To the public, Psoriasis may be one of the most misunderstood diseases. Often viewed as nothing more than a mild skin rash, psoriasis actually is a significant condition that usually plagues people for a lifetime. According to the National Institutes of Health, as many as 7.5 million Americans have the disease. Fortunately, a host of new treatments for the disorder are on the market.

"A whole new range of biological injectable drugs have become available that target more specifically the immunological defect," says M. Alan Menter, MD, chairman of the Division of Dermatology on the medical staff at Baylor University Medical Center in Dallas. "These are not just for initial clearing but for maintaining response and improving patients' lives. These are given on a long-term maintenance basis to provide continued impact on their quality of life."

According to the American Academy of Dermatology, new pharmaceuticals for psoriasis are better tolerated than the older drugs because they target the specific immune responses created by the disease instead of the entire immune system. That results in fewer side effects and less damage to the immune system.

"Psoriasis is characterized by either a few or multiple thick, red, scaly patches that can cover the entire body," Menter explains. "Patients often have severe dandruff, and can experience significant quality-of-life issues due to the visible, itchy nature of the lesions. The disease can also manifest itself in the joints, causing swollen, tender fingers, toes, wrists and ankles, as well as back and hip pain."

Joints become involved due to psoriatic arthritis, which affects up to 30 percent of patients with psoriasis and can occur at any age, even during childhood. Most people develop a mild or moderate form of the skin disease, but up to 25 percent have much more severe involvement. The reason for this disparity is unknown but probably genetic in nature. Currently there is no permanent cure for psoriasis.

Some of the new biological drugs are known generically as adalimumab, etanercept and infliximab, which block the tumor necrosis factor, a protein that can cause inflammation. Other drugs are alefacept and efalizumab, which reduce T cells, or white blood cells, that attack the body of those with psoriasis because of the increased number of abnormal white blood cells infiltrating the skin.

The drugs are delivered by subcutaneous injection weekly, twice weekly, or every other week, or by intravenous infusion over two to three hours every six to eight weeks, Menter says.

Researchers at Baylor and elsewhere continue refining current treatments and seek out new ways to fight the disease. "We're targeting which drug is most likely to work best in which patient, and equally important, continue to work, for the long term," Menter says. "The goal is to develop more specific new therapies — and someday, possibly a cure."  : :

Psoriasis is an autoimmune disorder in which the body's defense system mistakes some of its own cells for pathogenic, or disease-causing, invaders and tries to kill them. Because the disease originates in the bloodstream, it can cause devastating effects throughout the body, including inflammation in the skin, joints and internal organs, M. Alan Menter, MD, says. And those effects can be debilitating, with major self-esteem issues and not infrequent episodes of depression and rejection.

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