Many psoriasis patients, particularly those with psoriatic arthritis, take pain relievers, making this American Heart Association statement important also to people with psoriasis. The link between these pain relievers and heart attack also highlights the need for further study into the link seen between severe psoriasis and heart attack: to what extent is the psoriasis-heart attack link due to use of these NSAIDs by psoriasis and psoriatic arthritis patients, versus due to something about the disease itself?
Doctors treating people for chronic pain should avoid using all medications -- at least at first -- the American Heart Association advised yesterday in guidelines designed to have a significant impact on the use of medications known as nonsteroidal anti-inflammatory drugs, or NSAIDs.
The scientific statement said that, with the exception of aspirin, there is now strong evidence that NSAIDs are associated with an increased risk of heart attacks and stroke. If 100 patients who have had heart attacks in the past or are at risk for heart disease take these drugs for a year, researchers would expect to see six additional deaths in this group. NSAIDs reduce fever, pain and inflammation.
The statement expressed particular concern over a subgroup of these drugs known as Cox-2 inhibitors. The only drug in this group currently on the market in the United States is Celebrex.
The analysis, which pooled data from 68 studies involving more than 232,000 people, found no evidence that taking beta carotene, Vitamin A or Vitamin E extends life span and, in fact, indicated that the supplements increase the likelihood of dying by about 5 percent. Vitamin C and selenium appeared to have no impact -- either way -- on longevity.
We are growing a bit weary of these unusual psoriasis "remedies," but this one at least makes a bit of theoretical sense for symptom relief, if not for making psoriasis plaques go away.
How about Vicks VapoRub for psoriasis? A bit silly perhaps to use a cough suppressant for psoriasis, but as the label indicates, it is also a topical analgesic (a drug applied directly to the surface of the body to alleviate pain). Vicks has both camphor and menthol in it, so applying it to your skin may make it feel better for a while. (It also has alcohol, so be careful it does not dry out your skin.)
We're not recommending it, but it sure beats some of the other wacky things suggested out there.
Check back tomorrow when we will have a more important update to share with you.
Also from the UK, a reminder to tell your doctor about your psoriasis before you use Lamisil. There have been periodic reports in the medical literature over the years that terbinafine (Lamisil) can interact unfavorably with psoriasis.
In our continuing series of Latest News entries on outlandish products legitimate news outlets will write about as treatments for psoriasis, we have a really gross one for today. We apologize in advance, and will return to more serious work shortly.
How about consuming one's own urine? This one comes from the UK, in an admittedly light-hearted rundown of exotic treatment ideas. Official term: auto-urine therapy (very end of the article).
Needless to say, we are NOT recommending this treatment idea.
Should children be shielded from information on psoriasis treatments? Are psoriasis treatments "creepy"? Are they similar to showing kids sexual content?
The Spokane Spokesman-Review in Washington thinks so.
Last week, on page A9, they reviewed special internet search engines for kids that are designed to protect children from inappropriate content. Here is how the review began:
Parents have discovered the interesting phenomenon of Web search sites specifically designed for kids. The choices range from a kids' version of Ask.com, all the way to Yahooligans, a search site for younger browsers designed by Yahoo.
All of them work with filters that keep out context-based ads that refer to sexuality or creepy stuff like psoriasis remedies.
Here are the best of the bunch....
Yes, you read that right. Dropped right into an article on children's search engines is a swipe at people with psoriasis.
We tore into the Spokesman-Review editors in a letter, but perhaps they need to hear from YOU. Email them a letter to the editor, or call Steven Smith, Editor, at (800)789-0029 extension 5423, or email him.
You might mention that an estimated 400,000 children have psoriasis. Please be sure to show them the respect that they failed to show adults and children with psoriasis.
A few weeks ago, the New York Times covered a controversy about the cosmetics company Clinique buying the naming rights to a new center at a leading hospital, the Weill Medical College of Cornell University in New York City. The piece included an alleged quote trivializing psoriasis that the Times later admitted had not been said. Unfortunately, what was actually said was not so great either.
The Times was trying to quote Dr. Richard D. Granstein, chairman of the dermatology department at Weill Cornell, who was perhaps a tad defensive about having to defend something called the Clinique Skin Wellness Center at a major teaching hospital.
Here is the phony quote the Times later repudiated:
Dr. Granstein called relationships with beauty companies a "slippery slope" for medicine. But he said that beauty was not a new territory for medical schools because dermatology inherently involves a patient's appearance. Acne and psoriasis, for example, are "essentially cosmetic diseases," he said.
But three weeks later, on Feb. 15, the Times admitted that the quote was wrong. In fact, the paper said in a published correction:
An article on Jan. 25 about a new Clinique-sponsored clinic at Weill Medical College of Cornell University referred incorrectly to a comment about psoriasis by Dr. Richard D. Granstein, chairman of Weill's dermatology department. He said that psoriasis "can itch, but you don't die from it. It's often a cosmetic issue. For many people it is not debilitating." Dr. Granstein did not say that psoriasis is "essentially" a cosmetic disease.
Well, the accurate quote does not thrill us either, although we recognize that speaking on the record to reporters is hard and everyone who does it states things awkwardly at times. The actual quote unfairly minimizes the full range of psoriasis symptoms, and borders on being flippant or dismissive. He could have just said that obviously, dermatology deals in part with physical appearance, an issue of perhaps excessive importance in our society.
But the broader challenge that the quote reflects is a long-held and persistent belief by many important people--doctors, lawmakers, insurance company decision-makers--that psoriasis is what the reporter inaccurately put quotation marks around but what the Doctor's actual words were conveying: psoriasis is 'essentially' 'cosmetic'.
This is an interesting conundrum for anyone trying to get psoriasis taken seriously. After all, it is in fact true that for millions of people, (mild) psoriasis is merely a minor annoyance, and is largely a cosmetic issue. But it is also literally true that for millions of others, psoriasis is a significant daily problem in their lives, and for many of them, is debilitating.
So what do we do? Psoriasis can be mild and trivial. Psoriasis can also be so bad that people can't work, don't leave the house, consider suicide. Psoriasis is so variable, are we just doomed to have it trivialized in the media forever?
Of course not. We can alter public perceptions of psoriasis through sustained, aggressive educational efforts with the media and others.
Consider autism. Autism, believe it or not, can be mild. You probably meet people every day in your life or at work who are on the mild edge of an "autism spectrum disorder." They are included in the 1 in 150 children with autism figure. But the autism community has correctly framed the issue that autism is often so devastating that we as a society must do everything we can to defeat it. We agree with them about autism. And we feel that way about psoriasis.
We, as a community, need to be firm and insistent that psoriasis is a serious disease. The fact that many people have mild cases (blessedly), does not change that.
Agree? Disagree? Feel free to add your comments below by clicking on the # COMMENTS link.
And if you would like to give the Times a perspective on psoriasis different than Dr. G.'s, you can email a Letter to the Editor.
Good news! After more than a decade of stagnation in federal funding of psoriasis research (down 20% after inflation), even as the government DOUBLED research funding for other diseases, Psoriasis Cure Now can today report that the National Institutes of Health (NIH) gave psoriasis and psoriatic arthritis research its first significant funding increase in the year that just ended, from $6.6 million in 2005 to about $8 million in 2006.
Given that Psoriasis Cure Now was launched 25 months ago to reverse the abysmal psoriasis research funding situation, we are thrilled by this news.
But don't pop those corks just yet (and if you are taking methotrexate, don't pop those corks, period): NIH is currently projecting that psoriasis research funding for the current year will dip back down, to $7 million.
A powerful new documentary about living with chronic disease is about to premiere in New York City before moving to cities across the nation. INNERSTATE chronicles the lives of three individuals, one battling psoriasis, another Crohn's disease, and a third rheumatoid arthritis.
Through interviews with the patients, their families and friends, the movie weaves together three compelling stories of people trying to chase their dreams while grappling with these challenging diseases.
At the INNERSTATE website, you can watch the trailer, find a screening near you, and learn more about this film. Once you have seen it, you will wish this film had been created years ago.
Kudos to Centocor, makers of Remicade, for financing this impactful testament to people living with chronic diseases, and perhaps most importantly, for its compelling reminder that these diseases impact entire families, not just individuals.
"These emotional stressors can keep the best skin medicine in the world from working," he says. "You've got to address what's going on in the heart as well as on the skin."
Makes sense. We would add just two cautionary notes that are missing from the article. First, psoriasis is often minimized in our culture and in the media by suggesting that it is simply a reaction to stress. But psoriasis is seen in infants and in nuns, groups not known for needing psychoanalysis. Genes that make people susceptible to psoriasis have also been identified, so over-reliance on the "stress narrative" can undermine efforts to educate the public about the serious nature of this immune system disease.
Second, a leading dermatologist once told us she had treated janitors and CEOs, and both had lots of stress in their lives. Her point was that stress is a fact of life, like death and taxes, so while stress reduction can help, stress elimination is not a realistic long-term treatment option.
So while we will continue to resist media oversimplification of psoriasis as merely a function of stress, we would urge anyone with the disease to take those steps that appear to give our medications the best chance of working, including limiting tobacco, alcohol, body weight and stress in our lives. And don't forget to take those naps.
CNTO 1275 interleukin-12/23 monoclonal antibody for psoriasis
Hold on to your hats. Imagine a single injection clearing your psoriasis for weeks or months. (And not some phony internet scam but the real thing.) For some psoriasis patients, it was a reality in a recent clinical trial of an experimental psoriasis treatment currently called CNTO 1275. The treatment, made by Centocor (makers of Remicade), is given by a shot under the skin, like most of the current biologics. Some highlights of the study, which will appear in tomorrow's New England Journal of Medicine:
In the Phase Two trial, 81 percent of patients receiving four weekly 90 mg doses of CNTO 1275 achieved at least 75 percent improvement in their psoriasis, as measured by the Psoriasis Area Severity Index (PASI 75).
In addition, 52 percent achieved PASI 90, and 20% achieved total skin clearance (PASI 100).
Also, of those who received just a single, 90 mg dose, 59% achieved PASI 75 and 16% achieved PASI 100, a standard of total clearance that many psoriasis patients have given up ever reaching.
Wow.
Now at this early stage of testing, we have still not seen long term safety data (obviously), but in the clinical trial, serious adverse events (requiring hospitalization) were observed in four percent of patients receiving CNTO 1275 (including a pair of heart attacks) compared with one percent of patients receiving placebo. Keep your fingers crossed. You can read more about the CNTO 1275 Phase Two study here.
Most surprising, Dr. Langley said in an interview, was that the effects of the antibody lasted for three or four months, while the drug itself only lasts in the body for two weeks.
"We've never seen a drug that had this kind of effect with a single dose," he said. "The fact that it worked so quickly, it worked so well and it lasted so long has not been seen to this point."
"The notion that a single, simple injection of this experimental treatment wipes psoriasis off a significant proportion of test subjects is a stunning development," said Michael Paranzino, president of Psoriasis Cure Now, a nonprofit patient advocacy group, in a statement.
The Kensington, Md., group said that more than 70 potential psoriasis treatments are in development by pharmaceutical companies.
It is always good to hear about treatment options for children, since clinical trials on them are obviously not common. Of course, the labor-intensive Goeckerman method, which is extremely difficult for working adults, might not be so easy for today's highly-scheduled children, either. ["Average treatment duration was 20 days (range, 8-37 days)."]
Psoriasis is often portrayed as a disease of adults, which makes it worth quoting this line from the article:
The investigators analyzed data on 65 patients aged 4 months to 18 years (mean 11.6 years).
Tacrolimus/Protopic for mild to moderate psoriasis
A new study has found tacrolimus cream (brand name Protopic) effective for mild to moderate psoriasis. Both 0.1% and 0.5% formulations beat the placebo by more than 20% in this 10 week trial. (Interestingly, the 0.1% strength did as well as the 0.5% in this study.)
Tacrolimus appeared safe in the study, although the study was 10 weeks, not the 10 or more years that many psoriasis patients might need a treatment.
Tacrolimus (Protopic) cream, marketed by Astellas Pharma, is currently FDA-approved for the treatment of moderate to severe atopic dermatitis (eczema), but is already used by some dermatologists off-label to treat psoriasis. It is a non-steroid alternative.
Might JB991 and AN2728 spell 'hope' for psoriasis?
With the year's biggest annual dermatology conference just winding down here in Washington, DC, the announcements concerning new and emerging psoriasis treatments have been abundant and encouraging. Two more were recently released.
We note these not because they appear more (or less) promising than any of the others, but merely to note once again the interest in the biotech and pharmaceutical sectors in psoriasis research and treatments. We also like the fact that seemingly random collections of letters and numbers -- JB991, AN2728 -- might one day be the answer for someone's psoriasis. (After all, many of the treatments helping people today started out as code numbers.)
CariDee English, America's Next Top Model, talks psoriasis
For those of you who missed season seven of America's Next Top Model on Fox, the show hosted by supermodel Tyra Banks, here's an update: a woman with psoriasis won. CariDee English battled psoriasis throughout childhood, and now she is on the cover of Seventeen Magazine, won a big fat cash prize, and is on her way to being a big star.
"Abbott said a trial of 1,200 patients with moderate-to-severe psoriasis showed that 71 percent who were treated with Humira showed at least 75 percent skin clearance after 16 weeks, compared with 6.5 percent of patients given a placebo."
Abbott also says it will seek FDA approval of Humira for psoriasis in the first half of this year. Humira is already approved for psoriatic arthritis.
A 12-week course of Raptiva (efalizumab) significantly improved chronic severe plaque psoriasis of the hands and feet, researchers here reported today.
... Historically psoriasis of the hands and feet has been a treatment challenge. As a result [said Craig Leonardi, M.D., associate professor of dermatology at St. Louis University,] "we usually just throw everything at it--ultraviolet light, acetritin, methotrexate--but nothing has really worked, and the patients are left just miserable."
UCB, a Belgian pharmaceutical company, today presented to a dermatology conference data that it had announced last July, showing that their experimental treatment Cimzia (certolizumab pegol, CDP870), which has shown effectiveness against Crohn's disease, also showed strong results in a Phase Two trial for moderate to severe psoriasis.
The National Psoriasis Foundation and Amgen reported today that a significant portion of people with moderate to severe psoriasis may be undertreating their disease. A new analysis of their surveys of recent years found:
* Nearly 40 percent of patients surveyed with chronic moderate or severe psoriasis are not currently receiving any treatment.
* 57 percent of patients with severe psoriasis and 73 percent of patients with moderate psoriasis are receiving topical treatment alone.
These are pretty stunning figures, since there are numerous treatments that could be helping these people. Key unanswered questions: Is this under-treatment being driven by the patients, the doctors or the insurers? (And is it because of economics or something else?) And are these undertreated patients happy or unhappy with their health?
They also found that severe psoriasis may be associated with lower income.
This report is a good reminder to everyone with psoriasis that negatively impacts their daily lives: are you treating your psoriasis appropriately? Might you be happier with a more robust treatment effort? Have you mentioned this to your dermatologist? What do you mean you have not seen your derm for years....!
Investigators reported today at the American Academy of Dermatology annual meeting that patients with moderate to severe plaque psoriasis receiving REMICADE (infliximab) induction and maintenance therapy experienced significant improvements in productivity at week 10, which were sustained through week 50.
This will not be a surprise to people with psoriasis. When psoriasis is flaring, or is "moderate to severe," it is often harder to work hard (or play hard). Then, when a treatment works, patients often feel better both physically and emotionally and productivity rises.
But while that might seem so obvious as to make this study a waste of money; in fact, given the problems many patients have getting their health insurers to cover psoriasis treatments, it will be good to have some data to suggest the economic value of improving the health of people with psoriasis.
Centocor also presented additional data today further confirming that Remicade performs well for patients with severe psoriasis, as well as on nail psoriasis, which is hard to treat and takes time to show results.
