Top doctors: Advances in treating psoriasis

When skin cells shift into overdrive, they pile up on the skin's surface, forming craggy patches that are the hallmark of psoriasis.

The condition can be embarrassing and a blow to a person's self-esteem, says Dr. Antoinette Notaro, a dermatologist in private practice in Mattituck who's also an assistant clinical professor at Stony Brook University.

"Some people are very itchy, but most people are just upset about how they're looking," she said.

SYMPTOMS

Plaque psoriasis, the most common form of this immune system disorder, produces raised red areas flecked with silvery scales, according to the National Psoriasis Foundation. The lesions typically appear on the elbows, knees, scalp and lower back.

Psoriasis can affect the fingernails and toenails as well. Nails that pull away from the nail bed, discolor or develop pitting or ridging can be a sign of psoriatic arthritis, a related condition, reports the American Academy of Dermatology. In most people, psoriatic arthritis is usually mild and affects just a few joints. Without treatment, though, it can cause joint deterioration.

RISK FACTORS

Psoriasis most often develops between the ages of 15 and 35, though it can crop up at any time. And it can affect men and women alike.

Scientists believe genetics play a role in determining who gets the skin condition. Studies show the incidence of psoriasis is much greater among first- and second-degree relatives of people who have the condition than among the general population, according to a 2009 review in the New England Journal of Medicine.

The immune system is also involved. When someone has psoriasis, infection-fighting white blood cells, called T-cells, trigger a skin-cell reaction, causing new cells to produce more quickly than necessary, according to the dermatology academy.

CURRENT THINKING

As a first line of defense, topical medications such as corticosteroids, retinoids or vitamin D derivatives are considered the safest treatment. Ultraviolet (UV) light, sometimes called phototherapy, may be used to slow skin cell growth. The academy says the light can slow skin-cell growth and clear up plaques.

Notaro, however, said she doesn't use it with her patients. It's "inappropriate, I think, for a dermatologist who's telling all her patients to stay out of the sun and use sunscreen" to put people in a UV light box, she said.

For more severe cases or when other therapies fail, dermatologists recommend "systemic" treatment, which involves medicines that work throughout the body. Methotrexate, a drug taken orally or by injection, for example, has been shown to dramatically clear psoriasis, although serious side effects, particularly liver disease, can occur. The drug carries a warning that it should not be used by pregnant women as it could harm the fetus.

Biologics, drugs that block the action of certain immune cells or chemical messengers, are considered state-of-the-art treatment for psoriasis. Although serious side effects can occur, the drugs are "a real wonderful option" for people who have endured years of trial and error with other treatments, Notaro said. The newest one, Stelara (ustekinumab), hit the market less than a year ago.

Notaro said she is involved in a study to assess the five-year safety of Enbrel (etanercept), which was approved in 2004 by the U.S. Food and Drug Administration for the treatment of plaque psoriasis.

Treatment for psoriatic arthritis depends on the type a person has and how the person reacts to a drug. For mild cases, a doctor might prescribe an anti-inflammatory drug; more severe symptoms could require drugs that work to slow tissue damage.

THE LONG ISLAND SCENE

The Long Island Psoriasis Network, a support group of the National Psoriasis Foundation, meets at 7 p.m. the first Tuesday of every other month at North Shore University Hospital in Plainview. After a summer break, the meetings resume in October.