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Consistent Control of Psoriasis Elusive for Many Patients

Despite advances in treatment, many patients fail to experience significant improvement over long term

WEDNESDAY, Sept. 26 (HealthDay News) -- Over the long term, most psoriasis patients experience occasional rather than consistent improvement of their condition, despite treatment, according to a report in the September issue of the Archives of Dermatology.

Tamar Nijsten, M.D., Ph.D., of the Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues used data from the PUVA (psoralen-UV-A) study to follow 815 patients who had undergone between two and four physician global assessment examinations between 1985 and 2005. The majority of subjects were middle-aged men whose psoriasis had persisted for more than 25 years.

Only about 25 percent of participants experienced more than a one point change on the four-point physician global assessment scale over 20 years, and fewer than 5 percent had no psoriasis at all. At least 50 percent of patients with moderate-to-severe psoriasis at the study's outset were likely to be at the same level 10 years later, although those with severe disease had mild-to-moderate levels in at least two-thirds of the follow-up years. Of patients with mild-to-moderate disease, about 85 percent were likely to have the same level of disease after 10 years.

An accompanying editorial by Joel M. Gelfand, M.D., of the University of Pennsylvania in Philadelphia, concludes that, despite significant progress over the last 30 years, "we still have major gaps in our basic knowledge of the natural history of psoriasis, and a large percentage of patients with extensive psoriasis will continue to suffer from the burden of this disease for decades."

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