Worrying Won't Help Psoriasis Treatment

But new therapies may give patients less to stress about

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MONDAY, June 16, 2003 (HealthDayNews) -- How much you worry could affect how well you respond to some treatments for psoriasis.

A study appearing in the June issue of the Archives of Dermatology finds that people with psoriasis who worry a lot don't respond as well to certain treatments as do people who worry less.

The study authors suggest that psychological interventions both during and after treatment may boost a patient's success rate.

Other experts aren't so sure, though.

"I think if you're more anxious and have more stress in your life, there's no doubt that it makes psoriasis worse, but I don't know if psychotherapy is going to cure your psoriasis," says Dr. Ted Daly, director of pediatric dermatology at Nassau University Medical Center in East Meadow, N.Y. "I don't see that as a realistic manifestation. I think that the other biologics or things like that are more helpful."

Daly is referring to, among other things, a drug called alefacept (brand name Amevive), which was approved by the U.S. Food and Drug Administration in March and is widely considered to be a breakthrough drug for the treatment of psoriasis.

In fact, a second article appearing in the same issue of Archives found that people taking 15 milligrams of alefacept had a 75 percent reduction in their Psoriasis Area and Severity Index (PASI), a measure of the clinical severity of the condition. Most of the improvement continued during a 12-week follow-up period.

Alefacept halts the overproduction of skin cells -- a hallmark of psoriasis -- and also destroys the defective immune cells that trigger the harmful cascade of events. Some 2 million Americans suffer from the condition, which manifests as an uncomfortable buildup of excess skin cells on the surface of the skin.

Physicians and patients alike have long felt that stress can aggravate the condition. Of course, psoriasis itself can be a great source of angst. According to an editorial accompanying the article, 8 to 10 percent of psoriasis patients aged 18 to 54 years old actively contemplate suicide because of the disease. Many standard treatments can be used only intermittently because of side effects.

In the new study, researchers in England and Ireland set out to assess the effect of psychological distress on 112 patients undergoing an older psoriasis treatment -- psoralen plus ultraviolet A (PUVA). This treatment combines the light-sensitizing medication psoralen with UVA light therapy. The patients were enrolled from Hope Hospital in Manchester, England, and the City of Dublin Skin and Cancer Hospital in Ireland.

Participants' anxiety levels were categorized based on various psychological assessments while the clinical severity of the psoriasis was assessed with the PASI.

Those who were classified as "high-level" worriers took 1.8 times longer for their psoriasis to respond to PUVA therapy, compared to the "low-level" group. There was no real difference in the severity of the disease in either group. According to the study authors, "pathological" or high-level worrying was the only significant predictor of the time needed for PUVA to clear psoriasis.

One problem with PUVA treatment, Daly says, is that it can cause melanomas when taken long enough.

Even with the introduction of alefacept, topical therapy such as creams will still be used for most patients, says Dr. Mark Lebwohl, author of the alefacept study and professor and chairman of the department of dermatology at Mount Sinai School of Medicine in New York City.

Those with more extensive disease, however, will now have alternatives to methotrexate and cyclosporine, both of which have severe side effects and to PUVA, which is a carcinogenic. Even other types of light therapy, which are cumbersome because the patient must travel to the doctor's office three times a week, may opt for this biologic, he says.

One potential draw-back of alefacept is that it must be given by injection into the thigh muscle. "It's usually done in the office so you have to keep on going in," Daly says. After 12 weeks, however, the patients go off and the recent study showed a beneficial effect for an additional 12 weeks after the injections stopped. "It's on and off even though it's more work," Daly says.

Theoretically, physicians need to make sure patients taking alefacept don't have any other infections that could be aggravated (the drug affects the immune system), but the new study did not find this to be an issue among the 507 patients it followed.

More information

For more on psoriasis, visit the National Psoriasis Foundation or the National Library of Medicine.

SOURCES: Ted Daly, M.D., director of pediatric dermatology, Nassau University Medical Center, East Meadow, N.Y. and dermatologist, Garden City Dermatology, Garden City, N.Y; Mark Lebwohl, M.D., professor and chairman, department of dermatology, Mount Sinai School of Medicine, New York City; June 2003, Archives of Dermatology
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