Psoriasis - what's new? | Expert Guide from the Dailymail
(Dailymail.co.uk) - In this, the final part of our unique HOW TO BEAT series, we have worked closely with experts in each field of dermatology to bring you cutting-edge information about your complaint and the newest treatments available. It could be life-transforming.
This skin condition — characterised by raised flaking, itching red patches on various parts of the body — affects around 1.8 million people in Britain, most of them first affected before their 40th birthday.
It is an immune condition that causes the body to produce too many new skin cells. The extra cells accumulate and cluster in red, inflamed patches, thickening the skin, which often has a ‘silvery scale’ appearance.
A virus or infection such as tonsillitis — when the immune system is weakened — can trigger the condition in those with a genetic predisposition, as can a stressful event, says Christopher Griffiths, professor of dermatology at the University of Manchester and a world expert on psoriasis.
Around 30 per cent of people with psoriasis get painful joints — sometimes the joint pain comes before the skin condition appears — because the immune system targets the joints, triggering psoriatic arthritis.
SO WHAT WORKS?
The old and trusted methods of treating psoriasis are fast falling out of favour and there is new hope on the horizon in the form of a powerful injection and, in a year’s time, a once-a-day tablet that could halt symptoms in their tracks.
For the past 100 years products containing coal tar, a thick, heavy oil with a strong smell have been used for psoriasis.
They are still used today in some centres alongside a treatment called PUVA, which combines light therapy with psoralen tablets (psoralens are synthetic versions of compounds found in plants that increase the skin’s sensitivity to UV light).
This triggers a chemical reaction that slows down the production of skin cells. But coal tar can be unpleasant to use (it is smelly and can be messy) and PUVA has been linked with skin cancer.
‘When PUVA was introduced 40 years ago, the risks hadn’t been determined and though it was highly effective, people used it too often,’ says Professor Griffiths. ‘It not only increased wrinkles and brown spots but also the incidence of skin cancer.’
PUVA is still offered on the NHS but treatments are limited to one a year. Instead, specialists increasingly favour UV treatment (see laser box) which has a lower risk of skin cancer.
Mild cases of psoriasis can now be treated using gels containing vitamin D — which slows the over-active build-up of the top layer of skin — combined with a corticosteroid, which can dampen down the immune response.
And for severe cases — particularly where patients also have psoriatic arthritis — regular treatment with new ‘biologic’ injections can make a significant difference.
The treatment helps block the chemicals that lead to the immune response. ‘This new treatment has transformed the lives of patients with severe psoriasis in the past decade,’ says Professor Griffiths.
The injections are administered by the patient — just as someone with diabetes injects insulin — once a week or once every 12 weeks, depending on the type of treatment.
Four different biological therapies have been approved by the National Institute for Health and Care Excellence (NICE) and, according to Professor Williams, one more which promises to be even more effective is due for approval within 12 months.
‘Thirty years ago these patients would have been having significant amounts of PUVA, spending time in hospital and increasing their skin cancer risk — but now we can give them back normal lives,’ says Professor Griffiths.
The drugs are, however, expensive, so dermatologists use them only as a last resort, and come with the possibilities of side-effects such as increased risk of infection, rashes and, in very rare cases, neurological symptoms (such as seizures and inflammation of the nerves of the eyes) .
Another ground-breaking treatment, a new once-a-day tablet called apremilast, could become available in the UK in the next year. It works by inhibiting an enzyme in immune cells, causing an anti-inflammatory effect.
Trials on the drug in the U.S. have been promising and NICE is currently reviewing it as a treatment. Professor Griffiths has been conducting clinical trials of the drug in the UK.
‘So far, the results have been promising,’ he says. ‘If the drug is approved by NICE, it could further revolutionise the treatment of psoriasis.’
Being overweight is associated with a higher incidence of skin problems including psoriasis. As Neil Walker, a consultant dermatologist at the Lister Hospital, London, explains: ‘The science of this isn’t fully understood — we don’t know whether it’s being overweight that causes psoriasis or whether having psoriasis makes it more likely you will gain weight.’
The experts’ favourite products: For a moisturiser try La Roche Posay’s Iso-Urea Anti-Flake Body Milk, £14.
It contains humectants — substances that increase the moisture levels in the skin and also acts to gently remove surface skin cells, says Dr Joanna Gach, consultant dermatologist at University Hospital Coventry and BMI Meriden in Coventry. Dr Bewley suggests simple washes and creams and E45 moisturisers, £5.50.
Read more: http://www.dailymail.co.uk/health/article-2761187/What-s-spoiling-skin-From-eczema-acne-cold-sores-cancer-read-expert-guide-causes-best-treatments.html#ixzz3FJBBtfMn
This skin condition — characterised by raised flaking, itching red patches on various parts of the body — affects around 1.8 million people in Britain, most of them first affected before their 40th birthday.
It is an immune condition that causes the body to produce too many new skin cells. The extra cells accumulate and cluster in red, inflamed patches, thickening the skin, which often has a ‘silvery scale’ appearance.
A virus or infection such as tonsillitis — when the immune system is weakened — can trigger the condition in those with a genetic predisposition, as can a stressful event, says Christopher Griffiths, professor of dermatology at the University of Manchester and a world expert on psoriasis.
Around 30 per cent of people with psoriasis get painful joints — sometimes the joint pain comes before the skin condition appears — because the immune system targets the joints, triggering psoriatic arthritis.
SO WHAT WORKS?
The old and trusted methods of treating psoriasis are fast falling out of favour and there is new hope on the horizon in the form of a powerful injection and, in a year’s time, a once-a-day tablet that could halt symptoms in their tracks.
For the past 100 years products containing coal tar, a thick, heavy oil with a strong smell have been used for psoriasis.
They are still used today in some centres alongside a treatment called PUVA, which combines light therapy with psoralen tablets (psoralens are synthetic versions of compounds found in plants that increase the skin’s sensitivity to UV light).
This triggers a chemical reaction that slows down the production of skin cells. But coal tar can be unpleasant to use (it is smelly and can be messy) and PUVA has been linked with skin cancer.
‘When PUVA was introduced 40 years ago, the risks hadn’t been determined and though it was highly effective, people used it too often,’ says Professor Griffiths. ‘It not only increased wrinkles and brown spots but also the incidence of skin cancer.’
PUVA is still offered on the NHS but treatments are limited to one a year. Instead, specialists increasingly favour UV treatment (see laser box) which has a lower risk of skin cancer.
Mild cases of psoriasis can now be treated using gels containing vitamin D — which slows the over-active build-up of the top layer of skin — combined with a corticosteroid, which can dampen down the immune response.
And for severe cases — particularly where patients also have psoriatic arthritis — regular treatment with new ‘biologic’ injections can make a significant difference.
The treatment helps block the chemicals that lead to the immune response. ‘This new treatment has transformed the lives of patients with severe psoriasis in the past decade,’ says Professor Griffiths.
The injections are administered by the patient — just as someone with diabetes injects insulin — once a week or once every 12 weeks, depending on the type of treatment.
Four different biological therapies have been approved by the National Institute for Health and Care Excellence (NICE) and, according to Professor Williams, one more which promises to be even more effective is due for approval within 12 months.
‘Thirty years ago these patients would have been having significant amounts of PUVA, spending time in hospital and increasing their skin cancer risk — but now we can give them back normal lives,’ says Professor Griffiths.
The drugs are, however, expensive, so dermatologists use them only as a last resort, and come with the possibilities of side-effects such as increased risk of infection, rashes and, in very rare cases, neurological symptoms (such as seizures and inflammation of the nerves of the eyes) .
Another ground-breaking treatment, a new once-a-day tablet called apremilast, could become available in the UK in the next year. It works by inhibiting an enzyme in immune cells, causing an anti-inflammatory effect.
Trials on the drug in the U.S. have been promising and NICE is currently reviewing it as a treatment. Professor Griffiths has been conducting clinical trials of the drug in the UK.
‘So far, the results have been promising,’ he says. ‘If the drug is approved by NICE, it could further revolutionise the treatment of psoriasis.’
Being overweight is associated with a higher incidence of skin problems including psoriasis. As Neil Walker, a consultant dermatologist at the Lister Hospital, London, explains: ‘The science of this isn’t fully understood — we don’t know whether it’s being overweight that causes psoriasis or whether having psoriasis makes it more likely you will gain weight.’
The experts’ favourite products: For a moisturiser try La Roche Posay’s Iso-Urea Anti-Flake Body Milk, £14.
It contains humectants — substances that increase the moisture levels in the skin and also acts to gently remove surface skin cells, says Dr Joanna Gach, consultant dermatologist at University Hospital Coventry and BMI Meriden in Coventry. Dr Bewley suggests simple washes and creams and E45 moisturisers, £5.50.
Read more: http://www.dailymail.co.uk/health/article-2761187/What-s-spoiling-skin-From-eczema-acne-cold-sores-cancer-read-expert-guide-causes-best-treatments.html#ixzz3FJBBtfMn
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