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Psoriasis notes for Clinical Correlates

GENERAL
--affects the skin and joints
--we have 25 square feet of skin, weighing approximately 9 pounds, with 32 million bacteria per square inch on it, 20 feet of blood vessels and 72 feet of nerves (per square inch, still)
--red scaly patches on skin = psoriatic plaques = inflammation and excessive skin production --> silvery-white appearance
--common locations: skin of elbows and knees, palms of hands and soles of feet, on the scalp, inside ears, butt crack, etc.
--not contagious
--can be INSANELY ITCHY!!!
--chronic recurring condition
--fingernails and toenails frequently affected
--10-15% of people with psoriasis have psoriatic arthritis
--often associated with food intolerances and multiple chemical sensitivities that are often the result of dysbiosis or an imbalance of intestinal flora that causes yeast overgrowth --> systemic effects
--clinically associated with a deficiency of zinc, magnesium, essential fatty acids
--indicates a high degree of toxicity in the body
--associated with cardiovascular disease
--Annual treatment cost exceeds $3 billion, in 1993 was btw 2-3 billion


CAUSES?
--root cause of psoriasis is not proven
--genetic component = allele HLA-CW*0602
--immune mediated: most common T-helper cell type 1 (TH1) immunological disease. Evidence has linked TH1 diseases to myocardial infarction (MI).
--TH1 cells are active in psoriasis-related inflammation and in the inflammation that promotes the hardening of blood vessels (athlerosclerosis)
--diagnosis: "autoimmune disorder" = an allopathic "cop-out" diagnosis. "Integrative medicine argues that our immune system does not attack a healthy body." (Mercola)
--toxicity: immune system will go into overdrive when the body becomes toxic, example: aspartame can cause itchy rashes
--DISEASE PROGRESSION: mast cells come in, blood vessels curve, inflam due to interleukins & cytokines, increase in I cells, increase in blood vessels, spaces in basal layer, corkscrew blood vessels, loss of granulosum layer, increase in size of rete pegs and growth rate there, increase in CD8 and CD4 cells, dendritic cells mature, increase in surface keratinocytes...

AGGRAVATING FACTORS and/or TRIGGERS
--stress
--excessive alcohol consumption
--smoking
--Bacterial infections (staph)
--pressure or trauma to the skin
--weather: cold dryness worsens it, sunny hot and humid make it better (the beach)
--infections such as sinusitis or sore throat
--some drugs worsen psoriasis symptoms: antihypertensive ACE inhibitors and beta-blockers, Chloroquine (an anti-malaria drug), progesterone, indocin (the anti-inflammatory drug) and lithium.
--lack of sun, low vitamin D (Mercola)
--changing toner cartridge in laser printer
--People with psoriasis are more likely to smoke and to have diabetes, high blood pressure and high cholesterol. (JAMA. 2006;296:1735-1741)
--too much sun (sun poisoning)
--Laundry detergent
--Soaps, perfumes
--Household & workplace chemicals
--Animal dander
--Metals (such as nickel in jewelry)
--the Standard American Diet -- rich in sugar, processed and refined foods
--bacteria Streptococcus --> certain cases of guttate psoriasis

OCCURS WITH
--depression
--loss of self-esteem
--may confer an independent risk of MI, up to 3x in young patients with severe psoriasis taking conventional meds for the condition: http://jama.ama-assn.org/cgi/content/full/296/14/1735

INCIDENCE
--Psoriasis affects an estimated 2-3 percent of the world's population.
--125 million people worldwide have psoriasis
--between 5.8 and 7.5 million Americans have psoriasis (NIH)
--2.2 percent of American adults have been diagnosed with psoriasis
--11 percent of those diagnosed with psoriasis have also been diagnosed with psoriatic arthritis. This is a prevalence of 0.25 percent of American adults in the general population.
--2.5 percent of Caucasians have it
--Psoriasis prevalence in African Americans is 1.3 percent
--between 10 percent and 30 percent of people with psoriasis also develop psoriatic arthritis.

ONSET
--Psoriasis often appears between the ages of 15 and 25, but can develop at any age.
--Psoriatic arthritis usu develops between the ages of 30 and 50

SEVERITY
--Mild psoriasis = affecting less than three percent of the body, (palm of the hand equals 1 percent of the skin)
--Moderate = 3 percent to 10 percent
--Severe = over ten percent
--The majority of people with psoriasis have mild disease.
--Nearly 1/4 people with psoriasis have moderate to severe cases

HEREDITY
--About 1/3 of people with psoriasis report that a relative had psoriasis.
--If one parent has psoriasis, a child has about a 10 percent chance.
--If both parents have psoriasis, a child has an approx 50 percent chance of developing the disease.

TREATMENTS
--Most treatments focus on topical skin care to relieve the inflammation, itching, and scaling. For more severe cases, oral medications are used.
--Conventional medicine will tell you that there is no cure
--Commonest Tx: Hydrocortisone cream or ointment = a strong and toxic medicine of limited effectiveness and side effects: (long term use): thin, fragile, dry skin, suppression of adrenal glands
--"when you suppress a skin condition with cortisone, especially in children, the focus of the child's illness shifts from the skin to the lungs and they often develop asthma. Parents may be relieved their child's skin condition has cleared, but don't realize that they are substituting a milder condition for a much more serious one." (Carol Dean)
--antihistamines, like Benadryl, can relieve itching, but cause drowsiness

ALTERNATIVE TREATMENTS GENERAL:
--detox
--fulfill nutritional needs, treat for "syndrome x", incl: cardiovascular health
--other ideas

ALTERNATIVE TX: DETOX
--increase water intake
--increase fiber intake
--get sunshine (vitamin D)
--saunas, exercise that makes you sweat
--bowel, liver and kidney cleansing
--removal of mercury amalgams in your teeth
--chelate heavy metals
--stress reduction: meditation, journaling, etc

ALTERNATIVE TX: NUTRITION
--address nutritional deficiencies: psoriasis clinically assoc w/ deficiencies in Zn, Mg, EFAs
--take omega 3 fatty acids: a good fish oil supplement contains both EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid)
--probiotics
--digestive enzymes
--boost gastric acid production to improve digestion
--avoid food irritants and allergens: try an elimination diet. www.yeastconnection.com or the Weston A Price foundation also has one online.
--get sunshine (vitamin D)
--avoid table sugar, foods that contain sugar or high fructose corn syrup, any white food, white bread, biscuits, pizza dough, baked goods, anything that comes in a box and most canned foods, food additives
--avoid: ginseng, echinacea, inula, actium lappa
--avoid: alcohol, smoke, meat, dairy, wheat, corn, peanuts, common allergens
--magnesium: nuts, seeds, walnuts, nut and seed oils, especially flaxseed oil, evening primrose oil and black currant oil, and fresh green vegetables and/or supplement as magnesium citrate (300 milligrams twice daily)
--beta-carotene
--vitamin A (promotes tissue healing) green leafy vegetables, carrots, squash, sweet potatoes and dried beans
--vitamin E (helps moisturize skin from the inside and promotes tissue healing)
--selenium (help the body use vitamin E)
--zinc (wound healing and because psoriasis pts are often deficient)
--vitamin C but not heavy doses
--Dandelion: detoxifies the blood, thus eliminating allergens, inflammationy-causing toxins and chemicals from the body. It's most commonly used as a tea or you could take 250-500 mg. of dandelion extract daily.
--GARLIC
--glutathione
--cysteine
--B12
--folic acid
--Oil of Oregano
--??? plants with psoralen, UV sensitizer, include: the seeds of Psoralea corylifolia, the common Fig, celery, parsley and West Indian satinwood. safe to mammals, toxic to fish
--these dietary suggestions from the woman who recommends peeing on your psoriasis: Foods: A cup of cucumber juice everyday is very beneficial, as is carrot juice. Eat lots of green leafy vegetables - cooked or uncooked. Yoghurt, especially buttermilk is good. Avoid or reduce: eggplant (aubergine), peanuts and all other foods known to commonly cause allergies. Also, avoid taking too much dairy products. Cheese is a killer for psoraisis so pizza should be avoided or eaten infrequently. Best to cut down on starches like white rice, and especially fermented foods.

ALTERNATIVE TX: MORE
--many of the detox and nutritional requirements above also address this syndrome
--"patients with psoriasis should be encouraged to aggressively address their modifiable cardiovascular risk factors" (JAMA. 2006;296:1735-1741)
--Climatotherapy involves the notion that some diseases can be successfully treated by living in a particular climate. Several psoriasis clinics are located throughout the world based on this idea. The Dead Sea is one of the most popular locations for this type of treatment.
--tar soap is conventional Tx but it works and is low tech so naturopaths may well recommend it: active ingredient is Cade Oil, is in Head 'n' Shoulders to relieve itching and flaking, however to make is saleable Head 'n' Shoulders add perfume to cover up the smell (pure cade oil smells strongly of tar). However, adding perfume dilutes the oil and makes it less effective. Also found in shampoos such as PolyTar and Cold Tar Soap. BEST shampoo containing cade oil (in one opinion) is Soak 'n' Float, a solid shampoo bar from a store called Lush Cosmetics. It doesn't smell great but you're guaranteed around 80 washes from a bar and it doesn't fail to impress. Lush are great too because all of the products are vegetarian, most of them are vegan and the majority of their products are made with all natural ingredients. They're a very environmentally friendly company and totally against animal testing. lush.com (this comment from Charlotte Starlet)
--let fish eat your dead skin In Turkey & in Croatia (Altermedica), "doctor fish" in outdoor pools of spas encouraged to feed on psoriatic skin. Best known is the spa “Kangal Thermal Springs”
--lifestyle Tx: minimize stress, healthy diet, rest, sunshine and swimming in saltwater
--ocean: salt alone does not have any effect, sea water must have other effectors. People in the tropics differentiate between "live" and "dead" sea water: "live" sea water is water that has never been covered. Dead Sea clinics.
--humidity

NATURAL SALVES:
--Calendula: These creams are very popular in Europe for the topical treatment of eczema and psoriasis. The cream is often combined with soothing chamomile for a variety of skin conditions. It should be applied topically two or three times a day.
--Chamomile: The German Commission E approves the use of chamomile for treating a variety of skin conditions. Topical chamomile treatments can reduce inflammation and allergic reaction activity. Look for a cream containing 3 to 10-percent crude drug chamomile content and follow the label for dosage directions.
--The antioxidant N-acetylcysteine (NAC) has an ability to decrease proliferation of skin cells, in this study it worked on a severe form of dry skin called lamellar ichthyosis. (NAC) is a thiol that reacts with reactive oxidative intermediates and replenishes the intracellular CYSTEINE necessary for the production of GLUTATHIONE, an endogenous antioxidant. Twice daily on the skin. NAC is labile and breaks down, releasing stinky sulphur-containing compounds. Recent studies show that NAC suppresses proliferation of fibroblast cells (Lancet November 27,1999 Volume 354 Number 9193) Safe, non-toxic and relatively low cost approach. Although the treatment was not used for psoriasis, both diseases have similar underlying disorders of an increase in cellular proliferation.
--banana skins: ripened banana skins chopped in food processor with a little water and olive oil. apply messy goop on psoriasis. leave on for 20 minutes, then wash out ...looks like little pin pricks all through the scaly skin...repeat every day for a week, though may be gone before a week. the psoriasis may not come back, and did not in the testimonial where I found this recipe: http://www.helium.com/tm/858379/banana-skins-thats-psoriasishe

AVOID:
--scratching: Scratching that breaks the skin increases the risk of infection. Long-term scratching can cause the skin to become thick and leathery.
--letting the skin dry out
--cardiovascular risk factors
--urinating on sores

TOPICALS ARE USUALLY ROTATED
Suzanne had psoriasis as a child: "The salves changed all the time so I don't know what they were. The night before the doctor I'd have to put this black tarry gooey shit all over me and I'd have to sleep in special pajamas, the next morning I'd get up and it was like a special thing, we'd have to get the mineral oil out to get it off me. Then I had to wash my hair in zitar. There was some other stuff in the brown bottle with a funny smell they had me put on my hair. Most of the time it was a white creamy salve they put on me. When it got really bad and I got really covered they couldn't stop it from drying out and had this idea to keep it moist so they put salve on me and wrapped me in saran wrap to keep it moist, I couldn't wear pants so I had to wear a skirt and they just wrapped my legs from my knees down and put on knee socks and I wore a long sleeved shirt over my arms. They gave me salve and it would work for a couple of weeks and then it wouldn't work anymore and they'd have to change it. Wintertimes were worse than summertimes."

CONVENTIONAL/ALLOPATHIC TREATMENTS
FROM HERE DOWN

TOPICALS
--main topical Txs: corticosteroids (cortisonelike creams, gels, liquids, sprays, or ointments), vitamin D-3 derivatives, coal tar, anthralin, or retinoids
--each drug has specific adverse effects or loses potency over time
--common to rotate them
--Sometimes combined ex: keratolytics (substances used to break down scales or excess skin cells) are often added
--interactions: never mix salicylic acid with calcipotriene cream or ointment (a form of vitamin D-3)
--bath solutions
--moisturizers

TOPICAL: SALICYLIC ACID
--helps remove scales
--often combined with topical steroids, anthralin or tar
--both OTC and prescription
--never mix with calcipotriene cream or ointment (a form of vitamin D-3)
--combine with anthralin to improve outcome?

TOPICAL: TAR
--OTC, stinks
--active ingredient is cade oil (in Head n Shoulders but perfumed)
--also in PolyTar, Cold Tar Soap, also Soak n Float from Lush cosmetics
--topical, shampoo and bath solution forms
--can help slow the rapid proliferation of skin cells and help reduce inflammation, itching and scaling
--often used in combination with phototherapy
--Goekerman regimen
--side effects: folliculitis
--ANTHRALIN is an antiproliferative and anti inflammatory also made from coal tar??, tree bark extract??, mechanism unknown, prescription needed, for plaque psoriasis, does not work as quickly or as thoroughly as superpotent topical steroids, has no known long-term side effects, may require addition of salicylic acid to work effectively. may cause stains.

TOPICALS: DONOVEX
--form of synthetic vitamin D3
--slows down the rate of skin cell growth, flattens psoriasis lesions and removes scale
--can be used on the scalp and for nail psoriasis

TOPICALS: TACLONEX
--prescription ointment contains calcipotriene
--same active ingredient in Dovonex PLUS potent steroid betamethasone dipropionate
--calcipotriene slows down the rate of skin cell growth, flattens psoriasis lesions and removes scale
--steroid helps reduce inflammation and itch

TOPICALS: TAZORAC (a RETINOID)
--presciption gel or cream
--AKA by its generic name tazarotene, aka as a topical retinoid
-- = a vitamin A derivative and is also known as a topical retinoid
--can be used on the face, scalp and nails.

TOPICALS: CORTICOSTEROIDS
--topical cream
--routinely used to treat psoriasis
--prescription

PHOTOTHERAPY
--exposing the skin to ultraviolet light under medical supervision
--consistency is key
UVB PHOTOTHERAPY
--now prevalent
--artificial UVB light source, narrow band 311-312 band
--set length of time on a regular schedule
--home equipment available
PUVA = psoralen (light-sensitizing med) combined with exposure to ultraviolet light A
--UVA, like UVB, is found in sunlight
--UVA is not usually used alone to clear psoriasis: relatively ineffective unless used with a light-sensitizing medication such as psoralen.
--may improve psoriatic arthritis
--gen used in combination with other medications
--not helpful in treating psoriatic arthritis of the spine
--FDA-approved for the treatment of moderate to severe
--few short-term side effects
--long-term potential to increase the risk of skin cancers
PSORALEN
--light-sensitizing med, combine w/ exposure
--in repigmentation therapy, a patient is given a psoralen drug and then is exposed to ultraviolet light A (UV-A). When psoralen drugs are activated by UV-A, they stimulate repigmentation by increasing the availability of color-producing cells at the skin's surface.
--PUVA treatment used for psoriasis and (lesser) eczema, vitiligo and alopecia.
--a significant mutagen used for this purpose in molecular biology research.
--psoralen is found in figs, celery, a few other plant sources
--side effects include nausea, headache, skin cancer

SYSTEMICS
--pill or injection
--pt needs regular blood and liver function tests because of med toxicity
--warnings to pregnant women
--recurrence after systemic tx discontinued
--three main traditional systemic treatments are methotrexate, cyclosporine (broad immune suppressors) and retinoids (synthetic vitamin A)
--additional drugs (not specifically licensed for psoriasis) have been found to be effective: the antimetabolite tioguanine, the cytotoxic agent hydroxyurea, sulfasalazine, the immunosupressants mycophenolate mofetil, azathioprine and oral tacrolimus. These have all been used effectively to treat psoriasis when other treatments have failed.
--fumaric acid esters have also been used to treat severe psoriasis in Germany for over 20 years (not licensed in many other countries)

BIOLOGICS
--Biologics = manufactured proteins that interrupt the immune process involved in psoriasis.
--target specific immune fx (interleukins), not broad immune suppressors
--fairly new treatments for psoriasis and psoriatic arthritis
--overall safety is still being evaluated
--long-term side effects are not known
--expensive
--developed from living sources
--Amevive, Enbrel, Humira, Raptiva and Remicade are FDA approved for treating psoriasis.
--Enbrel, Humira and Remicade approved for Tx of psoriatic arthritis
--biologics focus on specific aspects of the immune function leading to psoriasis. These drugs (interleukin antagonists) are relatively new, and their long-term impact on immune function is unknown
--Ustekinumab (IL-12 and IL-23 blocker) shows hopeful results for psoriasis therapy.
A new natural systemic option, XP-828L, for mild to moderate psoriasis relief has been developed by a Canadian life science and technology company. This oral product with clinically proven efficacy and safety is extracted through a patented process from whey and has immuno-modulatory effects.

STANDARD ALLOPATHIC TX: IMMUNE SUPPRESSORS METHOTREXATE and CYCLOSPORINE

METHOTREXATE
--a generalised immunosuppressant therapy: NO CELL DIVISION
--is a folic acid analog, blocks regeneration of tetrahydrofolate
--inhibits synthesis of deoxythymidine monophosphate so no thiamine synthesis
--prescription systemic medication (usually sold as a generic)
--initially used to treat cancer
--1950's discovered effective in clearing psoriasis, OK'd by FDA in 1970's
--widely used for treating psoriatic and rheumatoid arthritis
--relieves the symptoms associated with psoriatic arthritis
--may help prevent joint destruction.
--usually is well tolerated in low doses
--lots of side effects and long-term potential for liver damage

CYCLOSPORINE
--also approved (as Neoral) prevent organ rejection in transplant patients
--may produce improvement in psoriatic arthritis
--get regular blood tests to check for kidney damage

STANDARD ALLOPATHIC TX: the RETINOIDS
--an oral retinoid
--synthetic form of vitamin A
--regulate epithelial cell growth.
--imp in vision, regulation of cell proliferation and differentiation, growth of bone tissue, immune function, and activation of tumor suppressor genes
--current research seeks to treat skin cancers. Currently 9-cis retinoic acid may be used topically to help treat skin lesions from Kaposi's sarcoma.
--3 generations, First: retinol, retinal, tretinoin (Retin-A), isotretinoin and alitretinoin, Second: etretinate and its metabolite acitretin, Third: tazarotene , bexarotene and Adapalene
--toxic in high doses. Toxic effects occur with prolonged high intake (in children 25,000-500,000 IU daily). A medical sign of chronic poisoning is the presence of painful tender swellings on the long bones. Anorexia, skin lesions, hair loss, hepatosplenomegaly, papilloedema, bleeding, general malaise, increased liability of biological membranes and of the outer layer of the skin to peel, pseudotumor cerebri, and death may also occur.
--Recent research has suggested a role for retinoids in cutaneous adverse effects for a variety of drugs including the ANTIMALARIAL drug PROGUANIL. It is proposed that drugs such as proguanil act to disrupt retinoid homeostasis.

RETINOIDS: ACCUTANE (oral or topical)
--Accutane = Isotretinoin (INN)
--used for the treatment of severe acne
--sometimes used in prevention and treatment of certain skin cancers
--Oral isotretinoin is marketed under various trade names, most commonly Accutane (Roche), Amnesteem (Mylan), Claravis (Barr), Decutan (Actavis), Isotane (Pacific Pharmaceuticals), Sotret (Ranbaxy), Oratane (Genepharm Australasia) or Roaccutane (Roche)
--topical isotretinoin most commonly marketed under the trade names Isotrex or Isotrexin (Stiefe

RETINOIDS: ACITRETIN [brand name Soriatane]
--second generation retinoid
--taken orally, and is typically used for psoriasis
--teratogen
--a metabolite of etretinate, which was used prior to the introduction of acitretin. Etretinate was discontinued because it had a narrow therapeutic index as well as a long elimination half-life (t1/2=120 days), making dosing difficult
--acitretin's half-life is approximately 2 days
--DON'T GET PREGNANT: Women must avoid becoming pregnant for at least 3 YEARS after discontinuing acitretin. In comparison, etretinate was not recommended at all for women who planned to become pregnant
--interferes with oral contraceptives esp microdosed progestin ('minipill') (Ovrette, Micronor, Nor-QD)
--avoid st john's wort with hormonal contraceptives
--take pregnancy tests regularly while taking acitretin. Stop taking acitretin and call your doctor immediately if you become pregnant, miss a menstrual period, or have sex without using two forms of birth control
--if pregnant: Do not consume any form of alcohol while taking acitretin and for 2 months after treatment. Alcohol and acitretin combine to form a substance that remains in the blood for a long time and can harm the fetus
--acitretin is present in the semen of male patients on med, no research on effects
--Do not donate blood while taking acitretin and for 3 years after treatment.
--side effects: liver damage, upset stomach, extreme tiredness, unusual bruising or bleeding, lack of energy, loss of appetite, pain in the upper right part of the stomach, yellowing of the skin or eyes, dark urine, or flu-like symptoms
--side effects: rare: skeletal

SYSTEMICS: HYDREA®
-- Hydrea = hydroxyurea capsules, USP is an ANTINEOPLASTIC agent, harmful to healthy dividing cells, used for cancer
--oral capsules active ingredient: 500 mg hydroxyurea. Inactive ingredients: citric acid, colorants (D&C Yellow No. 10, FD&C Blue No. 1, FD&C Red 40 and D&C Red 28), gelatin, lactose, magnesium stearate, sodium phosphate, and titanium dioxide.
--side effects: primarily bone marrow depression (leukopenia, anemia, and occasionally thrombocytopenia), and less frequently gastrointestinal symptoms (stomatitis, anorexia, nausea, vomiting, diarrhea, and constipation), and dermatological reactions such as maculopapular rash, skin ulceration, dermatomyositis. LOTS MORE inc: skin changes, atrophy, cancer, dysuria, alopecia, large dose --> drowsy, neuro disturbances mostly mild, renal tubule compromise --> elevated BUN, uric acid, creatinine, also BSP retention, fever, chills, malaise, edema, asthenia, elevation of hepatic enzymes.

SYSTEMICS THAT INHIBIT PURINE SYNTHESIS: MYCOPHENOLATE MOFETIL
--Mycophenolic acid (INN) or mycophenolate
--IMMUNOSUPPRESSANT used to prevent rejection in organ transplantation
--inhibits purine synthesis and proliferation of B and T lymphocytes
--initially marketed as the prodrug mycophenolate mofetil (abbreviated MMF)
--trade names: CellCept (mycophenolate mofetil; Roche) and Myfortic (mycophenolate sodium; Novartis)
--derived from the fungus Penicillium stoloniferum
--metabolised in the liver to the active moiety mycophenolic acid
--inhibits inosine monophosphate dehydrogenase, the enzyme that controls the rate of synthesis of guanine monophosphate in the de novo pathway of purine synthesis used in the proliferation of B and T lymphocytes.
--potent and can be used in place of the older anti-proliferative azathioprine
--for organ transplants usually used as part of a three compound regimen of immunosuppressants, also including a calcineurin inhibitor (cyclosporin or tacrolimus) and prednisolone.

SYSTEMICS: SULFASALAZINE
-- = Sulfasalazine (brand name Azulfidine in the U.S., Salazopyrin in Europe)
--a sulfa drug, a derivative of Mesalazine (5-aminosalicylic acid abbreviated as 5-ASA)
--used primarily as an anti-inflam agent in the treatment of rheumatoid arthritis and mainly inflammatory bowel disease, including ulcerative colitis and Crohn's disease
--found to reverse the scarring associated with cirrhosis of the liver. Apparently, cells called myofibroblasts, that cause scar tissue to form in a diseased liver, also give off proteins that prevent the breakdown of the scar tissue. Sulfasalazine appears to retard the secretion of these proteins.
--usually not given to children under 2 years of age.
--use has declined since other derivatives of 5-ASA are preferred, despite their increased cost, due to their more favourable side-effect profile (they do not yield the metabolite sulfapyridine)
--side effects: (common), mouth ulcers, sore mouth, loose bowel motions, headache or slight dizziness, itchy rash, (rare) drop in the numbers of white blood cells, can decrease the numbers of platelets, easy bruising, nosebleeds or bleeding gums, mild hepatitis, may aid the healing of cirrhosis of the liver, contact lenses permanently stained, perspiration, urine and semen turn orange, severe depression in young males.

SYSTEMICS THAT STOP GUANINE SYNTHESIS: 6-THIOGUANINE
--Tioguanine (INN), formerly Thioguanine (BAN)
--used in the treatment of cancer, esp acute leukaemias and chronic myeloid leukaemia
--antimetabolite: guanine analog
--by pseudofeedback interference with purine biosynthesis
--interferes with the synthesis of guanine nucleotides
--disrupts DNA manufacture in dividing cells
--may cause trouble by incorporation of thioguanine nucleotides into both RNA and DNA
--induces cell cycle arrest and apoptosis
--metabolized via methylation by thiopurine methyltransferase

ALLOPATHIC TREATMENTS FOR PSORIATIC ARTHRITIS
--NSAIDS
--DMARDS = Disease-modifying antirheumatic drugs (DMARDs)
----may relieve more severe symptoms and attempt to slow or stop joint and tissue damage and progression of psoriatic arthritis. Biologics, such as Enbrel, Humira and Remicade, are also considered DMARDs.

DMARD AND ANTIMALARIAL: PLAQUENIL
--commonly used with success in rheumatoid & psoriatic arthritis
--a pill once a day
--many months before seeing benefits
--side effects: vision changes (blurring, halos around lights, sensitivity to light), headache, dizziness, nausea and vomiting
--GET eye examinations periodically
--most common: Plaquenil = Hydroxychloroquine
----used to prevent or treat some malaria infections caused by mosquito bites
----also used, usually with other medications, to treat certain auto-immune diseases (lupus, rheumatoid arthritis) when other medications have not worked or cannot be used. It belongs to a class of medications known as disease-modifying antirheumatic drugs (DMARDs)
----can reduce skin problems in lupus and prevent swelling/pain in arthritis, though it is not known exactly how the drug works.
----may also be used for other types of infections (e.g., Q fever endocarditis).
----antimalarials can cause skin psoriasis to get worse in some individuals
----DMARD = disease-modifying antirheumatic drug

ANTI-TNF SYSTEMICS: ENBREL FOR ARTHRITIS, SUBCU IMMUNE SUPPRESSOR
--ENBREL blocks TNF-alpha, tissue necrosis factor, limits inflam response
--according to drug makers: People w/ immune disease have too much TNF. http://www.enbrel.com/
--ENBREL can lower the ability of your immune system to fight infections
--originally approved for rheumatoid arthritis in 1998
--reduced the progression of joint damage for two years among psoriatic arthritis pts
--Tx is once- or twice-weekly
--subcutaneous self-injections
--dose for adult patients with psoriatic arthitis is 50 mg/week
--Enbrel suppresses a cellular "messenger" called tumor necrosis factor-alpha (TNF-alpha) that helps trigger inflam.

ANTI-TNF SYSTEMICS: HUMIRA
--works by supressing TNF-alpha
--aka by its generic name adalimumab
--also approved to treat rheumatoid arthritis
--studied for Tx of psoriasis, some doctors are already prescribing it "off label"
--Tx is 40 mg, subcutaneous self-injections every other week.

ANTI-TNF SYSTEMICS: REMICADE
--another anti-TNF-alpha drug
--aka infliximab (generic name)
--also approved for ankylosing spondylitis, ulcerative colitis, rheumatoid arthritis and Crohn's disease
--being studied for the treatment of psoriasis, and some doctors are already prescribing it "off-label" for this disease.
--Tx is 5 mg per kilogram (kg) in three IV infusions in a doctor's office during the first six weeks of treatment. After the first three, continue Remicade infusions at regular intervals of eight weeks.

SYSTEMIC CORTICOSTEROIDS
--ORAL Steroid meds not generally recommended for long-term Tx of psoriatic arthritis
--used for relief of acute, severe joint inflammation and swelling
--large doses of steroids should be avoided because psoriasis lesions may get worse when Tx discontinued
--some severe forms of psoriasis, such as pustular psoriasis, may be provoked by the use of systemic steroids
--selective low-dose steroid injections to inflamed joints, tendons and the area around joints can improve ROM

FAR OUT: GOLD (CHRYSOTHERAPY) = injection of gold salts and administration of gold capsules by mouth
--for arthritis affecting the limbs
--not for treating arthritis of the spine
--also has been reported to be beneficial for rheumatoid arthritis
--use has declined somewhat in recent years

SYSTEMICS: IMURAN
--immunosuppressive drug
--potent anti-inflammatory effects
--for Skin lesions
--need regular blood tests

SYSTEMICS: SULFASALAZINE
--a sulfa drug developed to treat inflammatory bowel diseases, is sometimes used for psoriatic arthritis. Approximately one-third of psoriatic arthritis patients respond rapidly to this treatment (usually within four to eight weeks).
--a tablet given in evenly divided doses over a 24-hour period of time
--not recommended in patients with sulfa allergies, people with intestinal or urinary obstructions and individuals suffering from porphyria, a metabolism disease
--may require regular blood tests while a patient is on sulfasalazine to monitor cell counts and liver enzymes
--side effects: nausea, rash, headache, abdominal pain, vomiting, fever and dizziness.

SOURCES
http://www.psoriasis.org/about/stats/ (The treatments suggested by this site are entirely allopathic, and they say you had BETTER consult your doctor before you try any of that crazy alternative stuff. Also, they were very interested in reporting when each drug was OK'd by the FDA.)

Mercola at: http://v.mercola.com/blogs/public_blog/Psoriasis-Can-Triple-Your-Heart-Attack-Risks-1142.aspx

On Heart Attack Risk in young people with severe psoriasis
http://jama.ama-assn.org/cgi/content/full/296/14/1735

Carolyn Dean, M.D., N.D., is health advisor to Woman's Health Connection at www.yeastconnection.com and is featured on the website's "Ask the Expert" page. She has written Hormone Balance (to be released Spring 2005), Everything Alzheimer's, The Miracle of Magnesium and Natural Prescriptions for Common Ailments.

Medline
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601010.html

WebMD
http://www.webmd.com/drugs/drug-6986-Plaquenil+Oral.aspx?drugid=6986&drugname=Plaquenil+Oral

Comments

( 7 comments — Leave a comment )
neptunia67
Feb. 29th, 2008 04:06 am (UTC)
You don't mention the scalp. Psoriasis is quite common on the scalp. I have had psoriasis for about twenty-five years, on the scalp, inside my ears, on the feet, and palms of my hands. Major change in diet has helped much of it, but I still get corticosteroid injections in my scalp about once/year to control plaque build-up and dandruff. Not to mention that when it itches, it is impossible to ignore.
liveonearth
Feb. 29th, 2008 05:22 am (UTC)
Thanks! What other treatments have you tried? I'm adding the scalp.
neptunia67
Mar. 9th, 2008 08:46 pm (UTC)
I have tried all of the topical homeopathic remedies available, as well as salicylic acid, betamethasone, hydrocortisone, Head & Shoulders, zinc shampoo, and a couple of homemade occlusions that were made by my pharmacist in England. Very greasy, I think they had a petroleum base. I had to put them on my scalp and wear a shower cap to bed. There have been more over the years but I don't remember what they were called.

Current treatment includes a series of cortisone injections directly into the lesions, as well as topical application of 0.05% clobetasol propionate foam about twice/week, and 1% tar shampoo. I use Neutrogena T-Gel extra strength. I have been on this treatment for about four years now and it works pretty well. The series of injections takes place in three visits each three to four weeks apart, about once a year.

I also use 0.05% betamethasone dipropionate ointment (augmented with propylene glycol, propylene glycol monostearate, white wax and white petroleum) for my ears, once or twice a week. If they are not bothering me I don't use it at all, and sometimes I just moisturize them with lotion.

Edited at 2008-03-09 08:47 pm (UTC)
liveonearth
Mar. 10th, 2008 02:12 am (UTC)
Goodness gracious, that's a lot. My heart goes out to you.
neptunia67
Mar. 10th, 2008 02:07 pm (UTC)
Thanks. I have been dealing with this since I was sixteen, so have gone through many, many treatments. It is so much better now than it used to be. I am certain my dietary changes have made a huge improvement.
(Anonymous)
Sep. 27th, 2008 07:42 am (UTC)
Psoriasis diet change
What dietary changes helped improve your psoriasis?
(Anonymous)
Jul. 13th, 2008 05:56 am (UTC)
Use dead sea products
Use dead sea products, dead sea salt and dead sea mud, also try the creams. Look for products with natural content. Search for seanerals in google. Seanerals is a brand that offeres all natural dead sea products
( 7 comments — Leave a comment )

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