Category Archives: Psoriasis

A new study conducted byShu-Hui Wang and colleagues looks to examine the relationship between psoriasis and uveitis.

Psoriasis and psoriatic arthritis can lead to inflammation of the eyes, a condition termed uveitis (pronounced you-vee-EYE-tis), a disorder that affects approximately one in 1000 Americans. A nationwide cohort study that examined nearly 147 954 Han Chinese individuals with psoriasis including more than 10,107 with concomitant psoriatic arthritis, 137 847 without psoriatic arthritis and 147 954 matched non-psoriatic controls found that there was a higher incidence of uveitis in individuals with psoriasis, irrespective of whether they had psoriatic arthritis, compared to the controls.

Psoriasis is a systemic and chronic disease that is mediated by an immune system gone awry in combination with various genetic and environmental factors. Psoriasis is not restricted to the skin and epidemiological studies show that psoriasis is associated with an increased risk of mortality and morbidities. Activation of T cells and consequently, that of inflammatory cells in the skin promote the proliferation of keratinocytes and epidermal hyperplasia. Pro-inflammatory cytokines released by T cells, including TNF, IL-2 and Interferons induce an inflammatory cascade. Medications such as efalizumab and alefacept as well as anti-TNF drugs such as infliximab, etanercept and adalimumab are used to treat and control psoriasis.

Uveitis is a condition characterized by intraocular inflammation with about 40% being secondary to an immune-mediated disease and 30% not fitting into any well-defined etiology. Development of uveitis shows genetic predisposition with a strong link between uveitis and a locus on chromosome 9. Studies show that Th17 and Th1 immune responses are involved in the immunopathogenesis of the disease, with IL-17 and TNF levels being particularly high in the aqueous humor of patients with uveitis.

Patients with psoriasis are more likely to get uveitis than the average individual and strikingly, patients with psoriatic arthritis have a higher risk, with at least 7% developing uveitis. Very few studies have examined the ophthalmological pathologies associated with psoriasis and studies that have evaluated the association, particularly in the case of uveitis, are largely inconclusive due to contradictory findings. To put to rest such conflicts, Shu-Hui Wang and colleagues at the Far Eastern Memorial Hospital in Taiwan identified psoriatic patients from a specialized dataset that contained all people with psoriasis from 2000 to 2011 in the National Health Insurance Research Database, with controls selected from the 2005 Longitudinal Health Insurance Database that provided longitudinally linked anonymized data of 1 million enrollees. Using univariate and multivariate Cox proportional hazard models to estimate the hazard ratios and 95% confidence intervals for the association between statusof psoriasis and uveitis occurrence, the primary outcome of interest, Shu-Hui Wang and colleagues demonstrated that patients with psoriasis and psoriatic arthritis had 160.88 incidences of uveitis per 100,000 person-years, patients with psoriasis and without psoriatic arthritis had 103.99 incidences of uveitis per 100,000 person-years compared to 87.23 in the controls.

This study is at odds with another study examining a Turkish population which showed no relationship between psoriasis and uveitis. Limitations of the study include the possibility of misclassification of patients with psoriasis and psoriatic arthritis, those who were rated based on the severity of the disease, and the generalizability of the results since the population studied was Han Chinese. However, the results may serve as a guide for uveitis risk stratification among patients who present with a varied inflammatory profile and help patients to understand the risk and manifestations of uveitis.

Written By:Joseph M. Antony, PhD

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An Eye psore- A Clinical Relationship Between Psoriasis and Uveitis - Medical News Bulletin

A recent randomized phase II clinical trial demonstrates that risankizumab treats psoriasis, a chronic immune-mediated inflammatory skin disease, more effectively than ustekinumab.

Psoriasis, a chronic immune-mediated inflammatory skin disease, affects 2% of adults and is associated with a poor quality of life, obesity, hypertension, diabetes, hypercholesterolemia, and metabolic syndrome. Researchers suggests that interleukin-23 (IL-23), composed of a p19 and p40 subunit, plays a significant role in the disease by inducing and maintaining inflammatory cells. Current strategies include monoclonal antibodies aimed at the different subunits of interleukin-23, including ustekinumab and risankizumab. Ustekinumab targets the p40 subunit, which is also found in IL-12, and thus acts against both IL-23 and IL-12. In contrast, risankizumab only targets the p19 subunit and selectively inhibits IL-23 activity. Clinical studies have shown that both drugs are safe, well-tolerated, and effective in treating psoriasis patients.

A recent randomized phase II clinical trial compared the efficacy, onset, and duration of clinical response between the two drugs in patients with moderate-to-severe psoriasis. Patients were randomly assigned to receive either a single 18-mg dose of risankizumab at week 0, a 90-mg or 180-mg dose of risankizumab at week 0, 4, and 16, or a dose of ustekinumab at week 0, 4, and 16. Patients were subsequently followed for 32 weeks after the final injection (total trial period of 48 weeks). The primary endpoint was a 90% or greater reduction from baseline in the PASI or Psoriasis Area Severity Index, which is an evaluation of erythema (redness), scaling, and percentage of body-surface area affected. In addition, the authors investigated safety end points including severe and moderate adverse events.

At the end of the study, a 90% or greater reduction in PASI was observed in 73% of patients in the 90-mg risankizumab group and 80% of patients in the 180-mg risankizumab group, compared with only 40% of patients who received ustekinumab. This indicates that a 90 and 180-mg dose of risankizumab is more effective in treating psoriasis than ustekinumab. The authors also found that the onset of risankizumab was earlier than ustekinumab, and the benefits were sustained for longer. Also, patient reports and skin biopsies further suggest that risankizumab was more effective in treating psoriasis and its associated morbidities than ustekinumab.

In conclusion, the randomized phase II clinical trial demonstrates that risankizumab is superior to ustekinumab in treating psoriasis and its associated morbidities. The onset and duration of beneficial effects are more profound and longer with risankizumab treatment. Although two patients developed basal-cell carcinoma and one had an adverse major cardiac event with risankizumab; the study had a small sample size and short duration, making it difficult to assess safety profiles. Nonetheless, the study suggests that selective blockade of IL-23, via p19 subunit inhibition, is more effective in treating psoriasis than inhibition of both IL-23 and IL-12. Future studies are required to confirm these results, and to better assess the safety profile of risankizumab.

Written By:Haisam Shah, BSc

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Risankizumab Treats Psoriasis More Effectively Than Other Antibody Drug - Medical News Bulletin

FRIDAY, May 26, 2017 (HealthDay News) -- A new drug might help ease the pain and disability of a form of arthritis often linked to psoriasis.

According to Stanford University researchers, psoriatic arthritis is an inflammatory joint disorder tied to an out-of-control immune response. The disease affects about one in every 200 people and is often accompanied by the autoimmune skin disorder psoriasis.

Psoriatic arthritis typically arises after the age of 30 and can bring stiffness, pain and swelling of the joints, leading to real disability if treatments don't help.

The new study focused on more than 300 adult patients across 10 countries. These patients were no longer seeing an effect from standard biologic drugs or had never experienced a benefit in the first place.

"Only about half of psoriatic arthritis patients who are given TNF inhibitors get better," study lead author Dr. Mark Genovese said in a Stanford news release.

So, his team tried out a newer drug called Taltz (ixekizumab), already approved to fight psoriasis. The study was funded by the drug's maker, Eli Lilly & Co.

Patients were randomly assigned to receive injections of either Taltz or an inactive placebo. Over 6 months, about one-third got Taltz injections every two weeks, another third received the placebo every two weeks, while the remaining third received alternate injections of Taltz and the placebo.

More than half (53 percent) of those treated with the drug experienced at least a 20 percent reduction in the number of tender and swollen joints, compared to about 20 percent of those receiving the placebo, said Genovese. He's a professor of immunology and rheumatology at Stanford University Medical Center.

One expert in psoriatic arthritis was encouraged by the findings.

Taltz "is another new option for patients with psoriatic arthritis," said Dr. Waseem Mir, a rheumatologist at Lenox Hill Hospital in New York City. "The data shown in this article supports that certain patients who do not do well with other biologics that are in the market for psoriatic arthritis will now have another option for treatment of their painful disease," he said.

One potential side effect of these immune-focused drugs is a heightened vulnerability to infectious disease. However, Genovese said there was little difference in this regard between people taking Taltz and those on a placebo.

The study was published online May 24 in The Lancet.

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Promising Results for Drug to Fight Arthritis Linked to Psoriasis ... - Arizona Daily Star

The woman was forced to wear lace gloves every day to work due to the crippling self-consciousness brought on by her psoriasis.

Pat Woodward, 60, an estate agent from Hampshire, suffered from psoriasis for over ten years.

Her hands were so sore and unsightly she would wear gloves to work.

However, she finally overcame the condition after finding a treatment when she least expected.

PAT WOODWARD

Pats hands are worst affected but she also has psoriasis on her legs and her scalp.

Having psoriasis on my hands affects every aspect of my life.

As obvious as it sounds, you need your hands for literally everything, from washing and dressing in the morning to eating, driving, typing or gripping a pen, and of course, for interacting with others.

Until very recently Pat would wear lace gloves to work, both for her benefit and also because she didnt want to make others feel uncomfortable.

Getty Images/Cultura RF

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Resist the itch - Eczema is almost always itchy no matter where it occurs on the body and although it may be tempting to scratch affected areas of the skin, this should be avoided as much as possible

PAT WOODWARD

Psoriasis can be very painful and having my hand squeezed by an unsuspecting stranger was often excruciating, Pat said.

The gloves would hide the layers of white, peeling, flaking skin, often cracked where my palms and knuckles were so dry my skin had split open.

Pat battled with different treatments for years.

She tried creams, mainly steroidal creams, from her doctor, but when these failed to work she begged to try stronger treatments.

My self-esteem was at an all-time low and I had started to suffer from depression, Pat said.

Doctors prescribed anti-depressants and continued to look at possible treatment plans, including light therapy, whilst family and friends suggested remedies including turmeric soap and beeswax creams, but nothing worked for any length of time.

Pat even tried three cancer-fighting drugs that break down the immune system, Methotrexate,Cyclosporineand Stelara.

PAT WOODWARD

However, the side-effects were horrendous.

From palpitations and general sickness to bowel disruptions so severe I actually thought I had cancer, and painful mouth ulcers, I felt dreadful, Pat said.

After my last course of skin injections in 2016, I asked my doctor not to put me forward for anymore.

Pat resolved herself to misery until she came across the cure to her condition completely by chance.

I was at a clients valuing her property when she asked me about my gloves. I went through the usual rigmarole of explaining why and what for, and she suggested I try Oregon grape root on my skin.

Ive had my fair share of tips and suggestions from well-meaning friends and family, but Oregon grape root was new to me.

I was immediately hopeful when I tried the Body & Hand Wash because for the first time in a long time my skin felt clean.

PAT WOODWARD

I was really keen to see an improvement in my hands. I applied a thick layer of Serum on these and wore with gloves overnight.

Pat claims the serum was immediately soothing and by morning her hands felt less tight.

After a few days she started to notice a visible difference too, the skin was less angry looking and after about four weeks, the thick flakes of white skin had reduced significantly and the deeper cracks had almost healed.

Pat has been using the Oregon Skincare range of products, designed especially to help combat the symptoms of psoriasis. The range costs from 7.95 and is available from http://www.skinshop.co.uk.

Guttate psoriasis is a sub-type of the skin condition psoriasis which is characterised by flakey, itchy skin and cannot be cured - although creams can quell the condition.

The Dermatology Clinic London's Dermatologist Dr Daniel Glass advised these two lifestyle factors could bring about a flare-up.

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Psoriasis treatment update: Woman discovers miracle cure in THIS natural cream product - Express.co.uk

Introduction

Galectin Therapeutics (NASDAQ:GALT) is a small biotechnology company based in Norcross, Georgia, focusing on the innovation of medicines that inhibit galectin molecules for the treatment of various diseases such as nonalcoholic steatohepatitis ("NASH"), skin cancer and plaque psoriasis. After a temporary nosedive in 2016, share price appreciated by approximately 80% for the past 52-weeks. It is highly likely that recent capital appreciation is reflective of the firm's increasing intrinsic value due to key developments. A notable catalyst was the positive data for the exploratory phase 2a trial, which suggests that lead molecule GR-MD-02 could be used to treat plaque psoriasis. Despite the firm's emphasis on NASH, this research shall focus on the potential therapeutic application of GR-MD-02 for plaque psoriasis.

Source: Google Finance

Plaque Psoriasis

As an autoimmune disease, plaque psoriasis is caused by the body's natural defense system going haywire, thus, causing the presence of well-demarcated red silvery scales on the skin surface. Due to its chronic nature, patients are placed on lifelong therapy. According to expert recommendations, the treatment for plaque psoriasis depends on the disease's severity. Patients with mild to moderate disease are prescribed with topical corticosteroid as the first-line agent. For moderate to severe cases without any contraindication, phototherapy serves as the therapeutic of choice. Those who failed the mentioned light treatment are managed with various approved systemic drugs such as steroid and methotrexate.

Source: Visualdx

The main setbacks for systemic therapies relate to their adverse effects. Nonetheless, doctors still employ such treatments, because the benefits outweigh the risks. In contrast to currently available medicine, GR-MD-02 potentially has a favorable efficacy and safety profile. As a new medicine in its own class, Galectin's lead molecule has a favorable chance of cutting into the multibillion-dollar psoriasis market. This is due to the fact that physicians tend to prescribe a unique therapeutic, especially one with a favorable safety profile like GR-MD-02, rather than another medicine amongst many approved drugs. In other words, GR-MD-02 would have a better chance of market success than a statin in development.

Another positive note for investors is that global data projected sales for psoriasis to increase from $6.6B in 2014 to $13.3B by 2024. If Galectin can cut into a small portion of this pie, the share price should increase multiple folds. And this would signify warranted optimism for shareholders.

Serendipitous Finding

Originally employed in the phase 2 trial for NASH patients, GR-MD-02 was found by chance to be efficacious for treating plaque psoriasis, which often occurs along with NASH. One patient with mild psoriasis participating in the NASH trial reported complete skin disease resolution for over a year. Another patient with moderate psoriasis reported the lesser use of her usual steroid medication. As a result, the aforesaid serendipitous finding prompted Galectin to commence the exploratory phase 2a.

Exploratory Phase 2a Trial

In March 2017, Galectin reported promising data for psoriasis in the aforementioned open-label exploratory phase 2a trial. Five patients employed in the study were infused with 8 mg/kg of GR-MD-02, a total of 13 infusions, for 24 weeks. No serious adverse events were found. All patients achieved an average PASI ("Psoriasis Area and Severity Index") reduction of over 50%, which is a measure of symptomatic improvement. The promising exploratory trial data prompted further development of GR-MD-02 for psoriasis treatment. Nonetheless, Galectin remains focused on innovating therapeutics for NASH.

"We are pleased by the results of our 24-week psoriasis trial demonstrating the safety and efficacy of GR-MD-02 in patients with moderate to severe plaque psoriasis," said Peter Traber, M.D., president, chief executive officer ("CEO"), and chief medical officer ("CMO"). "Moreover, the activity of GR-MD-02 in a human disease strongly associated with non-alcoholic steatohepatitis and increased galectin-3 expression suggests that our lead compound may also show significant activity in NASH, which remains the company's primary target."

As Dr. Traber suggested, the positive psoriasis data can foretell favorable outcome for the NASH trials. In addition, we strongly believe that it is intelligent to speculate trials data results for both NASH and psoriasis by analyzing GR-MD-02's mechanism of action.

Unique Mechanism of Action

Galectins are small molecules in the body that direct communication within the cells when being bound to glycoproteins found on cellular surface. In the disease processes that include inflammation, fibrogenesis, cancer formation, galectin's activity is heightened. Numerous research reports found the supporting role of galectin in the development of psoriasis in human. And it is hypothesized that lead molecule GR-MD-02 works by inhibiting galectin, thus, halting the disease process while stimulating the body to heal itself.

Source: Galectin

Focusing on Orphan Disease

In building its presence in the multibillion-dollars orphan disease market, Galectin is conducting two clinical trials, NASH-CX and NASH-FX for the treatment of NASH cirrhosis and NASH advanced fibrosis, respectively. Investing in orphan disease is seemingly the new trend for biopharmaceuticals investing. A firm can charge a premium price for a drug that treats rare ("orphan") diseases. And not only that this is viewed favorably by authority, the approach also ensures profitability for the company as well as the availability of lifesaving drugs for patients.

Source: Galectin

NASH asides, Galectin concurrently innovates GR-MD-02 for treating other fibrotic conditions, including lung, kidney, and heart. In addition, the named molecule is being studied for its applications together with other approved therapies ("Yervoy and Keytruda") to treat the dreaded skin cancer that is melanoma.

Adequate Funding

The majority of developing biotech firms operate in the red, as it takes substantial capital in the ballpark of more than a billion dollars to fund a drug from bench research to marketing. Hence, one can observe the increasing trend in operational cash flow that is needed to develop GR-MD-02 in the figure below.

Source: Morningstar

It is wise for biotech investors to note three key financial metrics. The first is that dilutive financing is not excess. The second is that debt to equity is not staggering. The third is whether the firm has adequate capital to fund their drugs to full development. That being said, Galectin increased its shares outstanding from 6M to 30M for the past decade, which is not unwarranted for a developing biopharma. It is a good sign that the firm's balance sheet is clean of long-term debts while there is only $3.8M borrowed for the short-term. As of March 2017, $13M in non-restricted cash and cash equivalents remain for operational spending. This amount is adequate to fund operation through the end of this year, which is sufficient for the reporting of NASH-CX's top line data.

Capable Management

With the strong track record of performance and many years of wisdom, Peter Traber, M.D. is the top-notch CEO and CMO to navigate this ship for Galectin shareholders. Prior to joining Galectin, Dr. Traber served as CEO of the prestigious medical schools: Baylor University and the University of Pennsylvania. As the former CMO at GlaxoSmithKline (NYSE:GSK), Dr. Traber knows the ins of the large and successful biopharma.

Due to his uniquely diverse background as a physician, executive and a molecular biology research scientist with over 100 original research publications, Dr. Traber has the differentiated wisdom to gauge whether a molecule can succeed in both clinical trials as well as in the market. After all, a doctor knows which medicine will be likely prescribed. Burdening with a total of roughly $1B to be invested in a developing drug, it is comforting for investors that Dr. Traber is the cream of the crops expert. The chief is highly likely to deliver the best capital appreciation for shareholders and hopes for countless patients worldwide.

Potential Risks

As alluded, it takes significant funding to innovate a molecule from bench research to marketing. The chance of success is less than 5%, as more than 95% of the drugs in development failed to make it to the market. Therefore, it is imperative for investors to be cognizant that investing in a developmental stage biopharma incurs substantial risks as well as upsides. During this lengthy process, any negative data or indication of negativity can cause significant stock depreciation. An unfavorable trial outcome can nose dive share price by more than 50%. Conversely, positive data could throttle share price in the North by leaps and bounds. Substantial risks, volatility, and rewards are inherent to biotech investing. And while some investors lost money in biopharma investing, shareholders of Exelixis (NASDAQ:EXEL) and Jazz Pharmaceuticals (NASDAQ:JAZZ) have enjoyed over 10-bagger and 100-bagger returns, respectively.

To minimize the risks and to maximize the rewards, investors should exercise a basket approach to biopharma investing. A good strategy is to invest in a group of firms with promising drugs-in-development, leading by expert management with a strong track record, and having adequate cash to run their drugs through the complete innovation process. Of note, investors only need a few successful firms like Exelixis and Jazz to compound outstanding returns for a small portfolio in the run.

Conclusion

After the mini recession in the biopharmaceutical industry in late 2015 through 2016, there is a sense of warranted optimism in the market. Of many bio firms enjoying the late 2016 to 2017 rebound, Galectin has promising data and deserves the consideration of serious biotech investors. This small capitalization firm has a unique lead therapeutic that leverages on the biology of galectin to potentially treat the orphan disease, namely NASH. Moreover, the data favors its application to other conditions, particularly psoriasis, due to the drug's promising efficacy and safety profile. Despite that it is highly difficult to gauge the success of an early stage drug, the positive data for psoriasis can mean favorable outcome for the NASH trials. Furthermore, it only takes a single blockbuster, a drug that sells more than one billion dollars annually, to turn a small capitalization firm into a powerful growth biopharma. All in all, our analytical research reveals highly asymmetric risks to rewards that can deliver multiple folds capital appreciation for investors in the long run and hopes for patients worldwide.

Disclosure: I am/we are long GALT.

I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article.

Editor's Note: This article covers one or more stocks trading at less than $1 per share and/or with less than a $100 million market cap. Please be aware of the risks associated with these stocks.

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Galectin Therapeutics: Serendipity In Psoriasis, Strength In NASH ... - Seeking Alpha

May 22, 2017 TWEAK regulates inflammation in atopic dermatitis and psoriasis. Left: Normal skin. Middle: Skin inflammation in atopic dermatitis. Right: Blocking TWEAK reduces skin inflammation in atopic dermatitis. Credit: Courtesy of Dr. Daniel Sidler, La Jolla Institute for Allergy and Immunology

Superficially, psoriasis and atopic dermatitis may appear similar but their commonalities are only skin deep. Atopic dermatitis, also known as eczema, is primarily driven by an allergic reaction, while psoriasis is considered an autoimmune disease. Nevertheless, researchers at La Jolla Institute for Allergy and Immunology were able to pinpoint a common driver of skin inflammation in both diseases.

Their findings, published in the May 22, 2017 issue of Nature Communications, showed that TWEAK, a protein related to tumor necrosis factor (TNF), plays a major role in inducing pro-inflammatory signaling molecules that recruit immune cells to the skin. TNF is already a drug target in psoriasis.

"Atopic dermatitis and psoriasis are two distinct diseases that are induced by alternate immune responses and the factors involved are quite different," explains Michael Croft, Ph.D., professor and head in the Division of Immune Regulation, who led the research. "Showing that TWEAK is a critical mediator in both conditions, makes it a potential therapeutic target for the treatment of inflammatory skin diseases in general."

Over 30 million Americans have some form of atopic dermatitis, which typically develops during childhood but can occur at any age. Most people outgrow the itchy condition but some will continue to suffer from eczema in adulthood.

It is believed to result from a combination of genetics and environmental factors such as irritants and allergens that drive T lymphocytes to produce factors that cause abnormal changes in keratinocytes, the predominant cell type in the outermost layer of skin, as well as changes in other cells in the underlying dermis.

In psoriasis, T lymphocytes also drive an alteration in healthy keratinocytes, accelerating their life cycle. As a result, new keratinocytes move to the outer layer of skin faster than old skin cells can be sloughed off. The build-up of extra cells forms patches of red, itchy skin that are covered with silvery scales and can range from a few spots to major flare-ups that cover large swathes of skin.

"Atopic dermatitis and psoriasis are very common diseases and can have debilitating affects on people's daily lives," says the study's first author Daniel Sidler, M.D., Ph.D, formerly a postdoctoral researcher in the Croft lab and now a Primary Investigator at the University of Bern in Switzerland. "Understanding the molecular basis of these diseases is crucial before we can seek new treatments for these and other inflammatory skin diseases."

In their current study, Croft and his team, in collaboration with researchers at the biotechnology company Biogen, focused on TWEAK and its receptor, Fn14, which had previously been shown to participate in several inflammatory conditions such as inflammatory bowel disease, arthritis and lupus-like kidney disease. "TWEAK and its signaling receptor, Fn14, have emerged as a fundamental molecular pathway regulating tissue responses after acute tissue injury and in many different contexts of chronic injury and disease" said Linda Burkly, Ph.D., Senior Distinguished Investigator, VP, Biogen, Inc., and co-senior author on the current study.

When Sidler measured TWEAK signaling in skin, he found that the expression of both the receptor and ligand was upregulated in atopic dermatitis and psoriasis.

Keratinocytes and dermal fibroblasts, which form the connective tissue in skin, responded to increased TWEAK activity by producing a number of chemoattractive and pro-inflammatory factors commonly found in atopic dermatitis and psoriasis. It also amplified disease-specific cytokines, namely IL-13 and IL-17, further explaining why it can contribute to two fundamentally different diseases.

"TWEAK alone doesn't cause atopic dermatitis or psoriasis but it triggers the production of chemokines that recruit pathogenic inflammatory cells to the skin regardless of the condition," says Sidler. "Blocking TWEAK activity, alone or in combination with other treatments, may sufficiently control skin inflammation to clear up the debilitating symptoms and restore quality of life in severe cases of those diseases."

Explore further: Vitamin D levels not linked to asthma or dermatitis

More information: Daniel Sidler, Ping Wu, Rana Herro, Meike Claus, Dennis Wolf, Yuko Kawakami, Toshiaki Kawakami, Linda Burkly, and Michael Croft. "TWEAK mediates inflammation in experimental atopic dermatitis and psoriasis", 2017. Nature Communications (2017). DOI: 10.1038/NCOMMS15395

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Researchers reveal potential target for the treatment of skin ... - Medical Xpress

Psoriasis is complex to treat.

In fact, Physician Paul Bechet once said its the antidote to a dermatologists ego (1).

Its an autoimmune disease that causes chronic pain and itching that can severely impact quality of life.

Many foods and supplements are rumored to help with psoriasis treatment. But does research support these claims?

This article examines the evidence surrounding the relationship between diet and psoriasis.

What is Psoriasis and Its Symptoms?

Psoriasis is a chronic autoimmune disease that causes patches of skin to become inflamed and scaly.

It affects up to 4% of the worlds population (2).

Symptoms occur in flares, and include itching, pain, and skin lesions. Psoriasis may also cause pitted fingernails and toenails, as well as mouth sores.

There are six types of psoriasis. Each type causes a distinctive rash:

Plaque psoriasis.Image source.

Guttate psoriasis.Image source.

Inverse psoriasis.Image source.

Pustular psoriasis.Image source.

Erythrodermic psoriasis.Image source.

Summary: Psoriasis is a chronic condition that causes distinctive skin rashes, itching, inflammation, and pain. Symptoms occur in flares.

Psoriasis Causes

Psoriasis is caused by a combination of genetic, environmental, and immunological factors (3).

One large study found that a persons risk increases up to 65% if their parents have psoriasis, and up to 83% if both their parents and siblings have it (4).

Not everyone who carries the gene will develop psoriasis. However, exposure to certain environmental stimuli may increase a persons likelihood of developing the disease.

These stimuli include:

In the presence of both environmental and genetic factors, the immune system malfunctions.

T cells, which normally respond to infection and injury, are mistakenly activated as a result. These cells recruit other immune cells and trigger the release of inflammatory cytokines (13).

This causes the skin cells to die off and regenerate more quickly than they should.

Onset of psoriasis. Image source.

The same environmental factors that cause psoriasis can also lead to flares, so its best to limit exposure to them when possible.

Summary: Psoriasis occurs when the immune system mistakenly attacks healthy skin cells. Many people carry a gene for the disease and develop it after exposure to certain environmental factors.

Diet and Psoriasis Treatment

The standard treatments for psoriasis involve topical and oral medications, as well as ultraviolet light therapy.

There is no scientific proof that diet is an effective treatment for psoriasis on its own.

However, patient testimonials and studies have shown certain diet strategies may help relieve psoriasis symptoms, especially when combined with traditional therapies.

The following sections will focus on foods and nutrients that affect psoriasis severity.

Achieve and Maintain a Healthy Body Weight

Overweight (in a clinical setting) is characterized by a body mass index (BMI) greater than 24.9.

A BMI greater than 29.9 is classified as obese.

Many studies have found a possible link between obesity and psoriasis.

In one long-term study of more than 67,000 females (14):

Even weight gain of just 10 pounds (4.5 kg) appears to increase risk by up to 8%, regardless of BMI classification (15).

In addition to risk, obesity is also linked to disease severity. This is likely because excessive fat tissue increases production of inflammatory cytokines, which contribute to inflammation and lesions in psoriasis (16, 17).

It makes sense then that studies have shown that calorie restriction paired with medication is more effective in reducing psoriasis symptoms than medication alone (18).

Notably, most studies on obesity and psoriasis are observational. This means that researchers arent exactly sure if obesity causes the disease or vice versa.

In any case, psoriasis is linked with several other heart disease risk factors, including high cholesterol, diabetes, and high blood pressure.

Weight loss can reduce heart disease risk for people who are overweight or obese, so it makes sense to maintain a healthy weight (17).

You can calculate your BMI here.

Summary: Those who are very overweight are more likely to have psoriasis, although researchers arent sure if obesity causes it directly. Maintaining a healthy bodyweight also lowers risk of heart disease which is more common in psoriasis patients.

The Autoimmune Protocol, Gluten, and Alcohol

The autoimmune protocol (AIP) is a diet that eliminates gluten, soy, dairy, legumes, grains, added sugars, nightshades, and alcohol for at least 30 days.

The goal is to identify foods that trigger undesirable autoimmune reactions.

Theres a strong link between psoriasis and other autoimmune diseases. In one large study, those with psoriasis had higher rates of 14 different autoimmune disease than the general population (19).

Patient testimonials suggest that the AIP is helpful for many conditions, including psoriasis.

There have been no clinical trials on the AIP, so theres no scientific evidence to support it. But certain foods eliminated in the AIPincluding gluten and alcoholhave been reported to worsen psoriasis symptoms.

Some small studies have shown a gluten-free diet to improve psoriasis symptoms, but only in those with antibodies against gliadin (a protein found in gluten). These antibodies would be seen in those with celiac disease or non-celiac gluten sensitivity (20).

Although other studies found no benefits at all, so its all quite unclear at this stage (19).

A stronger link has been suggested between alcohol intake and psoriasis severity.

One review of 28 studies found that alcohol is likely a risk factor for developing psoriasis, and that those with the disease drink more than healthy adults (11).

Its best to avoid alcohol if you have psoriasis, or a strong family history of it.

Summary: Patient testimonials suggest that the autoimmune protocol may help with psoriasis, but this hasnt been formally studied. You should definitely avoid alcohol and potentially gluten too if you are sensitive.

Anti-Inflammatory and Mediterranean Diets

A Western diet high in fat, sodium, and added sugars has been linked to inflammation and autoimmune disease (21).

For this reason a so-called anti-inflammatory diet may ease psoriasis symptoms.

Theres no universal definition for anti-inflammatory diet, but it generally refers to a style of eating that (22, 23, 24):

An anti-inflammatory diet hasnt been studied in psoriasis specifically, but systemic inflammation is a key feature of the disease.

This diet pattern has also been shown to help with certain autoimmune diseases, so in theory and based on patient testimonials it may be beneficial (18, 25, 26).

Patient testimonials also indicate that an anti-inflammatory eating pattern is helpful for arthritis. As such, it may be useful for relieving pain and stiffness in those with psoriatic arthritis (27, 28).

The diet is similar in many ways to the Mediterranean diet, which includes fish and lean meats, vegetables, fruits, healthy fats, whole grains, and legumes.

In one study, stronger adherence to the Mediterranean diet was associated with fewer psoriasis symptoms. Further, those with fewer symptoms ate more fruit, vegetables, legumes, nuts, and fish and less meat (29).

More human studies are needed to know if the Mediterranean diet is beneficial for psoriasis. But given its other health benefits, such as reducing heart disease risk, it makes sense to eat this way regardless of its effects on skin (30).

Summary: Anti-inflammatory and Mediterranean diets emphasize healthy fats, fruits, vegetables, and whole grains. One study linked the Mediterranean diet with improved psoriasis symptoms.

Supplements for Psoriasis

Several dietary supplements have been reported tohelp with psoriasis treatment.

Fish Oil

Fish oil capsules contain the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA).

Its known for its anti-inflammatory properties.

In one literature review, 12 of 15 studies found fish oil to improve psoriasis severity (31).

The strongest evidence is in support of high-dose intravenous (IV) omega-3 infusions for plaque and guttate psoriasis. However, this isnt a typical therapy, and wouldnt be readily available to most patients (32, 33).

One small observational study found that oral fish oil supplements significantly reduced psoriasis severity and improved quality of life when paired with prescription ointment. Volunteers in this study received 640 mg of DHA plus EPA per day for eight weeks (34).

Change in Psoriasis Area and Severity Index (PASI) over duration of study for fish oil plus ointment group compared to ointment only group. Lower score is better. Click to enlarge.

Larger clinical trials are needed to confirm these effects but it looks promising.

Probiotics

Probiotics are beneficial bacteria that we eat.

They have been the focus of many studies recently because of the interaction between the gut microbiome and various health conditions, including psoriasis.

One study found adults with psoriasisespecially psoriatic arthritisto have less diversity in gut bacteria than healthy adults. The researchers likened the bacterial profile in psoriasis to that of inflammatory bowel disease, which often responds well to probiotics (35, 36).

In another study, 23 patients with mild to moderate plaque psoriasis received the probiotic Bifidobacterium infantis 35264 at a dose of 11010 colony forming units (CFU) per day for eight weeks.

Researchers found that most blood markers of inflammation (CRP and TNF-) were significantly lower at eight weeks (37).

Other probiotic strains havent been studied specifically in psoriasis yet.

Vitamin D

Vitamin D helps regulate the immune system by inhibiting T cell multiplication and limiting cytokine production (38).

Because T cells and cytokines play key roles in psoriasis, and because vitamin D deficiency is common among those with autoimmune disease, its been studied as a possible psoriasis treatment (38).

One literature review found vitamin D supplements and ointments to be as effective as corticosteroids in easing symptoms. The benefits were even greater when vitamin D was used with a high-dose steroid ointment (39).

The rest is here:
Psoriasis Treatment: Does Your Diet Matter? - Care2.com

Kelly Bensimon says shes dealt with psoriasis her entire life, and the condition made her scared to bare all for her 2010 Playboy shoot.

The former Real Housewives of New York City star and model tweetedabout her psoriasis on Friday as she was getting ready for a new photoshoot.

Ive had psoriasis since I was a kid. I hated it. I found it so embarrassing, Bensimon, 49,writes on Twitter. When I was a teen, I would spend hours in tanning beds, trying to get dark enough to cover it up. Not healthy! And not something I would recommend to anyone! But I was desperate. I thought that I couldnt be pretty with this issue.

She ended up becoming asuccessful model, but Bensimon says even then she doubted herself up until age 41, when she posed for Playboy.

Even as an adult, especially when I was modeling, I felt terrible about my skin. When I had a breakout, I wanted to hide from the world, she says. So, when Playboy asked me to bare it all, there was a part of me that was scared not because of the nudity, but because of the psoriasis!

But a funny thing happened when I took off my clothes and got in front of that camera. I forgot about all my imperfections I forgot about the itchies and flaws. I just felt beautiful. Like, if Playboy thought I was beautiful, then maybe I really was! I realized that my flaws were part of my whole, and that my whole was pretty great! Showing so much allowed me to finally drop my judgement[sp].

RELATED VIDEO:Kelly Killoren Bensimon Gets Real about the Public Judgment on Breastfeeding

Bensimon said in February that she wants to pose nude for Playboy again.

I am 49 and I did the cover 10 years ago [in 2010]. So I feel like I look better now, she told Page Six. I am glad that they are going back to showing women naked, it was a beautiful layout. And it would be a test to show that you can still look good at any age.

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Kelly Bensimon Reflects on Having Psoriasis and Her Nude Playboy Shoot: 'No One Is Perfect' - PEOPLE.com

Dr Maithili Kamat, Consultant Dermatologist at Jaslok Hospital and Research Centre helps us in understanding the latest treatment options for psoriasis.

Research in psoriasis treatment often doesnt hog the headline, unlike how the breakthrough researches in cancer or heart stroke does. But, in the recent past, it is interesting to note how psoriasis is categorised as immune system disease. Dr Maithili Kamat, Consultant Dermatologist at Jaslok Hospital and Research Centre helps us in understanding the latest treatment options for psoriasis.

Latesttopical treatments for psoriasis Topical treatment for psoriasis is medication applied to the skin. These are usually the first line of therapy in treating psoriasis. Topical treatments slow down or normalise excessive cell reproduction and reduce psoriasis inflammation.There are many OTC products like moisturisers and products containing Salicylic acid, Coal Tar etc.Prescription-based medicines containing Corticosteroids (steroids) or non-steroid drugs like anthralin, Vitamin D analogue- Calcipotriol, Calcineurin inhibitor-Tacrolimus, Retinoids- Tazarotene. Prescription-based topical drugs should strictly be monitored by a dermatologist.

Topical corticosteroids are effective for treating psoriasis Topical Corticosteroids (TCS) are used as anti-inflammatory agents to reduce the swelling and redness of psoriasis lesions.

TCS are available in a wide variety of strengths, right from super strong or superpotent (Class 1) to extremely weak or least potent (Class 7). The choice of the steroid potency depends on the site and severity of psoriasis. TCS have to be used for limited time periods and strictly under the supervision of a dermatologist. Read more aboutPsoriasis: Not just skin deep; linked to 10 other chronic diseases

Newest available oral treatment for psoriasis -The newest available oral treatment for psoriasis and psoriatic arthritis is Otezla (apremilast).It is an oral pill that helps your immune system fight inflammation in psoriasis by inhibiting a substance called phosphodiesterase.Otezla is also used to treat moderate to severe plaque psoriasis in people who may also receive phototherapy or other treatments for psoriasis. Before giving you the medicine, your doctor will check for your past history of depression or suicidal thoughts; kidney disease; or if you take seizure medication.

Oils can be good for psoriasis Fish oil containingomega-3 eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) taken orally can be adjuvant treatment in psoriasis care.

Top 3 therapies for treating psoriasis

Narrow band UVB therapy treatment Present in natural sunlight, ultraviolet B (UVB) is an effective treatment for psoriasis. UVB penetrates the skin and slows the growth of affected skin cells. The treatment involves close-fitting the skin to a synthetic UVB light source on a regular schedule. This treatment is controlled in a medical setting preferably. Read here5 foods you should NOT eat if you suffer from psoriasis

Goeckerman therapy First formulated in 1925 by American dermatologist William H. Goeckermans, the regimen is for treatment of moderate to severeplaque psoriasisusing a combination of crudecoal tar andartificialultraviolet radiation.It is a specialized form oflight therapy.

Photochemotherapy or psoralen plus ultraviolet A radiation (PUVA) PUVA is a combination treatment which consists of Psoralens (P) and then exposing the skin to UVA (long wave ultraviolet radiation). Psoralens are compounds found in many plants which make the skin temporarily sensitive to UVA.For oral PUVA, methoxsalen capsules are taken two hours before the UVA exposure. In most cases, treatment is undertaken two or three times each week.The patient should always wear goggles to protect the eyes from exposure to the radiation.

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Published: May 18, 2017 10:36 am | Updated:May 18, 2017 11:16 am

Disclaimer: TheHealthSite.com does not guarantee any specific results as a result of the procedures mentioned here and the results may vary from person to person. The topics in these pages including text, graphics, videos and other material contained on this website are for informational purposes only and not to be substituted for professional medical advice.

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Oral and therapy treatment for psoriasis - TheHealthSite

1. In a prospective observational study of over 1100 patients with moderate to severe plaque psoriasis, long-term use (156 weeks) of apremilast was not associated with an increase in common or serious adverse events compared to short-term use (52 weeks).

Evidence Rating Level: 2 (Good)

Study Rundown: Psoriasis is a chronic, inflammatory skin disease associated with a multitude of systemic manifestations and varying degrees of severity. Selecting the optimal therapeutic regimen requires the consideration of numerous factors including efficacy, disease severity, route of administration, cost, feasibility, safety, and tolerability. Due to the chronic nature of the disorder, evaluating the safety profile and tolerability of long-term medication use is critical. Apremilast is a novel oral phosphodiesterase 4 (PDE4) inhibitor that has previously demonstrated efficacy and safety for treating moderate-to-severe plaque psoriasis for up to 52 weeks. The purpose of this study was to assess the safety and tolerability of the long-term use of apremilast in patients with psoriasis.

This study is a prospectively evaluated 1,184 patients with plaque psoriasis from two phase 3 clinical trials evaluating the efficacy, safety, and tolerability of apremilast. At the conclusion of the study, there was no significant increase in common adverse events, serious adverse events, or the rate of drug discontinuation with the study dose of apremilast at 156 weeks compared to 52 weeks. This study is strengthened by its large sample size and the use of multiple trial sites. However, limitations include the lack of comparison to a control group and a sizeable patient dropout rate (21% patients remain at the end of study period), which may limit the external generalizability of these results. Additional prospective studies may be helpful to confirm these results.

Click to read the study in JAAD

Relevant Reading: Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: Results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM]

In-Depth [prospective cohort]: The study prospectively followed patients pooled from 2, similarly designed 52-week, multi-site phase 3 randomized controlled trials evaluating the efficacy, safety, and tolerability of apremilast in patients with moderate-to-severe plaque psoriasis. Overall, 1184 patients were treated with apremilast and 249 (21.0%) patients completed 156-week of treatment. Safety and tolerability was assessed by physical exam, documentation of adverse events, and laboratory tests. Descriptive statistics and exposure-adjusted incidence rates (EAIR) were calculated. Compared to patients treated with apremilast for 0 to 52-weeks, patients treated for >104 to 156-weeks experienced less common adverse events such as diarrhea (1.3% vs. 17.3%), nausea (1.5% vs. 15.7%), upper respiratory tract infections (6.7% vs. 15.5%), nasopharyngitis (6.0% vs. 14.1%), tension headache (1.2% vs. 9.0%), and headache (1.7% vs. 6.3%). The EAIR for major cardiac events (0.4/100 patient-years vs. 0.5/100 patient-years), malignancy (1.6/100 patient-years vs. 1.2/100 patient-years), and serious infections (0.5/100 patient-years vs. 0.9/100) were similar between both the 0 to 52week and 0 to 156week apremilast-exposure periods.

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2 Minute Medicines The Classics in Medicine: Summaries of the Landmark Trials is available now in paperback and e-book editions.

This text summarizes the key trials in:General Medicine and Chronic Disease, Cardiology, Critical and Emergent Care, Endocrinology, Gastroenterology, Hematology and Oncology, Imaging, Infectious Disease, Nephrology, Neurology, Pediatrics, Psychiatry, Pulmonology, and Surgery.

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Long-term use of apremilast for psoriasis associated with an acceptable safety profile - 2 Minute Medicine