Posts tagged "Psoriasis"

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My daughter is 4 and has extremely severe eczema from head to toe. What can I use to help her sleep

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Treatment Variability Found In Pediatric Psoriasis Outpatient Health Care Delivery

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Main Category: Eczema / Psoriasis
Also Included In: Pediatrics / Children’s Health
Article Date: 20 Sep 2011 – 2:00 PDT

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According to a report published Online First by Archives of Dermatology, one of the JAMA/Archives journals, most outpatient for pediatric psoriasis in the U.S. who visit dermatologists and pediatricians consist of white children aged 8 years and older, however, treatment approaches seem to vary according to physician specialty and patient age.

Background information in the article states that in the U.S. approximately 2.5 % of the population is affected by psoriasis, with 1% being children from birth to 18 years. A third of all patients develop first signs and symptoms by the age of 20 years. Health professionals consider various factors, such as disease severity, presentation and distribution of lesions, patient age and the presence of concurrent conditions in determining patients’ treatment. While topical medications are generally used for mild, localized cases in pediatric patients, more complex cases are usually treated with phototherapy and systemic medication. The authors state that, “Management of psoriasis in children can be challenging owing to a paucity of data and lack of standardized guidelines specific to the pediatric population.”

Sinae A. Vogel, B.S., from the University of California at the San Francisco School of Medicine and her team carried out a retrospective, cross-sectional examination based on data from the National Ambulatory Medical Care Survey. They evaluated outpatient-visit data from dermatologists and non-dermatologists from 1979 to 2007 of children from birth 18 years with a diagnosis of psoriasis. Data was not collected between the periods of 1982-1984 and 1987-1988.

They charted the frequency of medications in the database and divided them into three categories, i.e. topical corticosteroid group, topical non-corticosteroid and systemic. The corticosteroid category was further subdivided into a relative potency value from one (super potent) to seven (very weak).

Over the 28-year study period, an estimated 3.8 million pediatric psoriasis visits occurred in total, with a median (midpoint) of 123,420 visits per year. Almost two-thirds of patients (63%) visited dermatologists for the condition while 17% of psoriasis visits were made to pediatricians and 14 % to internists. Numbers of male and female patient visits were equal, with 93% of patients being white.

47% of visiting patients were aged between 13 to 18 years, with 35% of visits being made by children aged 8 to 12 years and 18% aged between 0 to 7 years respectively.

Researchers found that the most commonly prescribed medications consisted of topical corticosteroids with equal potency levels in younger and older children. In general, both younger and older age groups were commonly administered with betamethasone, a topical coricosteroid.

According to the findings, dermatologists and internists mostly prescribed high-potency steroids, while pediatricians most commonly prescribed the topical immunosuppressant tacrolimus. According to the study, dermatologist’s top 20 most-prescribed medications did not include topical calcineurin inhibitors, a medication preventing inflammation and the top 20 most-prescribed medications in any age group did not include systemic antipsoriatic agents.

The authors write, “This study confirms that pediatric psoriasis visits are frequent and represent a substantial burden of disease in the United States, validating the social, economic, and medical impact of this disease.” They highlight the age differences in office visits for the condition as well as trends in medication usage, and are especially concerned about the frequency of strong corticosteroid use in patients younger than 8 years. They comment: “In our experience, the highest potency topical corticosteroids are not commonly needed for psoriasis in young children.”

Trends like this indicate a need for treatment guidelines that address the condition in children. The authors conclude saying:

“The current state-of-the-art care for pediatric psoriasis is based primarily on experience and expert consensus. Some clinicians may not be anticipated to change even if standardized treatment guidelines existed, as such, education of our dermatology and non-dermatology colleagues about unique clinical and treatment aspects of pediatric psoriasis, rather than guidelines alone, may decrease the treatment gap by creating more comfortable, safe, and effective use of topical and systemic regimens for children with psoriasis.”

MLA

Certain Drugs Lower Risk Of Diabetes For Patients With Rheumatoid Arthritis Or Psoriasis

Main Category: Diabetes
Also Included In: Arthritis / Rheumatology;  Eczema / Psoriasis
Article Date: 21 Jun 2011 – 13:00 PDT window.fbAsyncInit = function() { FB.init({ appId: ‘aa16a4bf93f23f07eb33109d5f1134d3′, status: true, cookie: true, xfbml: true, channelUrl: ‘http://www.medicalnewstoday.com/scripts/facebooklike.html’}); }; (function() { var e = document.createElement(‘script’); e.async = true; e.src = document.location.protocol + ‘//connect.facebook.net/en_US/all.js’; document.getElementById(‘fb-root’).appendChild(e); }()); email to a friend   printer friendly   opinions  

In a study that included nearly 14,000 patients with rheumatoid arthritis or psoriasis, the use of certain disease-modifying antirheumatic drugs was found to lower the risk of diabetes, according to a study in the June 22/29 issue of JAMA.

Two common systemic inflammatory conditions, rheumatoid arthritis (RA) and psoriasis, predispose patients to insulin resistance and may place patients at risk for diabetes mellitus (DM). The treatment of psoriasis and RA includes disease-modifying antirheumatic drugs (DMARDs) such as tumor necrosis factor (TNF) inhibitors, which are directed against the inflammatory response, according to background information in the article. The relationship between these conditions and DM suggests that systemic immunosuppression may also reduce the risk for DM.

Daniel H. Solomon, M.D., M.P.H., of Brigham and Women’s Hospital, Boston, and colleagues examined the relationship between DMARD medications and the risk of newly diagnosed DM among participants with RA or psoriasis. The researchers conducted a retrospective cohort study among 121,280 patients with a diagnosis of either RA or psoriasis on at least 2 visits. The analyses were conducted in the context of 2 large health insurance programs, 1 in Canada and 1 in the United States, using administrative data. The average follow-up was 5.8 months and began with the first prescription for a DMARD after study eligibility was met. Drug regimens were categorized into 4 mutually exclusive groups: (1) TNF inhibitors with or without other DMARDs; (2) methotrexate without TNF inhibitors or hydroxychloroquine; (3) hydroxychloroquine without TNF inhibitors or methotrexate; or (4) other nonbiologic DMARDs without TNF inhibitors, methotrexate, or hydroxychloroquine.

The final study cohort consisted of 13,905 participants with 22,493 new treatment episodes starting 1 of the categories of DMARD regimens between January 1996 and June 2008. The researchers found 267 newly diagnosed cases of DM: 55 cases among 3,993 treatment episodes with nonbiologic DMARD users; 80 cases among 4,623 treatment episodes with TNF inhibitor users; 82 cases among 8,195 treatment episodes with methotrexate users; and 50 cases among 5,682 treatment episodes with hydroxychloroquine users. The incidence rates for DM were highest for individuals who switched to other nonbiologic DMARDs and lowest for TNF inhibitor users. “The fully adjusted models suggest a reduced relative risk of DM for TNF inhibitor and hydroxychloroquine compared with other nonbiologic DMARDs,” the authors write.

According to the authors, “The findings from this epidemiologic study should be considered hypothesis-generating. However, considering these results in light of prior findings regarding improved insulin and glucose metabolism and reduced DM risk with hydroxychloroquine and TNF inhibitors, there is evidence suggesting a possible role for DMARDs and immunosuppression in DM prevention. A randomized controlled trial testing the ability of these agents to prevent DM among participants with systemic inflammatory disorders should be considered.”

JAMA. 2011;305[24]2525-2531.

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

Of course, in regard to autoimmune etiology of DMII, BUT the effect of corticosteroids, widely used in treatment until recently, was different.

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Nearly 1 In 4 People With Psoriasis May Have Undiagnosed Psoriatic Arthritis

Main Category: Eczema / Psoriasis
Also Included In: Arthritis / Rheumatology
Article Date: 14 Oct 2011 – 0:00 PDT

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If you have psoriasis or a family history of psoriasis and you are experiencing joint pain and swelling, you could have psoriatic arthritis, a serious disease that may lead to joint destruction and disability.

New research from the National Psoriasis Foundation reveals that nearly one in four people with psoriasis – the most common autoimmune disease in the country, affecting as many as 7.5 million Americans – may have undiagnosed psoriatic arthritis, a type of inflammatory arthritis that affects the joints and tendons. This is in addition to the up to 2 million people already diagnosed with the disease.

The Psoriasis Foundation study found that 22 percent of psoriasis-only participants had significant symptoms of psoriatic arthritis, such as joint pain, pain that moved from one joint to the other; joints that were hot to the touch; and swollen, sausagelike fingers and toes.

Other key findings revealed that people with psoriatic arthritis are not being diagnosed in a timely manner. Forty-four percent of these respondents said they experienced symptoms for a year or longer before being diagnosed. Nearly one in three reported a delay of two years or longer to receive diagnosis.

“It’s vital to diagnose and treat psoriatic arthritis early in order to prevent or slow joint damage. Yet, nearly 30 percent of psoriatic arthritis patients said it took more than two years for a diagnosis,” said Dr. Mark Lebwohl, chair of the National Psoriasis Foundation Medical Board.

In response to these findings, the Psoriasis Foundation Medical Board issued a set of recommendations for both people with psoriasis and medical professionals who treat them to evaluate for symptoms of psoriatic arthritis.

For people with psoriasis and/or a family history of the disease, the medical board recommends watching for the following symptoms, and if they experience one or more, to call their physician: Pain, swelling or stiffness in one or more joints; Joints that are red or warm to the touch; Frequent joint tenderness or stiffness; Sausagelike swelling in one or more of the fingers or toes; Pain in and around the feet and ankles; Changes to the nails, such as pitting or separation from the nail bed; Pain in the lower back, above the tailbone. “Up to 30 percent of people with psoriasis develop psoriatic arthritis,” said Dr. Elaine Husni, a rheumatologist and psoriatic arthritis expert with the Cleveland Clinic in Ohio. “These guidelines could help millions of Americans with psoriasis recognize the signs of psoriatic arthritis early, so they can seek medical attention for a diagnosis and begin treatment. If untreated, the joint damage can be disabling.”

Additionally, the findings show that psoriatic arthritis significantly impacts quality of life: 63 percent say they are unable to be as active as they once were, nearly half (47 percent) say the disease impacts their ability to work, 34 percent report difficulty getting in and out of a car and 34 percent have stiffness for more than two hours after waking.

About the study

The National Psoriasis Foundation conducted interviews with 477 people with psoriasis and psoriatic arthritis by phone (202) and online (275) from April 13 to May 4, 2011. Sixty-two percent of the respondents had moderate to severe psoriasis.

About psoriatic arthritis

Psoriatic arthritis, a type of inflammatory arthritis that affects the joints and tendons, occurs in up to 30 percent of people with psoriasis – the most common autoimmune disease in the country, affecting as many as 7.5 million Americans. People with mild psoriasis are just as likely to develop psoriatic arthritis as those with moderate to severe forms of the disease. Symptoms of psoriatic arthritis include generalized fatigue; tenderness, pain and swelling of the tendons; swollen fingers and toes; joints that are hot to the touch; and reduced range of motion.

MLA

Chinese Eczema Once A Day Herbal Cream for Psoriasis and Atopic Dermatitis: Treatment

Is using Anti-fungus creams on Pityriasis Rosea making it worse?

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Beyond Biologics: Psoriasis Patients Can Still Benefit From Traditional Treatments :- Eczema.

Main Category: eczema / Psoriasis
Also Included In: Dermatology
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For patients with severe psoriasis, a new class of intravenous and injectable biological medicines known as “biologics” has brought about a near revolution in treatment.

But doctors at the University of Michigan Health System note that patients and their doctors should also consider long-established treatment alternatives. These can be far cheaper and avoid some of the risk factors associated with the immune system-suppressing biologics, such as increased risk of serious infection and lymphoma.

One of the oldest treatments for psoriasis is known as Goeckerman therapy. The process involves applying ointment made from coal tar to a patient’s skin and exposing the patient to ultraviolet radiation with light therapy, which work together to clear the patients’ skin.

The U-M Dermatology Day Treatment Center is among a small number of places in the country to offer a modernized version of the treatment, which dates back to the 1920s.

“Sometimes when new treatments come along, everyone jumps on the bandwagon,” says Thomas Anderson, M.D., medical director of the Day Treatment Center and associate professor of dermatology at the U-M Medical School. “But Goeckerman has a lot of advantages over biologics. One of the biggest ones is that you’re not on it forever.”

Cost can also be an important factor in deciding whether to use biologics or seek alternatives. The average course of biologics is $22,000 to $59,700 per year, according to a recent article in the International Journal of Dermatology, while Goeckerman therapy costs $10,000 to $12,000.

“The modified Goeckerman treatment has some advantages and we see good remissions,” says Allen Bruce, M.D., Ph.D., a psoriasis researcher and lecturer in the Department of Dermatology at the U-M Medical School. “It can be good for people who have certain risk factors, such as multiple sclerosis, cancer or a history of chronic infections. It’s also a good option for people who would prefer, for a number of reasons, not to be on biologics.”

The three-week tar and light therapy is intensive, but provides quick relief for many patients, allowing them to don shorts and participate in summer activities without being self-conscious about skin plaques. Remissions can last up to 10 years, but many patients require treatment every year or two.

According to a 2010 article in Pediatric Dermatology, Goeckerman therapy is unfairly considered a “lost art.” Given its record of safety and effectiveness, the authors recommended “the current trend toward abandonment of this treatment should be reversed.”

Psoriasis affects 7.5 million Americans, according to the National Psoriasis Foundation. Up to 30 percent of patients may also develop psoriatic arthritis, a painful joint condition.

Biologics can provide relief for patients with psoriatic arthritis, while Goeckerman treatment does not. Some patients pursue a combination of treatments that includes both biologics and Goeckerman.

Therapy at U-M’s Day Treatment Center is done on an outpatient basis. Patients who live within 30 miles can return home at night and in many cases hotel stays for patients from farther away are provided as part of the treatment cost.

Along with psoriasis, the center also treats rare skin conditions including chronic atopic dermatitis, eczema, chronic contact dermatitis and cutaneous t-cell lymphoma.

Source:
University of Michigan Health System

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

I had the Goeckerman treatment in 1977. At that time it involved a hospital stay of over two weeks. A very smelly greasy tar and Vaseline based ointment was applied to my entire body daily and I wore the same pajamas the entire time. I had a light treatment once a day. My Psoriasis was about 80% cleared but that lasted only about six weeks and came back with a vengeance. Unless the treatment is a lot more effective and less awful to endure, I absolutely would not do it again and would not recommend it to any other Psoriasis sufferer.

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