Psoriasis Treatments
Treating your psoriasis is critical to good disease management and overall health. Did you know that patients with psoriasis are at greater risk for Metabolic disorders, including diabetes, high blood pressure and heart disease? What works for one person with psoriasis might not work for another. So it's important to know the different treatment options and keep trying until you find the right regimen for you. Dr. Resnik has a special interest in helping patients successfully battle Psoriasis and Psoriatic Arthritis. He started the Miami Psoriasis Support Group 4 years ago and watched it grow into a vital part of the Tri-County area community. He is expert in the use of all the psoriasis therapies and will not stop trying until you do!
Psoriasis Severity
People with psoriasis on less than three percent of their body are considered to have a mild case. Those with three to 10 percent of the body affected by psoriasis are considered a moderate case. More than 10 percent is considered severe. (The surface area of the hand equals about one percent of the skin.) This grading scale favors insurance companies as they use these measures to arbitrarily deny effective medicines on the basis of lack of body surface area (BSA) involvement. This classification however does not take into account how your psoriasis affects your daily life. Dr Resnik strives to improve your quality of life by using all the tools available. Some people may not be bothered by head-to-toe psoriasis, (classified as severe by BSA count), while someone with involvement only of the palms (classified as mild by BSA count) may not be able to work because people won't want to shake his or her hand.
Types of treatments
Topical treatments
These usually consist of tar preparations, cortisone creams of varying strengths, calcium analogues, or exfoliative preparations with glycolic or salicylic acid. These can help small areas, but are a pain to put all over the body and, to add insult to injury, are usually dispensed in sizes which will run out in 2 days of appropriate use.
Phototherapy
Present in natural sunlight, UVB is an effective treatment for psoriasis. UVB penetrates the skin and slows the growth of affected skin cells. Treatment involves exposing the skin to an artificial UVB light source for a set length of time on a regular schedule. This treatment is administered in a medical setting or at home. Narrow band UVB puts out the active wavelength of sunlight, 311nm. Several studies indicate that narrow-band UVB clears psoriasis faster and produces longer remissions than broad-band UVB. NB-UVB phototherapy is available 5 days a week in our office.
Systemic medicines
Systemic medications are prescription drugs that work throughout the body. They are usually used for individuals with moderate to severe psoriasis and psoriatic arthritis, or psoriasis which affects your Quality of Life.
Systemic psoriasis drugs are taken by mouth in liquid or pill form or given by injection and fall into two categories: "traditional systemic" and "biologics." Traditional systemics have been used for more than 60 years.
Biologics
Biologics are a relatively new class of treatments for psoriasis and psoriatic arthritis. Soriatane (acitretin) Soriatane is an oral retinoid, which is a synthetic form of vitamin A. Acitretin is the only oral retinoid approved by the FDA specifically for treating psoriasis. The exact way Soriatane works to control psoriasis is unknown. In general, retinoids help control the multiplication of cells including the speed at which skin cells grow and shed. It is only used in men and women who are no of child-bearing potential. It has the advantage of making other therapies work more effectively, allowing us to lower the dose of both therapies. Cyclosporine Cyclosporine is an immunosuppressive drug that was first used to help prevent rejection in organ transplant patients. In 1997, the Food and Drug Administration (FDA) approved Neoral at much lower dose for people with severe psoriasis and otherwise normal immune systems. Cyclosporine selectively suppresses the immune system and slows down the growth of certain immune cells. Methotrexate Approved by the FDA in the 1970s for treatment of severe psoriasis, methotrexate was initially used to treat cancer. The drug is also highly effective in reducing the painful symptoms of psoriatic arthritis. In a person with psoriasis, methotrexate binds to and inhibits an enzyme involved in the rapid growth of skin cells and slows down their growth rate. Biologics
Biologic drugs, or "biologics," are a relatively new class of treatment for psoriasis and psoriatic arthritis treatments. They are given by injection or intravenous (IV) infusion.
A biologic is a protein-based drug derived from living cells cultured in a laboratory. While biologics have been used to treat disease for more than 100 years, the advent of modern day molecular biologic techniques has accelerated their use in modern day medicine tremendously in the last decade.
Different from the traditional systemic drugs that impact the entire immune system, biologics target specific parts of the immune system. The biologics used to treat psoriatic diseases act by blocking the action of a specific type of immune cell called a T cell, or by blocking proteins in the immune system, such as tumor necrosis factor-alpha (TNF-alpha) or interleukins 12 and 23. These cells and proteins all play a major role in developing psoriasis and psoriatic arthritis.
Tumor necrosis factor-alpha (TNF-alpha) blockers
Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab) and Simponi (golimumab) are drugs that block TNF-alpha. TNF-alpha is an immune system mediator called a cytokine that is a key mediator of inflammation. In psoriasis and psoriatic arthritis, there is excess production of TNF-alpha in the skin or joints that leads to the rapid growth of skin cells and/or damage to joint tissue. Blocking the TNF-alpha helps to stop the inflammatory cycle of psoriatic diseases.
Interleukin 12/23
Stelara (ustekinumab) works by selectively targeting the cytokines interleukin-12 (IL12) and interleukin 23 (IL23). Interleukins-12/23 are also cytokines which are thought to promote the inflammation associated with psoriasis.
Complementary Approaches
Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices and products that are not presently considered to be part of conventional, or Western, medicine. These can include Reiki, acupressure and acupuncture, and herbal and nutritional remedies. Dr Resnik believes that there are some things that help some of the people some of the time. He is always ready to accept things that work!
Ox Bile
There is evidence to suggest that some patients with psoriasis have "leaky" guts. Both the small bowel and the large bowel contain toxins and breakdown products produced by bacterial organisms; sometimes leaks may allow these toxic substances into the bloodstream. This toxic bacterial cell wall material is called bacterial peptidoglycan (PG). If it gets into the blood, and then circulates to the skin, it can trigger the innate immune system at the skin surface, leading to the development or worsening of psoriasis. The use of ox bile is intended to break up these endotoxins in the gut, prevent their absorption, and spare the liver the toxic effects.