RxPG News : Psoriasis

Psoriasis increases risk for heart attack

Wed, 11 Oct 2006 04:43:37 PST

( from http://www.rxpgnews.com ) Adults with psoriasis, especially younger patients with severe psoriasis, appear to be at increased risk for a heart attack, according to a study in the October 11 issue of JAMA.

Psoriasis is a common, chronic disease that affects about 2 percent to 3 percent of the adult population. It is associated with markers of systemic inflammation, such as increased C-reactive protein levels, which have been linked to the development of atherosclerosis and myocardial infarction (MI; heart attack), according to background information in the article. Several hospital-based studies have indicated that psoriasis is associated with a higher prevalence of cardiovascular diseases, including heart attack, but these studies did not control for major cardiovascular risk factors.

Joel M. Gelfand, M.D., M.S.C.E., and colleagues from the University of Pennsylvania, Philadelphia, conducted a perspective population-based cohort study to determine the risk of heart attack in patients with psoriasis when controlling for major cardiovascular risk factors. The study, which included a total of 556,995 control patients, and patients with mild (n = 127,139) and severe psoriasis (n = 3,837), compared outcomes among patients with and without a diagnosis of psoriasis. The patients, living in the United Kingdom, were 20 to 90 years of age. Adjustments were made for hypertension, diabetes, history of heart attack, hyperlipidemia (an excess of fats or lipids in the blood), age, sex, smoking, and body mass index. Up to five controls without psoriasis were randomly selected from the same practices and start dates as the patients with psoriasis.

The researchers found that the incidence of heart attack was higher in patients with severe psoriasis (5.13 MIs per 1,000 person-years) and mild psoriasis (4.04 MIs per 1,000 person-years) compared with control patients (3.58 MIs per 1,000 person-years), with patients who were younger and had severe psoriasis having the highest rate. For example, a 30-year-old patient with mild psoriasis had a 29 percent greater risk of having a heart attack than a patient without psoriasis; a 30-year-old patient with severe psoriasis had about three times the risk. A 60-year-old patient with severe psoriasis had a 36 percent increased risk for heart attack.

The magnitude of association between severe psoriasis and MI in those patients younger than 50 years is similar to the magnitude of association for other major cardiac risk factors, the authors write.

Our findings are novel and therefore it is important that additional studies be performed to confirm these results and determine their therapeutic implications. In particular, it is important to determine the impact of clinical markers of psoriasis activity, such as body surface area, as well as biomarkers of systemic inflammation (e.g., C-reactive protein) on the risk of MI in patients with psoriasis. In the meantime, as part of good medical care, patients with psoriasis should be encouraged to aggressively address their modifiable cardiovascular risk factors, the researchers conclude.

UV-A therapy more effective than narrowband UV-B therapy in chronic plaque psoriasis

Mon, 31 Jul 2006 17:30:37 PST

( from http://www.rxpgnews.com ) UV-A therapy was found to be more effective than narrowband UV-B therapy in treating patients with chronic plaque psoriasis, according to an article in the July issue of Archives of Dermatology.

It is unclear whether narrowband UV-B (NB-UVB) therapy is as effective as psoralen-UV-A (PUVA) therapy in treating psoriasis, according to background information in the article. PUVA therapy includes the combination of 8-methoxypsoralen medication (taken orally) and exposure to UV-A (long-wave) radiation. NB-UVB involves exposure to UV-B (short-wave) radiation and is thought to be safer than PUVA.

Sami S. Yones, M.Sc., and colleagues from King's College London conducted a randomized, double-blind trial comparing the efficacy of PUVA and NB-UVB therapies in treating chronic plaque psoriasis. Ninety-three patients with moderate-to-severe cases of the disease were recruited to participate in the study. Two hours before receiving UV treatment, patients in the NB-UVB group took a placebo and those in the PUVA group took 10-mg of 8-methoxypsoralen. Patients in both groups attended sessions twice weekly until their skin cleared, up to a maximum of 30 sessions. Patients whose skin cleared were followed up until relapse or for 12 months.

In patients with skin types I through IV (skin more likely to burn), PUVA was more effective than NB-UVB at clearing skin, with respective 84 percent vs. 65 percent clearance. Patients in the PUVA group also achieved skin clearance in a significantly shorter number of treatments, a median of 17 treatments, compared to 28.5 treatments in the NB-UVB group. Nearly half of patients in the PUVA group experienced erythema (redness of the skin) at some point during treatment, compared to less than one-quarter in the NB-UVB group. Six months after skin clearance was achieved, 68 percent of patients in the PUVA group were still clear compared to 35 percent of patients in the NB-UVB group. Overall, patients with skin types V and VI had a lower rate of clearance than those with skin types I through IV (24 percent vs. 75 percent).

The authors write that despite the disadvantages of PUVA treatment (i.e., may cause nausea, has the potential to cause skin cancer, cannot be used during pregnancy), their results "suggest that PUVA compared with NB-UVB tends to clear psoriasis more reliably, with fewer treatments and for longer and should, therefore, still be used in appropriate patients."

Dithranol may hold more hope for psoriasis sufferers

Tue, 06 Sep 2005 00:19:38 PST

( from http://www.rxpgnews.com ) Scientists at the University of Newcastle upon Tyne, studying the effects of a drug used in the treatment of a distressing skin condition, have found that it is actually killing off the cells which are the cause of the problem.

The team believe the discovery represents a major step towards enabling the design of better treatments for psoriasis, which affects up to a million people in the UK alone (figures from the Psoriasis Association).

Dithranol, which is widely used in the treatment of psoriasis, is derived from a natural compound, called chrysarobin. Chrysarobin is prepared from the araroba tree found in the rain forests of the Amazon. In India, the same substance is known as Goa powder.

Psoriasis is a genetic condition which, when triggered by certain factors such as injury or throat infection, leads to an over-production of skin cells ¬¬ called keratinocytes which causes a thickening of the skin, resulting in the raised red, scaly patches characteristic of psoriasis.

The team of scientists, led by Professor Nick Reynolds and Dr Mark Birch-Machin, of the Skin and Environmental Interactions Research Group in the School of Clinical and Laboratory Sciences at Newcastle University, studied the effects of dithranol an ointment applied to the surface of the skin which is used in the treatment of severe cases of psoriasis.

Professor Reynolds says: 'Psoriasis is what is known as a relapsing/remitting condition, which means that sufferers don't display the symptoms all of the time. Dithranol is a very effective treatment for episodes of psoriasis and it has been around for a long time, since the early 1900s. By studying the action of the drug, we wanted to gain a better understanding of how it works, to give us an insight into the mechanism of the condition.'

Laboratory studies showed that dithranol very quickly targeted skin cells' mitochondria the part of a cell from which it draws its energy causing the cells to die within 24 48 hours of the application of the drug, through a process of programmed cell death.

Professor Reynolds continued: 'Although dithranol is a very effective and safe treatment for psoriasis, its widespread use is limited because it is quite difficult to use and causes dark brown stains on clothing and bedding. Also, if it is not used properly, it can cause irritation or burning to the skin around the affected area, so it is most commonly used in hospitals, where the application of the ointment can be overseen by a nurse.'

Most people suffering an episode of psoriasis that requires treatment with dithranol therefore have either to attend hospital as an outpatient five days a week for a six week course of treatment, or be admitted for a three-week period.

'In modern life, this is far from ideal', says Professor Reynolds. 'These findings represent an important step towards the development of better-designed treatments for psoriasis sufferers'.

Gladys Edwards, Chief Executive of the Psoriasis Association said: 'The Psoriasis Association welcomes these new research findings. It is so important to develop new, effective and safe treatments for psoriasis and this research is clearly a positive step forward'.

Increased levels of estrogen may improve psoriasis

Wed, 18 May 2005 16:58:38 PST

( from http://www.rxpgnews.com ) Increased levels of estrogen that occur during pregnancy may be associated with improvement in psoriasis, according to a study in the May issue of the Archives of Dermatology, one of the JAMA/Archives journals.

Anecdotal reports have suggested that psoriasis tends to improve during pregnancy, according to background information in the article. The current study investigated prospectively how psoriasis fluctuates in pregnancy and correlated progesterone and estrogen levels in pregnancy with psoriatic change.

Jenny E. Murase, M.D., of the University of California, Irvine, and colleagues compared changes over the course of one year in psoriatic body surface area in women with psoriasis in a group of 47 pregnant women and a control group of 27 non-pregnant pre-menopausal women. The women reported on their stress level, perceived psoriatic severity and the extent of their body surface affected by psoriasis five times over the course of the year: pregnant women at 10, 20 and 30 weeks gestation, and six and 24 weeks after birth and the control group at baseline, 10, 20, 36 and 54 weeks following enrollment. Hormone levels at each assessment were determined for 19 of the pregnant women.

During pregnancy, 55 percent of the patients reported improvement in psoriasis, 21 reported no change and 23 percent reported worsening. Only nine percent of patients reported improvement post partum, 26 reported no change and 65 percent reported worsening. Psoriatic body surface area decreased significantly from 10 to 20 weeks' gestation compared to controls and increased significantly six weeks post partum. Although 65 percent of the pregnant patients reported worsening, their psoriatic body surface area only returned to pre-pregnancy levels, the authors report. In pregnant women with 10 percent or greater psoriatic body surface area, lesions decreased by 83.8 percent during pregnancy. Psoriatic body surface area levels in the controls remained the same throughout the year.

"High level of estrogen correlated with improvement in psoriasis, whereas progesterone levels did not correlate with psoriatic change," the authors write. "We believe that further examination of how estrogen may improve psoriasis is warranted. ...Whether estriol [a form of estrogen] can improve psoriasis or can prevent worsening of psoriasis in menopause should be explored."