A chronic skin disease that occurs when the immune system increases the growth cycle of skin cells, the condition most commonly manifests as raised, red patches covered by a white buildup of dead skin cells, though it can take other forms as well.
When Janis finally sought treatment for her psoriasis several years ago, she says, the key was in finding the right combination for her body. “I started with oral medication and creams, but once I tried one of the injectable medications, within two weeks, my skin was more or less cleared up.”
That first injectable treatment, known as Enbrel®, gave her about five years of relief before her body built up an immunity and the psoriasis started to come back. Curious about what might have changed during those five years, Janis says she sought the advice of a new dermatologist, hoping that he might provide a new approach. Fortunately, she was not disappointed.
Innovations in dermatology
For Matthew H. Mahoney, MD, an experienced dermatologist and founder of Mahoney Dermatology Specialists in Largo, evolutions in psoriasis treatment are especially exciting, given the number of people who suffer with the condition. “Psoriasis is quite common,” he explains, “and in severe cases, when it involves large areas of skin or debilitating areas like the eyelids or hands or feet, it can be life-altering.”
To help those people, as well as those with mild cases of psoriasis, there are a number of new treatment modalities, the doctor informs. “For patients like Janis, the two most effective new injectable drugs are the biologics. They are called biologics because they target specific proteins within the body.”
These medications, Humira® and Stelara®, are achieving dramatic results for many patients, he says, helping them to return to their activities of daily living. “Humira requires an injection every two weeks, while Stelara is administered every three months.”
In addition, Dr. Mahoney notes, Humira is particularly effective for patients who also suffer from psoriatic arthritis, which is a related condition affecting as many as ten to 15 percent of all psoriasis sufferers. “Psoriatic arthritis is a destructive process that can damage the bones, similar to rheumatoid arthritis,” he says, “and going without treatment can lead to impairment of the joints over time.”
While Stelara does not treat psoriatic arthritis, both Humira and Enbrel have proven very successful for patients with severe psoriasis, according to the doctor. “Sometimes, you have patients who have terrible psoriasis and they can’t walk because their feet, ankles, or knees are so severely involved,” he says. “We treat them with Enbrel or Humira and they can suddenly ambulate fine and their psoriasis is gone. It really can be a dramatic turnaround, often fairly rapidly.”
Beyond injectable medications, Dr. Mahoney adds, there are a number of other treatments available as well. “Narrow-band UVB therapy, or light therapy, has improved quite a bit, making it safer and creating less risk of skin cancer,” he informs. “There are also a lot of new topical treatments, which are a very good option.”
Unlike creams and ointments of the past, which were thick and messy, many new preparations are alcohol-based so they dry quickly, the doctor notes. “In that family of treatments, there is a liquid solution, as well as sprays and foams. Once they are dry, they’re dry, so these are great for people who don’t want to walk around with damp, greasy preparations on their elbows or knees.”
Another innovative advance, he says, is the use of Vitamin D in a cream or ointment form. “Vitamin D convinces skin cells to stop dividing so rapidly,” he explains, “which is what is happening in psoriasis. There are also medications typically used to treat acne that also keep cells from dividing so quickly, so patients don’t get those big, thick plaques associated with psoriasis.”
Additionally, for localized disease – meaning just one or two patches of psoriasis – Dr. Mahoney says that it is even possible to inject the areas with a steroid. “That method can sometimes lead to months of remission.”
Finally, as a systemic treatment for more severe cases, oral medications are another possibility, either used alone or in combination with other medications. “The one I probably use most is methotrexate, but there is also acitretin,” he shares.
The right combination
When Dr. Mahoney first saw Janis, her psoriasis was growing steadily worse despite her initial long-term success with Enbrel. “Janis is someone in the severe category that I described,” he says. “For these patients, the condition may become so severe that it covers their whole scalp, their ears, their chest, back, arms, and legs. And once it starts to cover large surface areas of the body, it can be really devastating to patients, including embarrassment when trying to go out in public.”
In fact, the doctor informs, many people don’t realize that many of the Bible’s references to leprosy were probably referring to people with psoriasis. “Leprosy is actually a contagious disease, but psoriasis is not at all contagious. It’s an autoimmune process, aggravated by stress.”
To best treat Janis, he opted to try Humira because she also struggled with psoriatic arthritis. “The Humira helped her everywhere but the ears, so we used a little bit of a topical preparation on her as well. She was very, very happy with that for a long time.”
“The Humira worked really well,” Janis agrees. “Before I tried it, the arthritis was so bad that I couldn’t even put my elbows down.”
Unfortunately, Dr. Mahoney says, the Humira eventually lost some of its effect. “She noticed some small patches coming back,” he says. “Some people are able to be on the same medication for years, and then, in others, I think the immune system builds antibodies to the antibody we’re putting into the patient.”
Determined to find the best solution, the doctor then put Janis on Stelara, and they are both optimistic about the results. “Stelara is the newest and probably the most effective treatment for psoriasis. It’s so important that people understand that these new treatments exist.”
Happy to now have so much more control over her condition, Janis could not agree more. “People need to try these things out,” she says. “I went for years without anything and then, when I started getting treatment, I thought, What was I thinking all that time ?
“Just don’t give up,” she stresses.
FHCN – Brenda Klettke