Psoriasis

• Psoriasis is a serious medical condition affecting the autoimmune system.
• The most common form, which affects about 80 percent of people who have the condition, is plaque psoriasis. It is characterized by patches of raised, reddish skin covered with silvery-white scales. Psoriasis usually occurs on the scalp, knees, elbows, hands, and feet.
• About 7.5 million Americans have psoriasis.
• In 2004, the total direct cost of treatment associated with psoriasis was $1.2 billion.

Psoriasis and Cardiovascular Risk

• A recent study in the Journal of the American Academy of Dermatology2 noted several medical conditions or situations that increase the cardiovascular risk for individuals who have mild to severe psoriasis, including:
• Smoking.
• Diabetes.
• Hypertension.
• Hyperlipidemia (an elevation of cholesterol lipids in the bloodstream).
• Increased Body Mass Index (BMI).
• Researchers who studied medical records of more than 680,000 British patients found that people in their 40s with severe psoriasis were more than twice as likely to suffer a heart attack than people without the skin disease.
• Mild psoriasis slightly raised the risk for heart attack by 20 percent for people in their 40s.

Treatment options

Biologics

• Biologic psoriasis medications are used to treat moderate to severe or disabling psoriasis and psoriatic arthritis.
• These treatments are made from living human or animal proteins and target the precise immune responses involved with psoriasis and the overactive cells that cause psoriasis.
• Current biologic medications, approved by the United States Food and Drug Administration and available only by prescription, include:

Adalimumab

• Blocks and helps lower the amount of TNF-alpha, a chemical found in the immune system that causes it to overreact, in the person's body, which helps reduce the inflammation that causes psoriatic arthritis.
• Approved for adults with moderate to severe chronic plaque psoriasis and psoriatic arthritis.

Alefacept

• Blocks the activation of T-cells (a type of white blood cell that helps fight disease and infection). T-cells overproduce in the skin of psoriasis patients, creating psoriasis lesions.
• Approved for treating moderate to severe plaque psoriasis in adults only.

Etanercept

• Inhibits excessive TNF-alpha production that can cause increased inflammation, swelling of the joints, scales, and thickness. In psoriasis, TNF-alpha is a chemical used by the immune system to signal the skin to reproduce and mature too quickly.
• Approved for the treatment of plaque psoriasis and psoriatic arthritis.

Infliximab

• Blocks and helps lower the amount of TNF-alpha, a chemical found in the immune system that causes it to overreact, in the person's body, which helps reduce the inflammation that causes psoriasis and psoriatic arthritis.
• Approved for adults who have severe plaque psoriasis and adults who have active and progressive psoriatic arthritis.

Phototherapy

• Ultraviolet light treatment, or phototherapy, is sometimes used to treat moderate to severe psoriasis and psoriasis that does not respond to topical therapy.
• The treatment involves exposing affected skin to wavelengths of ultraviolet light for a set length of time or a regular schedule under the supervision of a dermatologist.
• Phototherapy can be administered to adults and children when conventional psoriasis treatments have not been effective. It can be used in combination with topical treatments or systemic medications.
• Key phototherapy treatments include:

Ultraviolet B (UVB) Phototherapy

• Used to treat patients with moderate to severe psoriasis and thin plaques.
• Ultraviolet light induces biologic reactions in the skin's cells that decrease the number of skin cells that grow too quickly and kills T-cells in the skin, which can result in the clearing of psoriatic lesions.
• UVB phototherapy may be combined with another psoriasis therapy, such as the topical treatments calcipotriene (synthetic vitamin), tazarotene (retinoid) or anthralin, to increase effectiveness.

Psoralen + Ultraviolet Light A (PUVA)

• Treatment requires the patient to ingest, topically apply, or bathe in a medication called psoralen before being exposed to UVA rays.
• The combination of psoralen and UVA slows the rapid growth of skin cells and kills T-cells in the skin.

Excimer Laser

• Used to treat plaque psoriasis affecting limited areas of the body.
• Excimer lasers produce ultraviolet (UV) rays to induce biologic reactions in the skin's cells that reduce inflammation and decrease the number of skin cells that grow too quickly.