Treatment Options Expand for Psoriasis Patients09/13/13
FRIDAY, Sept. 13 (HealthDay News) -- For the legions of
Americans living with the red, scaly patches of psoriasis, doctors
have good news.
"We are at a point where we can help almost anyone, and we can do it fairly safely," said Dr. Mark Lebwohl, who chairs the National Psoriasis Foundation's medical board. "If you have psoriasis, there's usually a treatment out there that will make you better."
Some 7.5 million people in the United States have the autoimmune
disease, yet it's unknown to millions of others.
The telltale scaly patches often occur on the outside of the
elbows, knees and scalp, but they can appear anywhere on the skin
and may itch, sting or burn. Some people with psoriasis also
develop psoriatic arthritis, which causes stiffness, pain,
throbbing, swelling and tenderness in one or more joints.
Symptoms vary from person to person, as does severity of the
disease. Some people are affected mildly, while others have signs
of the disease over most of their body.
But Lebwohl said there are more treatment options available
today than ever before, and more are on the way. "We have medicines
that are pretty safe and incredibly effective for the large
majority of patients," he said.
For most people, the first line of treatment is a topical
medication. Topical corticosteroids are probably the most common
first treatment, he said, and they often work very well but are
prone to such side effects as thinning skin and stretch marks.
Dr. Janet Lin, a dermatologist at Mercy Medical Center in
Baltimore, also noted that people can develop a resistance to
topical corticosteroids, which means the medication won't work any
Another topical treatment is a class of medications known as
vitamin D analogues, which Lin said "help normalize the growth of
the skin cells, and they don't have the side effects of
corticosteroids." Examples are calcipotriol, calcitriol and
Two other topical formulations approved for psoriasis treatment
are salicylic acid and coal tar, according to the foundation.
Lin said that steroids injected into areas with psoriasis
patches can help thin out the scales, but they can be used only in
Light therapy can also help people with psoriasis. "There are
certain wavelengths in the UVA and UVB spectrum that help suppress
inflammation," she said. The problem with light therapy, though, is
that it must be administered in a doctor's office two to three
times a week, which makes it inconvenient.
Oral medications also are available and are often the first ones
tried for widespread psoriasis. "If someone is covered from head to
toe with psoriasis," Lebwohl said, "it's useless to try topical
Examples of oral medications are acitretin, cyclosporine and
methotrexate. He said that most insurance companies prefer that
people start with methotrexate because it's effective and
considerably less expensive than some of the alternative
treatments. Most oral drugs, however, are not considered advisable
for use by women during their childbearing years.
The newest and perhaps most helpful drugs for people with
psoriasis are called biologics and include such drugs as Enbrel,
Humira, Remicade and Stelara. They work by suppressing certain
parts of the immune system, and are given by injection or
intravenously, Lebwohl said. Because they affect the immune system,
however, they carry some increased risks.
"People usually do very well on these medications," Lin said, but she added that "they may see an increase in colds or in infections like strep throat."
For people with psoriatic arthritis, Lebwohl said, methotrexate
and most of the biologics are the preferred treatments.
Many people end up using a combination of medications -- a
biologic and topical corticosteroids, for instance.
Even more options are in the treatment pipeline.
Lebwohl said there are "at least two pills on the near horizon,
and at least five new biologics in the works." And, according to
the foundation, more oral medications and new topical treatments
are currently being tested in clinical trials.
"There are good medications to control psoriasis, but there's no cure yet," Lin said, but she added that, with all the new medications in development, there's reason to be hopeful.
The National Psoriasis Foundation has more about
hereto read how an Atlanta woman helps psoriasis
patients understand and cope with the condition.
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