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Psoriasis - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of psoriasis.

Highlights:

An estimated 5 million people have been diagnosed with psoriasis, and as many as 3.2 million adults have the disease without knowing it. Men are more likely to be undiagnosed than women.

Causes

Researchers have discovered seven new DNA variations that increase the risk of psoriasis. The same DNA variations linked to psoriasis and psoriatic arthritis are also associated with four autoimmune diseases: type 1 diabetes, Grave's disease, celiac disease, and rheumatoid arthritis, suggesting that all of these diseases have the same genetic basis.

Treatment

The drug, efalizumab (Raptiva), was withdrawn from the U.S. market because of the risk of causing multifocal leukoencephalopathy.
The drug etanercept (Enbrel), which is currently approved to treat psoriasis in adults, is also effective in children and adolescents with moderate-to-severe plaque psoriasis. There is currently no FDA-approved systemic (body-wide) drug available to treat psoriasis in young patients.
The FDA has approved adalimumab (Humira) for moderate-to-severe chronic plaque psoriasis. Studies have shown that the drug significantly improves symptoms in most patients.
The investigational biologic drug, ustekinumab, appears to reduce psoriasis symptoms after 12 weeks of treatment, compared to placebo (inactive drug). The drug's manufacturer has applied for FDA approval.
An investigational drug that is similar to cyclosporine but with fewer side effects has shown promise in clinical trials. In studies, ISA247 significantly reduced symptoms of plaque psoriasis compared to placebo. Most of the side effects with the drug were mild, and included headache and upper respiratory tract infections.

Resources

www.psoriasis.org -- National Psoriasis Foundation
www.aad.org -- American Academy of Dermatology
www.niams.nih.gov -- National Institute of Arthritis and Musculoskeletal and Skin Diseases
www.clinicaltrials.gov -- Find clinical trials

References

Chen YJ, Wu CY, Shen JL, Chu SY, Chen CK, Chang YT, Chen CM. Psoriasis independently associated with hyperleptinemia contributing to metabolic syndrome. Arch Derm. 2008;144:1571-1575.

Gelfand JM, Neimann AL, Shin DB, et al. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006 Oct 11;296(14):1735-41.

Kurd SK, Gelfand JM. The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: Results from NHANES 2003-2004. J Am Acad Dermatol. 2008 [Epub ahead of print].

Leonardi CL, Kimball AB, Papp KA, Yeilding N, Guzzo C, Wang Y, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomized, double-blind, placebo-controlled trial (PHOENIX 1). Lancet. 2008;371:1665-1674.

Liu Y, Helms C, Liao W, Zaba LC, Duan S, Gardner J, et al. A genome-wide association study of psoriasis and psoriatic arthritis identifies new disease loci. PLoS Genet. 2008;4(3):e1000041.

Menter A, Gottlieb A, Feldman SR, Voorhees ASV, Leonardi CL, Gordon KB, et al. Guidelines for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol. 2008;5:826-850.

Menter A, Griffiths CE. Current and future management of psoriasis. Lancet. 2007;370:272-284.

Paller AS, Siegfried EC, Langley RG, Gottlieb AB, Pariser D, Landells I, et al. Etanercept treatment for children and adolescents with plaque psoriasis. N Engl J Med. 2008;358:241-251.

Papp K, Bissonnette R, Rosoph L, Wasel N, Lynde CW, Searles G, et al. Efficacy of ISA247 in plaque psoriasis: a randomized multicentre, double-blind, placebo-controlled phase III study. Lancet. 2008;371:1337-1342.

Stern RS. Psoralen and ultraviolet A light therapy for psoriasis. N Engl J Med. 2007;357:682-690.

U.S. Food and Drug Administration. CDER Drug and Biologic Approvals for Calendar Year 2006 -- Updated through August 31, 2006. Last accessed on 15 October, 2006.

Weatherhead S, Robson SC, Reynolds NJ. Management of psoriasis in pregnancy. BMJ. 2007;334:1218-1220.

Reviewed last on: 4/10/2009
A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz. Previously reviewed by Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School (1/13/2009).

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