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News Bulletin December 2018

Psoriasis: Understanding fundamentals of Psoriasis- New Universe of Specialty Medications for treating psoriasis –FDA Approved

What you need to know about psoriasis

Psoriasis is a skin disease that affects over 7.5 million Americans. There are several types of psoriasis, including plaque, inverse, guttate, pustular and erythrodermic. Each type has unique characteristics.

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The typical form of psoriasis is marked by itchy, thick, red patches with silvery scales. Although these patches can appear on other parts of the body, they typically appear on the back, elbows, face, feet, knees and scalp.

Psoriasis is a long-term condition that often develops between the ages of 15 and 35. However, psoriasis can occur at any age.

How do you get psoriasis? It is triggered by an overactive immune system, which causes inflammation and a fast rate of skin cell turnover. Normal skin cells take about a month to grow deep in the skin and rise to the surface. But with psoriasis, the cells rise in a matter of days and even before they fully develop. The new and old cells then pile on top of the skin and result in redness and discomfort.

Genetics may also play a role in psoriasis. About one-third of people with psoriasis have a family member with the condition.

Psoriasis is not contagious. You cannot "catch" psoriasis from someone who has the condition. Psoriasis is diagnosed by a dermatologist or other health care provider who examines your skin. Sometimes, a health care provider may even take a piece of the affected skin and look at it under a microscope.

Treatment for psoriasis depends on how widespread and severe it is. Treatment options for psoriasis include light therapy, topical medications, and oral or injectable medications.

Psoriasis is an autoimmune disorder. In patients with the skin and scalp form of the disease, called plaque psoriasis, the body produces too many skin cells. This results in areas of thick skin that appear as silver-white patches. Psoriatic arthritis attacks the joints, causing pain and joint damage.

Traditionally, the treatment of psoriasis has been to address the symptoms. It is the field of cancer research that has yielded the most promising medicines that can treat autoimmune diseases as well. This research has led to several methods of reducing the autoimmune inflammatory process that causes the symptoms. Most of these involve systemic medications, introduced either by injections or pills.

New Drugs

According to the National Psoriasis Foundation, in 2016 there were18 injectable drugs were in development. Cosentyx (secukinumab), Otezla (apremilast) Enstilarare now available for prescription. There are 15 topical treatments that are applied directly to the plaques. One, Enstilar (LEO 90100) foam, is available now.

Cosentyx (injectable)

Cosentyx (secukinumab) is manufactured by Novartis Pharmaceuticals Corporation and was approved for patients’ use in January 2015. Secukinumab, the active ingredient, is an antibody. This antibody binds to a protein, called interleukin (IL)-17A, that helps cause the underlying inflammation. The medication bind to the protein and so prevents the plaque psoriasisprocess from starting.

Like all systemic anti-psoriasis drugs, there is the risk of side effects. These are severe allergic reactions, the risk of infections due to the expected actions of the drug itself. Most commonly, the reactions include upper respiratory infections and diarrhea.

Otezla (oral)

Otezla (apremilast) is manufactured by Celgene Corporation and is an anti-inflammatory (phosphodiesterase-4 inhibitor) which addresses both plaque psoriasis and psoriatic arthritis. Two pills are taken daily. The patient is introduced to the drug with a 28-day starter pack that gradually increases the amount of the drug.

Otezla has some possibly significant side effects. Nausea, loss of appetite and diarrhea can account for a weight loss of up to 10 percent. Depression is also an expected outcome for some patients.

Enstilar (topical)

Enstilar (LEO 90100), manufactured by LEO Pharma, is a foam product that is applied directly to plaque psoriasis scales, both on the skin and the scalp. The foam contains steroids and a Vitamin D analog. The foam is applied once daily for up to four weeks.

Side effects occurred in fewer than 1 percent of the patients and included itching, infection of hair follicles, and the psoriasis worsening.

The array of new medications is confusing and will take the patient working closely with his or herrheumatologist to find the best drug with the fewest side effects.

Up to 30 percent of people with psoriasis will develop psoriatic arthritis. This most commonlyoccurs between the ages of 30 and 50. This condition can cause pain, stiffness and swellingaround the joints. Your health careprovider will determine the best course of therapy for you.

Talk to our pharmacy staff if you have any questions about psoriasis and new specialty medications,including injections, used for treatment of Psoriasis and Psoriatic Arthritis.

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