Dramatic Changes in Treating Psoriasis

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Dr. Briley offers light therapy to a patient with psoriasis.

For most people, matters of personal health are indeed just that—personal. Broadcasting the status of your physical health to anyone and everyone is certainly not our social norm. In fact with today’s HIPPA laws, we as a society go to great lengths to keep our health status private. However, for people with psoriasis, hiding their personal health struggles is much more complex.

“Psoriasis causes areas of the skin to look scaly and raw,” says Dr. Laura Briley of Southern Dermatology in Raleigh. “Severe cases of psoriasis may cover 30 percent of a patient’s body—a huge percentage of someone’s skin. It’s often embarrassing and impossible to completely hide.”

Psoriasis is caused by a glitch in the natural cycle of skin cells, causing them to replicate too quickly, Dr. Briley explains. This leads to a build up of excess skin cells forming the scaly looking plaque on the surface of the skin, which may be itchy or painful.

“Sadly,” she continues, “a common misconception among people who don’t have psoriasis is that it’s contagious. People see the scaly looking skin caused by the disease and sometimes think these patients are lepers. The patients get accustomed to never being touched, never shaking someone’s hand, which is profoundly sad. Touch is such an important part of our whole world. It’s really important to know that psoriasis is not infectious.”

Dr. Briley sees patients with psoriasis from age 4 to 90, each with their own unique needs and complications. And as an expert in her field, she goes to great lengths to makes sure she approaches each patient from a holistic point of care.

“Another myth is that psoriasis is just a skin condition,” Dr. Briley continues. “In fact, it is an auto-immune disease that affects the skin, but also increases internal inflammation throughout the body. This internal inflammation affects the arteries, and because of this most psoriasis patients have a significant amount of cardiovascular disease, higher rates of heart attacks, and higher rates of other secondary conditions like diabetes.”

A New Class of Drugs: Changing Psoriasis Treatment

Luckily for Dr. Briley’s patients, the field of dermatology, like much of the medical world, has benefited greatly from the leaps and bounds in recent technological advancements.

“Biologics have changed the way we treat psoriasis completely,” Dr. Briley says with a smile. “We used to have limited options with dramatic side effects. For example, patients who were on Methotrexate—the old drug of choice—for 30 plus years would get liver dysfunction. In addition they would need liver biopsies on a regular basis, which came with another whole set of side effects because now you’re dealing with the need for a surgical procedure.

“Now, with the biologics,” she explains, “we are dealing with a different class of medications. These can still have side effects, of course, but the biologic medications have changed the conversation. Now the side effects are possible, not definite.”

Biologic dermatological medications, such as Humira, Enbrel, and Stelara, work by targeting the specific inflammatory markers causing the psoriatic inflammatory process. “The old medications,” Dr. Briley explains, “were suppressing the whole immune system—a blanket suppression. The biologics are more precise in their ability to affect just the markers we see in psoriasis, the specific pathways that have gotten out of loop, and to suppress them instead of the whole immune system.”

And results have improved, as well. “It used to be,” Dr. Briley continues, “that when a patient came in with 30 percent of their skin covered with psoriasis, we would start them on a medication and then wait six weeks to start seeing some improvement. At that point we could start increasing the medication dose, and maybe in six months or so we could get them to where only 10 percent of their body was covered with the plaque. Patients were generally pretty happy with that, but it takes a lot of time.

“But, now,” she says, “the biologic drugs have changed the whole time-line. Two new biologics have just come out that start working in a month or so, and now they are talking about 100 percent clearance of the skin. One Hundred percent!” she emphasizes “That is an amazing outcome.”

With two new biologic medications on the market—Cosentyx and Taltz—Dr. Briley is more able than ever to find the right treatment for her patients, and truly help to change their lives. “The psychological aspect of this disease is huge,” she says. “Depression rates are higher in psoriasis patients than in other groups, as are rates of alcoholism and obesity. It’s a difficult disease to live with because it’s what you feel people notice about you first. So when patients start seeing even just a thinning within a month, and then begin to watch it just melt away, they are so happy.”

The Root Cause

So what causes psoriasis? As with most things, explains Dr. Briley, it is a combination of factors. “Genetics are definitely a big player,” she says. “There are very specific gene groups that have now been teased out and identified. But it isn’t genes alone; it’s quite multifactorial. A person can have those genes their whole life, and just like other auto-immune diseases, it doesn’t progress. However, with enough environmental hits, the genes get switched on. Then suddenly you start to have flare-ups.”

Factors that can trigger the expression of the otherwise dormant psoriasis genes may be stress, a strep-infection, thyroid disease, or obesity. “Inflammatory markers are made in fat cells,” Dr. Briley says, “so the bigger your fat cells, the more inflammation you are going to have in your body. So if you gain a lot of weight and you have the genes, that can be the trigger.”

Because of this, Dr. Briley assesses each patient situation individually to come up with a treatment plan which goes beyond medications. “In addition to the biologics, you need to limit your stress, eat well, and have a good exercise program,” she says. “Generally, treat yourself kindly. I also encourage my patients to have regular visits with their primary care providers to monitor for cardiovascular disease.” h&h

Originally published in Health & Healing in the Triangle, Vol. 19, No. 4, Health & Healing, Inc., Chapel Hill, NC, publishers. Reposted with permission.