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Whats new in psoriasis

PSORIASIS

 There have been many a exciting developments in psoriasis.  Since we are all mostly interested in treatment we tell you the latest on the treatment.

 The introduction of calcipotriol (dovonex tm) has been one of the highlights of treatment advance in recent years.  Shifting the emphasis from traditional portals, an entirely new way emerged.  Calcipotriol (calcipotrnene – USA) is a vitamin D analogue.  So what’s new about calcipotriol.

 1.      calcipotriol and topical steroids

 Different regimes have tried calcipotriol in the morning.

Topical steroids at night.

This is applied regularly for two weeks and calcipotriol twice daily on weekdays and topical steroids twice daily on weekends.

 The above regimes apparently help to reduce the side effects of topical steroids.

 2.      Calcipotriol and PUVA

                   Phototherapy with PUVA is given and then calcipotriol is applied 

                    immediately AFTER the phototherapy session.

                 3.      Scalp treatment

 Solutions of calcipotriol have been introduced with the hope of treating psoriasis on the scalp.

It is inevitable that newer vitamin D analogues will be developed.  A few like maxacalcitol, tacalcitol are already here.

Tazarotene  derived from vitamin A analogues , is a topical application recently introduced.  It was associated with a small amount of irritation and soreness which led to a initial drop in usage.  Recently it has had a comeback after combination with topical steroids.  Tazarotene is applied in the evening and topical corticosteroids are applied in the morning.

The other usage is along with phototherapy.  After phototherapy ( dosages of light given, need to be reduced when combining with tazarotene) session tazarotene can be applied for added effect.

                   TLO1 UVB – (311nm)

An exciting aspect of phototherapy has been the wide spread use of this narrow band UVB treatment in psoriasis.  It is used more in Europe but has caught on the other side of the Atlantic as well.

It is hoped that the faster response to TLO1UB would be mirrored with a reduction in skin cancer causing potential, however this is not yet proven.

In this a chemical that increases the sensitivity of the skin to light is either given internally or applied locally.  The patient is then given exposure to the light.  When the psoriatic plaques take up light they reduce in size.  While many agents are in clinical trials none have been approved for treatment.

The introduction of “rotating treatment” concept is hoped to limit damage to any one organ.  Methotrexate, retinoids, cyclosporine, mycophenolate mofetil, 6 thisosulanine are used on a rotating basis in order to prevent the long term side effects of any particular treatment.

 Certain areas on the circulating blood cells (T cells) have specialized functions.  These are called receptors.  While blocking these receptors these cells can be switched off resulting in less activity.  This translates into less stimulation of skin cells to be shed which translates into clearing of psoriasis plaques.

Many proteins with long serial numbers have been used with good success in clinical trials.  So it is only a matter of time before they arrive on the market place.

 Watch this space.!!!!

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