Treatment Options Expand for Psoriasis Patients

There's no cure, but experts cite reasons for hope for 7.5 million Americans with the disease

Friday, September 13, 2013

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Psoriasis

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 longer.
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 tacalcitol.
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 limited areas.
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 treatments."
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.

SOURCES: Mark Lebwohl, M.D., chairman, medical board, National Psoriasis Foundation, and Sol and Ciara Kest professor and chairman of dermatology, Icahn School of Medicine at Mount Sinai, New York City; Janet Lin, M.D., dermatologist, Mercy Medical Center, Baltimore

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