New psoriasis treatments give hope to hopeless

DEAR DR. DONOHUE: I have a very severe case of psoriasis. My entire body is affected. I have had it for many years, but not this bad. I have tried many different creams and lotions, but nothing is helping. Is there some kind of pill I could take? -R.K.

ANSWER: You're not alone. Up to 3 percent of the world's population suffers from psoriasis. It's a lifelong affliction, with cycles when it improves followed by cycles when it gets much worse. Fortunately you are living at a time where the number of treatments for it have burgeoned.

Ordinarily it takes a month for the lowermost skin cells to reach the skin surface. That gives them time to mature. With psoriasis, the lowermost cells reach the surface in three to five days. These immature cells produce the red patches covered with silver scales so typical of psoriasis. The immune system is somehow involved in the process, prodding skin cells to cut short their period of maturation. The immune system also causes a release of chemicals that damage skin.

Psoriasis medicines that can be applied directly to the skin include cortisone drugs like Synalar or Aristocort. They come as creams, ointments, gels or lotions, and they control the process for many. Dovonex, which is related to vitamin D, is another skin-applied medicine, as is Tazorac, which belongs to the vitamin A family.

Ultraviolet B light can sometimes keep psoriasis in check. Ultraviolet A light, coupled with the oral drug psoralen, is another effective treatment. It might, however, lead to skin cancer for a few.

Oral drugs include methotrexate and cyclosporine. Soriatane is also taken by mouth. It's related to a powerful acne drug and cannot be taken before or during pregnancy.

There are new treatments called biologic agents. They act against a misbehaving immune system and keep it under wraps. Examples include Amevive, Raptiva and Enbrel. They're given by injection, and they represent a new era in psoriasis treatment.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.