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Recent Developments in Psoriasis Treatment

Psoriasis is a stigmatized skin condition that a surprisingly large portion of our population suffers from.  In the United States alone, 7.5 million people have psoriasis and 40 percent of those with psoriasis experience inflammation that may result in psoriatic arthritis (Psoriasis, 2017).  Additionally, those suffering from Psoriasis have a high rate of comorbidity with diseases such as: Crohn’s, colitis, inflammatory bowel disease, and depression; as well as an increased risk for heart disease, obesity, type II diabetes, lymphoma, and many other illnesses.  The first-line treatment usually consists of topical creams, a notoriously ineffective treatment for chronic Psoriasis.  More severe cases call for extensive measures such as phototherapy and biological treatments which tend to target the immune system.  Doctors worldwide have focused in on biological treatments and the development of new medications for treatment of chronic Psoriasis.  Below are some of the findings from two recent studies performed by researchers across the United States, and the United Kingdom.

In the first case series, “Ustekinumab-induced remission of recalcitrant guttate psoriasis,” doctors’ Brummer, Hawkes, and Duffin account their successful treatment, using Ustekinumab, of six different patients with guttate psoriasis.  Guttate psoriasis consists of chronic flare ups of dry, patchy papules and plaques, similar to plaque psoriasis.  Guttate is also frequently found in combination with streptococcal infections.  Severe cases, that don’t respond to other treatment methods are candidates for a more extreme, biological, treatments.  These biological treatments have yet to be studied systematically, but all six of the patients in this case study did show successes.  Many of these patient’s psoriasis resulted in reoccurring streptococcal pharyngitis infections.  After one injection of Ustekinumab, the majority of the five showed great improvement in their psoriasis and streptococcal infections.  After about six months of treatment, they showed clearance with an occasional break out.  These infrequent flare ups were typically handled using topical creams.  Only one of the six patients required additional injections upon more intense reoccurrence.  Additionally, Patient 4 displayed comorbidity with Crohn’s disease, so he continued regular injections for his Crohn’s.  Brummer, Hawkes, and Duffin conclude, “To date, there is only 1 published case report of a chronic guttate psoriasis patient who was successfully treated with ustekinumab.  Here we present 6 cases of recalcitrant guttate psoriasis successfully treated with ustekinumab” (Brummer, Hawkes, & Duffin, 2017).  Successes such as these are suggestive of a new era of treatment and greater understanding of the once baffling psoriasis.

In the study, “Recapturing adequate control of psoriasis by additional immunosuppressive agents alongside ustekinumab,” dermatologists in the United Kingdom teamed up to test the long-term effectiveness of biological treatments approved for chronic psoriasis.  Currently, ustekinumab, is the front runner longevity of treatment, while Etanercept appears to have the shortest survival.  Jayasekera, Parslew, and Al-Sharqi, propose a possible mechanism for loss of efficacy caused by the presence of antidrug antibodies.  In their study, patients underwent treatment using ustekinumab in combination with immunosuppressive agents.  Jayasekera, Parslew, and Al-Sharqi discuss their findings, “In our population of patients, we found that the addition of an immunosuppressive agent to ustekinumab seemed to restore response” (Jayasekera, Parslew, & Al-Sharqi, 2016).  These results are quite promising and ultimately expand upon the findings of the first case study.

Initial breakthrough studies, as described here, provide a baseline for further research and well as spark the interest of other researchers.  Positive results will hopefully make funding more accessible to further study the treatment of psoriasis.  Despite the limitations in these studies, their successes point in the right direction for future treatment.  While life with psoriasis can often be difficult, remaining hopeful for the future and open to new treatment options is the best way for one reduce stress levels and cope with a psoriasis diagnosis.  Educate yourself and find the resources available to help you! 

 

Works Cited

Brummer, G. C., BS, Hawkes, J. E., MD, & Duffin, K. C., MD, MS. (2017, September). Ustekinumab-induced remission of recalcitrant guttate psoriasis: A case series. Retrieved October 1, 2017, from http://www.jaadcasereports.org/article/S2352-5126(17)30127-3/pdf

Jayasekera, P. S., BM Medicine, MRCP, DERM, Parslew, R. A., MBCHB, FRCP, & Al-Sharqi, A., MBCHB, FRCP. (2016, July). Recapturing adequate control of psoriasis by additional immunosuppressive agents alongside ustekinumab. Retrieved October 1, 2017, from http://www.jaadcasereports.org/article/S2352-5126(16)30032-7/pdf

Psoriasis. (2017). Retrieved September 27, 2017, from https://www.aad.org/media/stats/conditions/psoriasis

Caitlyn