Tag Archives: psoriasis

High Stress Worsens Psoriasis

Posted on December 27, 2010 | 1 Comment

Chronic stress can lead to a  worsening of psoriasis. Peak levels of stress increase the risk of a psoriasis flare one month later.

The correlation of stress with psoriasis has been well known. Now, a study published in the October issue of the British Journal of Dermatology, “How Stress Gets Under the Skin“, shows how stress leads to changes in cortisol levels that influence psoriasis severity.

Cortisol is a hormone produced by the body that regulates a wide range of bodily functions, including inflammation. High levels of cortisol reduce inflammation. Acute stress acts via the HPA axis to increase cortisol levels in the body. However, chronic stress can lead to an overall reduction in cortisol levels

The researchers followed 62 patients with psoriasis for 6 months, measuring their self-reported measures of stress, psoriasis severity (as measured with the PASI score) and blood levels of serum cortisol.

The researchers found that peak levels of daily stress predicted an increase in psoriasis severity a month later. The peak levels of daily stress were also significantly associated with lower cortisol levels. Those who persistently experienced higher levels of daily stress had lower average cortisol levels than patients who experienced lower levels of daily stress.

The researchers concluded that the “results suggest that daily stressors influence disease outcome in patients with psoriasis by affecting cortisol levels at moments of high stress. Furthermore, patients with persistently high levels of stressors seem to have a specific psychophysiological profile of lowered cortisol levels and may be particularly vulnerable to the influence of stressors on their psoriasis.”

Here is concrete evidence of the mind-body connection and its role in psoriasis. Now, if only there were a cure for psoriasis.

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New Psoriasis Medications Reviewed by Psoriasis Experts

Posted on December 16, 2010 | Leave a comment
Craig Leonard, M.D. Dermatologist

Craig Leonard, M.D. - Psoriasis Expert

Psoriasis treatment options have expanded greatly over the last few years due to the development of new biologic medications.

In a story covered in Skin & Allergy News, dermatologists and psoriasis experts Dr. Craig Leonardi, M.D. and Dr. Alice Gottlieb, M.D. reviewed the latest research in new psoriasis medications and an evaluation of current therapies.

Briakinumab

The dermatologists noted that one of the most notable psoriasis medication in 2010 was of an investigational monoclonal antibody, briakinumab, made by Abbott. Like the recently approved psoriatic drug ustekinumab (Stelara), briakinumab is an injectable biologic agent that targets the interleukin-12 and -23 (IL-12/23) proteins, which are believed to promote the inflammation associated with psoriasis.

One briakinumab trial (M06-890) compared the efficacy and safety of briakinumab to placebo. The results showed that 80.7% of the 981 patients randomized to receive briakinumab every 4 weeks following an induction phase experienced a 75% improvement in psoriasis symptoms (PASI 75) at week 12, compared with 4.5% of the 484 patients randomized to placebo.

Three other trials compared briakinumab to etanercept (Enbrel) or methotrexate and found that significantly more patients randomized to receive briakinumab achieved improved clearance over those assigned etanercept, methotrexate or placebo.

Briakinumab has been submitted by the manufacturer to the FDA for approval.

Ustekinumab (Stelara)

Results of studies that investigated the use of Stelara for psoriasis found that there was a “favorable risk/benefit profile for up to 3 years of treatment.”

According to Dr. Leonardi, one of the study investigators, the maintenance of the favorable safety profile in patients who have been treated for several years is “encouraging”. He noted that ongoing 5-year follow-up studies will enable continued monitoring of the drug’s safety.

Psoriasis Medications in the Pipeline

The dermatologists reviewed additional psoriasis medications with a different mechanism of action. These include:

  • IL-17 inhibitors. Recent studies have suggested that immune system cells (T cells) produce IL-17A that may have acrucial role in the development of psoriasis. This has made IL-17  a potential treatment target. Two antibodies against IL-17 are being researched by Novartis and Amgen.
  • Oral and topical janus kinase (JAK) inhibitors are in phase II and III trials and have had promising results so far
  • Oral phosphodiesterase inhibitors, such as apremilast. Results from a Phase III studies regarding apremilast for the treatment of plaque psoriais is expected by summer 2011. Apremilast is manufactured by Celgene.
  • Topical niacin/calcipotriene. Calcipotriene is a vitamin D derivative that is a well established treatment for psoriasis. New studies are looking at combining this medication with other psoriasis medications for improved results. A recent double-blind, randomized trial reported that 50% of patients randomized to combination therapy with 0.005% calcipotriene and 1.4% nicotinamide achieved symptom clearance or near clearance, compared to 18.8% of those receiving placebo, 25% of those using nicotinamide alone, and 31.5% of those using calcipotriene alone. The findings suggest that the combination therapy “may prove effective as an alternative therapeutic option to calcipotriene monotherapy” according to the study authors.( Pilot, multicenter, double-blind, randomized placebo-controlled bilateral comparative study of a combination of calcipotriene and nicotinamide for the treatment of psoriasis.)

During the presentation, Dr. Leonardi stressed that the existing category of biologic medications, including tumor necrosis factor (TNF) antagonists (Enbrel, Humira, Remicade) continue to perform well.

Dr. Leonardi pointed out that “Given that the class is now 12 years old and includes 2 million patients, we are unlikely to learn of major safety risks at this point”.

What this means in clinical practice is that ustekinumab or briakinumab may be reasonable options for patients with a history of failure of TNF antagonists or a history of central or peripheral demyelination, but until longer-term safety data are available, it should not be the first choice in the majority of treatment-naive patients, said Dr. Leonardi.

Read the full story “Briakinumab, Ustekinumab trials point to future of psoriasis treatment“.

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Posted in Biologics for Psoriasis

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Guttate Psoriasis Outcome Relatively Good

Posted on June 24, 2010 | 3 Comments

Guttate psoriasis appears to have a better prognosis than other forms of psoriasis. That is the conclusion of a recent study published in the June issue of the Journal of Dermatology.

“Clinical course of guttate psoriasis: Long-term follow-up study“studied 26 patients with guttate psoriasis and found that 61.1% experienced complete involution of their psoriasis with long remission of at least one year.

Family history of psoriasis tended to be associated with a poor prognosis, although only four (11.1%) of the patients had a family history of psoriasis. Psoriasis in three of these patients developed into chronic psoriasis.

Similar to previous reports, the trunk and extremities were the sites most commonly involved and pruritus and itching were more common in patients with a good prognosis, although not significantly so.

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Stelara (ustekinumab) improves depression and anxiety.

Posted on June 3, 2010 | 3 Comments
Steve Feldman, M.D.

Study Author, Dermatologist, Steve Feldman, M.D.

Stelara (ustekinumab), one of the newer biologic medications prescribed for the treatment of psoriasis was found to reduce mild-to-severe anxiety in psoriasis patients after 12 weeks of use.
The research study by, Richard G. Langley, M.D., Steve Feldman, M.D., Alexa Kimball, M.D. and others published in the May 2010 issue the Journal of the American Academy of Dermatology (JAAD), “Ustekinumab significantly improves symptoms of anxiety, depression, and skin-related quality of life in patients with moderate-to-severe psoriasis” showed that treatment with Stelara provided relief of anxiety and depressive symptoms in patients with moderate-to-severe psoriasis.

The researchers analyzed the effect of Stelara on anxiety, depression, and impaired quality of life in 1230 patients with moderate-to-severe psoriasis who were randomly assigned to receive Stelara (ustekinumab) 45 or 90 mg/day or placebo. This was part of the PHOENIX 2 trial.

At baseline, the patients had an average Psoriasis Area and Severity Index score of 20, and 40.3% of patients reported symptoms of anxiety and 26.7% symptoms of depression.

After 12 weeks of treatment, patients receiving either 45 or 90 mg/day of Stelara had significantly greater improvements in depression and anxiety symptoms than patients taking placebo.

By 12 weeks, the proportion of patients with mild-to-severe anxiety and mild-to-severe depression had decreased by 34% and 55%, respectively, in patients receiving ustekinumab, compared with corresponding increases of 1.4% and 10.2% in placebo-treated patients.

One of the study authors, Dr. Kimball concluded that “these benefits in mood are important to quantify and should remind clinicians to ensure the patients at risk are appropriately identified and treated.”

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Calcitriol Helps Heal Corticosteroid-Damaged Skin

Posted on May 25, 2010 | 1 Comment

Researchers have found that calcitriol, the active ingredient of Vectical, can help to heal skin damaged by the use of topical corticosteroids. Both Vectical and corticosteroids are commonly prescribed medications for the treatment of psoriasis, but corticosteroids are known to harm the skin, even after short term use.

In a study published in the June 2010 issue of the British Journal of Dermatology, “Topical calcitriol restores the impairment of epidermal permeability and antimicrobial barriers induced by corticosteroids,” researchers investigated the changes to the skin of mice that had been exposed to corticosteroids, and the response to treatment with calcitriol (Vectical).

The skin treated with corticosteroids and calcitriol showed an improvement in the integrity of the outer layer (stratum corneum) and a recovery of the epidermal barrier that is important for controlling water loss and preventing infections.

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Severe Psoriasis Associated with a Higher Risk of Death from Heart Disease

Posted on April 19, 2010 | Leave a comment

Several clinical studies have been published in recent month pointing to the association of psoriasis with heart disease. They have presented data that psoriasis may be an independent risk factor for atherosclerosis, heart attack (myocardial infarction), and stroke. The risk appears to be greatest for severe psoriasis that has the greatest degree of inflammation that impacts the body.

However, it was not shown that this risk of developing heart disease resulted in any increase of death.

Now, a study published in the April 2010 issue of the European Heart Journal has found that people with severe psoriasis do, in fact, have an increased risk of death from cardiovascular disease (CV disease), such as a heart attack. And this risk is independent of traditional cardiovascular risk factors, such as obesity and smoking. This means that the risk is there for someone with severe psoriasis even if he or she is otherwise without other risk factors.

The study compared the medical records of over 14,000 patients with severe psoriasis to others with similar risk factors without psoriasis.

An editorial in the same issue suggested that those with moderate or severe psoriasis be aware of the importance of regular exercise, a healthy diet and the importance of smoking cessation.

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Psoriasis Patients Encourage to Make a Change

Posted on April 12, 2010 | 1 Comment

LeAnn RimesPsoriasis patient LeAnn Rimes is calling for people with psoriasis to pledge to better manage their disease as part of the awareness campaign “Stop Hiding from Psoriasis.” In partnership with the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF), LeAnn is encouraging people to take a stand against psoriasis by taking the Make a Change Pledge online at StopHiding.org.

“The purpose of the Make a Change Pledge is to empower people living with psoriasis to make changes that can help them increase their understanding of the disease and its impact on their everyday lives, as well as encourage them to work with a dermatologist to optimally manage their disease,” says LeAnn.

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