints, in the skin, in the liver, in the spleenthis is a whole-body disease, Dr. Mehta says.

Then they applied those findings to people who also had a heart attack. It was a eureka moment. Even if you accounted for all the other risk factors people had for cardiovascular disease, if they had psoriasis, it increased their risk for a heart attack by 53 percent, Dr. Mehta says.

As it turns out, the same overactive immune cells in the skin that lead to psoriasis can also be found in the heart arteries. In the arteries, however, the immune system is associated with plaque buildupa major risk for heart attack. So if you treat the psoriasis thats causing the immune system to be overactive, says Dr. Mehta, you can also reduce the risk of heart artery disease. Treating remote inflammation in the body can reduce the plaque that leads heart disease and heart attack, he says.

The treatment he uses is a biologic medicationa protein-based injectible drug created from living cells that targets the areas of the immune system associated with psoriasis. Using a biologic treatment redistributes fat in your body in a beneficial way, so youre not only improving the skin but also HDL, the bodys good cholesterol, as well as glucose levels which reduces the risk for diabetes.

Why are these findings so crucial? In addition to showing that patients with psoriasis may warrant early heart disease intervention, says Dr. Mehta, it also reveals a new risk factor (and treatment) for people with heart conditions. Along with diabetes, hypertension, high cholesterol, family history, and smoking, inflammation from psoriasis is an important variable in cardiac events. You have patients who are now learning about a sixth risk factor for heart attacksits pretty wild, he says.

MEET THE EXPERT:

Title: Director of the Psoriasis and Phototherapy Treatment Center and Professor of Dermatology at University of Pennsylvania Perelman School of Medicine

Research: Studying the benefits of at-home phototherapy treatment

Long used to help treat psoriasis, Ultraviolet B phototherapy improves symptoms by penetrating the top layer of the skin with narrowband UVB light, preventing skin cells from growing too quickly. Patients prefer it to systemic medications because its virtually free of side effects. But phototherapy is expensive, time consuming (it requires 12 weeks of in-office treatments), and not always covered by insurance.

Enter: Joel Gelfand, M.D., the director of the Psoriasis and Phototherapy Treatment Center and a professor of dermatology at University of Pennsylvania Perelman School of Medicine. Dr. Gelfand is studying the effects of at-home phototherapy as a lower cost, more accessible alternative to in-office treatments, so that more people can benefit from it.

Helming whats known as the LITE Study, Gelfand and his team are conducting an ongoing randomized, controlled study of 1,050 patients to compare the effectiveness of home-based phototherapy devices to office-based treatments. The study charts the success rate and safety of 12 weeks of therapy in both environments. It also documents the outcomes for three different skin toneslight skin, olive to light brown skin, and dark brown to black skinto measure tolerance and effectiveness.

Up until now, there hasnt been enough data on at-home therapies, and this has led to decisional uncertainty from patients, dermatologists, and insurers, Dr. Gelfand says. What were doing is an example of real-world pragmatic research designed to shift the practice of medicine in a way thats more patient-centered.

Not only does the study aim to provide important data on treatment response in patients of different skin colors, but it will ultimately help broaden the options for anyone struggling with this disease. Says Dr. Gelfand, Were trying to make phototherapy accessible and affordable to anyone who needs it.

MEET THE EXPERT:

Title: Assistant Professor at the University of Texas Southwestern

Research: Slowing cell metabolism to prevent hyper-skin growth linked to psoriasis

Heres the thing about psoriasis treatment: Because most medications broadly target the immune cells responsible for the disease in a system-wide way, they come with some serious side effects that are, in a word, uncomfortable. But, what if by simply targeting certain cell pathways the disease could be treated without side effects?

This is the question that lead Richard Wang, M.D., an assistant professor of dermatology at the University of Texas Southwestern, to start looking at glucose transport and metabolism to understand their roles in cell growth and division in conditions like psoriasis, which is characterized by skin overgrowth.

In a lab experiment, Dr. Wang and his team blocked glucose transport in the skin cells of mice using genetic and chemical inhibitors. Glucose is critical for cell survival and cell growth, Dr. Wang says. To maintain normal functioning throughout the body, glucose moves through transporters in very specific pathways so that growth and division of cells is controlled.

In people with psoriasis though, inflammation sends cells false signals that an infection is happening and those glucose transporters, which regulate the amount of glucose in cells, respond by letting more glucose in. All this extra glucose causes cells to divide, grow, and thickenresulting in the visible scales and inflamed skin characteristic of psoriasis. By blocking those glucose transporters in the mice, we were able to shut this process down, inhibiting the growth of skin cells and controlling inflammation without disrupting the skins normal functioning, Dr. Wang says.

While Dr. Wangs research is ongoing, the promise is clear: There is potential for a new, more targeted chemical inhibitor topical agent to treat humans with mild-to-moderate psoriasis without the side effects of traditional treatments, he says.

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Psoriasis guidelines reflect rise of NB-UVB, targeted and home therapies – Dermatology Times

Posted: at 12:41 am

The latest American Academy of Dermatology-National Psoriasis Foundation phototherapy guidelines incorporate several advances in efficacy, safety and patient convenience that were unavailable a decade ago.

RELATED:Biologic guidelines for psoriasis let providers choose

Weve come a long way in the field of phototherapy over the last 10 years, says M. Alan Menter, M.D. He is chairman of dermatology at Baylor University Medical Center, co-chair of the AAD Psoriasis Guideline Workgroup and founder of the International Psoriasis Council.

To produce the phototherapy guidelines, Dr. Menter and co-authors reviewed available data regarding previous phototherapy modalities, along with newer technologies including narrowband UVB (NB-UVB). With a wavelength of 290 to 320 nm, NB-UVB offers greater specificity and targeting for psoriasis and eczema than does broadband UVB (BB-UVB, 290 to 400 nm).

Formerly the mainstay of phototherapy, BB-UVB has been replaced by newer modalities. As monotherapy for adults with generalized plaque psoriasis, guidelines state, BB-UVB provides less efficacy than does NB-UVB, oral psoralen plus UVA (PUVA) or topical PUVA. Very few dermatologists still use oral PUVA, says Dr. Menter, although it works well for resistant psoriasis.

Now we also have intense electrodes and dye lasers, which are smaller lamps that penetrate much better for focal areas such as thick psoriasis patches on the elbows or knees, he says. Such technologies include excimer lasers (308 nm), targeted NB-UVB (311 to 313 nm) and pulsed-dye lasers (PDLs).

Whichever technology one chooses, guidelines emphasize the need to tailor dosing to the patients skin type. For example, minimal erythema dose (MED) testing with NB-UVB should begin at 250 mJ/cm2 for patients with skin types I and II, versus 350 mJ/cm2 for types III and IV.

Whereas Goeckerman therapy was a difficult, messy and time-consuming combination of light therapy and tar treatment, Dr. Menter says, physicians can supplement NB-UVB with concomitant topical therapies such as vitamin D analogs, retinoids and corticosteroids to potentially boost efficacy.

Disclosures:

Dr. Menter reports no relevant financial interests.

References:

Elmets CA, Lim HW, Stoff B, et al. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019;81:775-804.

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Psoriasis and Diet: What’s the Link? – HealthCentral.com

Posted: at 12:41 am

Editor's Note: This story is part of a new series on HealthCentral called "Get Your Ph.D.!", which is geared toward people who've got the basics of their condition down and want to up their expertise. Who's ready to go pro?!

Scientists have long known that obesity and psoriasis go hand-in-hand. Like chips and salsa or gin and tonic, if you have one disease, youre likely to have the other. The reason is that a high BMI can lead to inflammation in the body, which increases the risk for developing the challenging skin condition known as psoriasisor worsening existing symptoms if you already have it. Now, a new study published in the Journal of Investigative Dermatology suggests there may be another mechanism at work: Fat cells themselves may not be the culprits, say researchers, but rather specific types of foods are to blame.

In the study, conducted at the University of California, two groups of mice were fed different diets. Once group got a typical mouse meal; the other one was given a characteristic Western diet (basically, the mouse equivalent of a moderate-to-high fat, processed-sugar diet that mimicked what humans would eat on the same meal plan). The mice kept it up for four weeks, after which scientists took stock of their skin, and found that the creatures whod been chowing on the rodent version of burgers, fries, and shakes showed visible inflammatory changes including redness, scales, and thickened skinthe same hallmark symptoms consistent with human psoriasiseven if the mice hadnt appreciably gained weight.

This is important because many people think that its obesity alone that leads to the increased risk for psoriasis, says senior study author Sam T. Hwang, M.D., Ph.D., department chair and professor of dermatology at the University of California Davis School of Medicine. What this shows is that dietary changes can have a radical impact on the skinso its not just weight that makes a difference for developing psoriasis, but the types of foods you eat.

These so-called Western foods are typically high in saturated fat (butter, red meat, cheese and other dairy products made from whole milk, for example), plant-based oils (such as palm oil, coconut oil, and canola oil) and processed ingredients, like those in many baked goods. The foods also contain high levels of simple sugars, found in fruit juices, soda, candy, and even some whole fruits like apples, bananas, and watermelon.

So, what is it about these foods, common in American diets, that causes inflammation in the first place? Researchers believe they alter the composition of the microbiome, those billions of bacteria living in your gut that help maintain general health and the health of your immune system. Changing the balance of these bacteria through diet may ultimately lead to an inflammatory response related to psoriasis.

To break it down even further (we know, its complicated), high-fat foods cause bile acids from your gall bladder and liver to go into the gut to help with digestion, says Ronald Prussick, M.D., an assistant clinical professor of dermatology at George Washington University and medical director of the Washington Dermatology Center. These acids then cause bad bacteria to form, leading to inflammation inside the body.

What this all means: The study proposes that what you eat can alter the gut microbiome, causing changes in bile acid levels, which can affect inflammation.

This theory was tested in the study when the researchers administered cholestyramine, a drug used to lower cholesterol (high levels of which are found in fast foods and other western fare), to the mice and found that it helped reduce the risk of skin inflammation. Cholestyramine was shown to bind to bile acids in the intestine and release through the stool, allowing for inflammation to be lowered in the mice, Dr. Hwang says.

Doctors have long maintained that there is no single food that can treat or cure psoriasis, and thats still true. But if you have the skin condition or are at risk for the disease (which is frequently genetically determined), limiting or eliminating foods high in saturated fats and simple sugars can lessen the chances for inflammationand therefore possibly psoriasis, Dr. Hwang says.

What to eat instead? A Mediterranean-type diet, characteristically rich in healthy fats and omega-3 fatty acids, is known to help fight inflammation. It includes foods such as olive oil, avocados, nuts, seeds, fish like salmon and lake trout, and some meat or dairy from grass-fed animals, as well as fresh vegetables and fruits low on the glycemic index, like berries. Switching to a healthier diet can increase the chances of treating psoriasis more effectively, says Dr. Prussick.

Additionally, Dr. Prussick suggests cooking on lower heat by stewing, poaching, boiling, and steaming foods rather than grilling, frying, or toasting them. Heat causes sugars in foods to bind to proteins, known as advanced glycation end products (AGEs), which causes more inflammation, he says. He also recommends cooking with acids such as vinegar or lemon juice, which can reduce AGEs by 50%.

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COVID-19: What It Means for Diabetics and Those with Other Immune Diseases – PracticalPainManagement.com

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Links are emerging between the coronavirus and patients with chronic pain, obesity, diabetes, and immune conditions such as IBD, MS, and psoriasis. Preliminary clinical treatment recommendations for both stable and infected patients are reviewed.

Any immune disorder increases the risk of SARS-CoV-2virus and COVID-19 illness. The most prevalent immune disease is diabetes. Type 2 diabetes and obesity have increased worldwide to epidemic proportions and, together, are deadly contributors to the COVID-19 pandemic. Obesity and type 2 diabetes also are important factors in the management of chronic pain disorders.

This article first reviews the multifaceted impact of diabetes and obesity on chronic pain. A comparison of the immune/inflammatory response in diabetes to that of the COVID-19 infection is included, as is current and emerging research regarding the risk of diabetes on COVID-19 infection. Preliminary data regarding COVID-19 infection in non-rheumatic immune diseases, including inflammatory bowel disease (IBD), psoriasis, and multiple sclerosis (MS), are presented. Finally, treatment recommendations are provided. See also, Managing Rheumatic/Immune Diseases During COVID-19, which focuses on rheumatoid arthritis and systemic lupus erythematosus.

This review focuses on type 2 diabetes, which is closely related to the epidemic of obesity. The global prevalence of obesity has doubled in the past 20 years.1 Obesity, marked by BMI > 30, is the single most important risk factor for type 2 diabetes and there is a linear correlation of increased BMI with an increased risk of diabetes. Type 2 diabetes affects 500 million people worldwide and 10% of adults in the United States.1

Chronic pain affects one in three Americans and is the number-one symptom leading to physician visits.2 There is a strong correlation among obesity, type 2 diabetes, and chronic pain.2 The three broad categories of chronic pain - nociceptive (inflammatory), neuropathic, and nociplastic (central) - are each adversely affected by obesity and type 2 diabetes (see Table I.)

Obesity increases weight load and predisposes individuals to osteoarthritis of the knee and hip.3 The increased structural demands of obesity are also factors in chronic low back pain. For example, 12% of adults classified as obese have chronic low back pain compared to 3% of adults of normal weight.4 Obesity and type 2 diabetes activate inflammatory/immune mechanisms which can promote chronic pain. See also, Obesity and Pain Care: Multifaceted Considerations for Treatment, and Obesity and Rheumatoid Arthritis: What Clinicians Should Know.

Diabetic neuropathy is the most common complication of diabetes, affecting up to 50% of patients with type 2 diabetes. Carpal tunnel syndrome and other entrapment neuropathies are also more common in diabetic patients compared to the healthy population.

The prototypic nociplastic (central) chronic pain condition, fibromyalgia, is strongly associated with obesity as well. Between 25% and 60% of women with fibromyalgia are considered to be obese and type 2 diabetes is more common in those with fibromyalgia than in the general population.5 In a study of 123 obese fibromyalgia patients, those who lost at least 10% of their body weight showed greater improvement in pain and other symptoms.6

Obesity and type 2 diabetes have been associated with adipose tissue inflammation and alterations in immune activation.7 Specifically, tissue macrophages are involved in obesity-induced insulin resistance. T-cell subsets release cytokines which promote insulin resistance. Pro-inflammatory markers, including tumor necrosis factor (TNF) and C-reactive protein (CRP), can predict the subsequent development and severity of type 2 diabetes.8 Even short-term hyperglycemia has been shown to transiently blunt the immune response.9

Data to date* shows that inflammatory and immune mechanisms are involved in every aspect of COVID-19 infection.10 Once the viral-infected cells die, their necrosis triggers an inflammatory/immune response. In the initial phase of infection, there appears to be a fall-off in T-cell function and a reduction in natural killer cells. This can result in lymphocytopenia. Interferon (IFN) and complement activation limit viral spread but may quickly become overwhelmed. As a result, hyperinflammation can occur with massive release of cytokines, referred to as a cytokine storm. Levels of various interleukins (IL-2, IL-6 and IL-7), TNF, ferritin, troponin, and other inflammatory/immune markers end up being markedly elevated.

The presence of diabetes inhibits intracellular killing of any microbe.7 The increased susceptibility of COVID-19 infection in patients with diabetes may involve a more effective viral entry in cells, a decrease in viral clearance, and overall diminished T-cell function. Evidence from the 2003 severe acute respiratory syndrome (SARS), for example, found that SARS coronavirus readily entered islet cells, using angiotensin converting enzyme (ACE2) as its receptor, damaging islets and causing acute diabetes.11 Type 2 diabetes has been associated with increased expression of ACE in other tissues, including the lung, liver and heart, besides the pancreas. This connection may explain the higher rate of multi-organ failure and mortality in patients with type 2 diabetes and COVID-19 infection.12 Patients with diabetes also tend to have increased comorbidities, particularly cardiovascular disease, that have been associated with increased severity of COVID-19 infection.

Emerging Pandemic Data

Diabetes and cardiovascular disease appear to be the most common comorbidities in patients with COVID-19 infection. Data emerging from the SARS-CoV-2pandemic have shown an increased rate of COVID-19 infection and a higher risk for complications and death in patients with diabetes. Most of the statistics have not broken this down into type 1 or type 2 diabetes.

Data regarding COVID-19 in patients with diabetes is somewhat varied,with a prevalence of diabetes ranging from 10% to 20% in most series.12In a series of more than 72,000 cases of COVID-19 from China, diabetes increased the mortality rate three-fold, from 2.3% to 7.3% of cases.13 Looking back, diabetes and blood glucose levels were important risk factors for morbidity and mortality in patients infected with Pandemic Influenza A 2009 (H1N1), the SARS coronavirus, and the Middle East Respiratory Syndrome-related coronavirus (MERSCoV).10 However, a very recent meta-analysis could not confirm that diabetes increased the risk of COVID-19 infection but did find that it worsened the outcome.14

Independent of diabetes, obesity is an important risk factor for morbidity and mortality in COVID-19 infection. In a study from Italy, 48% of patients with COVID-19 admitted to an intensive care unit were obese.15 The need for mechanical ventilation correlated with patients BMI. The worst prognosis was in patients with a BMI > 35kg/m2. Hypertension, a common comorbidity in type 2 diabetes, is also a risk factor for COVID-19 infection and disease severity. Patients with hypertension and those treated with ACE inhibitors may overly express ACE2, resulting in increased severity of coronavirus cell entry.

In the two largest, recently published series regarding patients with irritable bowel disease, there was no strong evidence that IBD was a risk factor for COVID-19 infection. (Image: iStock)

Inflammatory Bowel Disease (IBD)

SARS-CoV-2 has been shown to enter gastrointestinal (GI) cells and up to 50% of fecal samples in patients with COVID-19 infection were positive for persistent viral detection.16 This may explain why many patients with the virus have GI symptoms. As discussed in part 1 of this topic (https://www.practicalpainmanagement.com/pain/myofascial/managing-rheumatic-immune-diseases-during-covid-1), one might expect that these immune mechanisms would put patients with IBD, which includes ulcerative colitis and Crohns disease, at greater risk for developing the COVID-19 infection.

However, that does not seem to be the case. In the two largest, recently published series, there was no strong evidence that IBD was a risk factor for COVID-19 infection. In a GI referral center following 20,000 patients with IBD, there were no reported cases of COVID-19.17 In a study from Italy, no cases of COVID-19 infection had been detected in 522 patients with IBD who were followed closely for one month.18 Of this sample, 22% were taking immunosuppressive drugs. Those patients continued on those medication regimens.

In patients with IBD, it has been postulated that ACE2 receptor viral affinity, important in initial upper respiratory infection, is different in the ileum and colon and up-regulation of ACE2 in the peripheral blood of IBD patients may limit COVID-19 infection.16 As detailed below, immunosuppressive drugs given to IBD patients may actually decrease the rate of infectivity and/or the severity of infection. Cytokines released in COVID-19 infection are similar to those found in the inflamed tissues of patients with irritable bowel disease.

A panel of IBD experts from China, the United Kingdom, and the US released guidelines for managing IBD patients, including recommendations regarding patient visits and medications.19 See Table II. The guidelines also include recommendations for treating a patient who has a fever. Importantly, it has also been recommended that any patient with IBD be screened for COVID-19 infection, even if asymptomatic.20

Multiple Sclerosis (MS)

There is no evidence to date that multiple sclerosis increases the risk of COVID-19 infection or any self-limited upper respiratory viral infection.21 However, there is an increased risk of pneumonia with MS and the risk of certain immune modulatory medications used in MS is not known.

Initial reviews by neurologists suggest that most MS patients should continue on immune therapy unless they have evidence of symptomatic COVID-19 infection.21 Certain medications used to manage MS are often associated with lymphopenias, such as alemtuzumab and cladribine, and patients taking these drugs may be at greater risk. Extended intervals between doses of immune therapies has therefore been recommended.21

Corticosteroids may be appropriate for acute disease exacerbations. Any patient hospitalized with COVID-19 should be taken off increased dose of corticosteroids within 4 weeks after recovery.21 The National Multiple Sclerosis Society has developed guidelines on the use of disease-modifying anti-rheumatic drugs (DMARDs) during the COVID-19 pandemic.22

Immunomodulators that do not suppress the immune system, such as interferons, glatiramer acetate, and natalizumab, are considered safest whereas other immunomodulators with immune actions, such as fingolimod and dimethyl fumarate, and immunosuppressants such as rituximab and alemtuzumab, have been shown more likely to increase the risk of the COVID infection.

Psoriasis and Related Skin Diseases

The most common immune-driven skin disease is psoriasis. Patients with psoriasis are often treated with immunosuppressive medications. There have been no studies linking psoriasis or other immune-related dermatologic conditions with increased risk of COVID-19 infection.

Lebwohl recently compared the rate of upper respiratory infections with most of the biologics/immune drugs used in psoriasis.23 According to his calculations, etanercept showed no increased infection compared to placebo whereas other TNF inhibitors had a 7% increased rate. Most of the interleukin blockers had a minimal rate of increased infections. The author cautioned that these data do not directly apply to COVID-19 and that there is evidence that immune therapy may prove helpful in the treatment of COVID-19 infection.

Hydroxychloroquine

Antimalarial medications, including hydroxychloroquine (HCQ) and chloroquine, have been featured prominently in media coverage of COVID-19.24 They also have been recommended by the Infectious Disease Society of America (IDSA) for those hospitalized with the infection, but only in the context of a clinical trial (more on this below).

HCQ, branded Plaquenil, has been used to treat rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) for more than 50 years. The drugsuse has been especially prominent in India, where HCQ has been approved for the treatment of type 2 diabetes since 2014.25 It has anti-inflammatory and immune properties, as well as antimicrobial effects, although only well-documented for malaria. Laboratory studies have demonstrated that these drugs may block the coronavirus from entering cells and a few uncontrolled or very small studies from China suggested that it may have been helpful in patients with COVID-19 infection. However, the drug may prolong the QT interval and should be used with extreme caution in patients with a history of cardiac arrhythmias.22 A baseline electrocardiogram should be done in any subject with cardiovascular disease.

Plaqueniland other antimalarials are being routinely given to patients hospitalized with COVID-19 infection in the US. Daniel H. Sterman, MD, the critical care director at New York Universitys Langone Health, noted that data about HCQs effectiveness are weak and unsubstantiated andwe do not know whether our patients are benefiting from hydroxychloroquine treatment at the present time.26

In fact, a number of medical experts, including NAID Director Anthony Fauci, MD, have raised caution about widespread use of these drugs. Dr. Fauci told The New York Times: I think weve got to be careful that we dont make that majestic leap to assume that this is a knockout drug We still need to do the kinds of studies that definitively prove whether any intervention, not just this one, any intervention is truly safe and effective.26

For those with rheumatic disease already on HCQ and antimalarials, the American College of Rheumatology has recommended that their HCQ and similar medication regimens be continued as long as the patients are stable and have no signs of infection or SARS-CoV-2 exposure. (See their full recommendations).See also,Hydroxychloroquine Use and Risk in the Management of Systemic Lupus Erythematosus.

Corticosteroids

Corticosteroids have been used in COVID-19 infected patients with pneumonia, especially in those with acute respiratory distress syndrome (ARDS). Most observational studies have not found evidence for their efficacy and guidelines from the World Health Organization (WHO) did not support the use of corticosteroids for pneumonia or ARDS associated with COVID-19 infection.27

TNF Inhibitors, Interleukins, and JAK Inhibitors

Like the antimalarial drugs, immunosuppressive and immune-modulating drugs have been tried in many hospitals throughout the world in patients with life-threatening COVID-19 infection. Their impact on immune receptors and cytokines may have a beneficial effect in certain phases of COVID-19 infection, such as the so-called cytokine storm. There is no evidence that TNF inhibitors are helpful or harmful in patients with COV-19 infection.28 Interleukins, including IL-1 and IL-6, seem to contribute to the cytokine storm of COVID-19 pulmonary disease. The IL-6 blocker, tocilizumab, is considered to be a good candidate for severe COVID-19 infection.28

Enzymes associated with intracellular signaling, janus kinase (JAK) inhibitors, including tofacitinib and baricitinab, are also being evaluated.

Ongoing Trials and Other Potentially Helpful Drugs

Overall, antimalarial drugs, corticosteroids, and other anti-inflammatory medications and immune-modulating drugs for the treatment of COVID-19 infection are being studied in clinical trials throughout the world.29

As of April 10, 2020, there were 440 studies dedicated to COVID-19 listed on ClinicalTrials.gov. The most commonly studied medication in these trials is hydroxychloroquine, with 15 clinical trials in COVID-19 infection. The first clinical trial in the US evaluating the safety and efficacy of HCQ in patients hospitalized with COVID-19 infection has started to enroll patients.30 This study, sponsored by the NIH, will treat hospitalized patients with 400 mg twice daily for 2 days and then 200 mg twice daily for 3 days or placebo for 5 days.

Other medications being tested in a number of countries include: tocilizumab, with 8 clinical trials, tofacitinib and sarilumab, as well as corticosteroids, each with 4 clinical trials listed. These medications are being evaluated primarily in hospitalized patients with severe infection but there are some studies looking at these drugs in early disease and a few using such medications as a prophylactic approach in high-risk subjects.

Since ACE inhibitors, angiotensin receptor antagonists and NSAIDs each may alter ACE2 receptor activity, there has been concern that such medications may enhance viral attachment and should not be used during the current pandemic.31 However, most reviews currently recommend that these drugs not be discontinued in subjects who have no signs of COVID-19 infection.32 There is anecdotal evidence that vitamin D supplementation could be helpful in COVID-19 infection.33

With regard to type 2 diabetes and COVID-19, comorbid diseases, including hypertension and cardiovascular disease, need to be carefully monitored. (Image: iStock)

Type 2 Diabetes

Every attempt should be made to achieve optimal control of the metabolic aspects of type 2 diabetes during the current COVID-19 pandemic.34Good blood glucose control, updated immunizations, and diet/weight loss are important now more than ever. Comorbid diseases, including hypertension and cardiovascular disease, need to be carefully monitored. Such monitoring should include more frequent patient visits.

Telehealth and other virtual/on-line medical visits are the best way to achieve such visits during the current pandemic. See, How HCPs Can Use Telemedicine in the Time of Coronavirus. There should be a lower threshold for hospitalizing patients with diabetes and suspected COVID-19 infection.

Other Immune Diseases

There is currently no strong evidence that the majority of patients with immune diseases, including rheumatic diseases, inflammatory bowel disease, multiple sclerosis, and psoriasis, are at increased risk for COVID-19 infection or for greater morbidity and mortality if infected. Nevertheless, clinicians should maintain a high index of suspicion for any patient with a significant immune disorder. It is imperative that the underlying immune disease be under good control. If patients are stable, they should be maintained on their current medications during the COVID-19 pandemic. If a new medication is being considered, a specialist may consider that certain immune-modulating medications may be potentially safer than others although there are no adequate studies.

If a patient has an active infection, particularly if hospitalized, immunosuppressive medications and corticosteroids should be transiently suspended, unless there are medical contraindications. However, as discussed, immunosuppressive and immune modulators are being used in life-threatening situations and may be found efficacious in the treatment of COVID-19. The community needs controlled clinical trials to ascertain whether that is true.

As noted, the IDSA published recommended guidelines for medications currently being treated in the COVID-19 pandemic.35 Their conclusions included that antimalarials and tocilizumab be used in hospitalized patients only in the context of a clinical trial. They suggested against the use of corticosteroids for treatment in hospitalized patients and only using them in patients with ARDS within a clinical trial.

Additional Considerations Regarding Chronic Pain, Stress, and the Immune System

Pain management providers know well that chronic stress, sleep, and mood disturbances are major factors in the development and severity of chronic pain. The impact of chronic stress on cortisol secretion and on the hypothalamic-pituitary-adrenal (HPA) axis plays a major role in chronic pain. The odds of an individual developing chronic widespread pain later in life has correlated with baseline HPA reactivity.36

Depression is closely linked to chronic pain, as detailed in the many reviews dedicated to the pain-depression dyad.37 Persistent sleep disturbances are one of the most important predictors of chronic pain.38 The current COVID-19 pandemic has put everyone in a state of hypervigilance. Increases in insomnia, anxiety, depression, cognitive disturbances, and suicidal ideation were seen in the initial wave of COVID-19 infection in China.39

Successful telemedicine and collaborative management of patients with chronic pain are well-documented.40 The novel coronavirus pandemic has forced more healthcare providers to utilize this technology which is becoming the primary point of contact for patients.41 Clinicians also must take advantage of web-based evaluation and treatment programs. These may include psychological as well as physical therapy, including relaxation techniques, guided imagery, and group classes. See Table III.

Individuals with type 2 diabetes are at increased risk for COVID-19 infection and have a worse prognosis if infected. This risk may be more related to comorbidities, especially obesity and hypertension, than to immune mechanisms. Thus far, there has been no evidence that common systemic, immune diseases such as IBD, MS, or psoriasis increase the risk of COVID-19 infection or its morbidity and mortality. Nevertheless, it is likely that patients with type 2 diabetes and other immune diseases will experience exacerbations of chronic pain triggered by increased stress, mood, and sleep disturbances. These factors increase the challenges faced by pain specialists and all healthcare providers.

*This article was written in early April 2020. Data and recommendations around COVID-19 continue to be released.

Last updated on: April 24, 2020

How Clinicians Can Manage Rheumatic and Immune Diseases During COVID-19

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The Economic Impact of Coronavirus on Psoriatic Arthritis Therapeutics Market : Segmentation, Industry Trends and Development to 2026 – Cole of Duty

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The Dermatologist Whos Obsessed With Sun Damage – The Cut

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Photo: Courtesy of the Laser & Skin Surgery Center of New York

Dermatologist Robert Anolik treats some of New Yorks most discerning faces his clients include Stephanie Seymour and Kelly Ripa but that doesnt stop him from worrying about fictional characters, too. Over the past few weeks, he, his wife, and their 7- and 5-year-old kids have been watching The Singing Detective, an 80s-era BBC show about a hospitalized mystery writer.

It has great music in it, but my kids keep asking me all these questions about the main character, whos covered in psoriasis and has psoriatic arthritis, says Anolik, a dermatologist at the Laser & Skin Surgery Center of New York. All I can think about is how that patient could be helped dramatically today with the approach of medical dermatology.

Anolik was a protege of the late Dr. Fredric Brandt, who was well-known in the beauty world for popularizing Botox. But what initially drew him to cosmetic dermatology wasnt injections or chemical peels, but DNA, RNA, and proteins. As a molecular biology major at Princeton, he spent one summer at the Institute for Genomic Research, studying the science of sequencing the human genome. In medical school, I saw how protein sequence analysis touched every field in medicine, but particularly skin and aging, he says. I approach skin with that kind of molecular framework to make it healthy and beautiful.

During his dermatological training at NYU, Anolik landed a fellowship with famed dermatologist Roy Geronemus, director of the Laser & Skin Surgery Center. Brandt was also part of the practice, and when he wanted to divide his time more evenly between his Miami and New York practices, Anolik became his official associate.

He wanted someone who also had laser expertise, which he knew I had, says Anolik. Even though we looked like total opposites, our personalities clicked.

Five years later, tragedy struck and Brandt took his own life. Anolik seamlessly took over, with high-profile clients now trusting their complexions to him.

These days, until he can see those patients again, hes been volunteering at Bellevue Medical Center, tending to patients with post-op wounds and other surgery-related issues. Stuff that needs attention by a physician, he says. Theyre all so overwhelmed, so hopefully I can help decrease the burden.

Anolik spoke with the Cut about the calming presence of Angela Lansbury, his complicated relationship with fruit, and why now is the perfect time to exfoliate.

Whats your definition of beauty? The Keats line beauty is truth; truth beauty is a chestnut for a reason. When I look at a face, my goal is to reveal its truth, that is to let its beauty become manifest, which is why I work very hard to eliminate distortions, both external (e.g., sun damage) and internal (e.g., psychological negativity).

What do you think of when you hear the term clean beauty? I get wary when I hear it. I believe in the sentiment that drives the clean beauty concept. As a scientist, however, I also believe in rigorous study over intuition and guesswork. Just because something grows on a tree doesnt mean its safe and/or effective. And even the cleanest ingredients in too high a quantity can be dangerous. For example, drinking too much water will kill us. And, conversely, an ingredient that sounds strange or worrisomely artificial can, in fact, be beneficial. A word of caution for those experimenting with only clean or alternative therapies: If you believe something is strong enough to help you, its likely strong enough to hurt you as well. So dont overdo it! And be sure to consult with a board-certified dermatologist about safe strategies.

Where, if anywhere, in your beauty (or life) routine are you not quitethat clean, green, or sustainable? I drink diet soda. Its dumb and I know better, but I do it anyway.

Please fill in the blank as it pertains to beauty or wellness: I think about ______a lot. SUN DAMAGE.

What is the opposite of beautiful? An artificial appearance. Lips that are too big or faces that are frozen are not beautiful. And believe me, I cringe more than you do when its obvious someone has had work done. Just because we can do something in cosmetic dermatology, doesnt mean we should.

What is your morning skin-care routine? Alastin Gentle Cleanser or Neutrogena Ultra Gentle Cleanser, shave, sulfacetamide wash to reduce shave irritation, LaRoche-Posay Anthelios Melt-In Sunscreen Milk SPF 60, SkinMedica HA5 Rejuvenating Hydrator.

Whats the last product you use every night? A prescription retinoid, then moisturizer. Usually Alastin Ultra-Nourishing Moisturizer or Cerave Cream.

Who cuts your hair? Garren. Asking Garren to cut my hair is like asking van Gogh to paint on a milk carton. But hes my friend; he pretends not to mind.

Toothbrush of choice: My wife bought me a Sonicare but I still use the freebie from the dentist.

Razor of choice: Gilette Fusion 5.

Shaving cream of choice: Gillette Fusion Hydra Shave Gel Ultra-Sensitive.

Hand wash of choice: Dove Foaming Hand Wash.

Hand sanitizer of choice: Purell.

Fragrance of choice: Hermes Eau dorange verte Eau de cologne.

Bath or shower: Shower, with Olay Ultra Moisture Body Wash with Shea Butter, R&Co. Television Shampoo, Television Conditioner, and Acid Wash.

What was your first grooming product obsession? In third grade, I discovered mousse. Id blow-dry my hair with it. Maybe I watched St. Elmos Fire a few too many times.

Daily carry-all of choice: Prada nylon shoulder bag. A gift from Dr. Brandt. Prada was a favorite brand of his.

What do you splurge on? My wifes very particular about our sons footwear. Lots of tiny pairs of Air Jordans, Converse, Vans, and Adidas Gazelles by our front door.

What is your classic uniform (under your lab coat)? Black or navy Brooks Brothers pants and black or navy Ralph Lauren crew neck sweater.

Whose shoes are you usually wearing? Greats Royale sneakers.

What do you own too many of? Medical journals. I know at this point that the past issues are all online where I read the new ones, but theres something enjoyable about referencing them with your handwritten notes. At some point, theyll find their way to the recycling bin.

Any secret talent or skill you possess? I can juggle.

What is your own personal definition of misery? Fruit of any kind in my desserts. I love cake but Im crushed when it turns out to be carrot, and I cannot get enough ice cream but I pout when the flavor turns out to be strawberry.

What is your own personal definition of glee? Getting my cholesterol tested. I dont eat all that well, and Im not great about exercising, but my cholesterol is always low. I find that so gratifying.

Favorite way or place to spend a weekend? Nantucket. My wifes family has a house there, and they make fun of me when I wear my aqua socks to the beach.

What do you most often disagree with others about? People who insist they need to get a base tan before a tropical vacation. This is nuts. You should avoid getting a tan before your tropical vacation and during your tropical vacation and after your tropical vacation. Heres what you should get instead: sunscreen and sun-protective clothing.

What must you adjust or fix when you see it done incorrectly? Bad Botox on someone who comes in for a first-time consultation.

Favorite CBD product: Ridgway Hemp Love Balms.

What calms you down? Seinfeld reruns on Netflix. And when Im really feeling stressed: Murder, She Wrote reruns on Amazon Prime (dont judge).

Comfort food: Oreos and milk.

Vice snack: Chili-roasted pistachios and Empire Bakery house-made Twinkies.

What do you foresee as the top beauty and wellness trends for 2020? Combination therapy, specifically more one-day treatments that combine multiple lasers and injections. We have been developing this for years and are now presenting safety data on the subject.Also, laser-assisted drug therapy, such as resurfacing lasers followed by topical applications of skin-brightener serums and platelet-rich plasma. Heres what I hope is the top beauty/wellness trend in 2020: a public repudiation of non-board-certified dermatologists performing cosmetic dermatology procedures on people.

What treatment at your practice is misunderstood and should be morepopular? Laser resurfacing. Granted, this is already a very popular treatment in our office, but I believe it should be even more popular. Somepatients come in with misinformation that laser resurfacing thins theskin. Nothing could be further from the truth. In fact, it does theopposite. It targets collagen-producing cells in the dermis andgenerates a stronger, more resilient skin.

What treatment is currently your favorite (understanding that thiscould change all the time)? Botox. And it has been for years. Precise treatment avoids artificial outcomes and allows for a refined, rejuvenated, lifted, rested appearance.

What activity do you do when the stress becomes too much these days?Cook. Ive been spending a lot of time with my cast-iron skillet. My cast-iron pizza is a favorite.

What have you been binge-watching? Ozark season three for suspense how good is Tom Pelphrey as Laura Linneys brother? And Cheers for laughs.

What has been an upside to this crazy time for you? My time with my wife and young sons, except during the screaming. And the homeschooling. And the cleaning.

Whats a good beauty treatment for someone whos stuck at home? Exfoliation. A downside of exfoliation is it can sometimes leave the skin dry and flaky, but if youre staying home, thats okay!

Conversely, what in your own grooming routine are you less on top of these days?Shaving, although my wife prefers a cleaner look, so early signs of a beard appear only now and then.

When this is all over, what are the first three to five things youll do or places youll go? The office will be my first stop! I miss my amazing patients! I expect Ill be there in overtime mode for a while getting everyone in. Id love a flat white at Laughing Man in Tribeca, maybe a burger at Odeon. Also we watched King Kong with the kids during quarantine, so my oldest wants me to take him to the top of the Empire State Building. He thinks King Kongs going to be there. I havent had the heart to set him straight.

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COVID-19 and psoriasis: Risks and precautions – Medical News Today

Posted: April 18, 2020 at 3:44 am

People with psoriasis may be wondering how COVID-19 might affect them. COVID-19 is a new illness resulting from infection with the novel coronavirus, or SARS-CoV-2.

At present, it is unclear how COVID-19 may affect those with psoriasis, which is an immune-mediated condition. This mean the condition occurs as a result of abnormal immune system activity. Scientists are also unsure about how it may impact the treatment of these individuals.

Some treatments for psoriasis, which are immunosuppressive medications, may increase the risk of a COVID-19, or of severe illness due to the virus. However, the effects are still unknown.

Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.

Keep reading to learn more about the potential risks of COVID-19 for those with psoriasis, including the precautions that people can take to reduce their risk of developing COVID-19 and its complications.

The details of how COVID-19 affects those with psoriasis remain unknown, but there is not yet evidence to suggest that it affects them differently than people without the condition.

According to the National Psoriasis Foundation (NPF), if a person is not taking an immunosuppressive medication and is free from other underlying diseases, there may be minimal additional risk of them contracting SARS-CoV-2 relative to the rest of the population.

However, as the virus is highly transmissible, spreads rapidly, and replicates rapidly, everyone is at risk. Even asymptomatic people can transmit the virus to others.

The NPF note that people with severe psoriasis, such as those who are on immunosuppressive therapies or have other medical conditions, probably are at higher risk of infection.

As psoriasis is a chronic immune-mediated condition, some people may take immunosuppressant drugs to keep their symptoms under control.

These medications can reduce immune function, which may increase the risk of infection with SARS-CoV-2 or other infectious agents. Immunosuppressive drugs could also increase the risk of severe symptoms.

According to the Centers for Disease Control and Prevention (CDC), conditions or medications that weaken the immune system and cause people to become immunocompromised increase the risk of severe COVID-19.

The International Psoriasis Council (IPC) recommend that people with psoriasis who receive a COVID-19 diagnosis discuss discontinuing or postponing their use of immunosuppressant medications with their doctor.

However, the IPC caution that doctors should carefully weigh the benefit-to-risk ratio of immunosuppressive treatments on an individual basis.

The medical board of the NPF do not recommend that people with psoriasis stop their treatment unless they have an active infection. They suggest that those in high risk groups discuss their options with their doctor.

The CDC list the following as high risk:

The World Health Organization (WHO) and other expert bodies are still learning about the effects of COVID-19 on those with co-occurring conditions.

The WHO list the most common COVID-19 symptoms as:

They state that other possible symptoms include:

Some people with COVID-19 also report a loss of taste or smell.

Symptoms typically develop within 214 days of exposure to the virus. They range from mild to severe, although the majority of people experience a relatively mild form of the disease, which will not require specialist treatment in a hospital.

Some people may be asymptomatic, meaning that they have no symptoms, despite testing positive for the virus that causes COVID-19. Asymptomatic individuals can still transmit the virus to others, though.

People can reduce the risk of exposure to the novel coronavirus by:

Anyone who thinks that they may have become exposed to the virus should:

It is advisable to call ahead before presenting at an emergency facility in case they need to put safety measures in place.

The NPF recommend that people with psoriasis discuss their treatment with their doctor. A doctor may recommend continuing medications or taking a break from them.

It is important that people only adjust or stop their treatment after consulting with their doctor.

So far, there is no specific treatment or vaccine for COVID-19. In those who contract the virus and develop symptoms, treatment aims to alleviate these symptoms. Treatments include:

People who develop severe illness will require hospitalization. In the hospital, doctors may put them on oxygen or a ventilator, or provide other specialist care.

In some cases, doctors may speak to a person about participating in a clinical trial, which is very important in helping experts learn about the disease and find effective treatments.

People with psoriasis who develop COVID-19 should speak to their doctor about their psoriasis treatment while ill.

Those taking immunosuppressive medications will often need to stop treatment temporarily until their doctor says that it is safe to resume. The doctor will advise on other types of psoriasis treatment on a case-by-case basis.

When someone tests positive for the novel coronavirus, their doctor will provide them with instructions for recovery. They will also explain to the individual how to self-isolate to reduce the spread of the virus to others.

People with mild symptoms can typically recover at home, while those with severe illness often require a hospital stay.

It is difficult to determine the outlook for people with COVID-19 and psoriasis, but this generally depends on:

Data from China showed that 80% of people who develop COVID-19 have mild-to-moderate symptoms and recover well. Of the remainder, 13.8% develop severe disease, and 6.1% become critical and require intensive care.

Prompt medical treatment may improve the outlook of people with severe disease and reduce the risk of complications, which include pneumonia and organ failure. In some cases, COVID-19 can also lead to death.

At present, experts know little about the effects of COVID-19 on people with psoriasis.

However, it seems that those who are not taking an immunosuppressive medication and do not have another co-occurring disorder have a similar risk to the rest of the population.

People taking immunosuppressive therapies who receive a COVID-19 diagnosis should consult their doctor immediately. It is likely that the doctor will advise them to stop taking these medications until they recover.

There is no specific treatment for the novel coronavirus, but individuals can reduce their risk of contracting it by maintaining physical distance from others, avoiding unnecessary public outings, and practicing good hygiene.

Individuals with psoriasis should speak to their doctor about their specific case. A doctor will address any concerns that a person has, and they may adjust their treatment plan accordingly.

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Dermatology-Rheumatology Care Clinic Reports High Satisfaction From Patients With Psoriasis, Psoriatic Arthritis – Rheumatology Advisor

Posted: at 3:44 am

The feasibility and efficacy of a joint dermatology-rheumatology clinic for the treatment of patients with psoriasis (PsO) and psoriatic arthritis (PsA) is supported by study data published in Dermatological Therapies.

Established at Attikon General University Hospital in Athens, Greece, the Psoriasis and Psoriatic Arthritis Clinic (PPAC) integrates expertise from dermatologists and rheumatologists for the treatment of patients with psoriasis and psoriatic arthritis. The dual clinic is held once a week by 6 specialists; the same hospital also holds regular psoriasis clinics twice weekly. On average, the PPAC receives 40 new patients per month. Patients typically belong to 2 categories: patients with psoriasis who are suspected to also have psoriatic arthritis, and patients with a rheumatology diagnosis in whom psoriatic arthritis is suspected. Demographic and clinical characteristics were extracted from patients who attended the clinic from 2017 to 2018. In addition, patient satisfaction with PPAC care was assessed using a Visual Analogue Scale (VAS).

The PPAC saw 185 patients with psoriasis who were diagnosed with psoriatic arthritis from December 2018 to January 2019. In these patients, mean age of psoriasis onset was 34 16 years and mean age of psoriatic arthritis onset was 47 12 years. The majority of patients had a diagnosis of severe plaque psorisis (78%). The most commonly diagnosed psoriatic arthritis was asymmetric oligoarticular arthritis (32%). More than half of patients were receiving biologic agents (57%) as treatment for psoriasis and psoriatic arthritis. Comorbidity rates were high, with 40% and 37% reporting hypertension and dyslipidemia, respectively.

In addition, 9% and 11% were being monitored for diabetes and depression, respectively. Patients reported high levels of satisfaction with the PPAC facility compared with attending separate clinics on referrals. The mean satisfaction-VAS score was 8611.5. Patients typically endorsed that the PPAC was timely, efficient, and patient-centered. Most patients also agreed that collaboration and teamwork between dermatologists and rheumatologists was essential to their care. When surveyed, dermatologists in the PPAC also agreed that interprofessional collaboration improved patient care quality and clinical outcomes.

These data support the feasibility of dual dermatology-rheumatology clinics for the management of psoriasis and psoriatic arthritis, study authors assert. Investigators noted that a strong word of mouth impact was observed from the PPAC, with many patients recommending the clinic to spouses or other family members. From a single clinical site and a relatively small cohort, results may not be generally applicable to other patient populations. Despite this, data support the concept of combined clinics delivering better integrated care forpatients [with PsO and PsA], the authors concluded.

Reference

Theodorakopoulou E, Dalamaga M, Katsimbri P, Boumpas DT, Papadavid E. How does the joint dermatology-rheumatology clinic benefit both patients and dermatologists? [published online February 24, 2020]. Dermatol Ther. doi: 10.1111/dth.13283

This article originally appeared on Dermatology Advisor

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Dermatology-Rheumatology Care Clinic Reports High Satisfaction From Patients With Psoriasis, Psoriatic Arthritis - Rheumatology Advisor

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