June 28, 2011 in Features

Escaping the itch

New injectable drugs promise relief from psoriasis, but not all doctors are convinced
Patricia Anstett Detroit Free Press
 
Andre Jackson photo

Nurse Jeanine Witten applies a tar treatment to the skin of Rev. Kelly Smith to treat his psoriasis at the University of Michigan Dermatology at Dominos Farms in Ann Arbor, Michigan, on Friday, May 20, 2011.
(Full-size photo)

Psoriasis
Causes and treatment

What it is: Some 7.5 million Americans have psoriasis, a chronic, relapsing disease that causes rashes and painful, inflamed, thick, scaly skin patches called plaques, according to the National Psoriasis Foundation.

These patches often occur on the elbows, knees, legs, scalp, lower back, face, palms of the hands and soles of the feet. About 15 percent of patients develop psoriatic arthritis, causing pain in their joints, according to the National Institutes of Health.

Causes: Psoriasis is a skin disorder triggered by the immune system. The body’s t-cells, which normally fight infection, mistakenly become overactive and trigger the condition. Often, there is a family history of the disease. Stress, infections, climate changes and some medicines, such as beta blockers taken to control high blood pressure, also can contribute.

Treatment: Doctors use what is referred to as a three-step approach: topical medicines; light treatments, known as phototherapy; and systemic drugs taken by mouth or injection.

The approaches may be used in combination. Doctors advise seeking therapy when the disease affects 10 percent or more of the body or is itchy or bothersome.

Source: Mayo Clinic

On the Web

The National Psoriasis Foundation, an education and support group, will host a webcast addressing drug treatments for psoriasis – “Systemics and Biologics: Risks and Rewards” – on Wednesday at 5 p.m. For more information, see www.psoriasis.org.

Take a shot and make it go away.

That’s quite tempting if you have a disease like psoriasis, an often itchy, painful skin problem that can take months to get rid of.

But doctors at leading treatment centers are raising concerns that new injectable medicines – a class of drugs called biologics – for the skin disease can bring their own problems, including infections that trigger more skin outbreaks, tuberculosis and rare cases of lymphoma, a type of cancer.

“The hoopla is that with these new drugs a person can get a shot that takes care of their psoriasis for three months; that’s a good thing,” says Dr. Thomas Anderson, medical director of the University of Michigan Day Treatment Center, one of 12 in the country that provides outpatient care for the skin disease.

“But as time goes on, these drugs may not be as effective in some patients,” Anderson says. “If you get an infection while you are on one of those drugs, your body may not be as capable of getting rid of it.”

For that reason, many patients might be best off trying conventional treatments first: moisturizing creams, lasers or light treatments known as phototherapy.

After using the biologic drugs, Kathy Bommarito, 42, of Clawson, Mich., earlier this year developed strep throat, then a horrible case of psoriasis that covered most of her body.

“It’s very painful, like a very bad sunburn,” Bommarito says of the disease she’s had off and on since her teens. “It hurt to sit down.”

Her father also had psoriasis, which can be hereditary.

“Hopefully my kids won’t get it,” says Bommarito, a middle school teacher and mother of two.

Her psoriasis abated after a week of light and moisturizing treatments, but returned 10 days later. She’s back to taking the biologic drug, Stelara, and light treatments three times a week.

“I’m trying to stay positive,” she says.

Brand names for other biologics include Amevive, Enbrel, Remicade, Humira and Raptiva. The drugs, which have come on the market in the past decade, affect the immune system but can go awry and end up causing infections.

Safety warnings listed on the labels for the drugs mention the chance of serious infections, TB and cancer. They recommend people tell doctors before filling a prescription if they have diabetes, are scheduled for major surgery, are pregnant, or have heart failure, cancer or nervous system disorders, among other chronic problems.

Doctors at the University of Michigan and Detroit’s Henry Ford Hospital tell patients that biologics aren’t often the best first choice because of the problems associated with them.

“We almost always try other things first,” says Dr. Iltefat Hamzavi, a Canton, Mich., dermatologist and Henry Ford Health System physician.

Hamzavi limits the drugs to patients with psoriasis over 10 percent or more of their body, or people with arthritic psoriasis, a painful joint problem.

Psoriatic arthritis usually appears between the ages of 30 and 50 and is believed to be triggered by genes, the immune system and environmental factors, according to the National Psoriasis Foundation.

Cost is another issue with the biologics. The injectables run $22,000 to nearly $60,000 a year, compared to $10,000-$20,000 for moisturizing and light therapy, depending on duration.

The University of Michigan and Ford both offer moisturizing treatments known as modified Goeckerman therapy.

The moisturizers, made from a coal tar substance, make you “smell like a road; it’s not my perfume of choice,” says Bommarito.

But some patients are completely clear of their outbreaks after treatment and have gone as long as 10 years without another episode, University of Michigan doctors say.

Tar from both coal and wood are used to create creams that help slow overactive growth of skin cells and reduce the inflammation, itching and scaling of psoriasis.

The creams also make the skin more sensitive to light treatments and make it possible to reduce the number of phototherapy sessions needed.

Jeanine Witten, nurse supervisor of the university’s outpatient dermatology program, says the moisturizing creams must be applied carefully in a downward motion to avoid causing pimples.

Once the creams go on, patients put on a pair of dampened pajamas, then a lightweight sauna suit that helps the medicine penetrate better.

Psoriasis sufferer Bommarito says the creams and suit “felt kind of weird the first day, but it’s actually quite comfortable. It’s kind of warm inside there.”

Laser treatments involve 13 to 20 treatments that last five to 10 minutes each, Henry Ford’s Hamzavi says. Three out of four patients get at least 75 percent clearance of their psoriasis with laser treatments, which can last four to six months or longer, he says.

Hamzavi said he considers Goeckerman therapy “dramatically effective, probably one of the most effective ways to clear psoriasis,” but it requires patients to take time off work.

Patients “always should seek treatment” if they are bothered by their psoriasis, he says: “There is no reason to just live with this disease anymore.”


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