Psoriasis Blog

Yesterday a patient I started on Humira just six weeks ago returned for a follow up visit. Initially he had a dozen or so rather large, thick plaques of psoriasis on trunk and extremities. So how did it go? Well as of yesterday, he was psoriasis free. That's pretty impressive. I distinctly remember his instructions to me six weeks ago: "Doc, give me the fastest medicine you have".

This weekend I had the honor to give two talks at the 2008 annual convention of the National Psoriasis Foundation. If you've not been to one of these meetings before, you should consider attending next year (which will likely be somewhere in the midwest). In addition to lectures, there are social events and an exposition hall with exhibits by organizations, pharmaceutical companies and other vendors.

Johnson and Johnsons new biologic drug ustekinumab will be reviewed for an additional three months before the FDA decides whether or not to approve it. This will give the FDA additional time to study some amendments made to the new drug application during the past few months.

Not getting your prescriptions filled and treating your condition is called "non-compliance" and it seems that patients with chronic conditions such as psoriasis are the most likely to be non-compliant. On the other hand, psoriasis patients seem to be very compliant with their use of home phototherapy equipment.

Psoriasis, like hypertension or diabetes is just one of those conditions that requires ongoing treatment for best results.

This month is psoriasis awareness month and the National Psoriasis Foundation has a campaign going on called "Free to Get In The Pool". Sometimes patients with psoriasis are stigmatized at public pools because the public assumes that their condition is contagious when it is not. Visit the Psoriasis Awareness Month website for more information.

Coal tar is old, older than John McCain even, but that doens't mean its not still very useful. In fact a recent study of a novel coal tar preparation proved better than Calcipotriene in clearing psoriasis - only the coal tar patients achieved a PASI 75. Good work coal tar!

Those thick, yellow and brittle nails may be due to psoriasis, but did you know that psoriatic nails are actually more prone to fungal infection than healthy nails? That's to say that you can easily have both conditions affecting your nails at the same time. Just treating the fungal infection is unlikely to provide significant cosmetic benefit if the psoriasis remains untreated, so it may be necessary to treat both, either concurrently or sequentially.

Two additional cytokines have been implicated in causing the red scaly plaques of psoriasis: IL-17 and interferon gamma. If history proves a reliable indicator, some biologic drugs designed to block the effects of these cytokines is probably not too far behind.

Seems Enbrel (etanercept) may have more uses than for just arthritis or psoriasis. In a small, open-label study, Alzheimer's patients regained speech skills with injection of Enbrel in the area around the spinal cord. This route of administration was chosen because Enbrel is too large a molecule to cross the protective barrier between the blood and the brain. Interestingly good results were noted. In two patients treated outside the study, dramatic and rapid improvement in speech was seen which continued afterwards. Amgen, who makes Enbrel was skeptical of the results due to their belief that the anti-inflammatory properties of Enbrel take much longer to take hold.

Both dandruff (seborrheic dermatitis) and psoriasis can cause redness, flaking and itching, but technically they remain different diseases. Clinically there are areas of overlap, for example when patients prone to both conditions have psoriasis-like rashes in the areas typically involved by seborrheic dermatitis (face, scalp, underarms and groin). Such combinations are often termed "sebopsoriasis" since they share features of both diseases.

A recent study out of Iran looked at the cause of dandruff (a yeast called Malassezia furfur) and found that psoriasis lesions tended to be colonized with a form of Malassezia that encourages inflammation. Perhaps this then is the "missing like" between these to disorders?