Psoriasis is a disease most commonly associated with rough, red, scaly patches of skin that appear on arms, legs and other body parts. And while these skin lesions present a problem, requiring treatment for thousands of people each year, new research suggests psoriasis may be far more serious than a simple skin disorder.
For years, physicians have known that psoriasis can be linked to psoriatic arthritis in a minority of patients. With joint swelling and pain similar to that of rheumatoid arthritis, the disease is evidence of systemic inflammation. A study published last fall in the Journal of the American Medical Association created a stir among dermatologists by suggesting that inflammation in people with psoriasis could affect not only skin and joints, but also the cardiovascular system, increasing the risk of heart attack among young patients with severe psoriasis.
“The JAMA study was big news in dermatology,” says Craig Leonardi, M.D., a dermatologist at Central Dermatology and clinical associate professor of dermatology at Saint Louis University. “The research showed a four-fold increase in heart attack risk in patients who have severe psoriasis versus those with mild cases.” He notes that the study, which was conducted based on data from Great Britain, identified cases treated with pills or injections as severe and those needing only topical medications as mild.
“This is the first time the link between psoriasis and heart disease has been studied, so we need to validate the findings with data from other parts of the world,” Leonardi says. “But if it holds up, it would justify treating patients with severe psoriasis with new and powerful drugs. It’s probably going to take years to sort out all the research.”
The study comes at a time when pharmaceutical companies are cranking out new medications to control psoriasis. Leonardi refers to it as a “hotbed of discovery,” noting that within the last six years, the U.S. Food and Drug Administration approved five new medicines belonging to a class known as ‘biologic drugs,’ which target specific immune responses to control disease. Although the drugs can be highly effective and have fewer side effects than older generations of systemic drugs, they are very expensive and not yet widely covered by insurance.
David Sheinbein, M.D., a dermatologist with Washington University Physicians, agrees that new drugs may offer effective treatment for severe cases. However, with about 7 million people suffering from psoriasis, and a majority of those cases being mild to moderate, he notes that most dermatologists continue to adhere to a standard treatment paradigm.
“To treat the rash, we can prescribe topical medications that contain vitamins or steroids,” he says. “Using those, along with moisturizers and mild soap, a lot of people can control the skin problem.” If the disease is more severe, which is often determined based on the amount of body area covered by the psoriasis rash, therapy using special ultraviolet light may offer good results. Sheinbein points out that medical light therapy is not the same as lying in a tanning booth, as dermatologists warn against too much sun exposure. He says that only the most severe cases or those involving psoriatic arthritis generally receive systemic drugs.
Even mild cases of psoriasis can interfere with life and work activities, taking a significant psychological toll. A rash on the hands and feet, for instance, can be uncomfortable and obvious. Sheinbein suggests stress management, relaxation techniques and exercise as ways to help ease the psychological angst that may accompany psoriasis. “By treating the skin rash, we help people improve their psychological state,” he says. “I’ve seen people enter new relationships and get new jobs after their skin clears.”
Helen Kim-James, M.D., a dermatologist with Chesterfield Valley Dermatology, suggests that patients, family and friends visit the National Psoriasis Foundation Web site for information on other resources that may be helpful in living with the disease. “We personalize treatment and take the patient’s finances, overall health and lifestyle into account,” she says.
“Psoriasis affects 3 percent to 4 percent of the population, so it’s not a rare disease,” Kim-James continues. “And people should know that with all the new and evolving treatments available, some people who’ve had it for years now can get effective treatment. You don’t have to live with this condition—you can control it.”