The American Academy of Dermatology says that dermatologists have studied three different kinds of diets: weight-loss, gluten-free and Mediterranean.

A weight loss diet

If you have psoriasis and are overweight, the AAD says, losing weight can: lead to less psoriasis on your skin; decrease the severity of your psoriasis; make psoriasis medication more effective

These effects can happen quickly, according to studies. In one small study of patients with psoriasis who were overweight, half of the patients followed a low-calorie diet. In just 16 weeks, the patients following the low-calorie diet had less psoriasis than the non-dieting group of patients with psoriasis. By week 24, many (66%) of the patients following the low-calorie diet had a 75% decrease in psoriasis on their skin. By comparison, only 29% of the non-dieting patients saw this 75% reduction.

During a clinical trial, dermatologists saw similar results. In this trial, dermatologists enrolled 303 patients with long-term plaque psoriasis. All patients were overweight and receiving treatment for psoriasis. Even with treatment, all continued to have psoriasis on their skin. In this clinical trial, half the patients were given a diet to follow and advice about the importance of exercising. The other group of patients was given information about how weight loss could be helpful. All patients were asked to lose 5% of their body weight within 20 weeks.

Patients in both groups lost weight. Those who lost 5% of their body weight had far less psoriasis on their skin. This trial shows that even a small amount of weight loss can reduce the amount of psoriasis on your skin.

Before starting a weight loss diet, talk with your dermatologist, the AAD says.

A gluten-free diet

Small studies suggest that if you have both psoriasis and a gluten sensitivity, following a gluten-free diet may help reduce psoriasis flare-ups.

People who have a gluten sensitivity have one of the following: Celiac disease: Symptoms include frequent diarrhea, belly pain, passing gas often, and feeling tired most of the time; and

gluten sensitivity: You test positive for celiac antibodies, but you don’t have celiac disease.

Here’s what happened during studies that looked at the effects on psoriasis sufferers of following a gluten-free diet.

In one study, 39 patients with psoriasis followed a gluten-free diet. Of these patients, 33 had a gluten sensitivity, and six patients did not have this sensitivity. After following the gluten-free diet: 73% of the patients with a gluten sensitivity had less psoriasis. None of the patients without a gluten sensitivity had less psoriasis.

In a very small study of seven patients who had psoriasis and a gluten sensitivity, all had completely clear skin after following a gluten-free diet.

If testing reveals that you’re sensitive to gluten, following a gluten-free diet may reduce the amount of psoriasis on your skin.

A Mediterranean diet

People who follow this diet get most of their fat from extra-virgin olive oil. They also eat at least two servings of vegetables and three servings of fruit every day. Each week, they eat at least three servings of fish or seafood, beans, and nuts.

All of these foods are rich in anti-inflammatory nutrients. Because psoriasis causes inflammation throughout the body, it’s believed that this diet could lead to less psoriasis on your skin.

It’s still too early to know whether this is true. However, one large study suggests a Mediterranean diet could help people with psoriasis. In this study, 35,735 patients were asked three times over a six-month period to answer surveys about what they ate.

After analyzing the results, the researchers found that the patients with severe psoriasis ate few — if any — foods found in the Mediterranean diet.

While this may suggest that following a Mediterranean diet can lessen the amount of psoriasis on your skin, it’s too soon to tell. Only about 2% of the patients in this study had psoriasis. The study also relied on people being able to recall what they ate. More research is needed to know how the Mediterranean diet affects psoriasis.

While changing what you eat (and drink) may seem simple, some fad diets can worsen psoriasis. Your dermatologist and primary care doctor can help you find a diet that meets your individual needs and works well with the medication in your treatment plan.

Always talk with your doctor before changing your diet.

The study, which involved both psychologists and dermatologists, was published in the Journal of the American Academy of Dermatology.

Investigators found that the stigma associated with the condition may lead people to avoid psoriasis patients, including not wanting to date them, shake hands or have the patients in their homes.

The study is the first to examine how common this stigma may be among the general population of the United States, as well as among medical students. Investigators also found that false perceptions about psoriasis itself continue to persist, including the belief that psoriasis is contagious and that it is not a serious illness.

Psoriasis is a common, chronic autoimmune disease affecting more than eight million Americans, causing painful, thick, red patches on the skin that often itch and bleed. It also has profound effects on health-related quality of life, and in moderate to severe cases, it carries an increased risk of heart attack, stroke, and premature death. It is not contagious, and while it is treatable, there is no cure.

“Although it’s widely recognized that the appearance of psoriasis can negatively impact patients’ social, professional, and intimate relationships, we wanted to quantify the perceptions patients with psoriasis face on a daily basis in order to understand how pervasive they are,” said the study’s senior author, Joel M. Gelfand, MD MSCE, a professor of Dermatology and Epidemiology at Penn. Rebecca L. Pearl, PhD, an assistant professor of Psychology in Psychiatry, was the lead author of the study.

Researchers used Amazon Mechanical Turk (MTurk), a web-based data collection service, to survey people about their perceptions of individuals with psoriasis. They also sent the survey directly to several hundred medical students. In all, 198 laypeople responded on MTurk and 187 medical students completed the emailed survey. All participants were shown images of people with psoriasis as well as close up photos of psoriasis lesions.

Overall, 54 percent of laypeople who responded said they did not want to date someone with psoriasis. Thirty-nine percent said they did not want to shake hands with someone suffering from the disease, while 32 percent said they did not want to have someone with psoriasis in their homes. Respondents also endorsed several stereotypes about people with psoriasis, with 57 percent saying they were insecure, 53 percent saying they were sick, 45 percent saying they were unattractive, and 27 percent saying they were contagious. Medical students demonstrated less stigmatizing views compared to the MTurk group. Among MTurk participants, those who knew someone with psoriasis or had heard of psoriasis demonstrated less stigmatizing attitudes.

“It’s possible that better education about the disease, as well as contact with individuals with psoriasis, may help to dispel myths and stereotypes and reduce negative perceptions,” Pearl said.

The researchers stressed the need for further research with a larger sample size before drawing any definitive conclusions. However, they said the findings do have implications for both public health and patient care.

Authors of that research report that patients with 10 percent or more of their body covered by psoriasis are at double risk of dying. That finding is not surprising considering psoriasis’ link to increased likelihood of heart attack, stroke, cardiovascular disease, inflammatory bowel disease, diabetes, life-threatening abdominal aneurysms, depression and even suicide.

Because psoriasis is a complex, systemic, lifelong disorder, people should seek professional medical assistance should inflamed, raised, scaly, itchy patches characteristic of the disease begin appearing on the skin. The patches are the result of an over-proliferation of skin cells, which, when scratched, may bleed and cause a burning or stinging sensation. Scratching also can lead to infection.

Psoriasis interrupts the body’s immune system by causing antibodies and immune cells to attack, or interfere with, healthy tissue. The autoimmune reaction triggers an overproduction of T-cells, resulting in development of plaques on the skin. T-cells are the body’s defense against invaders like bacteria and viruses.

Having a physician diagnose the condition in its earliest stages will ensure better management of the disorder, possibly slow or prevent certain disease-related processes and enhance a patient’s quality of life. Dermatologists, in particular, play an important role in screening patients for other diseases associated with psoriasis.

Early diagnosis is especially important since symptoms of eczema, a less serious skin problem, can sometimes be mistaken for those of psoriasis.

Considered the most prevalent autoimmune disease in the United States, psoriasis affects an estimated 7.5 million Americans and 125 million people worldwide. Between 10 percent and 30 percent of patients also will develop psoriatic arthritis, which promotes inflammation in and around the body’s joints.

The term psoriasis comes from a Greek word meaning “itchy.” Experts believe that people in biblical times may have oftentimes confused psoriasis with leprosy and isolated psoriasis patients even though the disorder is not contagious.

While the disease can develop at almost any age, it usually begins between the ages of 15 and 25. The most common form of the disorder is plaque psoriasis, which generates the appearance of scaly lesions typically on the scalp, knees, elbows and lower back.

Psoriasis has no known cure, but treatments, including creams, corticosteroids, retinoids and other topical medications; photodynamic (light) therapy; biologic drugs for more moderate psoriasis; and systemic medications to attempt controlling serious flareups of the disease, can be effective in alleviating and minimizing recurrence of symptoms.

New research has given scientists a better understanding of psoriasis’ cellular and molecular mechanisms, which also underly immunity system dysfunctions affecting the heart and other body organs. There’s hope that novel, more effective psoriatic treatments will be developed in the near term.

Meanwhile, patients can do much on their own to control psoriasis by avoiding triggers that aggravate symptoms or prompt recurrence of the disease. Here are some tips:

• Eat a well-balanced diet that includes omega-3 and vitamin D. Salmon, herring and walnuts are among sources of omega-3.
• Take short, warm – not hot – baths. Consider using fragrance-free bath oils or Epsom salts in the water to help reduce skin dryness and itching.
• Keep psoriatic skin moisturized. Use a topical ointment or cream, such as petroleum jelly. A moisturizer can be most effective when applied immediately after a bath.
• Try not to scratch that itch. Scratching further irritates the skin, and damaged skin can become infected.
• Reduce stress in your life. Stress can cause flare-ups of psoriasis.
• Avoid alcohol and stop smoking. Studies show both alcohol and smoking worsen symptoms of psoriasis and limit effectiveness of treatments.

The inaccurate claims and higher prices make it difficult for those with skin disorders such as eczema and psoriasis to find affordable, non-irritating, and safe moisturizers.

A release from Northwestern explains that the study examined the ingredients and performance of the top 100 best-selling, whole-body moisturizers at Amazon, Target, and Wal-Mart to determine the best consumer products based on affordability and how well they moisturized without causing a skin allergy.

Dermatologists have a responsibility to base their endorsements of moisturizers on evidence, especially if it leads to a higher price, said first author Steve Xu. This research will help dermatologists better understand the science behind moisturizers so they can more efficiently guide patients toward what they like, what is safe, and what is affordable.

Nearly half (45 percent) of the products in the study that claimed to be “fragrance free” actually had a fragrance cross reactor or botanical ingredient. The study found that the vast majority (83 percent) of products with “hypoallergenic” labels included a potentially allergenic chemical. Products that included a “dermatologist-recommended” label had a median price of $0.20 more per ounce than those that did not have the label.

The release quotes Xu, a resident physician in dermatology at Northwestern University Feinberg School of Medicine, as saying, “We looked into what it means to be ‘dermatologist-recommended,’ and it doesn’t mean much because it could be three dermatologists recommending it or 1,000.”

Products currently on the market that are free of typical skin allergens include white petroleum jelly, certain coconut oils that are cold-pressed and not refined, Vanicream’s hypoallergenic products and Aveeno Eczema Therapy moisturizing cream, according to Xu.

Moisturizers are a great solution for patients with skin disorders because they retain moisture in the skin, reduce inflammation, help prevent infection, are widely available and are largely affordable, Xu said. But it’s important to know if the ingredients contain allergens, which can be difficult because manufacturers do not have to list every chemical in their products if they are a fragrance. And the U.S. Food and Drug Administration has limited authority over cosmetics, Xu added.

But more labeling is not going to be enough.

“If manufacturers did list all the ingredients, their labels would be 75 pages,” Xu said. “As it stands now, patients have a challenging time making an informed decision by glancing at the back of the bottle. Our study highlights that and aims to make that search easier on consumers by informing dermatologists.”

The researchers looked for the presence of ingredients represented in the North American Contact Dermatitis Group (NACDG), which determines if a product contains typical skin allergens such as fragrance mix, parabens or tocopherol. Only 12 percent of the best-selling moisturizers were free of NACDG allergens.

The top three most affordable moisturizers in the study that were free of NACDG ingredients were Ivory raw unrefined shea butter, Vaseline original petroleum jelly and Smellgood African shea butter.

“There’s a huge loophole relating to fragrances, which is the number one cause of skin allergies related to cosmetics,” Xu said.

Often the products claiming to be “fragrance free” contained a fragrance cross reactor or a botanical ingredient, which can lead to an allergic reaction in some consumers.

“The more we know about the science behind moisturizers, the better we can guide our patients to what they like, what is safe and what is affordable,” Xu said.

Dermatologists like to prescribe ointments because evidence has shown the thickness of an ointment effectively hydrates and protects the skin better than any lotion, cream, butter or oil, Xu said. But he said, “The worst moisturizer is the one the patient won’t use.”

The most popular moisturizers, according to the study, were lotions (59 percent), followed by creams (13 percent), oils (12 percent), butters (8 percent) and ointments (2 percent).

“We could recommend a moisturizer that has no allergy risk and is affordable and effective, but if the patient doesn’t like it, it’s a wasted recommendation,” Xu said. “We need to program into our minds to think differently and strike that fine balance between safe ingredients and user preference.”

Dr. Jonathan Silverberg, assistant professor of dermatology and preventive medicine at Feinberg, a practicing dermatologist at Northwestern Medicine and founder and director of Northwestern Medicine’s Multidisciplinary Eczema Center, is senior author on the paper. Michael Kwa, a third-year medical student at Feinberg, is a co-author on the study.

More recently, studies have confirmed the effectiveness of phototherapy in controlling and minimizing outbreaks of psoriasis and vitiligo – in particular, the use of excimer lasers, which send a narrow, concentrated band of light to disease-affected areas of the skin, according to Christopher Byrne, RPA-C, certified physician assistant at Advanced Dermatology, P.C.

Although symptoms are different, both psoriasis and vitiligo are considered autoimmune diseases, with no known cure. They interrupt the body’s acquired immune system by causing antibodies and immune cells to attack, or interfere with, healthy tissue. In psoriasis, the autoimmune reaction triggers an overproduction of T-cells, resulting in development of plaques on the skin. T-cells are the body’s defense again invaders like bacteria and viruses. Vitiligo creates white skin patches by destroying the body’s melanocytes or pigment cells. Neither disease is life-threatening.

The International Federation of Psoriasis Associations reports that about 3 percent of the world’s population have some form of psoriasis. In the United States, approximately 150,000 new psoriasis cases are diagnosed every year. Even though vitiligo is listed as a “rare disease,” it affects about two million or more people in this country.

With an excimer laser, such as the hand-held Xtrac, dermatologists can break up the cells in the psoriasis plaques or darken the areas of skin affected by vitiligo, in some cases, achieving remission of the skin disorders for extended periods of time. This targeted light therapy is virtually painless, with few side effects like thinning or premature aging of skin. However, patients usually undergo multiple treatment sessions to achieve desired results, Byrne said.

The federal Food and Drug Administration (FDA) approved use of the Xtrac laser in 2000 for treatment of mild and moderate cases of psoriasis. Since then, improvements in technology and protocols have shown the Xtrac and other excimer lasers capable of controlling vitiligo and serious cases of psoriasis, as well, Byrne said.

Some researchers caution that the jury is still out on whether phototherapy alone, or in combination with other treatments, is more effective than other approaches against these skin disorders. However, scientists writing in an online article, “Recent advances in phototherapy for psoriasis,” in July 2016, stated that “phototherapy remains a mainstay treatment with promise for further advancement.” A study appearing in JAMA Dermatology, in April 2017, indicated long-duration phototherapy is effective in treating vitiligo.

Although phototherapy is oftentimes the weapon of choice in treating psoriasis and vitiligo, researchers continue the hunt for even more advanced options.

The American Academy of Dermatology reported in early 2017 that a class of drugs – Janus kinase inhibitors (JAK) – shows promise in the management of immune-system-related skin problems. The National Institutes of Health supports ongoing efforts to develop biologics that target cells and molecules involved in the regulation of the immune system.

“We have no magic pill yet for these chronic skin disorders,” Byrne said. “Doctors must assess each patient to determine the best treatment approach. For some individuals, management and remission of their skin disease may require a combination of therapies, including phototherapy, oral and topical treatments, biological agents, surgical procedures — even lifestyle changes.”

Of course, sometimes the best defense is a good offense. That’s why Byrne offers this advice for controlling outbreaks of chronic skin problems:

• Stop smoking; limit consumption of alcohol. Both smoking and alcohol may aggravate skin disorders.
• Practice good nutrition. Although little research has been done on links between diet and skin condition, proper nutrition helps maintain a person’s overall health.
• Protect the skin from cuts, scrapes and the harmful effects of the sun’s rays. “Insults” to the skin invite flare-ups of disorders like psoriasis and vitiligo.
• Manage stress. Stress is known to aggravate a psoriatic condition, and evidence suggests that a particularly stressful event could be one trigger for vitiligo.
• Seek out support groups to learn how to cope with skin diseases that can cause feelings of embarrassment and contribute to mood disorders and depression.

Advanced Dermatology, P.C. and the Center for Laser and Cosmetic Surgery (based in New York and  New Jersey) offers highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies. For more on their work, click here.

Do you have psoriasis? If so, it’s important to pay attention to your joints. Some people who have psoriasis get a type of arthritis called psoriatic arthritis.

This arthritis often begins with a few swollen joints. A single finger or toe may be noticeably swollen. Some people feel stiff when they wake up. As they move around, the stiffness fades.

Most people get psoriatic arthritis about 5 to 12 years after psoriasis. This arthritis can show up earlier. Some people get psoriatic arthritis and psoriasis at the same time. A few get psoriatic arthritis first and psoriasis later.

If you have psoriasis, there is no way to tell whether you will get psoriatic arthritis. This is why it is important to pay attention to swollen joints. An early diagnosis and treatment will help. These can reduce the effect that arthritis has on your life.

Treatment for psoriatic arthritis includes physical therapy, arthritis-friendly exercise, and medicine. A few medicines can prevent psoriatic arthritis from worsening and damaging your joints. Not everyone needs this medicine.

Like psoriasis, psoriatic arthritis is often a lifelong medical condition. It can flare and clear unpredictably.

How to recognize psoriatic arthritis

For most people, psoriatic arthritis develops years after psoriasis. Tell your dermatologist if you have psoriasis and any of these signs and symptoms:

A very noticeable swollen finger or toe.

Swollen and tender joints.

Stiffness when you wake up or sit for hours; stiffness fades as you move.

Nails that are pitted.

Nail separating from nail bed.

Lower back pain.

Heel pain.

Swelling on the back of your leg above your heel.

Who gets psoriatic arthritis?

Most people who get psoriatic arthritis have one or more of the following:

Psoriasis (plaque, guttate, or pustular).

Psoriasis that affects their nails.

Blood relatives who have psoriatic arthritis.

Psoriatic arthritis usually appears about 5 to 12 years after psoriasis begins. It is equally common in men and women. Most people develop it between 30 and 50 years of age. But psoriatic arthritis can begin at any age. Children may even get psoriatic arthritis.

It is important to know that not everyone who gets psoriasis will eventually develop psoriatic arthritis. There is no way to tell who will get psoriatic arthritis. You should tell your dermatologist if you have joint pain or stiffness when you wake up, or swollen joints that come and go. These are often the earliest symptoms.

What causes psoriatic arthritis?

We still do not know everything that happens inside the body to cause psoriatic arthritis. We know that like psoriasis, psoriatic arthritis is an autoimmune disease. When a person has an autoimmune disease, the body mistakes something inside as a foreign object. In the case of psoriatic arthritis, the body mistakes joints and tendons as foreign.

Like psoriasis, psoriatic arthritis also involves your genes; environment and immune system.

How is psoriatic arthritis diagnosed?

A single medical test is not available to diagnose psoriatic arthritis. To find out whether you have psoriatic arthritis, your doctor will do the following:

Look at your medical records.

Ask you specific questions. This usually includes questions such as whether any of your blood relatives have psoriasis or psoriatic arthritis.

Examine your joints. This examination includes looking at your body to see whether you have swollen joints. Your doctor will gently press on the skin around certain joints to find out whether the area is tender.

Send you for medical testing. This may include x-rays and a blood test.

Before giving you a diagnosis, your doctor considers your test results and everything he or she learned while meeting with you. In case you’re wondering, the result from your blood test cannot tell whether you have psoriatic arthritis. It tells your doctor whether you have inflammation throughout your body. People who have psoriatic arthritis have body-wide inflammation. Many other diseases also cause body-wide inflammation. Inflammation is a piece of the puzzle.

Because psoriatic arthritis can look like other types of arthritis, patients often see a dermatologist or rheumatologist for a diagnosis. A rheumatologist is a medical doctor who specializes in diagnosing and treating arthritis and other diseases of the joints, muscles, and bones. Rheumatologists and dermatologists generally have the most experience diagnosing and treating psoriatic arthritis.

How is psoriatic arthritis treated?

If you are diagnosed with psoriatic arthritis, it is important to know that treatment can: ease swelling, pain, stiffness, and other symptoms; stop the arthritis from getting worse and damaging your joints; and improve your quality of life.

Today, there are many treatment options for psoriatic arthritis. A treatment plan often includes several of the following:

 Therapy (physical, occupational, massage): These therapies can reduce pain. They can make it easier to move and do everyday tasks. If therapy can help, your doctor will write a prescription for the type(s) of therapy you need. Your therapist will work with your doctor and report your progress.

Patient education: Learning about psoriatic arthritis is important. The more you know, the better you can control this disease. Take time to learn the signs and symptoms. Ask your doctor what you should do when the arthritis flares. Learn about arthritis-friendly exercises and exercises that you should not do — at least for a while.

Exercise and rest: Each plays an important role. Arthritis-friendly exercises can help reduce pain, make it easier to move, and sometimes restore lost movement. Rest is important when psoriatic arthritis flares. Ask your doctor what kind of exercise is best for you.

Devices to protect joints: Braces, splints, and supports can protect affected joints and prevent further damage. They offer support for painful areas and can stop painful movements. You should not buy one without first talking with your doctor. The device must fit you properly. It must support the area that needs support. Your doctor may recommend that a physical or occupational therapist fit you.

Medicine: Medicine can reduce swelling and ease pain. A few medicines can prevent the arthritis from worsening. The medicines that are often part of a treatment plan for psoriatic arthritis are as follows:

When psoriatic arthritis is mild, patients usually can reduce signs and symptoms with:

Non-steroidal anti-inflammatory drugs (NSAIDS) (pronounced en-saids): These help reduce swelling and pain. Some NSAIDs that may be part of a treatment plan for psoriatic arthritis do not require a prescription. These include aspirin, ibuprofen, naproxen, and nabumetone.

Prescription NSAIDs include arthritis medicines such as celecoxib.Some people see their psoriasis worsen when they begin taking an NSAID. If this happens, call your dermatologist.

Tip: If you are taking aspirin or another medicine in the NSAID family, take the medicine immediately after you drink a glass of milk or eat a meal. This helps to protect your stomach. You should not drink alcohol when an NSAID is part of your treatment plan.

Shots of corticosteroids: When arthritis develops in a few joints, injecting this medicine into the swollen joints can quickly reduce swelling and pain.

Some people require stronger medicine to control their psoriatic arthritis. Your doctor may prescribe a disease-modifying, anti-rheumatic drug (DMARD) (pronounced dee-mard). DMARDs also reduce swelling and pain. Some DMARDs can prevent the arthritis from worsening and destroying joints. DMARDs that may be part of a treatment plan for psoriatic arthritis include:

Methotrexate: This medicine can reduce swelling in the joints and also is approved to treat psoriasis.

Injectable biologics: This type of medicine can prevent the arthritis from progressing and destroying the joints. Some of the biologics approved to treat psoriatic arthritis also can treat psoriasis.

All medicine can cause side effects. Before taking a medicine, ask your doctor about possible side effects.

Surgery: If you have badly damaged joints or medicine does not help, surgery may be an option. Surgery can lessen pain. It can help you move more easily. It can improve the appearance of damaged joints. After surgery, you may be able to perform everyday tasks more easily. Surgery requires downtime and involves some risk.

Managing psoriatic arthritis

If you have psoriatic arthritis, you may have trouble using your hands. You may have joint pain and swelling. These tips may help.

Talk with your doctor about exercise. No one exercise helps everyone. Your doctor may recommend some exercises. Other exercises may be discouraged. Your doctor can help you decide which exercises will benefit you. A few sessions of physical therapy may be helpful. Your doctor can write a prescription for physical therapy.

No exercise is right for everyone, but some types of exercise help many people who have arthritis. Topping this list are yoga, tai chi, and joint-friendly water exercises. Studies show that these can help ease pain in your joints. Walking, cycling, and training with lightweight dumbbells also may be options. Even if you have difficulty moving, exercise can help.

Many organizations offer arthritis-friendly exercise classes. To find out whether such classes are available in your area, contact your local hospital, YMCA, fitness center, community center, and park district.

Rest when needed

Learn what aggravates your arthritis. People living with arthritis say that some activities, foods, and habits cause their arthritis to flare. Each time your psoriatic arthritis flares, make a note of what you were doing or eating. This may help you learn what triggers your psoriatic arthritis.

Find out your healthy weight. If you’re not at that weight, try to reach it. Maintaining a healthy weight helps to reduce joint pain and allows you to move with greater ease.

Material courtesy of the American Academy of Dermatology.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations,  with a membership of more than 18,000 physicians worldwide. For more information, contact the AAD at 1-888-462-DERM (3376) or www.aad.org. Follow the AAD on Facebook (American Academy of Dermatology), Twitter (@AADskin) or YouTube (AcademyofDermatology).

Many patients showed significant recovery after just a single dose, and by the end of the trial, conducted at Rockefeller University and seven other centers, nearly all the patients showed dramatic, if not complete, improvement in their symptoms, according to a news release from Rockefeller.

“The striking result we achieved using a human antibody that targets the signal interleukin-23 suggests we are on the threshold of doing something very different from our current model of treating psoriasis with immunosuppressive drugs throughout an adult lifetime,” says study author James Krueger, director of the Milstein Medical Research Program, D. Martin Carter Professor in Clinical Investigation and head of the Laboratory of Investigative Dermatology at Rockefeller. “It raises the possibility of working toward long-term remission — in other words, a cure.”

The findings were published in The Journal of Allergy and Clinical Immunology.

Psoriasis is a debilitating disease in which the body’s immune system mistakenly turns on the skin, producing red, itchy, scaly patches. It appears that interleukin-23, a type of immune signaling molecule, initiates a series of interactions that lead to skin inflammation and excessive growth of skin cells.

The antibody used in this latest research, BI 655066, targets interleukin-23 and blocks its action.

Just a single treatment yielded what the team of investigators called “rapid, substantial, and durable clinical improvement in patients with moderate-to-severe psoriasis.” On average, according to the release from Rockefeller, patients who received the treatment had a more than 80 percent improvement in the severity and extent of their skin lesions that continued until tracking ended six weeks after treatment.

Scientists have known that Interleukin 4, also known as IL-4, an endogenous signal molecule, inhibits the inflammation that is characteristic of psoriasis. But until now, it wasn’t clear exactly how that happened.

Inflammation defends the body against invaders. But sometimes poorly directed immune reactions can trigger inflammation even though there is no attack from outside. That can cause tissue damage in psoriasis, and is a factor in other autoimmune disease such as multiple sclerosis and rheumatoid arthritis.

Researchers from the Technische Universität München (TUM) and the University of Tübingen used an animal model and a study of patients to increase the understanding of how IL-4 plays an important role in the immune system.

“Together with colleagues from Tübingen, we were able to show in earlier studies that the signaling molecule IL-4 is a promising candidate for the treatment of psoriasis,” said Prof. Tilo Biedermann, who holds the chair for Dermatology and Allergology and is Director of the Clinic and Polyclinic for Dermatology and Allergology. “However, before IL-4 can be used as a standardized medication, we have to understand the exact mechanism of action – and we’ve now succeeded in doing just that.”

In the study, according to a news release from TUM,  the scientists discovered that IL-4 inhibits specific immune cells in a natural way: it prevents the cells from synthesizing and releasing two signaling molecules, known as IL-23 and IL-17.

“The discovery is very interesting in that IL-23 activates special T-cells in the body, thus triggering inflammation. Evidently IL-4 is able to effectively block this pathway,” says Biedermann. In subsequent experiments with mice, the scientists also found that administration of IL-4 specifically inhibits inflammation of the skin via this mechanism.

Twenty-two patients with psoriasis were given injections of IL-4 over a period of six weeks Before treatment with IL-4, the study participants had high levels of IL-23 and IL-17 in their inflamed and itchy skin. After successful treatment, the two substances were barely detectable, and  inflammation and psoriatic skin changes disappeared.

The findings were published in the Proceedings of the National Academy of Sciences.

A release from the Universoty of Leeds in the UK explains that psoriatic arthritis (PsA) causes painful joint inflammation and can cause irreversible joint damage if left untreated.

PsA tends to affect people with psoriasis. This skin condition causes a red, scaly rash. Around one in five go on to develop PsA – usually within ten years of the initial skin problem being diagnosed.

Coming together to tackle the gaps in the treatment and diagnosis of psoriatic arthritis, expert rheumatologists, dermatologists and patient representatives from Europe and North America formed the Psoriatic Arthritis Forum, and have now made a series of recommendations to combat the condition.

The recommendations were published in July 2014 the journal Arthritis Care and Research

They included:

• Developing a screening tool for dermatologists and primary care doctors to identify suspected PsA patients

• Raising awareness about the progression, health-related quality of life components, and other health issues associated with PsA

• Improving communication between healthcare providers and patients

The release quotes Dr. Philip Helliwell of the School of Medicine at the University of Leeds, as saying, “We believe up to 50% of psoriasis patients with psoriatic arthritis are undiagnosed, living with sore, stiff and tender joints, without understanding what is causing this pain. Our review points the way forward for effective screening and treatment, in the hope that detection rates of the condition are improved and patients enjoy a better quality of life.”

In addition to better screening, experts have called for improved referrals of patients, as well as an algorithm – a step-by-step procedure for primary care physicians – to be developed to help community physicians on patient evaluation and treatment decisions.

Dr Helliwell added: “These recommendations serve as a guide for improving the timely diagnosis of PsA, as well as promoting global awareness of PsA. We need to develop better screening tools as a matter of urgency, as these will be cost-effective and lead to better health outcomes for thousands of people.”