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Is Stelara Stellar? The New Biologic on the Block

As we move farther away from the dark depths of winter, many of us “psoriatics” can anticipate a moderate reduction in our symptoms due to increased exposure to the sun. In my next newsletter I’ll discuss some of the lesser-known reasons behind this and other details regarding the connection between sunlight and psoriasis…but today I thought I would discuss another “stellar” topic- which would be the relatively recent arrival of a new “biologic” treatment for psoriasis. It’s called Stelara.

By know, most folks with psoriasis know about the biologics: Enbrel, Humira, Remicade, Raptiva and Amevive. The newest kid on the biologic block is Stelara, which seems poised to take on Enbrel as the first choice among the biologics in treating psoriasis. Stelara has demonstrated two significant advantages over Enbrel: the first is that it actually seems to work better (approximately 70-75% of those that take Stelara report a 75% decrease in symptoms after 12 weeks) and the second is that Stelara requires only a few injections over 12 weeks, compared to 24 for Enbrel. Additionally, Stelara works significantly differently than the other biologics: Stelara works by regulating the activity of interleukin-12 and interleukin-23, which are cytokines and important factors in the inflammatory immune response behind psoriasis and some other immune disorders. Most of the other biologics are what are called TNF (tumor necrosis factor) blockers and there is some hope that Stelara’s different focus will bring with it fewer and less serious side-effects, since it seems to be a more targeted approach. Thus far, the report from dermatologists after just a few months of Stelara being on the market is that Stelara is already their first choice after Enbrel.

It’s still too early to tell whether Stelara will show some of the drawbacks we’ve seen with the other biologics, which is that they often stop working and sometimes require steadily higher doses and the jury is still out on Stelara’s long-term side-effects, but for those that are interested in the bringing out the heavy guns to treat their

psoriasis, Stelara is certainly important to know about.

Personally, I will be sticking with turning to diet modification and coconut oil and my trusty dovonex whenever my own symptoms flare up, at least until that stops working for me; which it hasn’t yet!!

Good luck everyone, stay in touch, and enjoy the return of the sun.


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Psoriasis Treatment – What Are Your Options?

There is no substitute for visiting a doctor or dermatologist for help in getting a diagnosis and receiving treatment advice for psoriasis. However, because there are a large number of treatments which are considered effective, some of which are quite simple and inexpensive, many individuals can also find success in treating their psoriasis on their own. How? By informing themselves about the variety of available treatments and then treating themselves through a careful trial-and-error approach. Though there is still no simple cure for all psoriasis, many can find relief and partial or even total clearing of their skin by exploring available treatment options.

In this section describing the treatment of psoriasis, we will briefly review only some of the more popular and effective treatments, some of which involve using prescription or over-the-counter drugs and others which are more natural. However, before describing these treatments let’s briefly review what causes psoriasis.

Psoriasis is commonly understood to be a disorder of the immune system, and is called an auto-immune disorder. In psoriasis one’s own immune system, and in particular, one’s T-helper cells, mistakenly attacks one’s own skin cells. Most psoriasis treatments focus on addressing this immune response, either by suppressing the immune system, by removing the source or a link of the immune response, or by treating the symptoms on the skin. Ok, now let’s get on to a brief review of some of the more common treatments.

Biologics- Biologics are a new class of drugs for treating more severe cases of psoriasis, and include Amevive, Enbrel, Humira, Remicade, and now Stelara, among others. Amevive works by blocking the T-cell immune response, and Enbrel, Humira, and Remicade work by blocking another key factor in the immune response, which is called TNF-alpha. Stelara, the most recent to be approved, works by blocking the activation of some of the interleukin chains in the immune response. The biologics have given hope to many with moderate to severe psoriasis who were not previously helped by other treatments, however biologics also have a higher risk of sometimes serious side effects, such as infections. Other drawbacks are that the biologics usually have to be administered by injection or infusion, do not work for everybody, are very expensive, and the symptoms of psoriasis usually return after treatment ends.

Coal Tar- An old and common form of treatment used to control mild cases of psoriasis, coal toar is used in shampoos and creams. Though coal tar can reduce itching and inflammation for some people, it is only moderately effective, is messy, can irritate the skin and in high concentrations can be toxic and possibly carcinogenic.

Coconut Oil- Coconut oil has been receiving more attention recently as a treatment for psoriasis sufferers, both as a dietary supplement and as a skin ointment. Coconut oil contains high levels of lauric acid, which is known to help destroy candida in the intestinal tract, thereby healing one of the possible underlying causes of psoriasis. Coconut oil has also been shown to reduce inflammation, both when taken as a nutritional supplement or when applied to the skin.

Cyclosporin- Cyclosporin is an immunosuppressant and is effective at reducing psoriatic symptoms because it reduces and suppresses the immune system For the same reason, however, cyclosporin comes with a higher risk of side-effects and is usually only prescribed for more severe cases of psoriasis.

Diet Modification- Modifying one’s diet can often be the most effective form of controlling psoriasis. Why? There is increasing evidence that byproducts from food may be the triggers for the immune response which causes psoriasis. Some researchers have proposed that “leaky gut syndrome” (also called intestinal hyperpermeability) may be responsible for the “leaking” of food-based agents from the intestinal tract into the bloodstream. Thus, diet modification may help by not only removing the food triggers from one’s system, but also by helping to heal one’s intestinal tract, perhaps by combatting an overgrowth of candida, which is one possible cause of leaky gut syndrome. Those that are serious about controlling their psoriasis and that want to do so with minimal cost and risk of side-effects from medications should explore the research available on controlling psoriasis through modifying one’s diet. Some common food triggers include dairy products, highly acidic foods, fermented foods, alcohol, sugars, nuts, wheat, gluten, nightshades, and many others; however, it is important to recognize that different people may have different food triggers- one needs to experiment for oneself. Also, in addition to removing certain items, many have benefitted from adding other items to their diet, such as cocounut oil, fish oil and other omega 3’s, folic acid, zinc, antioxidants, Vitamin D and probiotics.

Dithralin (Anthralin) Dithralin is a synthetic form of an extract from the bark of the South American araroba tree. It is often quite effective, and works by blocking cell proliferation. It often takes a while to start working and can stain and irritate the skin.

Dovonex and other Vitamin D analogues
- Dovonex, the brand name for calcipotriene, is the most well known and widely used form of the Vitamin D analogues which are used to treat psoriasis. Others are Vectical and tacalcitol. Dovonex is a synthetic form of Vitamin D3, and works by inhibiting skin cell growth and proliferation. Many people report good results with Dovonex, and the known side effects are minimal, however, it can take a number of weeks before seeing results and some people report minimal clearing. Recently, the Vitamin D analogues have also sometimes been formulated to include hydrocortisone.

Methotrexate- Like cyclosporin, methotrexate is a systemic medication with more potentially serious side effects, but which can also offer relief for more serious cases of psoriasis as well as severe cases of psoriatic arthritis. Methotrexate works by inhibiting cell growth, and was originally approved for use as a chemotherapeutic treatment for cancer. The most serious potential side-effect of taking methotrexate is liver damage, and its use must be monitored by medical professionals.

Moisturizers- There are many forms of moisturizers used to treat psoriasis, which are helpful because they not only can soothe the skin and reduce itching, but because they can also help remove the top layer of scales, allowing other agents to more easily reach and treat the underlying skin cells. Oatmeal baths, salicyclic acid, epsom salt baths, saltwater bathing, and a variety of oils are just a few of many moisturizing treatments. Some moisturizers, such as coconut oil and ocean or salt water, may also work by reducing inflammation as well as merely lifting scales and soothing skin.

Omega 3’s (Fish Oil)- Dietary supplements such as fish oil containing Omega 3 fatty acids have been shown to reduce inflammation and some studies and people report good results.

Phototherapy, Sunlight- There are a number of different forms of phototherapy used to control psoriasis, which work by reducing skin cell growth. Though often effective, with phototherapy symptoms get worse before they get better, and the potential for overexposure brings with it a carcinogenic risk, hence the importance of medical oversight when choosing phototherapy.

Retinoids– Topical retinoids such as Tazorac come in creams and gels, and are a synthetic form of Vitamin A. Tazorac is the brand name for Tazoratene, and is also used to treat acne. Skin irritation is one side-effect, and it often takes 2-12 weeks to see results.

Topical Corticosteroids- The most common form of treatment. Topical steroids such as hydrocortisone are used in a variety of forms and applied to the skin. They work by reducing the inflammatory reaction. Topical steroids will usually provide temporary relief and reduce inflammation, scaling and itching, however, they do not address the underlying source of the symptoms, and because of side effects are usually only recommended for temporary use.

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Psoriasis Cure – What Can Be Done To Cure Psoriasis?

Is there a cure for psoriasis? Many “cures” for psoriasis have been proposed over the years and though certainly many effective treatments do exist, there is still as yet no true cure. Part of the reason for this is probably because the immune reaction in psoriasis is triggered by different things in different people. With a little research and a careful trial-and-error approach, however, many people are able to find, if not a total cure, then something close to it for themselves.

In recent years, there was some excitement when the first biologics came onto the psoriasis treatment scene, and there was a renewed hope for finding a true cure. Though effective, the biologics were not the hoped for cure-all. Still, some of the biologics provide approximately 65% of patients a clearance of 75% of their symptoms. Furthermore, approximately 35% of patients might expect an almost total clearance of symptoms from using biologics. Not a cure, for sure, but certainly effective. However, given the potential for adverse side-effects and the fact that many people can find similar relief from their symptoms using more natural or simpler treatments, it is usually recommended to try other approaches first.

Of course, over time numerous authors and researchers have suggested a variety of “cures” for psoriasis and if one searches the internet or the library one will find many of these claims.  What is confusing is that though many people are in fact significantly helpd and even sometimes “cured”, no single approach does the trick for everyone. Some are lucky, and find that a single form of treatment will do the trick, but most find that it takes a combination of treatments along with persistence to find a satisfactory solution.

Many are discovering that a crucial factor in acheiving a clearing of the skin is often modifying one’s diet and/or removing whatever may be triggering the immune system’s inflammatory reaction. Combined with programs that are designed to heal one’s digestive tract, often by treating it for leaky gut syndrome or candida overgrowth, dietary approaches often meet with great success, if they are followed, but that’s the hard part! Because sugars, fermented foods, dairy products, and wheat products (in other words, a lot of the more delicious food out there!) are the dietary triggers for many people, it can be challenging to maintain a diet, even if one finds that it  works. It often helps to add supplements that control candida overgrowth, such as coconut oil, to one’s diet to help with the dietary approach.

In fact, coconut oil is a good example of something that has been called a cure. Perhaps because of its powerful antimicrobial as well as moisturizing properties, also works well for many people’s psoriasis when used externally on the skin, since psoriasis is sometimes triggered by fungal or other external triggers.  And though many have therefore described coconut oil as a “cure” for their psoriasis, since it potentially treats psoriasis both internally and externally, there are still others for whom it does not work.

However, given the presence of so many effective treatments, ranging from coconut oil and diet modification to corticosteroids, Dovonex and the biologics, many people are able to find a solution to their psoriasis problem, if not a total cure.

If you’re not sure whether you have psoriasis, psoriasis pictures can help.

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Pustular Psoriasis – A Serious Form of Psoriasis

p>Pustular psoriasis is a relatively rare form of psoriasis characterized by raised bumps filled with pus, which are usually clearly defined and surrounded by red skin. When classified according to its severity, pustular psoriasis is described as one of three types; acute, sub-acute, and chronic, and in the acute form, can be quite dangerous. Sometimes pustular psoriasis is classified according to its distribution on the body; when described this way, pustular psoriasis is described as either as generalized pustular psoriasis or localized pustular psoriasis.

Generalized pustular psoriasis is also known as von Zumbusch psoriasis, and requires immediate medical attention and can even be fatal if not treated properly. It is often accompanied by fever, chills and aches and a chemical toxicity called polymorphonuclear leukocyte (PMNL) chemotaxis. The symptoms can arise within a matter of hours and often progresses into a drying out of the pustules, a glazing over of the skin, followed by the formation of more pustules. The acute generalized form most often occurs in adults and in the anal or genital areas, or in the folds of the skin.

The causes of pustular psoriasis are not very well understood, however pustular psoriasis has been associated with a withdrawal from topical or oral steroid use, and has also been identified as being potentially triggered by infection, pregnancy, certain drugs, and exposure to sunlight. Treatment for generalized von Zumbusch pustular psoriasis often requires hospitalization for rehydration and sometimes (ironically enough) the use of systemic steroids. Many of the usual treatments for psoriasis, such as Vitamin D-3, phototherapy, retinoids, Anthralin, methotrexate, cyclosporin and the biologics such as Enbrel, Amevive, and Humira are also used to treat pustular psoriasis, as are palliative measures such as compresses and saltwater solutions. Sometimes antibiotics are used, particularly if an infection is a clear trigger of the symptoms.

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Psoriatic Arthritis – Causes, Symptoms, Treaments

p>Psoriatic arthritis is a sometimes debilitating form of joint pain and arthritic inflammation that may affect up to 30% of those who have psoriasis. It usually appears between the ages of 30 and 50 and can often go undiagnosed if one is not aware of the connection between psoriasis and psoriatic arthritis. Though there is no cure, the symptoms do sometimes come and go, and there are also a number of somewhat effective treatments.

The cause of psoriatic arthritis appears to involve the presence of a number of co-factors, including a genetic predisposition and environmental triggers. Psoriasis of the skin usually (approximately 80% of the time) appears before arthritic inflammation appears. Though different from rheumatoid arthritis, it is a form of rheumatic (meaning inflammatory) disease, and is associated with a few other rheumatic diseases which are collectively referred to as “spondyloarthropathies” which refers to arthritis of the spine. This group of diseases includes ankylosing spondylitis,  Crohn’s disease, ulcerative colitis, inflammatory bowel disease, and reactive arthritis (which include’s Reiter’s disease) and some of the more common features of the group includes lower back pain and a higher incidence of a gene called HLA-B27. It has been suggested by some researchers that the presence of HLA-B27 makes one more susceptible to an arthritic reaction when infected by certain antigens, however, HLA-B27 by itself does not cause either psoriatic arthritis or the spondyloarthropathies, and one can have psoriatic arthritis without having HLA-B27.

There are a number of different types of psoriatic arthritis, and the most common is called the oligoarticular type, which accounts for more than 70% of cases and is defined by involvement of four or less joints. In 80% of cases of psoriatic arthritis there is a psoriatic pitting of the nails. There does not have to be a correlation between the severity of one’s arthritis and one’s psoriasis.

Because psoriatic arthritis can be quite serious and potentially debilitating, treatment often involves some of the more powerful anti-psoriatic agents such as cyclosporin, methotrexate, sulfasalazine, and systemic or local use of corticosteroids. More recently, many with psoriatic arthritis have found some relief from treatment with one of the newer “biologics” such as Enbrel, Humira, or Remicade, which inhibit an important part, called TNF-alpha, of the inflammatory response.

Some with psoriatic arthritis may also respond well to alternative treatments such as antibiotic therapy or diet modification. Because bacterial infection has been implicated as one of the co-factors for triggering rheumatic disease in general, antibiotic therapy is often worth exploring for those with auto-immune rheumatic diseases. Many also find that removing certain foods or healing intestinal and digestive problems helps their arthritic symptoms. Some of the more common food triggers include sugars, gluten, starches, acidic foods, and nightshades, though there is a wide range of responses in this area. Supplements such as fish oils and other foods high in omega-3 fatty acids and coconut oil may also be helpful because of their roles in reducing inflammation and maintaining a healthy digestive system.

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What is Guttate Psoriasis and How Is It Treated?

Guttate psoriasis is an uncommon form of psoriasis that occurs in less than 2% of those with psoriasis and typically affects children and young adults under the age of 30. The word “guttate” is derived from the Latin word gutta, which means “drop” and refers to the the characteristic small, pink, drop-like lesions associated with guttate psoriasis, which usually occur on the trunk or limbs, and which are not usually as thick or scaly as the lesions found in plaque psoriasis.

Guttate psoriasis is more clearly associated with infection than other forms of psoriasis, and in particular, streptococcal infection (strep throat), though it can also be triggered by viral or other infections. A genetic predisposition is often associated with guttate psoriasis.

The good news is that the symptoms of guttate psoriasis often resolve themselves even without treatment in a matter of weeks, though sometimes the symptoms will either not clear or return and can eventually turn into a more chronic form of psoriasis such as plaque psoriasis. The symptoms can come on quite quickly, often within just a few days, and will often first appear 2-3 weeks after a streptococcal infection.

Even though guttate psoriasis many times resolves itself without treatment, antibiotics are often helpful and prescribed to treat the underlying cause, particularly if it is a streptococcal infection. Antibiotics can also be used to potentially prevent future outbreaks of guttate psoriasis if one suspects one has a streptococcal infection, but the symptoms of guttate psoriasis have not yet appeared, and one has had a prior outbreak. Because guttate psoriasis lesions may be itchy, moisturizers are also a helpful form of treatment. Many of the more common forms of treating psoriasis, such as coal tar, phototherapy, and corticosteroids, are also sometimes used to alleviate the symptoms of guttate psoriasis.

If one has an acute form of guttate psoriasis, the likelihood of developing chronic plaque psoriasis later in life has been placed as high as 2 out of 3, but in general, the probability of developing chronic plaque psoriasis after a case of guttate psoriasis appears to be closer to 30%.

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Scalp Psoriasis Explained in Detail

Scalp psoriasis is a common and frustrating form of psoriasis, which can be embarrassing for some due to its location. Some people have mild and moderate cases, and others have severe forms. Sometimes hair can be lost due scalp psoriasis, but it usually will grow back if treatment is successful.

Scalp psoriasis can sometimes be confused with seborrheic dermatitis. To make a distinction, doctors will often look for signs of psoriasis on other parts of one’s body to determine if one has psoriasis. Scalp psoriasis is also often thicker than seborrheic dermatitis, and seborrheic dermatitis can sometimes be more yellow and greasy in appearance. Treatments for both are often similar, though scalp psoriasis can be more difficult to treat.

Treatments for scalp psoriasis are often not very different than treatments for psoriasis in general, with special considerations given to the hair. To treat the psoriasis, it is important to be able to apply treatments to the skin under the scales and plaques, so it is often helpful to keep one’s hair short, and to apply moisturizers or scale-lifting agents such as salicylic acid (which can be found in shampoos) to the lesions first.

Once the scales have been removed or softened, regular psoriasis treatments such as Dovonex or topical corticosteroids are often applied. Coal tar shampoo is used by some, though it can stain light-colored hair and is only moderately effective.

For more severe cases, biologics are often used, or systemic treatments such as cyclosporin or methotrexate.

Additionally, many people find that modifying one’s diet can be the simplest way of treating one’s psoriasis, whether found on the scalp or other parts of the body. Because the immune response that causes psoriasis may be triggered by certain parts of foods that are allowed to “leak” into the bloodstream though the intestinal walls, removing some foods or treating one’s intestinal tract for hyperpermeability can be effective for many people. Common food triggers include dairy products, highly acidic foods, fermented foods, alcohol, sugars, nuts, wheat, gluten, nightshades, and others; different people find different food triggers for themselves. In addition to removing certain triggers, many have benefitted from adding foods or supplements to their diet, such as cocounut oil, fish oil and other omega 3’s, folic acid, zinc, antioxidants, Vitamin D and probiotics. In our 29-page E-book, we devote 11 pages to covering diet alone, an important area of treatment and research for healing psoriasis.

Psoriasis Pictures: Diagnose Yourself With These Pictures

Plaque Psoriasis on Stomach Plaque Psoriasis on Arm
Plaque Psoriasis on Arm plaque psoriasis on back Plaque Psoriasis on Knees

Plaque Psoriasis

Though there is no substitute for a diagnosis from a dermatologist, psoriasis pictures can be useful to help determine if you have psoriasis. Psoriasis can sometimes be confused with eczema, another skin condition with symptoms of red or scaly skin rashes. Sometimes the location of the rashes can help determine whether one has psoriasis or eczema; for example, psoriasis is more likely to occur on the backs of elbows and fronts of knees (extensor surfaces) and eczema more likely to occur on the fronts of elbows and backs of knees (flexor surfaces). Psoriasis is also very commonly found on scalp or on the back and is often accompanied by a pitting of the nails, something which is not usually associated with eczema. Additionally, a form of arthritis called psoriatic arthritis may develop in anywhere from 5%-30% of individuals who have psoriasis. All of the above known factors helps doctors make a diagnosis of psoriasis.

There are different kinds of psoriasis, but by far the most common is called plaque psoriasis, which occurs in 80-90% of the cases of psoriasis. Plague psoriasis lesions usually involve red patches of skin, covered by scaly dry white plaques. They are most commonly found on the knees and elbows, as well as the scalp (see scalp psoriasis) and back, but can occur anywhere. Plaque psoriasis is definitely not contagious and is considered an inheritable condition, though environmental conditions such as diet and stress also play a large role in its appearance. It typically first appears in one’s 20’s, and though the condition can increase and decrease in severity throughout the course of one’s lifetime, it is considered chronic, and though many people do find relief and success from a variety of effective treatments (see psoriasis treatments), no single treatment can yet be truly considered a “cure-all” for psoriasis.

There are other kinds of psoriasis, though they are much less common than plaque psoriasis. Guttate psoriasis is more a more rare form of psoriasis, and will commonly follow a streptococcal infection, though it can also follow a chickenpox infection or a cold. Guttate psoriasis lesions are typically small, red, and round or drop shaped:


Guttate Psoriasis

Three other more rare kinds (affecting less than 10% of persons with psoriasis) of psoriasis are pustular psoriasis, inverse psoriasis and eythrodermic psoriasis.

1. Pustular psoriasis involves raised bumps that are filled with pus:


Pustular Psoriasis

2. Inverse psoriasis is typcially found in skin folds and appears as smooth shiny lesions:


Inverse Psoriasis

3. Erythrodermic psoriasis, though rare, can be quite dangerous and painful. It can cover a wide area of the skin, has a fiery appearance, and should be treated by medical professionals immediately:


Erythrodermic Psoriasis

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