Psoriasis

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The approval of abatacept (Orencia/Bristol-Myers Squibb) for psoriatic arthritis (PsA) earlier this month by the FDA offers a new treatment option for patients who are struggling to keep the disease under control.

As research advances understanding of psoriasis, drug development evolves to address various pathways to disease. A number of possibilities, now in clinical trials, appear safe, effective and promising with improved long-term clearance rates.

Newer medications have revolutionized psoriasis care in patients with moderate-to-severe cases, says a leading dermatologist, and more drugs in the pipeline promise to offer even more choices.

Indigo naturalis is an Old-World plant with multiple uses. Used in China for centuries as a traditional medicine, current clinical studies are proving its effectiveness as well as identifying mechanisms of action.

Dermatologists could be making greater use of topical retinoids and vitamin D preparations in treating a variety of hyperproliferative and other skin disorders. In the early days of psoriasis treatment, the “sandwich theory” focused on epidermal turnover and inflammation, with one drug or strategy for each layer.

Although many systemic immunomodulators are approved for psoriasis, their mechanisms of action suggest they have utility in indications ranging from atopic dermatitis (AD) to chronic urticaria. Understanding a systemic immunomodulator’s mechanism of action provides a theoretical basis for uses beyond its labeled indication.

Kevin D. Cooper, M.D., professor and chair of dermatology at Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, and Steven R. Feldman, M.D., Ph.D., professor of dermatology, Wake Forest University School of Medicine, Winston-Salem, N.C., weigh in on important gaps in dermatology research today.

Getting patients to use their prescriptions is another story-one that's shockingly understudied in dermatology. Just what works to improve medication adherence has stumped researchers outside dermatology. Several studies are cited.

Key trends among topical treatments for psoriasis include the potential reformulation of systemic therapies into topical form, the search for steroid alternatives and the optimization of vehicles, an expert says.

Richard D. Granstein, M.D., chairman of dermatology, Weill Cornell Medical College, New York, has conducted research on how the nervous system and, perhaps, stress can make psoriasis worse or control the phenotypic expression of psoriasis.

Many doctors, including dermatologists, would rather not address patients’ feelings about psoriasis. It’s part of how dermatologists protect themselves from bearing the burdens of patients’ woes, according to Richard Fried, M.D., Ph.D., a dermatologist and clinical psychologist in Yardley, Pennsylvania.

Psoriasis in nonwhite patient populations is not well described, according to Andrew F. Alexis, M.D., M.P.H., director of the Skin of Color Center, at St. Luke’s Roosevelt Hospital, Mount Sinai Health System, New York.