SUNDAY, Aug. 14, 2005 (HealthDay News) -- A new generation of drugs and therapies is providing hope for people driven to distraction by the irritation and discomfort of psoriasis.
The chronic skin disease creates misery for millions of Americans every year, with its lesions, scales and blisters causing severe physical discomfort and embarrassment.
That misery is compounded by the disease's resistance to treatment. People can spend years -- and possibly their entire lives -- waiting for the itch to go away.
"The one thing for people who have psoriasis is if you haven't been to a dermatologist recently, go back," said Paula Fasano, director of marketing and communications for the National Psoriasis Foundation. "Many people have given up on their treatment, and there are so many options where there are new treatments available and combination therapies."
Psoriasis affects between 2 percent and 2.6 percent of Americans, or between 5.8 million and 7.5 million people.
The disease occurs when the body suddenly begins overproducing skin cells. The cells pile up on the surface of the skin before they have a chance to mature, creating bright red patches covered with silvery scales.
These patches of skin cause itching, burning and stinging sensations. They most often occur on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet. But they can occur on skin anywhere on the body, according to the National Institutes of Health (NIH).
Doctors believe the disease is linked to the immune system and is genetic in nature. But no one is certain why some people suffer from psoriasis while others do not, or what causes the disease to first start and then spread.
The therapy chosen for a particular patient depends in large part on the severity of their psoriasis, according to the NIH. Doctors use what is called the "1-2-3" approach to determine treatment, based on the size of the affected area, the type of psoriasis and the patient's response to initial treatments.
Step one involves treatment applied directly to the skin, such as a steroid cream or ointment. In step two, light-based therapy (most often ultraviolet rays) is used to soothe the lesions. Step three involves medicines that affect the immune system in a way to prevent the overproduction of skin cells.
Those medicines include new breakthrough drugs called "biologics."
"If you just have psoriasis on your elbows, we're going to give you a cream," said Dr. Steven R. Feldman, a professor of dermatology, pathology and public health sciences and director of the Center for Dermatology Research at the Wake Forest University School of Medicine in Winston-Salem, N.C. "If you have more generalized psoriasis, then you'll be a candidate for the new biologics."
The biologic drugs are made up of living proteins formed in bacteria, versus chemically created drugs, said Dr. Andrew Blauvelt, of the department of dermatology at the Oregon Health & Science University in Portland.
Blauvelt said the biologic drugs resemble a "laser-guided missile," compared with the "big bomb" medicines of years past.
"The biologics are excellent. Everyone should know them, and not everyone does," Blauvelt said. "They work in very specific ways, unlike past medicines that worked in a broad, nonspecific manner. That has allowed us to target specific symptoms and decrease side effects."
Biologics are injectable and are usually self-administered at home, another plus for the new treatments. "They aren't messy creams and ointments," Blauvelt said.
On the down side, biologics can be quite expensive and are relatively untested, as most have been approved for use over the past few years.
"The cost is still very high, and we still don't know the long-term effects," Blauvelt said.
Biologics also do not work on all psoriasis patients. Doctors estimate that only a third of patients will respond dramatically to a particular biologic, which means much trial and error in finding the best treatment.
Another advance has the potential to improve the lives of psoriasis sufferers -- and it isn't medical in nature. The National Psoriasis Foundation has undertaken an initiative to consolidate the support groups for the disease and make them available to more people than ever before.
The lesions and sores caused by psoriasis can lead to depression and other psychological maladies, Feldman said. Much comfort can be found in sharing stories with other sufferers.
"People who are naturally isolated by these lesions on their skin can feel part of a group," he said. "Some of my patients have come to me and said, 'Dr. Feldman, this group has been better than any treatment I've had.'"
More information
To learn more, visit the National Psoriasis Foundation.
