What categories of treatment options are available for Psoriasis?
Well, Gold Standard Treatments have been around for many years, including ultraviolet light, including just UVB, which can be administered in an office setting. Or something called PUVA, which is UVA, in addition to the patient takes a drug called Psoralen, which makes them light sensitive.
Topical steroids of course are a mainstay of treatment. Other topical agents such as topical retinoids called Tazorac is one brand name, vitamin D, derivatives, and tar preparations have been around for many, many years; it smells and it's messy, it stains their clothes, but it can work. And then of course we get into the immune blocking agents such as Methotrexate.
What are topical treatments indicated in treating Psoriasis?
Topicals would be a good choice for someone who has limited disease: elbows, knees, scalp, just certain areas, and the more skin surface involvement there is, the more likely that they would need oral therapy.
What role does phototherapy play in treating Psoriasis?
Phototherapy is good for someone with more skin involvement as well. But it's difficult for people who can't make it to the office three to five days a week, that's the difficulty with phototherapy.
Is sunlight also helpful in treating Psoriasis?
Sunlight is very helpful, and going to the beach, the saltwater, and the sunlight, there is actually a treatment called Dead Sea Therapy, those are things that are known to help Psoriasis. Not everybody benefits from sunlight, but I would say most patients do. That's why they typically get worse in the wintertime.
Are antirheumatic drugs useful in treating Psoriasis?
Well, a drug such as Methotrexate, which is actually a chemotherapeutic drug, is used in both psoriatic arthritis and Psoriasis, and is extremely helpful. However, you have to worry about liver toxicity.
With all of these treatments available, why are biologic agents necessary?
Your immune suppressants such as Methotrexate and Cyclosporine, suppress your immune systems, so they can have deleterious effects on the body, whereas your immune modifying agent, such as your biologics, specifically target the damaging proteins, so they don't have as much affect on your body.
How important has the approval of biologic agents for treating Psoriasis been for your patients?
It's an enormous breakthrough, because we have these drugs that are now targeted specifically to the problems in the skin with Psoriasis without affecting the normal cells, so it's a huge breakthrough for these patients.
How do biologic agents work in treating Psoriasis?
The biologic agents are often receptor antibody proteins, and one that's been looked at as a Tumor Necrosis Factor antibody called Enbrel. This helps by blocking specifically the Tumor Necrosis factor which is elevated in psoriatic lesions, without affecting normal cells. So you don't have the side effects of immune suppression. You don't have the side effects of depleting your normal T-Cells.
Are large numbers of Psoriasis patients reacting favorably to these biologic agents?
It seems to be working. It's certainly not 100%. In fact, if you look at 75% improvement in these scores they call PASI scores for Psoriasis, you may only get between a 35% and 45% improvement. It doesn't sound like a lot, but if you have got Psoriasis, you are willing to try anything.
And if you can get 50% improvement, you are going to have more patients that get that. So you are not always looking for clearing, in other words, if you can just get improvement, which it seems like these drugs are doing. They don't work right away, it may take three months or so to see improvement.
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