The 2002 Official Patient's Sourcebook on Psoriasis: A Revised and Updated Directory for the Internet Age

THE 2002 OFFICIAL PATIENT’S SOURCEBOOK on J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS ii IC...

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THE 2002 OFFICIAL PATIENT’S SOURCEBOOK

on

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

ii

ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on Psoriasis: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83405-9 1. Psoriasis-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.

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Dedication To the healthcare professionals dedicating their time and efforts to the study of psoriasis.

Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to psoriasis. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

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About ICON Health Publications In addition to psoriasis, Official Patient’s Sourcebooks are available for the following related topics: ·

The Official Patient's Sourcebook on Acne

·

The Official Patient's Sourcebook on Acne Rosacea

·

The Official Patient's Sourcebook on Atopic Dermatitis

·

The Official Patient's Sourcebook on Behçet Syndrome

·

The Official Patient's Sourcebook on Epidermolysis Bullosa

·

The Official Patient's Sourcebook on Lichen Sclerosus

·

The Official Patient's Sourcebook on Lyme Disease

·

The Official Patient's Sourcebook on Raynaud's Phenomenon

·

The Official Patient's Sourcebook on Scleroderma

·

The Official Patient's Sourcebook on Sjogren's Syndrome

·

The Official Patient's Sourcebook on Vitiligo

To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

Contents vii

Table of Contents INTRODUCTION...................................................................................... 1

Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4

PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON PSORIASIS: GUIDELINES .................. 9

Overview............................................................................................................... 9 What Is Psoriasis? .............................................................................................. 10 What Causes Psoriasis?...................................................................................... 11 How Is Psoriasis Diagnosed? ............................................................................. 11 What Treatments Are Available for Psoriasis? .................................................. 12 What Are Some Promising Areas of Psoriasis Research? .................................. 16 How Can People Contribute to Psoriasis Research? .......................................... 17 Where Can I Find More Information about Psoriasis? ...................................... 17 More Guideline Sources ..................................................................................... 18 Vocabulary Builder............................................................................................. 32

CHAPTER 2. SEEKING GUIDANCE ....................................................... 37

Overview............................................................................................................. 37 Associations and Psoriasis.................................................................................. 37 Finding More Associations................................................................................. 42 Finding Doctors.................................................................................................. 44 Finding a Dermatologist..................................................................................... 45 Selecting Your Doctor ........................................................................................ 45 Working with Your Doctor ................................................................................ 46 Broader Health-Related Resources ..................................................................... 47 Vocabulary Builder............................................................................................. 47

CHAPTER 3. CLINICAL TRIALS AND PSORIASIS .................................. 49

Overview............................................................................................................. 49 Recent Trials on Psoriasis .................................................................................. 52 Benefits and Risks............................................................................................... 60 Keeping Current on Clinical Trials.................................................................... 63 General References.............................................................................................. 64 Vocabulary Builder............................................................................................. 65

PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 67 CHAPTER 4. STUDIES ON PSORIASIS .................................................... 69

Overview............................................................................................................. 69 The Combined Health Information Database ..................................................... 69

viii Contents

Federally-Funded Research on Psoriasis ............................................................ 80 E-Journals: PubMed Central .............................................................................. 93 The National Library of Medicine: PubMed ...................................................... 94 Vocabulary Builder........................................................................................... 103

CHAPTER 5. PATENTS ON PSORIASIS ................................................ 113

Overview........................................................................................................... 113 Patents on Psoriasis.......................................................................................... 114 Patent Applications on Psoriasis...................................................................... 129 Keeping Current ............................................................................................... 137 Vocabulary Builder........................................................................................... 137

CHAPTER 6. BOOKS ON PSORIASIS .................................................... 143

Overview........................................................................................................... 143 Book Summaries: Federal Agencies .................................................................. 143 Book Summaries: Online Booksellers ............................................................... 146 The National Library of Medicine Book Index ................................................. 148 Chapters on Psoriasis........................................................................................ 151 General Home References ................................................................................. 154 Vocabulary Builder........................................................................................... 155

CHAPTER 7. MULTIMEDIA ON PSORIASIS ......................................... 157

Overview........................................................................................................... 157 Video Recordings .............................................................................................. 157 Bibliography: Multimedia on Psoriasis ............................................................ 158 Vocabulary Builder........................................................................................... 160

CHAPTER 8. PERIODICALS AND NEWS ON PSORIASIS ...................... 161

Overview........................................................................................................... 161 News Services & Press Releases ....................................................................... 161 Newsletter Articles ........................................................................................... 171 Academic Periodicals covering Psoriasis.......................................................... 179 Vocabulary Builder........................................................................................... 180

CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 183

Overview........................................................................................................... 183 NIH Guidelines................................................................................................. 183 NIH Databases.................................................................................................. 184 Other Commercial Databases ........................................................................... 196 The Genome Project and Psoriasis ................................................................... 197 Specialized References....................................................................................... 202 Vocabulary Builder........................................................................................... 203

CHAPTER 10. DISSERTATIONS ON PSORIASIS .................................... 205

Overview........................................................................................................... 205 Dissertations on Psoriasis ................................................................................ 205 Keeping Current ............................................................................................... 206

PART III. APPENDICES .................................................. 207

Contents

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APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 209

Overview........................................................................................................... 209 Your Medications: The Basics .......................................................................... 210 Learning More about Your Medications .......................................................... 211 Commercial Databases...................................................................................... 217 Contraindications and Interactions (Hidden Dangers) ................................... 219 A Final Warning .............................................................................................. 220 General References............................................................................................ 220 Vocabulary Builder........................................................................................... 222

APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 223

Overview........................................................................................................... 223 What Is CAM? ................................................................................................. 223 What Are the Domains of Alternative Medicine?............................................ 224 Can Alternatives Affect My Treatment? ......................................................... 227 Finding CAM References on Psoriasis............................................................. 228 Additional Web Resources................................................................................ 239 General References............................................................................................ 257 Vocabulary Builder........................................................................................... 258

APPENDIX C. RESEARCHING NUTRITION ......................................... 261

Overview........................................................................................................... 261 Food and Nutrition: General Principles........................................................... 262 Finding Studies on Psoriasis ............................................................................ 266 Federal Resources on Nutrition........................................................................ 270 Additional Web Resources................................................................................ 271 Vocabulary Builder........................................................................................... 276

APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 279

Overview........................................................................................................... 279 Preparation ....................................................................................................... 279 Finding a Local Medical Library ...................................................................... 280 Medical Libraries Open to the Public............................................................... 280

APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 287

Overview........................................................................................................... 287 Your Rights as a Patient................................................................................... 287 Patient Responsibilities .................................................................................... 291 Choosing an Insurance Plan............................................................................. 292 Medicare and Medicaid .................................................................................... 294 NORD’s Medication Assistance Programs ..................................................... 297 Additional Resources ........................................................................................ 298 Vocabulary Builder........................................................................................... 299

ONLINE GLOSSARIES.................................................... 301 Online Dictionary Directories.......................................................................... 308

PSORIASIS GLOSSARY.................................................. 309

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Contents

General Dictionaries and Glossaries ................................................................ 334

INDEX................................................................................... 336

Introduction

1

INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don't know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3

Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2

2

Psoriasis

Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor's offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The 2002 Official Patient’s Sourcebook on Psoriasis has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to psoriasis, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on psoriasis. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on psoriasis should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate

Introduction

3

options is always up to the patient in consultation with their physician and healthcare providers.

Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching psoriasis (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to psoriasis. It also gives you sources of information that can help you find a doctor in your local area specializing in treating psoriasis. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with psoriasis. Part II moves on to advanced research dedicated to psoriasis. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on psoriasis. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with psoriasis or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with psoriasis. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with psoriasis.

Scope While this sourcebook covers psoriasis, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that psoriasis is often considered a synonym or a condition closely related to the following: ·

Arthritic Psoriasis

·

Arthropathic Psoriasis

·

Parapsoriasis

4

Psoriasis

·

Plaque Psoriasis

In addition to synonyms and related conditions, physicians may refer to psoriasis using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world's illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for psoriasis:4 ·

696.0 psoriasis, arthritis, arthropathic

·

696.1 other psoriasis

·

696.1 psoriasis, any type except arthropathic

·

696.2 parapsoriasis

For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to psoriasis. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.

Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson's approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with psoriasis will log on to the Internet, type words into a search engine, and receive several Web 4 This list is based on the official version of the World Health Organization's 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”

Introduction

5

site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with psoriasis is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of psoriasis, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors

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PART I: THE ESSENTIALS

ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on psoriasis. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of psoriasis to you or even given you a pamphlet or brochure describing psoriasis. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.

Guidelines

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CHAPTER 1. THE ESSENTIALS ON PSORIASIS: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on psoriasis. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on psoriasis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on psoriasis. Originally founded in 1887, the NIH is one of the world's foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world's most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.

5

Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.

10 Psoriasis

There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with psoriasis and associated conditions: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc. ) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html

·

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines at http://www.nih.gov/niams/healthinfo/

Among those listed above, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is especially noteworthy. The mission of NIAMS, a part of the National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. The NIAMS provides the following guideline concerning psoriasis.6

What Is Psoriasis?7 Psoriasis is a chronic (long-lasting) skin disease characterized by scaling and inflammation. Scaling occurs when cells in the outer layer of the skin reproduce faster than normal and pile up on the skin’s surface. Psoriasis affects between 1 and 2 percent of the United States population, or about 5.5 million people. Although the disease occurs in all age groups and 6This and other passages are adapted from the NIH and NIAMS (http://www.niams.nih.gov/hi/index.htm). “Adapted” signifies that the text is reproduced with attribution, with some or no editorial adjustments. 7 Adapted from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): http://www.niams.nih.gov/hi/topics/psoriasis/psoriafs.htm.

Guidelines 11

about equally in men and women, it primarily affects adults. People with psoriasis may suffer discomfort, including pain and itching, restricted motion in their joints, and emotional distress. In its most typical form, psoriasis results in patches of thick, red skin covered with silvery scales. These patches, which are sometimes referred to as plaques, usually itch and may burn. The skin at the joints may crack. Psoriasis most often occurs on the elbows, knees, scalp, lower back, face, palms, and soles of the feet but it can affect any skin site. The disease may also affect the fingernails, the toenails, and the soft tissues inside the mouth and genitalia. About 15 percent of people with psoriasis have joint inflammation that produces arthritis symptoms. This condition is called psoriatic arthritis.

What Causes Psoriasis? Recent research indicates that psoriasis is likely a disorder of the immune system. This system includes a type of white blood cell, called a T cell, that normally helps protect the body against infection and disease. Scientists now think that, in psoriasis, an abnormal immune system causes activity by T cells in the skin. These T cells trigger the inflammation and excessive skin cell reproduction seen in people with psoriasis. In about one-third of the cases, psoriasis is inherited. Researchers are studying large families affected by psoriasis to identify a gene or genes that cause the disease. (Genes govern every bodily function and determine the inherited traits passed from parent to child.) People with psoriasis may notice that there are times when their skin worsens, then improves. Conditions that may cause flareups include changes in climate, infections, stress, and dry skin. Also, certain medicines, most notably beta-blockers, which are used to treat high blood pressure, and lithium or drugs used to treat depression, may trigger an outbreak or worsen the disease.

How Is Psoriasis Diagnosed? Doctors usually diagnose psoriasis after a careful examination of the skin. However, diagnosis may be difficult because psoriasis can look like other skin diseases. A pathologist may assist with diagnosis by examining a small skin sample (biopsy) under a microscope.

12 Psoriasis

There are several forms of psoriasis. The most common form is plaque psoriasis (its scientific name is psoriasis vulgaris). In plaque psoriasis, lesions have a reddened base covered by silvery scales. Other forms of psoriasis include ·

Guttate psoriasis--Small, drop-like lesions appear on the trunk, limbs, and scalp. Guttate psoriasis is most often triggered by bacterial infections (for example, Streptococcus).

·

Pustular psoriasis--Blisters of noninfectious pus appear on the skin. Attacks of pustular psoriasis may be triggered by medications, infections, emotional stress, or exposure to certain chemicals. Pustular psoriasis may affect either small or large areas of the body.

·

Inverse psoriasis--Large, dry, smooth, vividly red plaques occur in the folds of the skin near the genitals, under the breasts, or in the armpits. Inverse psoriasis is related to increased sensitivity to friction and sweating and may be painful or itchy.

·

Erythrodermic psoriasis--Widespread reddening and scaling of the skin is often accompanied by itching or pain. Erythrodermic psoriasis may be precipitated by severe sunburn, use of oral steroids (such as cortisone), or a drug-related rash.

What Treatments Are Available for Psoriasis? Doctors generally treat psoriasis in steps based on the severity of the disease, the extent of the areas involved, the type of psoriasis, or the patient’s responsiveness to initial treatments. This is sometimes called the “1-2-3” approach. In step 1, medicines are applied to the skin (topical treatment). Step 2 focuses on light treatments (phototherapy). Step 3 involves taking medicines internally, usually by mouth (systemic treatment). Over time, affected skin can become resistant to treatment, especially when topical corticosteroids are used. Also, a treatment that works very well in one person may have little effect in another. Thus, doctors commonly use a trial-and-error approach to find a treatment that works, and they may switch treatments periodically (for example, every 12 to 24 months) if resistance or adverse reactions occur. Treatment depends on the location of lesions, their size, the amount of the skin affected, previous response to treatment, and patients’ perceptions about their skin condition and preferences for treatment. In addition, treatment is often tailored to the specific form of the disorder.

Guidelines 13

Topical Treatment Treatments applied directly to the skin are sometimes effective in clearing psoriasis. Doctors find that some patients respond well to sunlight, corticosteroid ointments, medicines derived from vitamin D3, vitamin A (retinoids), coal tar, or anthralin. Other topical measures, such as bath solutions and moisturizers, may be soothing but are seldom strong enough to clear lesions over the long term and may need to be combined with more potent remedies. ·

Sunlight--Daily, regular, short doses of sunlight that do not produce a sunburn clear psoriasis in many people.

·

Corticosteroids--Available in different strengths, corticosteroids (cortisone) are usually applied twice a day. Short-term treatment is often effective in improving but not completely clearing psoriasis. If less than 10 percent of the skin is involved, some doctors will begin treatment with a high-potency corticosteroid ointment (for example, Diprolene®,8 Temovate®, Ultravate®, or Psorcon®). High-potency steroids may also be used for treatment-resistant plaques, particularly those on the hands or feet. Long-term use or overuse of high-potency steroids can lead to worsening of the psoriasis, thinning of the skin, internal side effects, and resistance to the treatment’s benefits. Medium-potency corticosteroids may be used on the torso or limbs; low-potency preparations are used on delicate skin areas.

·

Calcipotriene--This drug is a synthetic form of vitamin D3. (It is not the same as vitamin D supplements.) Applying calcipotriene ointment (for example, Dovonex®) twice a day controls excessive production of skin cells. Because calcipotriene can irritate the skin, however, it is not recommended for the face or genitals. After 4 months of treatment, about 60 percent of patients have a good to excellent response. The safety of using the drug for cases affecting more than 20 percent of the skin is unknown, and using it on widespread areas of the skin may raise the amount of calcium in the body to unhealthy levels.

·

Coal tar--Coal tar may be applied directly to the skin, used in a bath solution, or used on the scalp as a shampoo. It is available in different strengths, but the most potent form may be irritating. It is sometimes combined with ultraviolet B (UVB) phototherapy. Compared with steroids, coal tar has fewer side effects, but it is messy and less effective

Brand names included in this fact sheet begin with a capital letter and are provided as examples only. Their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory. 8

14 Psoriasis

and thus is not popular with many patients. Other drawbacks include its failure to provide long-term help for most patients, its strong odor, and its tendency to stain skin or clothing. ·

Anthralin--Doctors sometimes use a 15- to 30-minute application of anthralin ointment, cream, or paste to treat chronic psoriasis lesions. However, this treatment often fails to adequately clear lesions, it may irritate the skin, and it stains skin and clothing brown or purple. In addition, anthralin is unsuitable for acute or actively inflamed eruptions.

·

Topical retinoid--The retinoid tazarotene (Tazorac) is a fast-drying, clear gel that is applied to the surface of the skin. Although this preparation does not act as quickly as topical corticosteroids, it has fewer side effects. Because it is irritating to normal skin, it should be used with caution in skin folds. Women of childbearing age should use birth control when using tazarotene.

·

Salicylic acid--Salicylic acid is used to remove scales, and is most effective when combined with topical steroids, anthralin, or coal tar.

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Bath solutions--People with psoriasis may find that bathing in water with an oil added, then applying a moisturizer, can soothe their skin. Scales can be removed and itching reduced by soaking for 15 minutes in water containing a tar solution, oiled oatmeal, Epsom salts, or Dead Sea salts.

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Moisturizers--When applied regularly over a long period, moisturizers have a cosmetic and soothing effect. Preparations that are thick and greasy usually work best because they hold water in the skin, reducing the scales and the itching. Phototherapy

Ultraviolet (UV) light from the sun causes the activated T cells in the skin to die, a process called apoptosis. Apoptosis reduces inflammation and slows the overproduction of skin cells that causes scaling. Daily, short, nonburning exposure to sunlight clears or improves psoriasis in many people. Therefore, sunlight may be included among initial treatments for the disease. A more controlled form of artificial light treatment may be used in mild psoriasis (UVB phototherapy) or in more severe or extensive psoriasis (psoralen and ultraviolet A [PUVA] therapy). ·

UVB phototherapy--Some artificial sources of UVB light are similar to sunlight. Newer sources, called narrow-band UVB, emit the part of the ultraviolet spectrum band that is most helpful for psoriasis. Some physicians will start with UVB treatments instead of topical agents. UVB

Guidelines 15

phototherapy is also used to treat widespread psoriasis and lesions that resist topical treatment. This type of phototherapy is normally administered in a doctor’s office by using a light panel or light box, although some patients can use UVB light boxes at home with a doctor’s guidance. Generally at least three treatments a week for 2 or 3 months are needed. UVB phototherapy may be combined with other treatments as well. One combined therapy program, referred to as the Ingram regime, involves a coal tar bath, UVB phototherapy, and application of an anthralin-salicylic acid paste, which is left on the skin for 6 to 24 hours. A similar regime, the Goeckerman treatment, involves application of coal tar ointment and UVB phototherapy. ·

PUVA--This treatment combines oral or topical administration of a medicine called psoralen with exposure to ultraviolet A (UVA) light. Psoralen makes the body more sensitive to this light. PUVA is normally used when more than 10 percent of the skin is affected or when rapid clearing is required because the disease interferes with a person’s occupation (for example, when a model’s face or a carpenter’s hands are involved). Compared with UVB treatment, PUVA treatment taken two to three times a week clears psoriasis more consistently and in fewer treatments. However, it is associated with more short-term side effects, including nausea, headache, fatigue, burning, and itching. Long-term treatment is associated with an increased risk of squamous cell and melanoma skin cancers. PUVA can be combined with some oral medications (retinoids and hydroxyurea) to increase its effectiveness. Simultaneous use of drugs that suppress the immune system, such as cyclosporine, have little beneficial effect and increase the risk of cancer. In very rare cases, patients who must travel long distances for PUVA treatments may, with a physician’s close supervision, be taught to administer this treatment at home.

Systemic Treatment For more severe forms of psoriasis, doctors sometimes prescribe medicines that are taken internally. The following are types of medications available for the treatment of psoriasis: ·

Methotrexate--This treatment, which can be taken by pill or injection, slows cell production by suppressing the immune system. Patients taking methotrexate must be closely monitored because it can cause liver damage and/or decrease the production of oxygen-carrying red blood cells, infection-fighting white blood cells, and clot-enhancing platelets. As a precaution, doctors do not prescribe the drug for people with long-term

16 Psoriasis

liver disease or anemia. Methotrexate should not be used by pregnant women, by women who are planning to get pregnant, or by their male partners. ·

Cyclosporine--Taken orally, cyclosporine (Neoral®) acts by suppressing the immune system in a way that slows the rapid turnover of skin cells. It may provide quick relief of symptoms, but it is usually effective only during the course of treatment. The best candidates for this therapy are those with severe psoriasis who have not responded to or cannot tolerate other systemic therapies. Cyclosporine may impair kidney function or cause high blood pressure (hypertension), so patients must be carefully monitored by a doctor. Also, cyclosporine is not recommended for patients who have a weak immune system, those who have had substantial exposure to UVB or PUVA in the past, or those who are pregnant or breast-feeding.

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Hydroxyurea (Hydrea®)--Compared with methotrexate and cyclosporine, hydroxyurea is less toxic but also less effective. It is sometimes combined with PUVA or UVB. Possible side effects include anemia and a decrease in white blood cells and platelets. Like methotrexate and cyclosporine, hydroxyurea must be avoided by pregnant women or those who are planning to become pregnant.

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Retinoids--A retinoid, such as acitretin (Soriatane®), is a compound with vitamin A-like properties that may be prescribed for severe cases of psoriasis that do not respond to other therapies. Because this treatment also may cause birth defects, women must protect themselves from pregnancy beginning 1 month before through 3 years after treatment. Most patients experience a recurrence of psoriasis after acitretin is discontinued.

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Antibiotics--Although not indicated in routine treatment, antibiotics may be employed when an infection, such as Streptococcus, triggers the outbreak of psoriasis, as in certain cases of guttate psoriasis.

What Are Some Promising Areas of Psoriasis Research? Researchers continue to search for genes that contribute to the inherited and other causes of psoriasis. Scientists are also working to improve our understanding of what happens in the body to trigger this disease. In addition, much research is focused on developing new and better treatments. Some of these experimental treatments, such as agents directed at the specific types of T cells involved, work to improve the disease with less overall suppression of the immune system.

Guidelines 17

How Can People Contribute to Psoriasis Research? The National Psoriasis Tissue Bank, which is supported by the National Psoriasis Foundation, is helping researchers worldwide study the inherited tendency toward psoriasis. The tissue bank has DNA from the white blood cells of more than 250 families affected by the disease. There is particular interest in large families in which psoriasis is both common and spans two or more generations. More recently, the tissue bank has begun research involving families having at least two siblings with psoriasis. People seeking more information or families interested in participating in a study should contact National Psoriasis Tissue Bank Baylor University Medical Center Suite 656, Wadley Tower 3600 Gaston Avenue Dallas, TX 75246 214/820-2635 Fax: 214/820-1296

Where Can I Find More Information about Psoriasis? National Psoriasis Foundation 6600 SW 92nd Avenue, Suite 300 Portland, OR 97223 503/244-7404 800/723-9166 Fax: 503/245-0626 http://www.psoriasis.org The National Psoriasis Foundation provides physician referrals and publishes pamphlets and newsletters that include information on support groups, research, and new drugs and other treatments. The foundation also promotes community awareness of psoriasis.

18 Psoriasis

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse 1 AMS Circle Bethesda, MD 20892-3675 301/495-4484 TTY: 301/565-2966 Fax: 301/718-6366 NIAMS Fast Facts--For health information that is available by fax 24 hours a day, call 301/881-2731 from a fax machine telephone. http://www.niams.nih.gov/ This clearinghouse, a public service sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), provides information about various forms of these diseases. The clearinghouse distributes patient and professional education materials and also refers people to other sources of information.

More Guideline Sources The guideline above on psoriasis is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to psoriasis. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with psoriasis. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.

Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following as being relevant to psoriasis:

Guidelines 19

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Guides On Psoriasis Psoriasis http://www.nlm.nih.gov/medlineplus/psoriasis.html Psoriasis http://www.nlm.nih.gov/medlineplus/ency/article/000434.htm Psoriasis - guttate http://www.nlm.nih.gov/medlineplus/ency/article/000822.htm

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Other Guides Psoriatic arthritis http://www.nlm.nih.gov/medlineplus/ency/article/000413.htm

Within the health topic page dedicated to psoriasis, the following was recently recommended to patients: ·

General/Overviews Psoriasis Source: American Academy of Dermatology http://www.aad.org/pamphlets/Psoriasis.html Psoriasis FAQs Source: American Academy of Dermatology http://www.skincarephysicians.com/psoriasisnet/mythsANDfacts.h tm

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Diagnosis/Symptoms Skin Rashes and Other Changes: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/545.html

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Treatment Methotrexate Source: American Academy of Family Physicians http://familydoctor.org/handouts/628.html New Treatments Offer Relief to Millions of Americans With Psoriasis Source: American Academy of Dermatology http://www.aad.org/PressReleases/OffersHope.html

20 Psoriasis

Psoriatic Arthritis: Treatment Slows Joint Damage Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AR00013 ·

Specific Conditions/Aspects Psoriatic Arthritis Source: National Psoriasis Foundation http://www.psoriasis.org/b300.htm

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Children Juvenile Psoriatic Arthritis Source: Arthritis Foundation http://www.arthritis.org/conditions/diseasecenter/juvenilepsoriatic arthritis.asp Psoriasis: The "Dry Skin" Disease Source: American Academy of Dermatology http://www.aad.org/Kids/psoriasis.html

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From the National Institutes of Health Questions and Answers about Psoriasis Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/hi/topics/psoriasis/psoriafs.htm

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Organizations American Academy of Dermatology http://www.aad.org/ National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/ National Psoriasis Foundation http://www.psoriasis.org/ PsoriasisNet Source: American Academy of Dermatology http://www.skincarephysicians.com/psoriasisnet/index.htm

Guidelines 21

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Research Psoriasis Causes Disability That Equals Other Major Medical Diseases Source: American Academy of Dermatology http://www.aad.org/PressReleases/psoriasis_causes_disability.html PsoriasisNet Update Source: American Academy of Dermatology http://www.skincarephysicians.com/psoriasisnet/update_current.htm

If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on psoriasis and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·

Handbook for Teens with Psoriasis Source: Portland, OR: National Psoriasis Foundation. 2001. 20 p. Contact: Available from National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (800) 723-9166 or (503) 2447404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: Contact NPF for current pricing. Summary: This illustrated booklet serves as an information source for adolescents living with psoriasis and uses a question and answer format to help them gain insight into the disease. The booklet begins by

22 Psoriasis

presenting facts about psoriasis, including what it is, who gets it, what causes it, and how it is treated. This is followed by a description of the types of psoriasis. The booklet then discusses types of psoriasis treatment such as topical agents, ultraviolet light therapies, and systemic medications; the role of the patient in treatment and treatment decisions; and the questions teens need to ask their doctor about psoriasis treatments. Other topics include the impact of psoriasis on self esteem, ways to cope with the emotional aspects of psoriasis, and guiding principles for coping with psoriasis. In addition, the booklet addresses lifestyle and social issues, including the impact of stress, chlorine, sunlight, body or ear piercing, and tattoos on psoriasis; the way to explain psoriasis to new friends or dates; the impact of psoriasis on an intimate relationship; and ways to cover up psoriasis. ·

Informacion General sobre los Tratamientos para la Psoriasis Source: Portland, OR: National Psoriasis Foundation. 2001. 24 p. Contact: Available from National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (800) 723-9166 or (503) 2447404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: Contact NPF for current pricing. Summary: This booklet, which is written in Spanish, provides people who have psoriasis with general information on its treatment. Although there is no cure for psoriasis, existing treatment and combinations of treatments are effective in reducing or minimizing its impact. There are generally three levels of treatment for psoriasis. The first level consists of topical medications, including anthralin, calcipotriene, tazarotene, topical retinoids, and topical steroids. If these medications are not effective or appropriate, then a second level of treatment is recommended. This level involves the use of ultraviolet (UV) B light, lasers, and psoralen plus UV A light. The third level of treatment focuses on the use of systemic medications such as cyclosporine, methotrexate, retinoids, and sulfasalazine. The booklet also includes guidelines on the treatment of psoriasis and provides information about the National Psoriasis Foundation. 1 figure.

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Young People and Psoriasis: Infancy Through Adolescence Source: Portland, OR: National Psoriasis Foundation. 1999. 20 p. Contact: National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (800) 723-9166 or (503) 244-7404. Fax (503) 2450626. E-mail: [email protected]. Website: www.psoriasis.org.

Guidelines 23

Summary: This booklet for the general public and young people with psoriasis focuses on the special problems confronting infants, children, and adolescents who have psoriasis. It uses a question-and-answer format to explain what psoriasis is, who gets psoriasis, the different types of psoriasis, the cause of psoriasis, the role of infection and skin injury in psoriasis, the available treatments for psoriasis, and the role of the patient in treating psoriasis. In addition, the booklet answers questions frequently asked by parents or other care givers, offers practical advice for parents and adolescents, presents an interview with a pediatric dermatologist, and lists educational literature available from the National Psoriasis Foundation. ·

Genital Psoriasis Source: Portland, OR: National Psoriasis Foundation. 1998. 12 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available. Summary: This pamphlet provides people who have psoriasis with information on genital psoriasis. Although this type of psoriasis acts much the same as psoriasis elsewhere on the body, its location on or near the tender skin of the reproductive organs requires special treatment. The pamphlet presents methods of treating psoriasis on the pubis, the upper thighs, the creases between thigh and groin, the genitals, the anus and surrounding area, and the buttocks crease. Precautions on the use of ultraviolet light, topical vitamin D, and topical retinoids in treating genital psoriasis are presented. Other topics include relieving itching and getting a correct diagnosis. In addition, the pamphlet offers tips on dealing with genital psoriasis, presents a Bill of Rights for people who have psoriasis, provides information about the National Psoriasis Foundation (NPF), and lists NPF special services.

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Your Diet and Psoriasis: Does Nutrition Play a Role? Source: Portland, OR: National Psoriasis Foundation. 1998. 20 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available. Summary: This pamphlet provides people who have psoriasis with information on the possible role of nutrition in treating it. Although there appears to be little statistical verification that manipulating diet is a valid

24 Psoriasis

treatment option, people who have psoriasis may want to consider changing or supplementing their diet if it seems to improve their condition and does not endanger their overall health. Guidelines on maintaining overall well being, are followed by research findings about psoriasis and diet, focusing on findings about the turkey diet, the low protein diet, starvation and weight loss, oral zinc, fish oil, evening primrose oil, lecithin, shark cartilage, and the Edgar Cayce regimen. Traditional Chinese medicine, herbal remedies, and vitamins and supplements are also discussed. In addition, the pamphlet recommends evaluating diet claims for psoriasis and offers advice on evaluating advertised claims for psoriasis cures and treatments. The pamphlet concludes with information on nutritional resources and on the National Psoriasis Foundation. 10 references. ·

Specific Forms of Psoriasis: Pustular, Guttate, Inverse, Erythrodermic Source: Portland, OR: National Psoriasis Foundation. 1998. 12 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available. Summary: This pamphlet provides people who have psoriasis with information on the triggers, characteristics, and treatment of its specific forms: guttate, pustular, generalized and localized pustular, inverse, and erythrodermic. Guttate psoriasis often starts in childhood or young adulthood. Guttate lesions are droplike and usually appear on the trunk and limbs. This form of psoriasis may resolve on its own, but bland ointments may be needed during the acute eruptive stage. Pustular psoriasis usually occurs in adults and is characterized by white pustules surrounded by red skin. Forms of pustular psoriasis include the von Zumbusch type, palmo-plantar pustulosis, and acrodermatitis continua of Hallopeau. Inverse psoriasis is found in the armpits, in the groin, under the breasts, and in other skin folds around the genitals and buttocks. Steroid creams and ointments are effective in treating this form. Erythrodermic psoriasis is a very inflammatory form characterized by periodic, widespread, fiery redness of the skin. Treatment may include medium potency topical steroids, moisturizers, oatmeal baths, bed rest, methotrexate, acitretin, or cyclosporin. In addition, the pamphlet provides information on the National Psoriasis Foundation (NPF) and special NPF services.

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Psoriasis on Specific Skin Sites Source: Portland, OR: National Psoriasis Foundation. 1998. 12 p.

Guidelines 25

Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available. Summary: This pamphlet provides people who have psoriasis with information on treating specific skin sites, including the face, eyelids, eyes, ears, mouth, skin folds, hands, feet, palms, soles, and nails. The first method of treating facial psoriasis is with moisturizers and Vaseline. Mild topical steroids can be used intermittently. Other drugs and ultraviolet light can also be effective. Eyelid inflammation requires washing the lid margins and eyelashes with tap water and baby shampoo. Special ophthalmic steroid medication is used if scaling on the eyelid must be treated. Topical antibiotics are used to treat conjunctivitis, the most common type of interior eye involvement. Scale buildup that blocks the ear canal should be removed by a physician or by means of an over-the-counter ear cleaning kit. Treatment for oral psoriasis involves topical steroids designed to treat moist areas, while steroid creams and ointments are effective in treating psoriasis on skin folds. General measures for treating psoriasis on the hands and feet include emollients, mild soaps, and soap substitutes. Other methods are traditional topical therapy, psoralen plus ultraviolet light A (PUVA), and systemic therapies. Pustular psoriasis of the palms and soles is normally treated with topical agents; although PUVA or systemic therapies may be needed, as well. The major treatments for nails are topical therapy, intralesional injection of steroids, systemic therapy, and cosmetic repair. The pamphlet provides guidelines on nail care and concludes with information on the National Psoriasis Foundation. ·

Scalp Psoriasis Source: Portland, OR: National Psoriasis Foundation. 1998. 20 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available. Summary: This pamphlet provides people who have psoriasis with information on treating scalp psoriasis. This form, which can range from very mild to very severe, occurs in at least 50 percent of those who have psoriasis. Scalp psoriasis can sometimes cause hair loss, and scalp itching may be troublesome as well. Because there are many options, people need to select scalp treatments that are agreeable to them. The pamphlet discusses various medications in terms of their features and mode of application. Medications include tars, topical steroids, intralesional

26 Psoriasis

steroid scalp injections, anthralin, calcipotriene, tazarotene, antimicrobial therapy, ultraviolet light, medicated shampoos, and systemic medications. Specific considerations for treating the forehead, neck, and ears are presented. Other topics include softening and removing scales from psoriasis lesions before treating them and applying medications effectively. In addition, the pamphlet answers common questions about scalp psoriasis, presents a sample treatment regimen, lists some scalp psoriasis products, and concludes with information on the National Psoriasis Foundation. ·

Overview of Psoriasis Treatments Source: Portland, OR: National Psoriasis Foundation. 1998. 20 p. Contact: National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (800) 723-9166 or (503) 244-7404. Fax (503) 2450626. E-mail: [email protected]. Website: www.psoriasis.org. Summary: This booklet for individuals with psoriasis presents an overview of options for treating psoriasis. Although a wide range of treatments are available, no psoriasis treatment is universally effective. Treatments can be divided into three categories: sunlight and topical agents, phototherapy, and systemic medications. Topical therapies include topical steroids, coal tar, anthralin, topical vitamin D, salicylic acid, tazarotene, occlusion therapy, moisturizer, bath solutions, nonprescription medications, and sunbathing. Phototherapy may involve exposure to ultraviolet light B or the use of psoralen and exposure to ultraviolet light A. Systemic medications include methotrexate, retinoids, sulfasalazine, and cyclosprorine. Therapies may be combined or rotated. In addition, the booklet provides some tips for taking care of the skin and lists educational literature available from the National Psoriasis Foundation. 1 figure and 1 photograph.

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Sunlight and Psoriasis Source: Portland, OR: National Psoriasis Foundation. 1997. 12 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available. Summary: This pamphlet provides people who have psoriasis with information on using sunlight as a treatment option. Therapy involves exposing all affected areas to short multiple exposures of sunlight. However, people who use sunlight therapy must be careful not to get a sunburn because this may cause psoriasis to flare. The pamphlet provides

Guidelines 27

guidelines on selecting a sunscreen and protective glasses, discusses the use of ultraviolet light therapies for sun-sensitive people, identifies the interactions between sunlight and other psoriasis treatments, and presents the warning signs of skin cancer. In addition, the pamphlet provides information on climatotherapy sites, focusing on the Dead Sea. Information about Dead Sea therapy includes the climate in the area, the treatment regimen used, the side effects, and drug interactions. In addition, the pamphlet provides tips for people traveling to the Dead Sea for treatment, lists items to take, and offers suggestions on making travel arrangements. 1 table. ·

Conception, Pregnancy, and Psoriasis Source: Portland, OR: National Psoriasis Foundation. 1996. 12 p. Contact: National Psoriasis Foundation, 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (503) 244-7404. (503) 245-0626 (fax). Summary: This booklet for individuals with psoriasis provides general information about psoriasis treatments during conception, pregnancy, and breast feeding. Treatments that should be avoided when trying to conceive a child include oral retinoids, photochemotherapy, methotrexate, and hydroxyurea. Treatments that are safe for pregnant women include some topical medications, phototherapy, and cyclosporine. Women with psoriasis who choose to breast fed should avoid application of topical steroids to the breasts, photochemotherapy, and systemic medications. In addition, the booklet presents information on the genetic aspects of psoriasis and lists educational literature available from the National Psoriasis Foundation.

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Nail Psoriasis: Recognition and Control Source: Schaumburg, IL: Council for Nail Disorders (CND). 1996. 6 p. Contact: Available from Council for Nail Disorders. 930 Meacham Road, Schaumburg, IL 60173. (847) 330-9830. Price: Single copy free. Summary: This pamphlet uses a question and answer format to provide people who have nail psoriasis with information on this condition. Psoriasis affects the nails in up to 50 percent of people with psoriasis of the skin. People who have psoriatic arthritis develop nail psoriasis more often than people who have psoriasis of the skin do. Pits of different shapes, sizes, and depths are the most common signs of nail psoriasis. Psoriatic patches under the nail may cause it to separate from the nail bed. In addition, the skin under the nail may thicken and appear silvery white, yellowish, or brown. Nail psoriasis is among the most difficult forms of psoriasis to treat, and options include topical medications,

28 Psoriasis

ultraviolet light, injection medications, and oral medications such as methotrexate and retinoids. The pamphlet offers suggestions for controlling nail psoriasis and provides information on the Council for Nail Disorders. ·

Psoriasis: How It Makes You Feel Source: Portland, OR: National Psoriasis Foundation. 1996. 24 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available. Summary: This pamphlet provides people who have psoriasis with information on the emotional impact of the disease. The way that people with psoriasis recognize and respond to their emotions may determine how successfully they cope. The pamphlet recommends that people with psoriasis allow themselves to feel angry, sad, and frustrated so that they can start to manage these feelings; recognize feelings as part of the process of learning to live with skin that looks different; talk about psoriasis; take responsibility for treatment choices; seek professional counseling if necessary; and educate themselves about the nature of psoriasis and learn to talk about it factually. The pamphlet then suggests a cognitive therapy strategy for dealing with experiences caused by distortion, disappointment, helplessness, and hopelessness. This is followed by questions and answers about the emotional aspects of living with psoriasis, a personal account, and the role of a person who wants to help someone with psoriasis. In addition, the pamphlet offers tips for people who have psoriasis and tips for others. The pamphlet concludes with information on the National Psoriasis Foundation.

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Psoriasis: Preguntas Comunes y sus Respuestas [Psoriasis: Common Questions and Answers] Source: Portland, OR: National Psoriasis Foundation. 1999. 6 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available. Summary: This pamphlet uses a question and answer format to provide people who have psoriasis with information on this chronic skin disorder. Topics include cause, diagnosis, and treatment; the features of guttate, pustular, inverse, erythrodermic, and arthritic psoriasis; and the

Guidelines 29

parts of the body affected. The pamphlet concludes with information on the National Psoriasis Foundation.

The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “psoriasis” or synonyms.

Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·

FAQ - About Psoriasis Summary: Answers to the questions most often received from patients and the general public about this skin disorder. Source: National Psoriasis Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2715

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Psoriasis Information Site Index Summary: Visitors to this site may search this index for links to patient education fact sheets, medical and alternative treatment and therapies for psoriasis , psoriasis statistics, research information, news Source: National Psoriasis Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2716

30 Psoriasis

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PsoriasisNet Summary: Links to info about psoriasis and its treatment. Includes a glossary. Source: American Academy of Dermatology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6381

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Questions and Answers About Psoriasis Summary: This consumer health information fact sheet contains general information about psoriasis. Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3778

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Retinoids Summary: In recent years new synthetic derivatives of Vitamin A (retinoids) have been developed for the treatment of various skin conditions, such as severe acne, sun spots, wrinkles, and psoriasis. Source: American Society For Dermatologic Surgery http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6748

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Skincarephysicians.com Summary: An index to Web pages on psoriasis, eczema, aging skin, acne, melanoma, and actinic keratoses. Source: American Academy of Dermatology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6380

Guidelines 31

·

What is Psoriasis? Summary: This consumer health information fact sheet provides basic information about this non-contagious skin disorder. Source: National Psoriasis Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2714

The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to psoriasis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. NORD (The National Organization of Rare Disorders, Inc.) NORD provides an invaluable service to the public by publishing, for a nominal fee, short yet comprehensive guidelines on over 1,000 diseases. NORD primarily focuses on rare diseases that might not be covered by the previously listed sources. NORD’s Web address is www.rarediseases.org. To see if a recent fact sheet has been published on psoriasis, simply go to the following hyperlink: http://www.rarediseases.org/cgi-bin/nord/alphalist. A complete guide on psoriasis can be purchased from NORD for a nominal fee.

32 Psoriasis

PEDBASE Similar to NORD, PEDBASE covers relatively rare disorders, limited mainly to pediatric conditions. PEDBASE was designed by Dr. Alan Gandy. To access the database, which is more oriented to researchers than patients, you can view the current list of conditions covered at the following Web site: http://www.icondata.com/health/pedbase/pedlynx.htm.

Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

·

drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html

·

Family Village: http://www.familyvillage.wisc.edu/specific.htm

·

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

·

Med Help International: http://www.medhelp.org/HealthTopics/A.html

·

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

·

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

·

WebMDÒHealth: http://my.webmd.com/health_topics

Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Acitretin: An oral retinoid effective in the treatment of psoriasis. It is the major metabolite of etretinate with the advantage of a much shorter half-life when compared with etretinate. [NIH] Acne: An inflammatory disease of the pilosebaceous unit, the specific type usually being indicated by a modifying term; frequently used alone to designate common acne, or acne vulgaris. [EU] Acrodermatitis:

Inflammation involving the skin of the extremities,

Guidelines 33

especially the hands and feet. Several forms are known, some idiopathic and some hereditary. The infantile form is called Gianotti-Crosti syndrome. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]

Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anthralin: An anti-inflammatory anthracene derivative used for the treatment of dermatoses, especially psoriasis. It may cause folliculitis. [NIH] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Balanitis: Inflammation of the glans penis; it is usually associated with phimosis. [EU] Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for medical purposes with the addition of therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Blister: Visible accumulations of fluid within or beneath the epidermis. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Chronic: Persisting over a long period of time. [EU] Coal: A natural fuel formed by partial decomposition of vegetable matter under certain environmental conditions. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Conjunctivitis:

Inflammation of the conjunctiva, generally consisting of

34 Psoriasis

conjunctival hyperaemia associated with a discharge. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents, characterized in the acute stage by erythema, edema associated with a serous exudate between the cells of the epidermis (spongiosis) and an inflammatory infiltrate in the dermis, oozing and vesiculation, and crusting and scaling; and in the more chronic stages by lichenification or thickening or both, signs of excoriations, and hyperpigmentation or hypopigmentation or both. Atopic dermatitis is the most common type of dermatitis. Called also eczematous dermatitis. [EU] Emollient: Softening or soothing; called also malactic. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH]

Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH] Hydroxyurea: An antineoplastic agent that inhibits DNA synthesis through the inhibition of ribonucleoside diphosphate reductase. [NIH] Hyperhomocysteinemia: An inborn error of methionone metabolism which produces an excess of homocysteine in the blood. It is often caused by a deficiency of cystathionine beta-synthase and is a risk factor for coronary vascular disease. [NIH] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH]

Guidelines 35

Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lithium: Lithium. An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH] Melanoma: A tumour arising from the melanocytic system of the skin and other organs. When used alone the term refers to malignant melanoma. [EU] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Ophthalmic: Pertaining to the eye. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Photochemotherapy: Therapy using oral or topical photosensitizing agents with subsequent exposure to light. [NIH] Phototherapy: Treatment of disease by exposure to light, especially by variously concentrated light rays or specific wavelengths. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Pustular: Pertaining to or of the nature of a pustule; consisting of pustules (= a visible collection of pus within or beneath the epidermis). [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles

36 Psoriasis

in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Squamous: Scaly, or platelike. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Sunburn: An injury to the skin causing erythema, tenderness, and sometimes blistering and resulting from excessive exposure to the sun. The reaction is produced by the ultraviolet radiation in sunlight. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxic: Pertaining to, due to, or of the nature of a poison or toxin; manifesting the symptoms of severe infection. [EU] Venereal: Pertaining or related to or transmitted by sexual contact. [EU]

Seeking Guidance 37

CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with psoriasis. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.9 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with psoriasis. The chapter ends with a discussion on how to find a doctor that is right for you.

Associations and Psoriasis As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.10 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 10 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 9

38 Psoriasis

influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·

American Autoimmune Related Diseases Association, Inc Address: American Autoimmune Related Diseases Association, Inc. Michigan National Bank Building, 15475 Gratiot Avenue, Detroit, MI 48205 Telephone: (313) 371-8600 Toll-free: (800) 598- 4668 Fax: (313) 371-6002 Email: [email protected] Web Site: http://www.aarda.org/ Background: The American Autoimmune Related Diseases Association, Inc. (AARDA) is a national not-for-profit voluntary health agency dedicated to bringing a national focus to autoimmunity, a major cause of serious chronic diseases. The Association was founded for the purposes of supporting research to find a cure for autoimmune diseases and providing services to affected individuals. In addition, the Association's goals include increasing the public's awareness that autoimmunity is the cause of more than 80 serious chronic diseases; bringing national focus and collaborative effort among state and national voluntary health groups that represent autoimmune diseases; and serving as a national advocate for individuals and families affected by the physical, emotional, and financial effects of autoimmune disease. The American Autoimmune Related Diseases Association produces educational and support materials including fact sheets, brochures, pamphlets, and a newsletter entitled 'In Focus'. Relevant area(s) of interest: Psoriasis, Scleroderma, Vitiligo

·

American Skin Association Address: American Skin Association 150 East 58th Street, 33rd Floor, New York, NY 10155-0002 Telephone: (212) 753-8260 Toll-free: (800) 499-7546

Seeking Guidance 39

Fax: (212) 688-6547 Email: [email protected] Web Site: None Background: The American Skin Association (ASA) is a national nonprofit organization dedicated to building a network of lay people to achieve more effective prevention, treatment, and cure of skin disorders. ASA programs include generating support for skin research and providing information and education to the public regarding the skin and its disorders. ASA's mission is to identify, promote, and support research in biology of the skin, stimulate the transfer of advances in the field to clinical care of dermatology patients, and educate the community regarding diseases, symptoms, and care of the skin. To meet this goal, the Association engages in fundraising to support research and develops local chapters throughout the country. Information on a wide spectrum of skin disorders is available including 'Your Newborn's Skin and the Sun,' 'Ultraviolet Index: What You Need To Know,' 'Outdoor Sports and Your Skin,' and 'Proper Skin Care Can Make Gardening a Bed of Roses.' Founded in 1987, ASA also publishes 'SkinFacts,' a quarterly newsletter. Relevant area(s) of interest: Psoriasis, Vitiligo ·

Canadian Psoriasis Foundation / La Fondation Canadienne duPsoriasis Address: Canadian Psoriasis Foundation / La Fondation Canadienne du Psoriasis 824 Meath Street, Ottawa, K1Z 6E8, Canada Telephone: (613) 728-4000 Toll-free: (800) 265-0926 Fax: (613) 728-8913 Email: [email protected] Web Site: http://www.psoriasis.ca Background: The Canadian Psoriasis Foundation/La fondation canadienne du psoriasis is a not-for-profit voluntary health organization dedicated to promoting the health and improving the quality of life of Canadians affected by psoriasis through education, advocacy, service, and research. Psoriasis is a common, recurrent skin disorder characterized by thickened patches of reddish, inflamed skin and silvery or grayish, dry skin scaling due to abnormally rapid growth and turnover of skin cells. Although the exact underlying cause of psoriasis is unknown, the disease often appears to be familial. The Canadian Psoriasis Foundation was established in 1983 and currently has 16 chapters and approximately 1,300 members. The Foundation is committed to providing current information on psoriasis to inquirers including affected individuals, family members, health care

40 Psoriasis

professionals, and the general public; distributing educational literature to schools, libraries, hospitals, and clinics across Canada; publishing regular newsletters with feature articles on traditional and nontraditional psoriasis treatments; and conducting regular conferences and workshops. In addition, the organization provides referrals to dermatology facilities in Canada; promotes and supports research; promotes public and professional awareness of the disorder and the needs of affected individuals; and establishes and maintains local chapters in cities throughout Canada, providing a national communication network. The Foundation's educational materials include booklets, pamphlets on the various forms of psoriasis, a treatment series, and a quarterly newsletter entitled 'CPF Newsletter,' which includes information on new and existing treatments, research developments, and organizational activities on a national and local basis. The Canadian Psoriasis Foundation also has a web site on the Internet. Relevant area(s) of interest: Arthropathic Psoriasis, Psoriasis ·

March of Dimes Birth Defects Foundation Address: March of Dimes Birth Defects Foundation 1275 Mamaroneck Avenue, White Plains, NY 10605 Telephone: (914) 428-7100 Toll-free: (888) 663-4637 Fax: (914) 997-4763 Email: [email protected] Web Site: http://www.modimes.org Background: The March of Dimes Birth Defects Foundation is a national not-for- profit organization that was established in 1938. The mission of the Foundation is to improve the health of babies by preventing birth defects and infant mortality. Through the Campaign for Healthier Babies, the March of Dimes funds programs of research, community services, education, and advocacy. Educational programs that seek to prevent birth defects are important to the Foundation and to that end it produces a wide variety of printed informational materials and videos. The March of Dimes public health educational materials provide information encouraging health- enhancing behaviors that lead to a healthy pregnancy and a healthy baby. Relevant area(s) of interest: Epidermolysis Bullosa, Psoriasis

·

National Psoriasis Foundation Address: National Psoriasis Foundation 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195

Seeking Guidance 41

Telephone: (503) 244-7404 Toll-free: (800) 723-9166 Fax: (503) 245-0626 Email: [email protected] Web Site: http://www.psoriasis.org/ Background: The National Psoriasis Foundation is a voluntary not-forprofit organization dedicated to providing support to and improving the quality of life for individuals with psoriasis, a chronic skin disorder; educating the public; and promoting and supporting research for psoriasis. Established in 1968 by affected individuals, physicians, and researchers, the National Psoriasis Foundation is committed to publishing the most current information on psoriasis and providing a forum for affected individuals to speak out. The organization promotes funding for psoriasis research and seeks to establish an alliance between affected people, the medical and scientific communities, and the pharmaceutical industry. The National Psoriasis Foundation promotes patient advocacy and legislation beneficial to affected individuals; provides appropriate referrals (e.g., to support groups); and offers a variety of educational materials. These materials include a regular newsletter and reports. Relevant area(s) of interest: Psoriasis ·

Psoriatic Arthropathy Alliance Address: Psoriatic Arthropathy Alliance P.O. Box 111, St. Albans, Hertfordshire, AL2 3JQ, United Kingdom Telephone: (192) 367- 2837 Toll-free: (800) 598- 4668 Fax: (192) 367-2837 Email: [email protected] Web Site: http://www.paalliance.org Background: The Psoriatic Arthropathic Alliance (PAA) is a non-profit support and informational organization for individuals affected by psoriatic arthropathy (PA) and other related conditions. Psoriatic arthropathy is a rheumatoid-like arthritic condition that is associated with psoriasis of the skin or nails, and a negative rheumatoid arthritis (RA) serology laboratory test. The disorder is more common in females than males. The mission of the PAA is to provide support and information to individuals affected by PA. Established in 1993, the Alliance also monitors medical and health care services and supports research into the causes, prevention, and management of PA and related conditions. In addition, the group acts as a lobbyist for patient rights. Consisting of 1,000 members, the Alliance produces educational materials

42 Psoriasis

that are available to medical professionals, medical students, and the general public. PAA publishes a periodic newsletter and a journal and offers a networking service. Relevant area(s) of interest: Psoriasis

Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.

The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about psoriasis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “psoriasis” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.

The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “psoriasis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop

Seeking Guidance 43

boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “psoriasis” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with psoriasis. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “psoriasis” (or a synonym) in the search box.

Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. The following Internet site may be of particular interest: ·

Psoriasis Society of Canada http://www.psoriasissociety.org

44 Psoriasis

Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with psoriasis must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:11 ·

If you are in a managed care plan, check the plan's list of doctors first.

·

Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.

·

Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.

·

Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.

Additional steps you can take to locate doctors include the following: ·

Check with the associations listed earlier in this chapter.

·

Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.

·

The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at http://www.abms.org/newsearch.asp.12 You can also contact the ABMS by phone at 1-866-ASK-ABMS.

·

You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA's Web site: http://www.amaassn.org/aps/amahg.htm.

This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. While board certification is a good measure of a doctor's knowledge, it is possible to receive quality care from doctors who are not board certified. 11 12

Seeking Guidance 45

If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.

Finding a Dermatologist To find a dermatologist in your area, you can use the “Find a Dermatologist” search engine provided by the American Academy of Dermatology. With a membership of 13,000, the American Academy of Dermatology represents virtually all practicing dermatologists in the United States and Canada. Type the following Web address into your browser to begin your search: http://www.aad.org/DermSearch/index.html. To search for dermatologists by U.S. state, enter your state into the search box and click “Search.” To search for dermatologists practicing outside the U.S., select “international members.” Enter your country and click the “Search” button.

Selecting Your Doctor13 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·

Give me a chance to ask questions about psoriasis?

·

Really listen to my questions?

·

Answer in terms I understood?

·

Show respect for me?

·

Ask me questions?

·

Make me feel comfortable?

·

Address the health problem(s) I came with?

13 This

section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.

46 Psoriasis

·

Ask me my preferences about different kinds of treatments for psoriasis?

·

Spend enough time with me?

Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.

Working with Your Doctor14 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·

You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.

·

It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.

·

Bring a “health history” list with you (and keep it up to date).

·

Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.

·

Tell your doctor about any natural or alternative medicines you are taking.

·

Bring other medical information, such as x-ray films, test results, and medical records.

·

Ask questions. If you don't, your doctor will assume that you understood everything that was said.

·

Write down your questions before your visit. List the most important ones first to make sure that they are addressed.

·

Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.

·

Ask your doctor to draw pictures if you think that this would help you understand.

This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.

14

Seeking Guidance 47

·

Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.

·

Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.

·

Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.

·

After leaving the doctor's office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.

By following these steps, you will enhance the relationship you will have with your physician.

Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:15 ·

Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html

·

Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html

·

Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html

Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters:

You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.

15

48 Psoriasis

Arthropathy: Any joint disease. [EU] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Vitiligo: A disorder consisting of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck, and in skin folds. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent state is reached. [NIH]

Clinical Trials 49

CHAPTER 3. CLINICAL TRIALS AND PSORIASIS Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning psoriasis.

What Is a Clinical Trial?16 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for psoriasis is to try it on patients in a clinical trial.

The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.

16

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What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·

Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.

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Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on psoriasis.

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Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for psoriasis compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?

Various organizations support clinical trials at medical centers, hospitals, universities, and doctors' offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on psoriasis carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on psoriasis. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.” This

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treatment, like a placebo, has no effect on psoriasis and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how psoriasis develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for psoriasis. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial's investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo

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surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.

Recent Trials on Psoriasis The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to psoriasis.17 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·

Conditioning, the Placebo Effect, and Psoriasis Condition(s): Psoriasis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This study uses the psychological principle known as classical conditioning to try to improve the standard treatment of psoriasis. Classical conditioning is a process of behavioral modification in which a person learns to connect a certain response-in this case, improvement of psoriasis-with a new action, or stimulus-in this case, application of an inactive cream. The goal of this study is to show that people with psoriasis who are maintained on corticosteroid cream part of the time and an inactive (placebo) cream at other times will need a lower total amount of active medication over time than will people who are treated only with the active drug. Phase(s): Phase I

17

These are listed at www.ClinicalTrials.gov.

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Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005922;jsessionid=70E1481 55114A228E0D24848C469E326 ·

Micellar Paclitaxel to Treat Severe Psoriasis Condition(s): Psoriasis Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI) Purpose - Excerpt: This study will evaluate the safety and effectiveness of micellar paclitaxel for treating severe psoriasis. Paclitaxel in another formulation (Taxol) is approved by the Food and Drug Administration for use in patients with cancer. This drug can decrease growth of cancer cells and of new blood vessels. Because patients with psoriasis have an increase in skin cell and blood vessel growth, paclitaxel may also improve their condition. The dose of drug used in this study is much lower than those used to treat cancer patients and is expected to cause relatively few side effects. Patients 18 to 70 years of age with psoriasis lesions affecting at least 20% of their skin may be eligible for this study. Candidates will be screened with a history and physical examination, blood and urine tests, electrocardiogram, and possibly an exercise stress test. Participants will receive six intravenous (through a vein) infusions of paclitaxel over a 6-month period. Each infusion will take about 2 hours. Patients will stay in the clinic for observation for at least 1 hour before going home and will return to the clinic for follow-up examination and tests one week after each infusion. However, on weeks 0 and 8 visit will last for approximately 8 hours and will require a return to the clinic the following morning. Blood collection will be performed during the week 0 and 8 visits to determine how fast Micellar Paclitaxel is eliminated from your body. Approximately 2 teaspoons of blood will be taken prior to the infusion, twice during the infusion, and eight times during the 22 hours following the infusion for a total of eleven samples. These return visits will last approximately 1-2 hours. Patients will have the following procedures: 1. A skin biopsy (removal of a small tissue sample for microscopic examination) will be done at the first visit (week 0) and again at weeks 6, 14 and 22. The area of the biopsy will be numbed with an anesthetic, and a small circle of skin about the width of a pencil eraser and half as deep will be cut and lifted away. Stitches will be placed and removed 1 to 2 weeks later. 2. A history and physical examination will be done at every visit. Patients will be interviewed about changes in their skin condition and about treatment side effects and will be examined by a

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nurse or physician. 3. Blood and urine samples will be collected at frequent intervals (nearly every visit) to test for side effects. 4. Photographs of the skin will be taken at the first visit and at several later visits to document changes in psoriasis. 5. A blood sample will be drawn for genetic testing to look for gene changes in people with psoriasis. 6. An electrocardiogram will be taken at the last visit. This will be done at week 24 and compared to the screening EKG. 7. Gonadal toxicity monitoring will be started with all patients entered into the protocol as of May 2001. Blood will be drawn to measure Inhibit A for females and Inhibit B for males at weeks 0, 6, 14, and 22. Phase(s): Phase II Study Type: Interventional Contact(s): Maryland; National Cancer Institute (NCI), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222 [email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00006276;jsessionid=70E1481 55114A228E0D24848C469E326 ·

Study of Psoriatic Arthritis Condition(s): Psoriasis; Psoriatic Arthritis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This study will examine the genetic and immune factors involved in the cause and development of psoriatic arthritis-a disease of both the skin and joints. It will describe the medical features and natural course of the disease and determine participants' eligibility for experimental treatment protocols. Patients with known or suspected psoriatic arthritis 5 years of age and older and their relatives may enroll in this study. Patients will be evaluated with a medical history and physical examination, electrocardiogram, blood tests and X-rays. Additional procedures may include: 1. Leukapheresis-Collection of white blood cells for genetic analysis. Whole blood is collected through a needle placed in an arm vein. The blood circulates through a machine that separates it into its components. The plasma is removed and the cells are returned to the body through a second needle placed in the other arm. 2. Skin biopsy-Removal of a small skin sample for microscopic analysis. An area of skin is numbed with an anesthetic and one to three small circular

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portions (about 1/4 inch in diameter) are cut and removed. 3. Joint aspiration-Removal of a small sample of synovial fluid (lubricating joint fluid). An area of skin around the biopsy site is numbed with an anesthetic, and a needle is inserted into the joint to pull out a small fluid sample. 4. Synovial needle biopsy-Removal of a small sample of synovial tissue (tissue lining the joint). An area of skin around the biopsy site is numbed with an anesthetic and a large needle is inserted into the joint. A smaller needle attached to a syringe is then placed inside the larger needle and small pieces of synovial tissue are removed. 5. Genetic studies-Saliva and blood samples will be collected for gene testing. Saliva is collected by rinsing the mouth with a tablespoon of salt water and spitting into a test tube. Patients will be followed once or twice a year and may be evaluated for participation in an experimental treatment study. Participating relatives of patients will fill out a brief medical history questionnaire and provide a DNA sample (blood sample or tissue swab from the inside of the cheek). Study Type: Observational Contact(s): Maryland; National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222 [email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001420;jsessionid=70E1481 55114A228E0D24848C469E326 ·

Treatment of Psoriasis with Parathyroid Hormone Condition(s): Plaque psoriasis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This is a clinical study in two phases. The first phase compares the effect of an ointment containing parathyroid hormone (PTH) with the effect of a placebo ointment (inactive ointment without PTH) on psoriasis lesions. Neither the study participants nor the researchers will know who is receiving PTH ointment and who is receiving placebo until the end of this first study phase. The second phase is a study of the PTH ointment on large areas of psoriasis to find out how long the effects last. Phase(s): Phase I; Phase II Study Type: Interventional

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Contact(s): Sheila Decastro 617-638-8869; Massachusetts; Boston University School of Medicine, Boston, Massachusetts, 01843, United States; Recruiting; Michael Holick, Ph.D., M.D., Principal Investigator. Study chairs or principal investigators: Michael Holick, Ph.D., M.D., Principal Investigator Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00007306;jsessionid=70E1481 55114A228E0D24848C469E326 ·

A Study of Retrovir in the Treatment of Psoriasis in HIV-Positive Patients Condition(s): HIV Infections; Psoriasis Study Status: This study is no longer recruiting patients. Sponsor(s): Glaxo Wellcome Purpose - Excerpt: To evaluate the feasibility of Retrovir (AZT) in the treatment of psoriasis in HIV antibody positive patients. Retrovir has been shown to be effective in the treatment of AIDS. In addition, the administration of AZT appears to have induced a remission of psoriasis in one case study. In light of AZT's antiviral activity and potential effectiveness as an agent for the treatment of psoriasis, this would be the most likely treatment for HIV positive, psoriatic patients whose disease progresses quickly. Study Type: Interventional Contact(s): North Carolina; Glaxo Wellcome Inc, Research Triangle Park, North Carolina, 27709, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002286;jsessionid=70E1481 55114A228E0D24848C469E326

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Scalp Psoriasis Treatment with a Fiber Optic Comb Condition(s): Psoriasis Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This study will test the safety and effectiveness of a novel fiber optic device for treating scalp psoriasis with ultraviolet (UVB) light. A effective treatment is not currently available for people with scalp psoriasis. Present methods for treating psoriasis with UV-B light cannot be used for the scalp because hair is usually blocking the light

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from reaching the affected skin. Our method overcomes this problem with the use of a comb that has optical fibers to deliver light directly to the skin. We will evaluate this device in a clinical setting and will use the results to tailor the design of the comb before producing it in large quantities. Phase(s): Phase I; Phase II Study Type: Interventional Contact(s): Zafiris Gourgouliatos 310-575-0188 [email protected]; Massachusetts; Massachusetts General Hospital, Boston, Massachusetts, 02114-2696, United States; Charles Taylor 617-724-3564 [email protected] Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00007293;jsessionid=70E1481 55114A228E0D24848C469E326 ·

Treatment of Psoriasis Using Acitretin in HIV-Positive Patients Condition(s): HIV Infections; Psoriasis Study Status: This study is no longer recruiting patients. Sponsor(s): Hoffmann-La Roche Ltd Purpose - Excerpt: To determine the efficacy of acitretin in the treatment of psoriasis in HIV/AIDS patients. Etretinate, a retinoid, has proven successful in the treatment of HIV-infected patients with psoriasis, but it has an elimination half-life of 100 days. Acitretin, a metabolite of etretinate, has a much shorter half-life of 2 to 3 days. Acitretin has proven effective in treating psoriasis in patients without HIV infection by reducing skin involvement and clearing of the condition, but it has not been thoroughly evaluated in HIV-infected patients. Phase(s): Phase III Study Type: Interventional Contact(s): New York; Beth Israel Med Ctr, New York, New York, 10003, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002143;jsessionid=70E1481 55114A228E0D24848C469E326

·

Research in Skin Inflammation Condition(s): Psoriasis Study Status: This study is completed.

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Sponsor(s): National Cancer Institute (NCI) Purpose - Excerpt: This study will examine the production of proteins called chemokines in inflammatory skin reactions. It is thought that chemokines attract or recruit white blood cells from the blood stream into the skin when there is a skin injury or infection, causing inflammation. This study will examine chemokine production in induced inflammatory reactions to try to gain a better understanding of how white blood cells are attracted to inflamed areas of the body. Healthy normal volunteers between 33 and 60 years old may be eligible for this study if they 1) have no history of chronic skin disease; 2) are not allergic to eggs; and 3) do not tend to form large irregular scars after trauma to the skin from, for example, cuts, scratches and surgical incisions. Candidates will be asked a short series of questions and have a limited skin examination. Participants will have 10 ml (2 tablespoons) of blood drawn from an arm vein at the start and end of the 5-day study and undergo the following procedures: 1. Day 1 - Participants receive an injection in the right upper arm of mumps antigen (a protein commonly used to tests for immunization against mumps) and an injection of "vehicle" (saline plus the preservatives thimerosal, glycine and formaldehyde) in the left upper arm. 2. Day 3 - Participants who develop a swelling from the mumps antigen larger than 5 mm wide will receive another injection of antigen in the right arm and another injection of vehicle in the left arm. Those whose swelling is not greater than 5 mm will be excluded from the study at this point. 3. Day 5 - All four injection sites, plus another site on the left upper arm will be biopsied. For this procedure the five injection areas are numbed with a local anesthetic. A punch biopsy instrument that resembles a small cookie cutter (about one-third the diameter of a dime) is inserted about one-fifth of an inch deep into the skin and the tissue is removed. Two stitches are used to close the wound. Antibiotic and bandages are applied for 5 days. Nine days after the biopsy the participant returns to NIH for removal of the stitches. New molecular biology techniques will be used to measure changes in chemokine production in the biopsied tissue. Study Type: Observational Contact(s): Maryland; National Cancer Institute (NCI), 9000 Rockville Pike Bethesda, Maryland, 20892, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00026741;jsessionid=70E1481 55114A228E0D24848C469E326

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·

Study of Topical Calcitriol in Children With Psoriasis Condition(s): Psoriasis Study Status: This study is completed. Sponsor(s): National Center for Research Resources (NCRR); Boston University School of Medicine Purpose - Excerpt: Objectives: I. Determine the therapeutic efficacy and safety of topical calcitriol in children with psoriasis. Study Type: Interventional Contact(s): Michael F. Holick 617-638-4546. Study chairs or principal investigators: Michael F. Holick, Study Chair; Boston University School of Medicine Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00006275;jsessionid=70E1481 55114A228E0D24848C469E326

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Study of Topical Calcitriol or Oral Calcitriol in Patients with Psoriasis Condition(s): Psoriasis Study Status: This study is suspended. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); Boston University School of Medicine Purpose - Excerpt: Objectives: I. Evaluate the long term safety and efficacy of orally administered calcitriol in patients with at least 5% of their body covered with psoriasis. II. Evaluate the long term safety and efficacy of topically administered calcitriol in patients with at least 5% of their body covered with psoriasis. III. Compare the topical calcitriol treatment to the oral calcitriol treatment in these patients. Study Type: Interventional Contact(s): Michael F. Holick 617-638-4546. Study chairs or principal investigators: Michael F. Holick, Study Chair; Boston University School of Medicine Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004468;jsessionid=70E1481 55114A228E0D24848C469E326

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The Evaluation of Oral Acitretin in the Treatment of Psoriasis, Cutaneous Disorders of Keratinization, Multiple Basal Cell Carcinomas and Other Retinoid Responsive Diseases Condition(s): Basal Cell Carcinoma; Keratosis Palmaris et Plantaris; Psoriasis Study Status: This study is completed. Sponsor(s): National Cancer Institute (NCI) Purpose - Excerpt: This is a continuing study which evaluates the longterm safety and efficacy of oral acitretin in an open manner in the treatment of psoriasis, cutaneous disorders of keratinization, multiple basal cell carcinomas and other retinoid responsive diseases. Study Type: Observational Contact(s): Maryland; National Cancer Institute (NCI), 9000 Rockville Pike Bethesda, Maryland, 20892, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005660;jsessionid=70E1481 55114A228E0D24848C469E326

Benefits and Risks18 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·

A new treatment could be more effective than the current treatment for psoriasis. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.

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If the treatment is effective, then it may improve health or prevent diseases or disorders.

This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f2 91. 18

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·

Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.

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People who take part in trials contribute to scientific discoveries that may help other people with psoriasis. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent

Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial's risks and benefits, the researcher’s expectations of you, and your rights as a patient. What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital's Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.

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What Are a Patient's Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·

Information on all known risks and benefits of the treatments in the study.

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Know how the researchers plan to carry out the study, for how long, and where.

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Know what is expected of you.

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Know any costs involved for you or your insurance provider.

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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.

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Talk openly with doctors and ask any questions.

After you join a clinical trial, you have the right to: ·

Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.

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Receive any new information about the new treatment.

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Continue to ask questions and get answers.

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Maintain your privacy. Your name will not appear in any reports based on the study.

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Know whether you participated in the treatment group or the control group (once the study has been completed).

What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don't have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care.

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What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·

What is the purpose of the clinical trial?

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What are the standard treatments for psoriasis? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?

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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?

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How long will the treatment last? How often will I have to come back for follow-up exams?

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What are the treatment's possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?

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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?

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How will my health be monitored?

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Where will I need to go for the clinical trial? How will I get there?

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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?

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Will I be able to see my own doctor? Who will be in charge of my care?

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Will taking part in the study affect my daily life? Do I have time to participate?

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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?

Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with

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most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “psoriasis” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

A Guide to Patient Recruitment : Today's Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna

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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna

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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna

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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information

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Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna ·

Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna

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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna

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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Aspiration: The act of inhaling. [EU] Bandages: Material used for wrapping or binding any part of the body. [NIH] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Etretinate:

An oral retinoid used in the treatment of keratotic

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genodermatosis, lichen planus, and psoriasis. Beneficial effects have also been claimed in the prophylaxis of epithelial neoplasia. The compound may be teratogenic. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Gonadal: Pertaining to a gonad. [EU] Immunization: The induction of immunity. [EU] Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Intravenous: Within a vein or veins. [EU] Keratosis: Any horny growth such as a wart or callus. [NIH] Leukapheresis: The preparation of leukocyte concentrates with the return of red cells and leukocyte-poor plasma to the donor. [NIH] Metabolite: process. [EU]

Any substance produced by metabolism or by a metabolic

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins c-mos. [NIH] Parathyroid: 1. situated beside the thyroid gland. 2. one of the parathyroid glands. 3. a sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]

Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU]

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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL

ABOUT PART II In Part II, we introduce you to additional resources and advanced research on psoriasis. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on psoriasis. In Part II, as in Part I, our objective is not to interpret the latest advances on psoriasis or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with psoriasis is suggested.

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CHAPTER 4. STUDIES ON PSORIASIS Overview Every year, academic studies are published on psoriasis or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on psoriasis. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on psoriasis and teach you how to keep current on new studies as they are published or undertaken by the scientific community.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and psoriasis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the

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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “psoriasis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·

Skin Manifestations Related to HIV Source: STEP Perspective; Vol. 4, No. 2. Contact: Seattle Treatment Education Project, 1123 E John St, Seattle, WA, 98102, (206) 329-4857, http://www.thebody.com/step/steppage.html. Summary: Afflictions of the skin are a serious concern for HIV-infected people. This article discusses the most commonly seen skin conditions and ways to treat them. These include seborrheic dermatitis, a dandrufflike skin condition affecting the scalp, face, chest, back, groin, and armpits. Individuals who have recurrent episodes of seborrheic dermatitis may benefit from using dandruff shampoo as a body wash. Psoriasis often occurs after HIV infection. The initial lesions often begin like seborrheic dermatitis but spread to the armpits, groin, elbows, knees, and lower back. Significant improvement is often seen after using AZT at higher doses and from phototherapy. Herpes simplex virus is a common infection among people with HIV. Because the herpes virus contributes to immune suppression, many physicians prescribe oral acyclovir as a prophylaxis. Herpes zoster, or shingles, is common in people with HIV. Acyclovir is used in an intravenous form to treat the shingles, as are topical creams. Molluscum contagiosum is a viral infection producing lesions that can appear anywhere on the body. Treatment includes topical ointments, AZT, and retinoic acid. Human Papillomavirus (HPV) causes warts that are treated with cryotherapy, electrocautery, excision, or injections of alpha interferon. Xeroderma is a dry skin condition treated with oil and lotions. Folliculitis can be found around hair follicles and responds well to ketoconazole treatment. Bacillary angiomatosis appears as papules or nodules and often resembles Kaposi's sarcoma. Treatment includes a 3- to 4-week regimen of antibiotic. A review of photodermatitis, insect bite reactions, drug reactions, nail disorders, and hair changes conclude the article.

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Superficial Fungal Infection of the Skin: Where and How It Appears Help Determine Therapy Source: Postgraduate Medicine. 109(1): 117-120,123-126,131-132. January 2001. Summary: This journal article provides health professionals with information on the features, diagnosis, and management of tinea pedis, tinea corporis, tinea cruris, tinea versicolor, tinea capitis, tinea faciei, tinea manuum, cutaneous candidiasis, and onychomycosis. Tinea pedis, the most common fungal infection of the skin, involves the plantar surface and interdigital spaces of the foot and can include inflammatory and noninflammatory lesions. Differential diagnosis of tinea pedis includes acrodermatitis continua, candidiasis, contact dermatitis, eczema, erythrasma, psoriasis, pustular bacterids, pyoderma, and secondary syphilis. Tinea pedis usually responds to topical agents such as econazole nitrate, ketoconazole, and terbinafine hydrochloride. Tinea corporis, commonly referred to as ringworm of the body, is dermatophytosis of the glabrous skin of the trunk and extremities. This condition typically develops after inappropriate topical corticosteroid therapy. Treatment involves topical therapy. Tinea cruris, or jock itch, is a dermatophytosis of the proximal medial thigh and buttock. Differential diagnosis includes mechanical intertrigo and candidiasis. Treatment involves topical therapy. Tinea versicolor, or pityriasis versicolor, is typically found in regions of the body that have sebaceous glands. The characteristic finding is skin depigmentation. Differential diagnosis includes vitiligo, tinea corporis, pityriasis rosea, pityriasis alba, and secondary syphilis. Topical therapies such as terbinafine, econazole, ketoconazole, and selenium sulfide lotion or shampoo are effective topical therapies. Tinea capitis, which is a dermatophytic infection of the head and scalp, can have a range of clinical presentations. Differential diagnosis includes seborrheic dermatitis, dandruff, scalp psoriasis, atopic dermatitis, and alopecia areata. An oral agent such as griseofulvin is usually needed to successfully treat this condition. Tinea faciei is dermatophytosis of the nonbearded areas of the face. This infection responds to topical therapy. Tinea manuum, an unusual dermatophytic infection of the interdigital and palmar surfaces, may coexist with other fungal infections. Differential diagnosis includes pompholyx, eczema, secondary syphilis, and callus formation. Although the condition responds to topical therapy, it may recur if untreated onychomycosis is present. Cutaneous candidiasis, a skin infection caused by Candida albicans and other species, often presents with erythema, cracking, or maceration. Topical agents commonly used to treat this condition include nystatin, ketoconazole, miconazole nitrate, and clotrimazole. Onychomycosis, a

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fungal infection of the nail unit, has a wide variety of clinical presentations. Differential diagnosis includes psoriasis, lichen planus, alopecia areata, subungual tumors and warts, and bacterial infections. Oral agents are more successful than topical agents. The article also discusses the topical and systemic agents used to treat cutaneous fungal infections. Topical agents include imidazoles, allylamines, and polyenes. Systemic agents include griseofulvin, ketoconazole, itraconazole, terbinafine, and fluconazole. 16 figures, 2 tables, and 21 references. ·

Treatment of Psoriasis: An Algorithm-Based Approach for Primary Care Physicians Source: American Family Physician. 61(3): 725-733. February 1, 2000. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 9066000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article provides health professionals with information on the diagnosis and treatment of psoriasis. Although the primary cause of psoriasis remains unknown, abnormal epidermal cell kinetics and abnormal activation of immune mechanisms are thought to be the major contributors. Psoriasis is characterized by red, thickened plaques with a silvery scale. The lesions vary in size and degree of inflammation. Psoriasis is categorized as localized or generalized, based on the severity of the disease and its overall impact on the patient's quality of life and well being. The diagnosis of psoriasis can usually be made on the basis of the clinical presentation. If the diagnosis is uncertain, a biopsy can be performed or consultation with a dermatologist can be obtained. Once the diagnosis of psoriasis is made, patient education about the disease should begin. Points that should be emphasized about the disease initially include its noncontagious nature, the possibility of controlling but not curing it, and the factors that exacerbate the disease. In all cases, the therapeutic goal is to maximize treatment efficacy and the patient's quality of life while minimizing side effects. Topical therapy, including corticosteroids, calcipotriene, coal tar products, tazarotene, and anthralin, is the mainstay of treatment for localized disease. Psoriatic plaques that fail to respond to topical therapy may be improved by administration of intralesional corticosteroid injections. The patient who has refractory lesions may benefit from more advanced forms of treatment such as ultraviolet B alone or psoralens plus ultraviolet A; outpatient treatment at a clinic specializing in psoriasis; and systemic therapy with oral retinoids, methotrexate, or cyclosporine. Both physicians and patients need to understand that there is no

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definitive cure for psoriasis. 4 figures, 4 tables, and 17 references. (AAM). ·

Questions About Psoriasis Source: American Family Physician. 61(3): 736. February 1, 2000. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 9066000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article uses a question and answer format to provide people who have psoriasis with information on the causes and treatment of this disease. Psoriasis is a very common noncontagious skin disorder that causes large, thick, scaly red or purple patches on the skin. The exact cause of psoriasis is unknown. Anyone can get psoriasis, and the disease sometimes runs in families. Although there is no cure for psoriasis, it can be controlled with proper treatment. Options for treating psoriasis include keeping skin moisturized; using prescription creams, ointments, and lotions; taking oral medications; and undergoing ultraviolet light therapy. Exacerbating factors include stress, infections, and certain medications. The article includes sources of additional information about psoriasis.

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Help for Psoriasis Source: American Family Physician. 59(4): 964. February 1999. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 9066000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article uses a question and answer format to provide people who have psoriasis with information on this skin condition, which causes red, silvery scales and flaky patches. The cause is unknown, and there is no cure. Although diagnosis is usually based on visual inspection of the skin, a biopsy may be needed in some cases. Mild psoriasis may not need any treatment or may be treated with materials available without a prescription, such as moisturizing creams and shampoos, ointments with salicylic acid, and preparations that contain coal tar. Prescription creams containing steroids are used for more severe cases. Other treatment options include phototherapy; light plus psoralen therapy; and drugs such as methotrexate, etretinate, acitretin, calcipotriene, and tazarotene.

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Topical Psoriasis Therapy Source: American Family Physician. 59(4): 957-962. February 1999.

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Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 9066000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article provides health professionals with information on the efficacy and limitations of topical therapies used to treat psoriasis. Until recently, the mainstays of topical therapy have been corticosteroids, tars, anthralins, and keratolytics. Recently, however, vitamin D analogs, a new anthralin preparation, and topical retinoids have expanded the therapeutic armamentarium of physicians. Corticosteroids have anti-inflammatory, immunosuppressive, and antiproliferative properties. In general, mid-potency corticosteroids are used for lesions on the torso and extremities; low-potency corticosteroids are used for areas such as the face, genitals, or flexures; and high-potency corticosteroids are usually reserved for recalcitrant plaques or lesions on the palms of the hands and soles of the feet. Drawbacks of corticosteroid therapy include tachyphylaxis, skin atrophy, and adrenal suppression. Keratolytic agents help remove scales or hyperkeratosis. Salicylic acid is a commonly used keratolytic agent. Anthralin, which is available in ointment, cream, and paste forms, has been demonstrated to inhibit cell growth and restore cell differentiation. It is usually applied once daily at night and can be very irritating to normal skin. Coal tar appears to have antiproliferative and anti-inflammatory actions. However, it can cause contact allergy, and its use is limited by its inconvenience. Calcipotriene, a vitamin D analog, is generally well tolerated when applied twice daily. Like corticosteroids, calcipotriene can be considered a first-line agent and is available as an ointment, cream, or solution. Retinoids mediate cell differentiation and proliferation. Oral retinoids have many adverse systemic effects, so topical retinoids were developed to avoid many of them. Tazarotene, a topical retinoid, is rapidly metabolized in the skin and converted to tazarotenic acid. Local skin irritation and pruritis are frequent side effects. In addition, tazarotene may be teratogenic. 3 figures, 2 tables, and 26 references. (AA-M). ·

Tazarotene, a Receptor-Selective Topical Retinoid, in the Treatment of Psoriasis Source: Journal of New Developments in Clinical Medicine. 17(2): 133145. 2nd Quarter 1999. Summary: This journal article provides health professionals with information on the use of tazarotene, a receptor-selective topical retinoid, in the treatment of psoriasis. Tazarotene is an acetylenic retinoid and prodrug of tazarotenic acid. A thin layer of tazarotene gel should be applied once daily in the evening to dry psoriatic plaques. Tazarotene

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normalizes keratinocyte differentiation, reverses keratinocyte hyperproliferation, and suppresses inflammation in treated plaques. Various studies have evaluated the effectiveness and safety of this agent, which has been shown to induce remission of psoriasis following the cessation of therapy. Although the drug is effective and well-tolerated as monotherapy, its efficacy can be further enhanced when it is used in combination with mid- or high-potency corticosteroids or ultraviolet B phototherapy. The combination of tazarotene and a mid-potency corticosteroid appears to be more efficacious than twice-daily dose of calcipotriene. Tazarotenic acid, the metabolite of tazarotene, has a short elimination half-life of 1 to 2 hours and does not accumulate in tissues. Very low plasma levels of tazarotene and its active metabolite have been detected, but treatment-related systemic adverse events have not been reported during clinical trials. Adverse effects, consisting primarily of dose-related local cutaneous itching, burning, erythema, and irritation, can be minimized with concurrent use of lubricants or medium- or highpotency corticosteroids. 1 table and 40 references. (Sum-M). ·

Skin Problems of Musicians Source: International Journal of Dermatology. 38(3): 192-195. March 1999. Summary: This journal article provides health professionals with information on a study that investigated the skin problems of high level musicians in a professional orchestra. A health questionnaire was administered to 97 orchestra players and 20 singers. The questionnaire asked about any skin changes directly related to their instruments. Past and current skin problems were also investigated. Twelve musicians who reported dermatitis associated with the playing of their instruments were patch tested. The study found that the most common skin problems were seen in violin players. Typically, the clinical lesion was a localized area of lichenification on the left side of the neck just below the angle of the jaw. Hyperpigmentation, erythema, inflammatory papules, localized alopecia, and pustules were present in different cases. Positive patch test reactions to nickel were found in two violin players, and one other violinist was allergic to colophony. Other skin problems found among the musicians included hyperhidrosis, cheilitis, and calluses of the fingertips. Among the group of singers, the dermatologic findings were mostly stress related. Problems included lichen planus, psoriasis, seborrheic dermatitis, and urticaria. The article concludes that musicians are at risk from occupationally related dermatoses. These data will be useful for the evaluation of musicians with similar difficulties. 3 figures, 1 table, and 10 references. (AA-M).

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Koebner Phenomenon in Psoriasis Source: Postgraduate Medicine. 106(3): 39-40. September 1999. Summary: This journal article provides health professionals with information on the Koebner phenomenon in psoriasis. This phenomenon, which was first noted by Henrich Koebner in 1872, describes the appearance of new psoriatic lesions on otherwise normal skin in response to trauma. The phenomenon can be elicited by bites, burns, tattoos, lacerations, pressure, scratches, incisions, surgical scars, furuncles, vaccinations, sunburn, and radiation. Patients who have psoriasis should be cautioned to avoid preventable injury to the skin. The article presents the case of a 17 year old girl with a history of psoriasis since early childhood who experienced exacerbated disease on her elbows and knees and on her right lateral ankle at the site of a tattoo that had been applied a few months earlier. Following 1 month of treatment, her psoriasis improved 75 percent, but some disease activity remained on the extensor surfaces and the tattooed area. In this patient, the Koebner phenomenon that occurred in the recently tattooed area was identical in appearance to other lesions and was similarly resistant to certain treatments. 1 figure and 10 references.

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Corticosteroid-Induced Flare of Psoriasis: How to Control, Better Yet, Avoid Source: Postgraduate Medicine. 106(7): 31-32. December 1999. Summary: This journal article uses a case report to provide health professionals with information on corticosteroid induced flares of psoriasis. A 55 year old man who had a 25 year history of psoriasis experienced a generalized flare of the disease. Prior to the flare, the man had an exacerbation of asthma that was treated with systemic corticosteroids and prednisone. The prednisone dosage was started at 60 milligrams per day and tapered over 3 weeks. The man experienced a dramatic psoriasis flare during tapering. He was treated with the retinoid etretinate, emollients, and triamcinolone 0.1 percent cream. After 8 weeks, the psoriasis cleared completely, and clearance was maintained for a 6 month period using topical corticosteroids and low dose acitretin. Many genetic, environmental, and local factors can influence the pathogenesis of psoriasis. For example, as in this man's case, cessation of oral corticosteroids can trigger a severe flare or even cause progression to generalized pustular psoriasis. 2 figures and 8 references.

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Juvenile Psoriasis: Early Interventions Can Reduce Risks for Problems Later Source: Postgraduate Medicine. 103(4): 89-92, 95-96, 99-100. April 1998. Summary: This journal article for health professionals presents an overview of juvenile psoriasis. This skin disease is characterized by epidermal hyperplasia and greatly accelerated epidermal turnover. Lesions are usually discrete, erythematous papules and plaques covered with silvery scales. Lesions tend to be symmetric. Genetic, systemic, and environmental factors influence the course of psoriasis. Environmental factors, such as cutaneous trauma, drugs, low humidity, or stress, seem to be the most important in the course of juvenile psoriasis. It occurs in both sexes with nearly equal frequency. Estimates of total prevalence throughout the world range from 0.1 percent to 3 percent. Although the mean age at onset is 27.8 years, many patients were diagnosed before age 20. The guttate form of psoriasis is probably the most common in children. Many methods are available to treat psoriasis, including exposing the skin to sunlight and using topical preparations such as emollients and moisturizers, tar preparations, anthralin preparations, topical corticosteroid therapy, and vitamin D3 ointment. Systemic methods include cytotoxic antimetabolite drugs, photochemotherapy, and retinoids. However, these drugs are not safe for long-term use by infants and children. In addition, patient education is an important aspect of disease management. A total-care approach is the optimal way of managing the disease. 6 figures, 3 tables, and 20 references.

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Adult Skin Disease in the Pediatric Patient Source: Dermatologic Clinics. 16(3): 593-608. July 1998. Summary: This journal article provides health professionals with information on the epidemiology, clinical features, differential diagnosis, and treatment of various adult skin diseases in children. Diseases discussed include psoriasis, lichen planus, Sweet's syndrome, rosacea, and mycosis fungoides (MF). In addition, the article highlights the distinctive features of lichen sclerosus and immunobullous diseases in childhood. Psoriasis is characterized by erythematous papules or plaques with silvery white scales. The clinical features of skin lesions of psoriasis in children are identical to those in adults. Plaque type psoriasis is the most common form seen is children, and guttate psoriasis is also common. Pustular psoriasis is uncommon in both adults and children, and psoriatic erythroderma is very rare in children. Treatment options include topical medications such as emollients, corticosteroids, coal tar, anthralin, calcipotriol, and tazarotene; ultraviolet light; and systemic agents such as methotrexate and systemic retinoids. Lichen planus is an

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uncommon skin and mucous membrane disease in both adults and children. The main features of this disease are small, violaceous, flattopped polygonal papules that are usually intensely itchy. Mucosal involvement is very rare in children under 16 years. Oral antihistamines and topical corticosteroids are the main treatment options. Rosacea is a chronic facial eruption that is rare in children. The clinical presentation of rosacea in children is similar to that seen adults, with a vascular and inflammatory component. Therapy includes topical metronidazole gel and systemic antibiotics. Sweet's syndrome, which is usually seen in women between the ages of 30 and 50 years, is rare in the pediatric age group. This syndrome is associated with fever. The skin lesions are bright red tender plaques and nodules. Treatment involves systemic glucocorticoid therapy. MF can present in childhood but is more common in adults over age 50. The morphology of the skin lesions of MF in childhood resembles that seen in adults with similar stages of MF. Treatment depends on the stage, and alternatives include photochemotherapy, topical steroids, and topical chemotherapy. 8 figures, 3 tables, and 140 references. ·

Pruritic Skin Diseases in the Elderly Source: Journal of Dermatology. 25(3): 153-157. March 1998. Summary: This journal article provides health professionals with information on a retrospective study that gathered clinically relevant data on both pruritic skin diseases and etiologic factors in the elderly patient. A total of 149 elderly men and women with pruritic skin problems were selected for study at a dermatologic clinic in a hospital in Bangkok, Thailand, from November 1996 to January 1997. There were 62 men and 87 women enrolled in the study. Among these elderly patients, pruritic skin disease was the most common problem, found in about 41 percent of participants. Xerosis was the most common problem. Inflammatory eczema and lichen simplex chronicus were the second and third most common problems. Other pruritic skin diseases were skin infections, psoriasis vulgaris, urticaria, drug rash, insect bite, and anogenital pruritus. Xerosis usually occurred with increased bathing frequency and strong soaps and detergents. The causes of inflammatory eczema were seborrheic dermatitis, allergic contact dermatitis, dyshidrosis, and stasis dermatitis. Statistical analysis of xerosis and inflammatory eczema by sex showed no difference, but there was more inflammatory eczema among women. 5 tables and 22 references. (AA-M).

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Psoriasis: New Clues to Causation, New Ways To Treat Source: Patient Care. 33(9): 154-158,161-164. May 15, 1999.

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Summary: This journal article provides health professionals with information on the cause and treatment of psoriasis. This chronic, fluctuating, inflammatory skin condition ranges from mild to severe. The features of plaque psoriasis include circumscribed areas of thickening, redness, and overlying silvery scaling. Diagnosis is based on clinical examination. Patients who have mild, circumscribed psoriasis may be able to manage their symptoms with simple topical remedies. People who have more extensive skin involvement are likely to benefit from referral to a dermatologist or psoriasis specialty center. Medications available to treat psoriasis include traditional agents such as coal tar and anthralin preparations and topical corticosteroids, as well as newer agents such as the vitamin D derivative calcipotriene and the receptorselective retinoid tazarotene. In addition, new topical options are in development or undergoing evaluation. Phototherapy with ultraviolet B (UVB) light remains the most widely used form of phototherapy. Trials of narrow-band UVB, which is expected to provide a significant advance, are under way. Photochemotherapy, which uses ultraviolet A light in combination with the photosensitizing agent and a psoralen compound, has been used successfully for more than 20 years. The main long-term concern of phototherapy is the development of squamous cell carcinoma and melanoma. Various systemic medications may be used to treat patients whose psoriasis does not respond to topical treatment or phototherapy. Systemic agents include methotrexate, oral retinoids, and cyclosporine. Many dermatologists try various different rotational programs to reduce the adverse effects and pharmacologic limitations associated with various agents and approaches. A long-term plan for disease management can also be helpful for patients. 8 figures and 13 references. ·

New Topicals for Mild and Moderate Psoriasis Source: JAAPA: Official Journal of the American Academy of Physician Assistants. 12(4): 52-54,57-58,60. April 1999. Summary: This journal article provides health professionals with information on new topical agents for treating mild to moderate psoriasis. Although the cause of psoriasis is not clear, it is commonly accepted that a genetic predisposition combined with a triggering event such as skin trauma, psychologic stress, streptococcal infections, alcohol abuse, or ingestion of certain medications may initiate the process. Topical corticosteroids have been the mainstay of treatment because of their effectiveness, ease of use, and low cost. However, side effects limit their usefulness. Coal tar ointments and shampoos and anthralin also have unpleasant side effects. The limitations of these agents have led to

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the search for agents that can effectively relieve symptoms while avoiding the side effects and inconvenience of using them. The Food and Drug Administration approved the vitamin D analog calcipotriene and the vitamin A product tazarotene for topical treatment of psoriasis. Calcipotriene inhibits T lymphocyte proliferation. At 0.005 percent, calcipotriene is appropriate as a first or second line agent in moderate psoriasis. The drug has the efficacy of a medium potency topical corticosteroid. The ointment or cream is applied sparingly to the affected area twice a day for at least 2 to 6 weeks. Treatment may be continued for as long as 1 year. Side effects include hypercalciuria, hypercalcemia, and nephrolithiasis. The drug should not be used on the face or groin because of the risk of irritation. Tazarotene, a newly developed topical retinoid, targets retinoic acid receptors in the skin. The drug, which can be used for plaque psoriasis covering less than 20 percent of the body's surface area is applied in the evening. Several studies have demonstrated tazarotene's efficacy, which may be improved by combining it with a medium or high potency corticosteroid such as fluocinonide. The article provides guidelines on incorporating these new agents into patient care management. 1 table and 19 references.

Federally-Funded Research on Psoriasis The U.S. Government supports a variety of research studies relating to psoriasis and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.19 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to psoriasis and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore psoriasis and related conditions. In some cases, therefore, it may be difficult 19 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for psoriasis: ·

Project Title: Five Dose Trial of ABX Il8 in Treatment of Severe Plaque Psoriasis Principal Investigator & Institution: Krueger, Gerald G.; University of Utah 200 S University St Salt Lake City, Ut 84112 Timing: Fiscal Year 2001 Summary: ABX-IL-8 is a humanized monoclonal antibody generated in transgenic mice. The antibody has a high affinity for IL-8, and can neutralize IL-8, as demonstrated in several assay systems. The antibody inhibits binding to neutrophils, inhibits IL-8-induced calcium flux, and inhibits MAC-1 expression, elastase release, and chemotaxis. Dr. Krueger did the developmental work for this protocol by demonstrating in an experimental system that unaffected skin from patients with psoriasis, grafted onto nude mice, generated psoriasis-like lesions when IL-8 was injected. This effect was totally blocked by administering ABX-IL-8. These animal data suggest that an antibody against IL-8 might be an effective method of treating plaque-phase psoriasis. From the study done on the GCRC, safety of the drug was determined, and then appropriate dosing ranges established. The drug proved remarkably effective in the treatment of plaque-phase psoriasis, and a manuscript describing the beneficial effects of this therapy is now in preparation. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: genetic analysis of psoriasis Principal Investigator & Institution: Bowcock, Anne M.; Professor; Genetics; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2000; Project Start 1-JAN-1998; Project End 0-NOV2001 Summary: (Adapted from the applicant's abstract) - Psoriasis is a complex disease that affects approximately 2% of the population. It results in abnormal proliferation of immature keratinocytes and recruitment of T cells to the dermis and epidermis. This results in three major features: induration, scaling, and erythema. A variety of novel proteins have been identified in psoriatic skin that include proinflammatory cytokines, adhesion molecules, HLA-DR, keratins, and alteration in the cellular distribution of integrins. The mode of inheritance of psoriasis is complex, although a familial component is now accepted as

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a result of twin studies, sib pair studies, the identification of large numbers of multiply affected families, and more recently, by evidence for linkage to particular chromosomal regions in some families. The applicants previously provided strong evidence for linkage to the distal end of chromosome 17q. HOMOG estimates indicated that the disease is genetically heterogeneous. A second study recently showed evidence for linkage of psoriasis to chromosome 4 (near D4S1535) in five families from Ireland. In both of these studies, psoriasis susceptibility behaves as an autosomal dominant trait with high penetrance. There is also an autoimmune component to psoriasis, and Cw6 carriers are at 15-fold higher risk of disease. The applicants now propose to localize additional genes conferring susceptibility to psoriasis by performing a genome-wide linkage screen on 250 sib pairs and 27 multiply affected families. Markers will be selected at 3 cM intervals, and genotyping will be performed using an ABI 377. This will require the generation of 1,300,000 genotypes over 3 years (approximately 450,000 per year). Susceptibility loci will be identified by parametric and nonparametric means with GENEHUNTER. Regions where p<0.01 will be analyzed further by collaborators in an additional 250 sib pairs. The applicants will refine potential susceptibility regions with closely linked markers. The results of this study should be the localization of additional psoriasis susceptibility genes to defined regions of the genome. In the last year of funding any highly promising candidate genes in these regions will be screened for alterations in affected individuals from linked families and in sporadic cases. When alterations are found, they will be screened for in 100 unrelated controls to determine the possibility of their contributing to the development of psoriasis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Immunopathogenesis of Psoriasis Principal Investigator & Institution: Kupper, Thomas S.; Professor & Chair of Dermatology; Brigham and Women's Hospital 75 Francis St Boston, Ma 02115 Timing: Fiscal Year 2000 Summary: Psoriasis affects 2% of the world's population. Very recently, it was appreciated that psoriasis has many features of an autoimmune disease, and a pathogenic paradigm that implicates activated skin homing T cells responding to an as yet unknown epidermal antigen(s) has emerged. In support of this paradigm, it is clear that all effective treatments for psoriasis have T cells as their targets. Skin directed therapies, including UVB and PUVA, directly induce apoptosis of intraepidermal T cells, while systemic therapies such as low dose

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methotrexate and cyclosporin target activated T cells throughout the body. More recently, a number of clinical trials have been initiated that use novel immunomodulatory agents such as CTLAIg, DAB-IL-2, antiCD40L, and LFA3-TIP. Because the prominent immunological component of psoriasis was only recently appreciated there are large gaps in our knowledge about the immunopathology of this disease. In this proposal, we hypothesize that psoriasis is mediated by a recirculating population of CD8+, CLA (cutaneous, lymphocyte antigen) + effector T cells that become activated in epidermis in response to autoantigen. In aim 1, we propose to compare the VbetaCDR3 spectratype profile of lesional psoriatic CD8+ (CD25+) T cells with the analogous profile found in the CLA+ CD8+ fraction of peripheral blood. It is predicted that substantial overlap will exist. In aim 2, using epidermal antigen as well as anti-CD3, we will isolate and expand clones of putative disease related (as well as unrelated) CD8+ T cells form both blood and epidermis. In our third aim, we will use an established SCID/Hu model, involving non-lesional psoriatic skin grafted onto SCID mice, to test whether putative disease related clones can induce a psoriatic phenotype in vivo. Using this model, we will also test the efficacy and mechanism of action of both anti CD40 ligand and LFA3TIP in treating psoriasis. Finally, in our fourth aim we will perform transcriptional profiling on T cells (including candidate disease related clones) and epidermal cells from psoriasis patients and from normal patients in an effort to carefully assess differences between these populations. The long term goal of this research is to better understand the nature of immune response underlying psoriasis. This will provide a means to understanding why certain therapeutic approaches are superior to others, as well as to developing novel approaches to therapy. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: MEDI-507 Monoclonal Antibody in Plaque Psoriasis Principal Investigator & Institution: Langley, Richard Gb.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2000; Project Start 1-FEB-1978; Project End 0-NOV2002 Summary: The primary objective of this study is to describe in patients with plaque psoriasis the dose level at which no dose limiting toxi cities occur following a single intravenous infusion of MEDI-507. Secondary objectives: 1) to evaluate serum concentrations of MEDI-507, 2) to evaluate the pharmacodynamic effects of MEDI-507 on the absolute lymphocyte count and the dynamics of the following lymphocyte phenotypes: CD2, CD3, CD19(+)20(+) and CD16(+)56(+) in the peripheral

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blood, 3) to desribe CD2 receptor occupancy by MEDI-507, 4) to describe CD2 receptor occupancy by MEDI-507, 5) to describe the change in the clinical grade and histopathology of plaque psoriasis in MEDI-507 recipients, 6) to evaluate development of anti-MEDI-507 antibodies. Tcells are an essential part of the pathophysiology of psoriasis, and agents active against T-cells have ameliorated the disease. MEDI-507, a humanized monoclonal antibody, binds to the CD2 receptor found on the surfacces of T-cells and natural killer (NK) cells and may suppress the function of these cells or eliminate them from the circulation. This openlabel protocol is the first administration of MEDI-507 to psoriatic patients. It will describe safety, adverse reactions, lymphocyte population kinetics, change in psoriasis clinical grade and histopathology, specific serum cytokine concentrations, serum MEDI-507 concentrations and MEDI-507 immunogenicity. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Novel Therapeutic Approach to Psoriasis Principal Investigator & Institution: Pershadsingh, Harrihar A.; Bethesda Pharmaceuticals, Inc. 1016 Lakeview Way Redwood City, Ca 94062 Timing: Fiscal Year 2001; Project Start 0-SEP-1997; Project End 1-AUG2003 Summary: (Applicant's abstract): Psoriasis is a common, inflammatory disease of the skin characterized by hyper-proliferation of keratinocytes. A variety of antipsoriatic therapies are available, however, due to problems with side effects and variability in clinical response, intense clinical and commercial interest remains in the development of new treatments. Thiazolidinediones, a novel class of compounds that activate the nuclear hormone receptor PPAR gamma, have recently been found to reversibly inhibit the proliferation of both normal and psoriatic human keratinocytes in vitro, and ameliorate the histologic abnormalities of psoriatic skin in organ culture and in the scid mouse/human skin transplant model of psoriasis. In the current proposal, we will: 1) perform pilot studies of the antipsoriatic effects of orally administered thiazolidinediones in humans; 2) investigate the cellular mechanisms that mediate the antipsoriatic effects of thiazolidinediones, and 3) investigate the antipsoriatic potential of a recently developed series of novel thiazolidinediones that are expected to be more effective than existing compounds with respect to ameliorating the epidermal inflammation and hyperproliferation that characterizes psoriasis. By investigating clinical efficacy, by addressing therapeutic mechanisms, and by testing novel thiazolidinediones, the current Phase II studies will significantly advance the potential for Phase III commercial development of thiazolidinediones

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in the treatment of psoriasis. Proposed Commercial Application: Not Available Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Safety / Efficacy of Topical 19 Nor 1,25 Dihydroxyvitamin D3 for Psoriasis Principal Investigator & Institution: Holick, Michael F.; Professor; Boston University 121 Bay State Rd Boston, Ma 02215 Timing: Fiscal Year 2000; Project Start 1-DEC-1978; Project End 0-NOV2001 Summary: The goal of this pilot study is to determine the therapeutic efficacy and safety of the vitamin D analog 19-nor-1 alfa, 25dihydroxyvitamin D3 for the treatment of plague type psoriasis in adults. This will be accomplished by evaluating the topical application of either placebo petrolatum or petrolatum that contains 1.5 mcg of 19-nor1,25(OH)2D3 in 0.1 g petrolatum. Expected outcome: Only 19-nor-1,25 (OH)2D3 will be effective for treating psoriasis. A total of up to 20 adults patients with plague psoriasis who have lesions over at least 5% of their bodies will be studied. Study subjects will be male or female between the ages of 18-80. The patients will apply to a 50 cm2 lesion 0.10g of white petrolatum that contains 1.5 mcg of 19-nor-1,25 (OH)2D3 once a day for three months. A comparable 50 cm2 psoriasis lesion will receive 15 mcg/g of white petrolatum daily. The study will be conducted in a double blind, right/left sided, semi-controlled fashion. Neither the physician nor study nurse who is making the assessment will know which lesion is receiving which compound. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Scalp Psoriasis Treatment with a Fiber Optic Comb Principal Investigator & Institution: Gourgouliatos, Zafirios F.; Bunsen Rush Laboratories, Inc. Woodbridge, Ct 06525 Timing: Fiscal Year 2000; Project Start 8-AUG-2000; Project End 1-JUL2002 Summary: Scalp psoriasis can be treated with a novel fiber optic delivery system that irradiates the psoriatic scalp of patients with UV-B light via an Optical Fiber Comb. The currently used methods for treatment of psoriasis with light are not applicable to the scalp because hair is usually blocking the light from reaching the affected skin. Our method overcomes this problem with the use of a "comb" that has optical fibers to deliver light directly to the skin. An UV-B Lightsource and a Fiber Optic Comb for use in clinics and doctor's offices have been developed during

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Phase I of this project. During Phase II this device will be evaluated in a clinical setting. The results of this trial will provide data about the effectiveness of the device. These results will be used to tailor the device before it is ready for volume production. In addition a lower cost device for home use will be developed, implementing the findings of the clinical trial and the experience gained during Phase I. If successful the UV-B Lightsource and Fiber Optic Comb will provide treatment to people affected with scalp psoriasis. At present, these people do not have any effective treatment available to them. PROPOSED COMMERCIAL APPLICATIONS: Psoriasis of the scalp affects more than two million people in the U.S. alone. Patients will require their own light combs, replaceable after 100- 200 uses. In a conservative scenario, assuming that only 1/3rd of affected patients were treated, in a physician's office, where one device might be used for 100 patients, 6,600 units would be needed in addition to several hundred thousand combs per year. Many patients would desire their own light source for convenience. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Tolerability of Bg9712 in Moderate to Severe Plaque Psoriasis Principal Investigator & Institution: Krueger, j; University of Utah 200 S University St Salt Lake City, Ut 84112 Timing: Fiscal Year 2000 Summary: Psoriasis is an inflammatory skin condition characterized by exuberant overgrowth of the most superficial layer of skin cells, coupled with inflammation. Critical to the development of psoriasis is a type of blood cell called an activated T-lymphocyte. These cells, along with another type of blood-derived cell called the antigen-presenting cell, localize around the lesions of psoriasis. In fact, these two types of cells migrate into an area before overgrowth of skin cells begins. When effective treatments have been used for psoriasis, it has been demonstrated that the activated T-cells are depleted just before the skin lesions regress. This multi-center, randomized, multi-dose, doseescalation study was developed by Dr. Krueger and collaborators at other universities to evaluate a synthetic protein that blocks the interaction between the antigen-presenting cell and the activated T-cell, and thus prevents proliferation of activated T-cells. Preliminary studies done by Dr. Krueger on the GCRC established that intravenous infusions of agents of this type were effective and well tolerated. The purpose of the current study was to determine if a new preparation generated using a slightly different method of production (a method which generated a

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product with enhanced stability) might be more effective than the previously used forms. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Topical Cyclosporin a for Dermatitis and Psoriasis Principal Investigator & Institution: Rothbard, Jonathan B.; Cellgate, Inc. 552 Del Rey Ave Sunnyvale, Ca 94085 Timing: Fiscal Year 2001; Project Start 2-SEP-2001; Project End 1-AUG2002 Summary: (Verbatim) The protective outer layer of the skin, the stratum corneum, serves to exclude therapeutic drugs like cyclosporin A (CsA). Preliminary experiments have unambiguously established that short polymers of arginine cross the stratum corneum of murine and human skin to enter the epidermal and dermal tissue. Similar penetration into all layers of the skin was observed when short polymers of arginine were conjugated to CsA, which in unconjugated form fails to penetrate skin. These conjugates reached infiltrating T cells in the dermis of inflamed skin. Related conjugates using a releasable linker provided therapeutically active CsA conjugates, thus providing a means of focally delivering systemically toxic drugs for the treatment of psoriasis and dermatitis while alleviating the problem of systemic toxicity. The goal of this proposal is to select a lead CsA -transporter conjugate for further development. This will entail the synthesis and evaluation of a series of GsA-transporter conjugates comprising a set of transporters with a range of tissue penetrating ability. A labeled subset will be assessed for tissue penetration and a corresponding releasable subset will be evaluated in vitro by assaying their ability to inhibit secretion of Il-2 by activated T cells and in vivo using an animal model of contact dermatitis. PROPOSED COMMERCIAL APPLICATION: Current topical therapies for dermatitis and psoriasis all have fundamental problems. When administered orally, immunosuppressants can be effective, and by, intralesional injection, CsA dramatically reduces or clears psoriatic lesions. CsA is not currently used to treat dermatitis and is used only in severe cases of psoriasis because of systemic toxicity. The proposed conjugates are expected to provide the first highly efficacious topical treatments for atopic/contact dermatitis and psoriasis, which together total >20 million US patients. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Use of Humanized Cd25 (Anti-Tac) in the Treatment of Psoriasis Principal Investigator & Institution: Krueger, James G.; Professor; Rockefeller University 66Th and York Ave New York, Ny 10021 Timing: Fiscal Year 2000 Summary: It is known that IL-2 receptor-bearing T-lymphocytes (CD3+, CD25+, CD122+) induce type I psoriasis. The hypothesis addressed in the current proposal is: (1) T-cell mediating psoriasis are MHC class I restricted and belong to the Tc1 subset of effector CD8+ lymphocytes. The following hypotheses regarding the mechanism will also be discussed: (2) CD4+ T cells (or other IL-2 receptor-bearing cells) are pathogenic. (3) Type I psoriasis is a primary disorder of keratinocytes with activation of T cells as a secondary event. (4) Activated Langerhans cells (or other dendritic antigen-presenting cell types) are directly pathogenic. IL-2 receptor-bearing T-lymphocytes (CD3+CD25+CD122+) induce type I psoriasis. T-cells mediating psoriasis are most likely MHC class I restricted and belong to the Tc1 subset of effector CD8+ lymphocytes. The major alternative hypothesis is that other IL-2 receptorbearing cells, especially CD4+ T-cells, are pathogenic. Less likely alternative hypotheses are 1) that type I psoriasis is a primary disorder of keratinocytes with activation of T cells as a secondary event or 2) that activated Langerhans cells (or other dendritic antigen-presenting cell types) are directly pathogenic. This hypothesis is being tested by the in vivo administration of three novel immune-modulating drugs (which target activation and/or effector phases of immune responses) to patients with psoriasis vulgaris. Two of these agents directly target IL-2 receptors that are up-regulated on activated T-lymphocytes, and the other agent indirectly suppresses IL-2 receptor expression by T-lymphocytes. The agents being studied are DAB389IL2, a rationally engineered fusion toxin which binds selectively to activated T-lymphocytes; rh Interleukin-11, an anti-inflammatory that modulates T-lymphocyte activation, and a humanized monoclonal antibody to CD25, the subunit of the IL-2 receptor that confers high-affinity interaction with IL-2. The major objectives of these studies are, first, to explore the safety and efficacy of novel immune-targeted therapeutic agents in the most common human immune-mediated disease (psoriasis vulgaris) and, secondly, to use these therapeutic agents as specific immune probes to dissect the contribution of different immune mechanisms to disease pathogenesis. Hence, our analysis plan is geared to investigate a broad range of immune pathways that might be affected by each agent. Proposed studies include analysis of (1) Molecules regulating early, mid, and late stages of T-cell activation, including expression of pathways such as CTLA4, Fas, and Fas ligand,

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believed to terminate immune responses; (2) Type I vs. type II cytokines synthesized by individual T-lymphocytes using new flow cytometrybased techniques (defines some subsets of effector lymphocytes); (3) Differentiation of memory vs. effector populations of CD8+ and CD4+ Tcell subsets using multiple molecular markers such as GMP-17 (TIA-1), CD27, CD28, CD57, CD45 isoforms, and CD29; (4) Trafficking of T-cells into psoriatic skin lesions, including expression of regulatory adhesion molecules such as CLA, CD11a, ICAM-1, CD29, and P/Eselectins; (5) Down-regulation of immune responses as measured by induction of Tcell apoptosis vs. induction of T-cell anergy. Furthermore, "mature" or activated Langerhans cells (as well as other types of dendritic antigenpresenting cells) may provide the stimulus for ongoing T-cell activation in psoriatic skin lesions. Hence, we will also study the effects of specific immune-blockade on the expression of co-stimulatory molecules (CD80, CD86, CD54, and CD40) that are up-regulated on dendritic cells in psoriatic skin lesions. Currently, the treatment of human autoimmune or immune-mediated diseases is hampered by 1) the lack of specific immune-directed therapeutics, especially agents without serious toxicity for non-immune cells and 2) a poor understanding of specific immune effector pathways and leukocyte or lymphocyte subsets that produce characteristic cellular pathology. As a whole, this group of diseases, which includes psoriasis, rheumatoid arthritis, inflammatory bowel disease, atopic dermatitis, type I diabetes, autoimmune thyroiditis, multiple sclerosis, and a variety of other disorders, constitutes a significant fraction of chronic human disease and overall health care costs. As the most common immune-mediated human disease, psoriasis is the best model system with which to gain a comprehensive understanding of mechanisms involved in pathogenesis (it is accessible for study of leukocyte subsets in the diseased tissue; single-agent therapeutic trials can be conducted successfully in this disorder; and tissue-related pathology can be completely reversed by successful immune-directed therapy). Information about the safety, efficacy, and cellular/molecular mechanisms of new immune-directed therapeutics that are attained by the study of psoriasis can then be applied to other human immune-mediated diseases. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Interaction between Psoriatic Keratinocytes and T Cells Principal Investigator & Institution: Cooper, Kevin D.; Professor; Dermatology; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106

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Timing: Fiscal Year 2000; Project Start 5-AUG-1995; Project End 1-AUG2002 Summary: Psoriasis is characterized by a marked T cell dependent hyperproliferation of the keratinocyte population within lesions of afflicted individuals. We have recently identified a clonogenic population of progenitor keratinocytes which, in normal skin, rarely undergo transition from the G0 stage of the cell cycle into the G1 cell cycle stage, however, in psoriatic lesions these progenitor cells are all actively cycling in G1 /S/G2/M. Relative to normals, clonogenic G0 keratinocytes hyperrespond to lymphokines from lesional T cell clones, in an ex vivo model of synchronized cell cycle induction from G0, particularly if stimulated with fibronectin (Fn). Changes in the clonogenic keratinocyte interactions with dermal/epidermal junction (DEJ) extracellular matrix may be a key link that confers psoriatic proliferation potential and T cell activation dependence in this disease. Both involved and uninvolved areas of psoriasis reveal increased Fn deposition at the DEJ. We show preliminary data that demonstrates that the Fn deposited is of an embryonic splice variant that splices in the EDA segment (EDA Fn). EDA which confers enhanced display of the RGD site, but is rarely stably expressed in adult human tissue. Further, keratinocytes from psoriatic individuals show increased alpha5beta1 integrin expression, a fibronectin receptor, enhanced integrin dependent spreading and focal adhesion kinase (FAK) activation, specifically on Fn. It is our hypothesis that increased Fn, Fn receptor, and Fn dependent functional activation in psoriasis are in response to the DEJ EDA Fn, and that an EDA-Fn rich versus poor ECM will regulate keratinocyte cell cycle progression and responsiveness to in combination with immune mediators. We propose to identify the cell type(s) in psoriasis responsible for production of EDA Fn, using assays for protein and mRNA with in situ localization. We will test whether or not EDA Fn regulates the FAK activation and proliferation of keratinocytes in a skin equivalent model in which keratinocytes engineered to overexpress EDA Fn production are used to form the epidermis. We will also test whether EDA Fn protein alone induces FAK phosphorylation, and its downstream kinase linked to cell cycle, MAPK, as well as cell cycle markers, in fresh ex-vivo normal and psoriatic keratinocytes. Blocking fragments of EDA Fn to the Fn matrix and specific integrin pair inhibitors will identify therapeutic intervention targets. This project will provide important and novel information that will translate rapidly to new treatments for psoriasis as well as to understand morphogenesis, with broad relevance to development, aging and cancer. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Interleukin 7 in Inflammatory Skin Diseases Principal Investigator & Institution: Ansari, Aftab A.; Professor; Emory University 1380 S Oxford Rd Atlanta, Ga 30322 Timing: Fiscal Year 2000; Project Start 1-MAR-1994; Project End 0-APR2004 Summary: Psoriasis is a common inflammatory skin disorder characterized by T lymphocyte infiltration, epidermal hyperkeratosis, and increased angiogenesis. The factors that initiate and maintain the psoriatic process are not well understood. We know that psoriasis can be exacerbated by systemic administration of Thl cytokines and lithium, and can be alleviated by glucocorticoids, methotrexate, and ultraviolet light. We have demonstrated in a transgenic mouse model that over expresses IL-7, an angiogenic phenotype closely resembling human psoriasis. In addition, IL-7 is highly expressed in human psoriasis and can be down regulated by ultraviolet light, which may account for some of the beneficial properties of this therapy in psoriasis. l) We will determine the cell lineages that synthesize IL-7 and express its cognate receptor, IL-7R, in psoriasis 2) We will determine whether factors known to aggravate psoriasis, such Thl cytokines and lithium regulate IL-7 secretion and synthesis. 3 ) We will determine whether angiogenic factors such as vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFUF) regulate IL- 7 synthesis and secretion. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: The Role of Bacterial Toxins in Human Skin Disease Principal Investigator & Institution: Leung, Donald Ym.; Head, Div of Pediatric Allergy & Immunol; National Jewish Medical & Res Ctr and Research Center Denver, Co 80206 Timing: Fiscal Year 2000; Project Start 7-JUL-1992; Project End 1-MAY2005 Summary: Atopic dermatitis (AD) and psoriasis are the two most common chronic inflammatory skin diseases in the general population. Colonization and infection with S. aureus has been reported to exacerbate AD and psoriasis. The mechanisms by which bacteria participate in the pathogenesis of these skin diseases are unknown. Recent studies demonstrating that approximately 60% of Staphylococcus aureus from AD and psoriasis patients produce superantigens (SAgs) provide a plausible mechanism by which S. aureus could exacerbate skin inflammation. In particular, it has been shown that staphylococcal SAgs can engage HLA-DR on macrophages and activated keratinocytes to induce the release of cytokines and cause the selective stimulation of T

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cells expressing specific T cell receptor(TCR) Vbeta regions. Indeed in AD, SAg production has been associated with more severe skin disease. S aureus, which do not secrete SAgs, produce alpha toxin, a potent keratinocyte activator in vitro whose effects on the immune response in vivo is unknown. The specific aims of this competing renewal grant application will be: First, to determine whether AD and psoriasis skin lesions and their respective peripheral blood skin homing receptor positive T cells are associated with a selective expansion of T cells expressing TCR Vbeta regions that react with SAgs on lesional skin. Second, to investigate whether SAgs contribute to the severity of AD by inducing glucocorticoid insensitivity in skin homing T cells, and to assess the mechanisms by which this occurs. Third, to determine the histologic and immunologic effects of staphylococcal alpha toxin vs SAgs on the skin of normal controls vs patients with AD or psoriasis. Geneticallyengineered mutant SAgs incapable of binding to either HLA-DR or the TCR will be used to decipher the molecular mechanisms of SAgmediated skin inflammation in vivo. Fourth, to investigate the mechanisms leading to enhanced colonization of S aureus on the skin of patients with AD and psoriasis. Mutant S. aureus selectively deficient in various adhesin genes will be used to define the precise molecules involved in the attachment of S. aureus to inflamed skin surfaces. The role of bacterial toxins in the pathogenesis of skin diseases are poorly understood. The skin is an important model to study the pathogenesis of immunologic reactions in tissues. Thus, the elucidation of immune mechanisms by which SAgs exacerbate AD and psoriasis should have important consequences for the development of effective therapeutic modalities in the treatment of a variety of inflammatory diseases. With the increased prevalence of antibiotic resistant S. aureus and drug allergy, it is essential to develop new non-antibiotic strategies in combating bacterial toxin-mediated skin diseases. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Topical Parathyroid Hormone Related Peptide for Psoriasi Principal Investigator & Institution: Malabanan, Alan Ona.; Boston University 121 Bay State Rd Boston, Ma 02215 Timing: Fiscal Year 2000; Project Start 1-DEC-1978; Project End 0-NOV2001 Summary: The goal of this pilot study is to determine the therapeutic efficacy and safety of a parathyroid hormone related peptide analog parathyroid hormone (1-34) (PTH (1-34) for the treatment of plaque psoriasis. This will be accomplished by evaluating the topical application

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of either placebo, Novasome A cream or a cream containing 20.0mg of PTH (1-34) on 0.1 gm of Novasome A cream. Expected outcome: Only PTH in Novasome A cream will be effective for treating psoriasis. This study plans to recruit a total of up to 40 adults patients with plaque psoriasis who have lesions over at least 5% of their bodies. Study subjects will be male or female between the ages of 18-80. Patients will apply to 25 cm square lesion 0.1 gm Novasome A that contains 20.0 mg of PTH once a day for two months. A comparable 25 cm square psoriasis lesion will receive 0.1 gm of Novasome A cream daily. The study will be conducted in a double blind, right/left sided, self-controlled fashion. Neither the physician nor nurse who is making the evaluation will know which lesion is receiving which compound. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

E-Journals: PubMed Central20 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).21 Access to this growing archive of e-journals is free and unrestricted.22 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “psoriasis” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for psoriasis in the PubMed Central database: ·

Notch signalling is linked to epidermal cell differentiation level in basal cell carcinoma, psoriasis and wound healing by Jacques Thelu, Patricia Rossio, and Bertrand Favier; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=111189

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Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis by Darren M Ashcroft, Alain Li Wan Po, Hywel C Williams, and Christopher E M Griffiths; 2000 April 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27334

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 21 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 22 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 20

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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.23 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with psoriasis, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “psoriasis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “psoriasis” (hyperlinks lead to article summaries): ·

Effect of dietary supplementation with n-3 fatty acids on clinical manifestations of psoriasis. Author(s): Bjorneboe A, Smith AK, Bjorneboe GE, Thune PO, Drevon CA. Source: The British Journal of Dermatology. 1988 January; 118(1): 77-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2829958&dopt=Abstract

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Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis. Author(s): Soyland E, Funk J, Rajka G, Sandberg M, Thune P, Rustad L, Helland S, Middelfart K, Odu S, Falk ES, et al. Source: The New England Journal of Medicine. 1993 June 24; 328(25): 1812-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8502270&dopt=Abstract

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Effect of fish oil supplementation on erythrocyte lipid pattern, malondialdehyde production and glutathione-peroxidase activity in psoriasis.

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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Author(s): Corrocher R, Ferrari S, de Gironcoli M, Bassi A, Olivieri O, Guarini P, Stanzial A, Barba AL, Gregolini L. Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 1989 February 15; 179(2): 121-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2920445&dopt=Abstract ·

Effect of heliotherapy on skin and joint symptoms in psoriasis: a 6month follow-up study. Author(s): Snellman E, Lauharanta J, Reunanen A, Jansen CT, JyrkinenPakkasvirta T, Kallio M, Luoma J, Aromaa A, Waal J. Source: The British Journal of Dermatology. 1993 February; 128(2): 172-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8457451&dopt=Abstract

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Effect of heliotherapy on the cost of psoriasis. Author(s): Snellman E, Maljanen T, Aromaa A, Reunanen A, JyrkinenPakkasvirta T, Luoma J. Source: The British Journal of Dermatology. 1998 February; 138(2): 288-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9602876&dopt=Abstract

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Effect of psoriasis heliotherapy on epidermal urocanic acid isomer concentrations. Author(s): Snellman E, Koulu L, Pasanen P, Lammintausta K, Neuvonen K, Ayras P, Jansen CT. Source: Acta Dermato-Venereologica. 1992; 72(3): 231-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1357870&dopt=Abstract

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Effect of topical Hydrocotyle Asiatica in psoriasis. Author(s): Natarajan S, Paily PP. Source: Indian J Dermatol. 1973 July; 18(4): 82-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4777768&dopt=Abstract

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Effect of topical use of camptothecine-dimethyl sulfoxide solution in psoriasis. Author(s): Chiao C, Li H.

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Source: Chin Med J (Engl). 1975 September; 1(5): 355-60. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=811448&dopt=Abstract ·

Effectiveness of relaxation and visualization techniques as an adjunct to phototherapy and photochemotherapy of psoriasis. Author(s): Benhard JD, Kristeller J, Kabat-Zinn J. Source: Journal of the American Academy of Dermatology. 1988 September; 19(3): 572-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3049703&dopt=Abstract

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Effects of dietary supplementation with eicosapentaenoic acid in patients with psoriasis. Author(s): Maurice PD, Allen BR, Barkley A, Stammers J. Source: Adv Prostaglandin Thromboxane Leukot Res. 1987; 17B: 647-50. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2823563&dopt=Abstract

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Effects of dietary supplementation with polyunsaturated ethyl ester lipids (Angiosan) in patients with psoriasis and psoriatic arthritis. Author(s): Lassus A, Dahlgren AL, Halpern MJ, Santalahti J, Happonen HP. Source: J Int Med Res. 1990 January-February; 18(1): 68-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2139859&dopt=Abstract

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Effects of Mahonia aquifolium ointment on the expression of adhesion, proliferation, and activation markers in the skin of patients with psoriasis. Author(s): Augustin M, Andrees U, Grimme H, Schopf E, Simon J. Source: Forschende Komplementarmedizin. 1999 April; 6 Suppl 2: 19-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10352377&dopt=Abstract

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Effects of Medical Resonance Therapy Music on patients with psoriasis and neurodermatitis--a pilot study. Author(s): Lazaroff I, Shimshoni R.

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Source: Integrative Physiological and Behavioral Science : the Official Journal of the Pavlovian Society. 2000 July-September; 35(3): 189-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11286371&dopt=Abstract ·

Effects of psychologic intervention on psoriasis: a preliminary report. Author(s): Zachariae R, Oster H, Bjerring P, Kragballe K. Source: Journal of the American Academy of Dermatology. 1996 June; 34(6): 1008-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8647966&dopt=Abstract

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Efficacy of bimolane in the Malassezia ovalis model of psoriasis. Author(s): Xu B, Noah PW, Skinner RB Jr, Bale G, Chesney TM, Rosenberg EW. Source: J Dermatol. 1991 December; 18(12): 707-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1806601&dopt=Abstract

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Elevated spermidine and spermine levels in the blood of psoriasis patients. Author(s): Proctor MS, Fletcher HV Jr, Shukla JB, Rennert OM. Source: The Journal of Investigative Dermatology. 1975 October; 65(4): 409-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1176793&dopt=Abstract

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Evaluation of a multicentre study of synchronous application of narrowband ultraviolet B phototherapy (TL-01) and bathing in Dead Sea salt solution for psoriasis vulgaris. Author(s): Schiffner R, Schiffner-Rohe J, Wolfl G, Landthaler M, Glassl A, Walther T, Hofstadter F, Stolz W. Source: The British Journal of Dermatology. 2000 April; 142(4): 740-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10792225&dopt=Abstract

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Evening primrose oil and marine oil in the treatment of psoriasis. Author(s): Oliwiecki S, Burton JL. Source: Clinical and Experimental Dermatology. 1994 March; 19(2): 127-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8050140&dopt=Abstract

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Experience with psoriasis in a psychosomatic dermatology clinic. Author(s): Polenghi MM, Molinari E, Gala C, Guzzi R, Garutti C, Finzi AF. Source: Acta Derm Venereol Suppl (Stockh). 1994; 186: 65-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8073842&dopt=Abstract

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Fish oil supplementation results in decreased hypertriglyceridemia in patients with psoriasis undergoing etretinate or acitretin therapy. Author(s): Ashley JM, Lowe NJ, Borok ME, Alfin-Slater RB. Source: Journal of the American Academy of Dermatology. 1988 July; 19(1 Pt 1): 76-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2969924&dopt=Abstract

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High-dose topical calcipotriol in the treatment of extensive psoriasis vulgaris. Author(s): Bourke JF, Berth-Jones J, Iqbal SJ, Hutchinson PE. Source: The British Journal of Dermatology. 1993 July; 129(1): 74-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8369213&dopt=Abstract

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HLA system and therapy of psoriasis. Author(s): Zlatkov NB, Minev M, Dourmishev AL, Martinova F. Source: Dermatologica. 1983; 166(3): 156-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6852329&dopt=Abstract

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Human skin proteases. Fractionation of psoriasis scale proteases and separation of a plasminogen activator and a histone hydrolysing protease. Author(s): Fraki JE, Hopsu-Havu VK. Source: Archives for Dermatological Research. Archiv Fur Dermatologische Forschung. 1976 August 27; 256(2): 113-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9031&dopt=Abstract

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Hypnosis in a case of long-standing psoriasis in a person with character problems. Author(s): Frankel FH, Misch RC.

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Source: Int J Clin Exp Hypn. 1973 July; 21(3): 121-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4701785&dopt=Abstract ·

Increased erythrocyte glutathione peroxidase activity in psoriatics consuming high-selenium drinking water at the Dead-Sea Psoriasis Treatment Center. Author(s): Shani J, Livshitz T, Robberecht H, Van Grieken R, Rubinstein N, Even-Paz Z. Source: Pharmacol Res Commun. 1985 May; 17(5): 479-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4034629&dopt=Abstract

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Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Author(s): Kabat-Zinn J, Wheeler E, Light T, Skillings A, Scharf MJ, Cropley TG, Hosmer D, Bernhard JD. Source: Psychosomatic Medicine. 1998 September-October; 60(5): 625-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9773769&dopt=Abstract

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Influence of water and salt solutions on UVB irradiation of normal skin and psoriasis. Author(s): Boer J, Schothorst AA, Boom B, Hermans J, Suurmond D. Source: Archives for Dermatological Research. Archiv Fur Dermatologische Forschung. 1982; 273(3-4): 247-59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7165354&dopt=Abstract

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Intestinal permeability in patients with psoriasis. Author(s): Humbert P, Bidet A, Treffel P, Drobacheff C, Agache P. Source: Journal of Dermatological Science. 1991 July; 2(4): 324-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1911568&dopt=Abstract

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Kangal hot spring with fish and psoriasis treatment. Author(s): Ozcelik S, Polat HH, Akyol M, Yalcin AN, Ozcelik D, Marufihah M.

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Source: J Dermatol. 2000 June; 27(6): 386-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10920584&dopt=Abstract ·

Keratosis circumscripta. A distinct dermatological entity or a variant of psoriasis? Author(s): Soyinka F, Laja AO. Source: Dermatologica. 1978; 156(6): 341-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=658574&dopt=Abstract

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Know your organizations: the Psoriasis Association. Author(s): Henley L. Source: Health Visit. 1982 January; 55(1): 21. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6915913&dopt=Abstract

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Lack of consensus among experts on the choice of UV therapy for psoriasis. Author(s): Stern RS, Beer JZ, Mills DK. Source: Archives of Dermatology. 1999 October; 135(10): 1187-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10522665&dopt=Abstract

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Lesional elastase activity in psoriasis. Diagnostic and prognostic significance. Author(s): Wiedow O, Wiese F, Christophers E. Source: Archives for Dermatological Research. Archiv Fur Dermatologische Forschung. 1995; 287(7): 632-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8534125&dopt=Abstract

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Long-term local trioxsalen photochemotherapy in psoriasis. Author(s): Vaatainen N, Hannuksela M, Karvonen J. Source: Dermatologica. 1981; 163(3): 229-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7286362&dopt=Abstract

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Long-term outcome of severe chronic plaque psoriasis following treatment with high-dose topical calcipotriol. Author(s): Bleiker TO, Bourke JF, Mumford R, Hutchinson PE.

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Source: The British Journal of Dermatology. 1998 August; 139(2): 285-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9767244&dopt=Abstract ·

Low-dose narrow-band UVB phototherapy combined with topical therapy is effective in psoriasis and does not inhibit systemic T-cell activation. Author(s): de Rie MA, Out TA, Bos JD. Source: Dermatology (Basel, Switzerland). 1998; 196(4): 412-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9669117&dopt=Abstract

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Malignant tumours and psoriasis: climatotherapy at the Dead Sea. Author(s): Frentz G, Olsen JH, Avrach WW. Source: The British Journal of Dermatology. 1999 December; 141(6): 108891. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10606857&dopt=Abstract

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Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Author(s): Syed TA, Ahmad SA, Holt AH, Ahmad SA, Ahmad SH, Afzal M. Source: Tropical Medicine & International Health : Tm & Ih. 1996 August; 1(4): 505-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8765459&dopt=Abstract

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Many patients with psoriasis use sunbeds. Author(s): Turner RJ, Farr PM, Walshaw D. Source: Bmj (Clinical Research Ed.). 1998 August 8; 317(7155): 412. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9694766&dopt=Abstract

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Melanosis coli: a consequence of "alternative therapy" for psoriasis. Author(s): Bertram PD. Source: The American Journal of Gastroenterology. 1993 June; 88(6): 971. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8503405&dopt=Abstract

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Neuroimmunologic aspects of psoriasis. Author(s): Raychaudhuri SP, Farber EM. Source: Cutis. 2000 November; 66(5): 357-62. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11107521&dopt=Abstract

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Neuropathogenesis and neuropharmacology of psoriasis. Author(s): Raychaudhuri SP, Rein G, Farber EM. Source: International Journal of Dermatology. 1995 October; 34(10): 68593. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8537154&dopt=Abstract

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Non-aromatic naphthalane preparation; preliminary clinical study in the treatment of psoriasis vulgaris. Author(s): Alajbeg I, Krnjevic-Pezic G, Smeh-Skrbin A, Vrzogic P, Vucicevic-Boras V, Dobric I, Cekic-Arambasin A. Source: Journal of Pharmaceutical and Biomedical Analysis. 2001 December; 26(5-6): 801-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11600291&dopt=Abstract

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Observations on effect of Fructus Psoraleae injection in 800 cases of psoriasis. Author(s): Lu YT. Source: J Tradit Chin Med. 1983 September; 3(3): 229-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6556410&dopt=Abstract

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Photochemotherapy of psoriasis with 4,5',8-trimethylpsoralen. Author(s): Sehgal VN, Rege VL, Kharangate VN, Reys M. Source: Dermatologica. 1975; 150(5): 316-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1102366&dopt=Abstract

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Phototherapy of psoriasis: comparative experience of different phototherapeutic approaches. Author(s): Karrer S, Eholzer C, Ackermann G, Landthaler M, Szeimies RM.

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Source: Dermatology (Basel, Switzerland). 2001; 202(2): 108-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11306830&dopt=Abstract ·

Physical and psychologic measures are necessary to assess overall psoriasis severity. Author(s): Kirby B, Richards HL, Woo P, Hindle E, Main CJ, Griffiths CE. Source: Journal of the American Academy of Dermatology. 2001 July; 45(1): 72-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11423838&dopt=Abstract

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Physical illness and the family emotional system: psoriasis as a model. Author(s): Kerr ME. Source: Behavioral Medicine (Washington, D.C.). 1992 Fall; 18(3): 101-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1421744&dopt=Abstract

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Plasma levels of 8-methoxypsoralen after bath-PUVA for psoriasis: relationship to disease severity. Author(s): Gomez MI, Azana JM, Arranz I, Harto A, Ledo A. Source: The British Journal of Dermatology. 1995 July; 133(1): 37-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7669638&dopt=Abstract

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Preliminary report on the therapeutic effect of khellin in psoriasis. Author(s): Abdel-Fattah A, Aboul-Enein MN, Wassel G, El-Menshawi B. Source: Dermatologica. 1983; 167(2): 109-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6628802&dopt=Abstract

Vocabulary Builder Acyclovir: Functional analog of the nucleoside guanosine. It acts as an antimetabolite, especially in viruses. It is used as an antiviral agent, especially in herpes infections. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH]

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Alopecia: Baldness; absence of the hair from skin areas where it normally is present. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Ankle: That part of the lower limb directly above the foot. [NIH] Anogenital: Pertaining to the anus and external genitals. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Antiproliferative: Counteracting a process of proliferation. [EU] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atopic: Pertaining to an atopen or to atopy; allergic. [EU] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cheilitis: Inflammation of the lips. It is of various etiologies and degrees of pathology. [NIH] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Clotrimazole: An imidazole derivative with a broad spectrum of antimycotic activity. It inhibits biosynthesis of the sterol ergostol, an important component of fungal cell membranes. Its action leads to increased membrane permeability and apparent disruption of enzyme systems bound to the membrane. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and

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some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytostatic: An agent that suppresses cell growth and multiplication. [EU] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Dendritic: 1. branched like a tree. 2. pertaining to or possessing dendrites. [EU]

Depigmentation: Removal or loss of pigment, especially melanin. [EU] Dermatophytosis: Any superficial fungal infection caused by a dermatophyte and involving the stratum corneum of the skin, hair, and nails. The term broadly comprises onychophytosis and the various form of tinea (ringworm), sometimes being used specifically to designate tinea pedis (athlete's foot). Called also epidermomycosis. [EU] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH]

Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Econazole: A broad spectrum antimycotic with some action against Gram positive bacteria. It is used topically in dermatomycoses also orally and parenterally. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Erythrasma: A chronic, superficial bacterial infection of the skin involving the body folds and toe webs, sometimes becoming generalized, caused by Corynebacterium minutissimum, and characterized by the presence of sharply demarcated, dry, brown, slightly scaly, and slowly spreading patches. [EU] Fluconazole: Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in AIDS. [NIH] Fluocinonide: A topical glucocorticoid used in the treatment of eczemas. [NIH]

Folliculitis: Inflammation of a follicle or follicles; used ordinarily in reference to hair follicles, but sometimes in relation to follicles of other kinds. [EU]

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Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Griseofulvin: An antifungal antibiotic. Griseofulvin may be given by mouth in the treatment of tinea infections. [NIH] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hyperhidrosis: Excessive perspiration. polyhidrosis, and polyidrosis. [EU]

Called

also

hyperidrosis,

Hyperkeratosis: 1. hypertrophy of the corneous layer of the skin. 2a. any of various conditions marked by hyperkeratosis. 2b. a disease of cattle marked by thickening and wringling of the hide and formation of papillary outgrowths on the buccal mucous membranes, often accompanied by watery discharge from eyes and nose, diarrhoea, loss of condition, and abortion of pregnant animals, and now believed to result from ingestion of the chlorinated naphthalene of various lubricating oils. [EU] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hyperthermia: Abnormally high body temperature, especially that induced for therapeutic purposes. [EU] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Ichthyosis: A group of cutaneous disorders characterized by increased or aberrant keratinization, resulting in noninflammatory scaling of the skin. Many different metaphors have been used to describe the appearance and texture of the skin in the various types and stages of ichthyosis, e.g. alligator, collodion, crocodile, fish, and porcupine skin. Most ichthyoses are genetically determined, while some may be acquired and develop in association with various systemic diseases or be a prominent feature in certain genetic syndromes. The term is commonly used alone to refer to i.

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vulgaris. [EU] Immunosuppressant: An agent capable of suppressing immune responses. [EU]

Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Induration: 1. the quality of being hard; the process of hardening. 2. an abnormally hard spot or place. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]

Intertrigo: A superficial dermatitis occurring on apposed skin surfaces, such as the axillae, creases of the neck, intergluteal fold, groin, between the toes, and beneath pendulous breasts, with obesity being a predisposing factor, caused by moisture, friction, warmth, and sweat retention, and characterized by erythema, maceration, burning, itching, and sometimes erosions, fissures, and exudations and secondary infections. Called also eczema intertrigo. [EU] Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH]

Keratolytic: An agent that promotes keratolysis. [EU] Ketoconazole: Broad spectrum antifungal agent used for long periods at high doses, especially in immunosuppressed patients. [NIH] Kinetic: Pertaining to or producing motion. [EU] Laceration: 1. the act of tearing. 2. a torn, ragged, mangled wound. [EU] Lichenification: Hypertrophy of the epidermis, resulting in thickening of the skin with exaggeration of the normal skin markings, giving the skin a leathery barklike appearance, which is caused by prolonged rubbing or scratching. It may arise on seemingly normal skin, or it may develop at the site of another pruritic cutaneous disorder. [EU] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids

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comprise the glycolipids, lipoproteins, and phospholipids. [EU] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Lymphokines: Soluble protein factors generated by activated lymphocytes that affect other cells, primarily those involved in cellular immunity. [NIH] Maceration: The softening of a solid by soaking. In histology, the softening of a tissue by soaking, especially in acids, until the connective tissue fibres are so dissolved that the tissue components can be teased apart. In obstetrics, the degenerative changes with discoloration and softening of tissues, and eventual disintegration, of a fetus retained in the uterus after its death. [EU] Malondialdehyde: The dialdehyde of malonic acid. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Methoxsalen: A naturally occurring furocoumarin compound found in several species of plants, including Psoralea corylifolia. It is a photoactive substance that forms DNA adducts in the presence of ultraviolet A irradiation. [NIH] Miconazole: An imidazole antifungal agent that is used topically and by intravenous infusion. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH] Neurodermatitis: An extremely variable eczematous dermatosis presumed to be a cutaneous response to prolonged vigorous scratching, rubbing, or pinching to relieve intense pruritus, having the potential to produce polymorphic lesions at the same or different times, and varying in severity, course, and morphologic expression in different individuals. It is believed by some authorities to be a psychogenic disorder. The term is also used to refer to lichen simplex chronicus (circumscribed n.) and sometimes to atopic dermatitis (disseminated n.). [EU] Neuropharmacology: The branch of pharmacology dealing especially with the action of drugs upon various parts of the nervous system. [NIH]

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Neutrophil: Having an affinity for neutral dyes. [EU] Nickel: Nickel. A trace element with the atomic symbol Ni, atomic number 28, and atomic weight 58.69. It is a cofactor of the enzyme urease. [NIH] Nystatin: Macrolide antifungal antibiotic complex produced by Streptomyces noursei, S. aureus, and other Streptomyces species. The biologically active components of the complex are nystatin A1, A2, and A3. [NIH]

Papillomavirus: A genus of papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH]

Papule: A small circumscribed, superficial, solid elevation of the skin. [EU] Peroxidase: A hemeprotein from leukocytes. Deficiency of this enzyme leads to a hereditary disorder coupled with disseminated moniliasis. It catalyzes the conversion of a donor and peroxide to an oxidized donor and water. EC 1.11.1.7. [NIH] Petrolatum: A colloidal system of semisolid hydrocarbons obtained from petroleum. It is used as an ointment base, topical protectant, and lubricant. [NIH]

Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of YEASTS. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Pityriasis: A name originally applied to a group of skin diseases characterized by the formation of fine, branny scales, but now used only with a modifier. [EU] Plague: An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plasminogen: The inactive precursor of plasmin (=enzyme that catalyses the hydrolysis of peptide bonds at the carbonyl end of lysine or arginine residues). [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisone:

A synthetic anti-inflammatory glucocorticoid derived from

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cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]

Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Prophylaxis: The prevention of disease; preventive treatment. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: 1. itching; an unpleasant cutaneous sensation that provokes the desire to rub or scratch the skin to obtain relief. 2. any of various conditions marked by itching, the specific site or type being indicated by a modifying term. [EU] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]

Pyoderma: Any purulent skin disease. Called also pyodermia. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Refractory: Not readily yielding to treatment. [EU] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU]

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Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spermidine: A polyamine formed from putrescine. It is found in almost all tissues in association with nucleic acids. It is found as a cation at all pH values, and is thought to help stabilize some membranes and nucleic acid structures. It is a precursor of spermine. [NIH] Spermine: A biogenic polyamine formed from spermidine. It is found in a wide variety of organisms and tissues and is an essential growth factor in some bacteria. It is found as a polycation at all pH values. Spermine is associated with nucleic acids, particularly in viruses, and is thought to stabilize the helical structure. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH]

Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Superantigens: Microbial antigens that have in common an extremely potent activating effect on T-cells that bear a specific variable region. Superantigens cross-link the variable region with class II MHC proteins regardless of the peptide binding in the T-cell receptor's pocket. The result is a transient expansion and subsequent death and anergy of the T-cells with the appropriate variable regions. [NIH] Syphilis: A contagious venereal disease caused by the spirochete treponema

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pallidum. [NIH] Tachyphylaxis: 1. rapid immunization against the effect of toxic doses of an extract or serum by previous injection of small doses. 2. rapidly decreasing response to a drug or physiologically active agent after administration of a few doses. [EU] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Thermal: Pertaining to or characterized by heat. [EU] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Trioxsalen: Pigmenting photosensitizing agent obtained from several plants, mainly Psoralea corylifolia. It is administered either topically or orally in conjunction with ultraviolet light in the treatment of vitiligo. [NIH] Tumour: 1. swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. a new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Urticaria: Pathology: a transient condition of the skin, usually caused by an allergic reaction, characterized by pale or reddened irregular, elevated patches and severe itching; hives. [EU] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Venereology: A branch of medicine which deals with sexually transmitted disease. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH]

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CHAPTER 5. PATENTS ON PSORIASIS Overview You can learn about innovations relating to psoriasis by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.24 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with psoriasis within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with psoriasis. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.

24Adapted

from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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Patents on Psoriasis By performing a patent search focusing on psoriasis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on psoriasis: ·

Peptides and methods against psoriasis Inventor(s): Chang; Jennie C. C. (San Marcos, CA), Brostoff; Steven W. (Carlsbad, CA), Carlo; Dennis J. (Rancho Santa Fe, CA) Assignee(s): The Immune Response Corporation (Carlsbad, CA) Patent Number: 6,413,516 Date filed: January 14, 1994 Abstract: This invention relates to methods of preventing or reducing the severity of psoriasis. In one embodiment, the method involves administering to the individual a peptide having substantially the sequence of a non-conserved region sequence of a T cell receptor, present on the surface of T cells mediating psoriasis or a fragment thereof, wherein the peptide or fragment is capable of causing an effect on the immune system to regulate the T cells. In particular, the T cell receptor has the V.beta. region-V.beta.3, V.beta.13.1 or V.beta.17. In another embodiment, the method involves gene therapy. The invention also relates to methods of diagnosing psoriasis by determining the presence of psoriasis predominant T cell receptors. Excerpt(s): This invention relates to the immune system and, more specifically, to methods of modifying pathological immune responses in psoriasis. ... Psoriasis is characterized by epidermal keratinocyte hyperproliferation, coupled with an inflammatory infiltrate. The pathogenesis of this disease is not fully understood. T cell activation appears to play a vital role in triggering and/or maintaining the disease. As evidence, cyclosporin A works effectively on improving the patient's condition. ... A need exists for improved and effective means of curing or ameliorating psoriasis. Such a treatment should ideally control the inappropriate T cell response, rather than merely reducing the

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symptoms. The present invention satisfies this need and provides related advantages as well. Web site: http://www.delphion.com/details?pn=US06413516__ ·

Animal model for psoriasis for the prevention and treatment of psoriasis in humans Inventor(s): Ehrhardt; Rolf (San Francisco, CA), Hong; Kenneth (El Cerrito, CA), Queen; Cary (Los Altos, CA) Assignee(s): Protein Design Labs, Inc. (Fremont, CA) Patent Number: 6,410,824 Date filed: December 8, 1999 Abstract: Methods and compositions are provided for the creation and screening of non-human animal models having many of the histologic characteristics of human psoriasis. Immunocompromised host animals are injected with a purified population of CD45Rb positive cells, which are tolerant of the host major histocompatibility antigens, but are mismatched at one or more minor antigens. The injected cells are stimulated with a pro-inflammatory cytokine, e.g. IL-12, and a polyclonal activating agent. The injected animals develop a chronic skin disorder that includes histological features observed in human psoriasis, e.g. rete pegs, severe acanthosis and infiltration of Th1 cells into the dermis. Excerpt(s): Psoriasis is a chronic skin disease, characterized by scaling and inflammation. Psoriasis affects 1.5 to 2 percent of the United States population, or almost 5 million people. It occurs in all age groups and about equally in men and women. People with psoriasis suffer discomfort, restricted motion of joints, and emotional distress. When psoriasis develops, patches of skin thicken, redden, and become covered with silvery scales, referred to as plaques. Psoriasis most often occurs on the elbows, knees, scalp, lower back, face, palms, and soles of the feet. The disease also may affect the fingernails, toenails, and the soft tissues inside the mouth and genitalia. About 10 percent of people with psoriasis have joint inflammation that produces symptoms of arthritis. ... When skin is wounded, a wound healing program is triggered, also known as regenerative maturation. Lesional psoriasis is characterized by cell growth in this alternate growth program. In many ways, psoriatic skin is similar to skin healing from a wound or reacting to a stimulus such as infection, where the keratinocytes switch from the normal growth program to regenerative maturation. Cells are created and pushed to the surface in as little as 2-4 days, and the skin cannot shed the cells fast enough. The excessive skin cells build up and form elevated, scaly

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lesions. The white scale (called "plaque") that usually covers the lesion is composed of dead skin cells, and the redness of the lesion is caused by increased blood supply to the area of rapidly dividing skin cells. ... The exact cause of psoriasis in humans is not known, although it is generally accepted that it has a genetic component, and a recent study has established that it has an autoimmune component. Whether a person actually develops psoriasis is hypothesized to depend on something "triggering" its appearance. Examples of potential "trigger factors" include systemic infections, injury to the skin (the Koebner phenomenon), vaccinations, certain medications, and intramuscular injections or oral steroid medications. Web site: http://www.delphion.com/details?pn=US06410824__ ·

Compositions for and method of treatment for psoriasis Inventor(s): De Oliveira; Mariana (788 Adelaide Street West, Toronto, Ontario, CA) Assignee(s): none reported Patent Number: 6,403,654 Date filed: April 13, 2000 Abstract: Improved compositions for treating psoriasis, including a body wash composition, spray composition and cream composition and the use of these novel compositions in a system or method of treating psoriasis. Excerpt(s): This invention relates in general to a treatment for psoriasis and more particularly to a medication for treating psoriasis having three different formulations, a system for using the medication, and a method of medical treatment. ... Psoriasis is a skin disorder that includes the presence of small elevations of the skin that may be characterized as elevated red lesions, plaques or pustules on the skin which eventually result in silvery scales. These silvery scales and plaque are the result of accelerated epidermal proliferation and the metabolic activity and proliferation of capillaries in the dermal region and the invasion of the dermis and epidermis by inflammatory cells. More specifically, the capillaries in the dermal region become tortuous and dilated as well as suffering an inflammatory reaction causing the skin to redden. ... The exact mechanism which triggers the abnormal cell proliferation is not known, though it is believed there may be biochemical stimuli and environmental factors. The severity and course of psoriasis can vary greatly depending on the individual, but in general this chronic skin

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condition recurs throughout the life of the individual with varying intervals of one month to many years. Web site: http://www.delphion.com/details?pn=US06403654__ ·

Topical medicament for the treatment of psoriasis Inventor(s): Lipi; Ramon Efrain Vasquez (Lujan-Mendoza, AR) Assignee(s): Curacid America Corporation (Washington, DC) Patent Number: 6,383,499 Date filed: February 26, 2001 Abstract: A topical medicament for the treatment of psoriasis comprises metallic iodine, virgin wax, a variety of oils of animal and plant origin, camphor, chlorophyll and benzoic acid in a pharmaceutically acceptable emollient excipient base. Excerpt(s): The present invention relates to a topical medicament for treating psoriasis. ... Psoriasis is a common chronic skin disease whose cause is unknown. It is characterized by persistent patches of redness covered with scales. The disease is, in part, determined by a genetically dominant trait. While it is absent at birth, it can begin at any age from childhood to extreme old age. Psoriasis does not, however, appear to be a communicable disease and there are no known causative factors for it in the environment. ... In the involved patches, the cells of the epidermis grow and multiply many times faster than normal. The agents currently used for treatment of psoriasis include ultraviolet light, coal tar, ammoniated mercury, anthralin, and topical corticosteroids. Methotrexate has been used to treat psoriasis by systemic administration, but such treatment method is accompanied by all the side effects commonly encountered with its use for other conditions. Antimetabolite drugs such as aminopterin, thioguanine, and azaribine have also been used in treating this disease. Systemic corticosteroids or anti-malarial drugs such as chloroquine may aggravate psoriasis by mechanisms that are not understood. A low relative humidity also aggravates the disease, probably by allowing desiccation of the skin and irritation. Web site: http://www.delphion.com/details?pn=US06383499__

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·

Betamethasone- and hyaluronic acid-treated thin adhesive plaster for the treatment of psoriasis dermatitis and dermatosis Inventor(s): Donati; Elisabetta (Cavallasca, IT), Rapaport; Irina (Rovio, CH) Assignee(s): Altergon S.A. (Lugano, CH) Patent Number: 6,379,695 Date filed: October 22, 1999 Abstract: Thin adhesive plaster having a thickness lower than 500 .mu.m for the treatment of psoriasis, dermatitis and dermatosis, comprising:a) a support comprising an outer layer in plastic film and an inner layer in woven or non-woven fabric having approximately the same size as the plastic film,b) an adhesive layer placed on the support inner layer having approximately the same size as the support comprising an adhesive matrix in the form of hydrogel, betamethasone or a pharmaceutically acceptable salt thereof and optionally hyaluronic acid or a pharmaceutically acceptable salt thereof,c) a protective plastic film contacted with the adhesive layer and removable immediately prior to use. Excerpt(s): The present invention refers to a plaster in the form of a thin film for the treatment of slight psoriasis, allergic dermatitis, and dermatosis. ... Corticosteroids are amply used in cases of eczema, dermatitis, contact dermatitis, psoriasis, etc., being remarkably efficacious for the treatment of skin diseases. However, prolonged treatments with said drugs cause untoward side effects at a systemic level, such as for example the suppression of the adrenocortical pituitary function, a phenomenon taking place even when corticosteroids are for external use and administered locally. Web site: http://www.delphion.com/details?pn=US06379695__

·

Methods and compositions for the treatment of psoriasis Inventor(s): Foon; Kenneth A. (Lexington, KY), Chatterjee; Malaya (Lexington, KY) Assignee(s): University of Kentucky Research Foundation (Lexington, KY) Patent Number: 6,355,244 Date filed: November 16, 1998 Abstract: This invention provides methods of treating psoriasis which entail eliciting an immune response in an individual against an antigen

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aberrantly expressed in psoriatic tissue, such as a ganglioside, in an individual. The anti-ganglioside immune response is elicited by administration of an antigen such as a ganglioside, an anti-idiotype moiety for a ganglioside, or a polynucleotide encoding an anti-idiotype moiety. Also described is a strategy for developing additional compositions for psoriasis. The compositions elicit an immunological response against a target antigen present on psoriatic tissue, which in turn can be detected using antibody affinity-purified from the serum of the treated subject. The presence of the immunological response correlates positively with control or resolution of the psoriatic symptoms. Excerpt(s): Psoriasis is a chronic condition that affects as much as 2.6% of the population of the developed world. A recent survey reported by the National Psoriasis Foundation estimates that 6.4 million people suffers from psoriasis, of which about 500,000 is rated as severe. The annual patient cost for treating psoriasis is currently estimated at $1.6 to $3.2 billion. Every year, about 400 people are granted disability by the Social Security Administration, and another 400 people die from psoriasisrelated causes. ... It is not known what causes psoriasis, although there is evidence of a genetic predisposition and an autoimmune etiology. Onset may be triggered by systemic infections such as strep throat, skin injury, vaccinations, and certain oral medications such as steroids. Subsequently, the immune system is thought to induce inflammation and excessive skin cell reproduction, which can be exacerbated by additional factors such as stress and diet. ... The typical lesion of psoriasis is a well-demarcated erythematous plaque, covered by thick, silvery scales. Psoriasis can become so extensive as to cause exfoliative erythroderma, in which the entire epidermal surface is in a state of hyperproliferation. Gluttate psoriasis is a form of the disease following streptococcal pharyngitis, with widely distributed characteristic 1-3 cm lesions. Pustular psoriasis is characterized by numerous sterile pustules of 2-5 mm in diameter, and may lead to an acute, explosive, life-threatening episode of fever, chills, leukocytosis, hypoalbuminemia, and hypocalcemia, demanding immediate, vigorous therapy. Previously stable plaque-type psoriasis can be acutely exacerbated by viral infections, particularly HIV. Psoriasis is also associated with five different forms of psoriatic arthritis, including distal interpharangeal involvement; an asymmetric, oligoarticular pattern; a symmetric polyarthritis; arthritis mutilans; and sacroiliitis and spondylitis. Web site: http://www.delphion.com/details?pn=US06355244__

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·

Composition for treating and/or ameliorating the diseases of dandruff, seborrheic dermatitis, psoriasis and eczema and symptoms thereof Inventor(s): Hopkins; John (Newbury, GB), Khaiat; Alain (Singapore, SG), Manigbas; Noel D. (Muntinlupa, PH), Ping; Elizabeth Wen (Shanghai, CN), Baker; Rex J. (Shanghai, CN) Assignee(s): Johnson & Johnson Consumer Products, Inc. (Skillman, NJ) Patent Number: 6,333,027 Date filed: April 21, 2000 Abstract: A composition that is useful for treating and/or ameliorating the diseases of dandruff, seborrheic dermatitis, psoriasis, and eczema and/or the symptoms associated therewith, and is non-stinging to the eyes is disclosed. The composition contains from about 0.5 weight percent to about 16 weight percent of at least one amphoteric surfactant; from about 1 weight percent to about 10 weight percent of at least one anionic surfactant; from about 0.1 weight percent to about 10 weight percent of at least one non-ionic surfactant; and from about 0.1 percent to about 15 percent active ingredient selected from Undecylenamidopropylbetaine, Undecylenic Acid, and mixtures thereof. A method for treating and/or ameliorating the diseases of dandruff, seborrheic dermatitis, psoriasis, and eczema and/or the symptoms associated therewith including topically applying an effective amount of the composition to the area desired is also disclosed. Excerpt(s): The present invention relates to a composition that is useful for treating and/or ameliorating the disease of dandruff, seborrheic dermatitis, psoriasis And eczema and/or the symptoms associated therewith and has a low degree of ocular and skin irritation. More specifically, this invention is related to such compositions comprised of undecylenamidopropylbetaine and mixtures thereof with undecylenic acid which are suitable for such uses. ... In a second embodiment, the present invention provides a method for treating and/or ameliorating the diseases of dandruff, seborrheic dermatitis, eczema, and psoriasis and/or the symptoms associated therewith comprising, consisting essentially of, and/or consisting of: topically applying an effective amount of the detergent composition described above to an area desired. ... In a third embodiment, the present invention provides a method for treating and/or ameliorating the diseases of dandruff, seborrheic dermatitis, eczema, and psoriasis and/or the symptoms associated therewith comprising, consisting essentially of, and/or consisting of: topically applying an effective amount of a detergent composition including a) from about 1 percent to about 11 percent of at least one amphoteric surfactant; b) from about 1 percent to about 8 percent of at least one

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anionic surfactant; c) from about 1 percent to about 10 percent of at least one non-ionic surfactant; and d) from about 3.5 percent to about 9 percent active ingredient comprised of, based upon the total weight of detergent composition, 1) from about 3 percent to about 7 percent of Undecylenamidopropylbetaine; and 2) from about 0.5 percent to about 2 percent of undecylenic acid, to an area desired. Web site: http://www.delphion.com/details?pn=US06333027__ ·

Chemical entity (endipalene) in the treatment of psoriasis Inventor(s): Endrici; Giorgio (Via Brescia 2, 38100 Trento, IT) Assignee(s): none reported Patent Number: 6,291,534 Date filed: May 25, 2000 Abstract: In the literature, a correlation between the inhibition of 5lipoxygenase and anti-inflammatory and immunomodulatory activity sufficient to effectively treat psoriasis, is known. It seems that, in particular, the excellent results can be obtained with lonapalene (6chloro-2,3-dimethoxynaphthalendioldiacetate). However, the clinical use of lonapalene has not been successful most likely due to the significant number of side effects. With these considerations, after various studies, we have identified a molecule which we have patented with the name of endipalene, which seems to guarantee notable therapeutic results without side effects. Excerpt(s): If one considers that psoriasis afflicts 2% of the population in North Europe and an equal portion of the Caucasians in the USA and that more than 91% of patients with psoriasis have a relative or first or second degree afflicted with the same disease, it is evident that there is a significant possibility to get success in the field of, if research confirm the positive results. Web site: http://www.delphion.com/details?pn=US06291534__

·

Protease inhibitors for use in the treatment of psoriasis Inventor(s): Bunn; Clive Leighton (West Ryde, AU), Sharp; Phillip John (Glebe, AU) Assignee(s): Biotech Australia Pty Limited (Roseville, AU) Patent Number: 6,288,025 Date filed: August 5, 1999

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Abstract: Psoriasis may be treated by topical administration of a urokinase inhibitor, such as PAI-2, or a combination of protease inhibitors, such as PAI-2 with other serine protease inhibitors and/or with protease inhibitors such as inhibitors of metalloproteinases, acid proteases, and thiol proteases. Excerpt(s): At the cellular level, psoriasis is characterized by a hyper proliferation of epidermal keratinocytes, accompanied by infiltration of T lymphocytes and other immune system cells, the latter giving rise to inflammation similar to that in autoimmnune diseases. The epidermal turnover time for a keratinocyte to travel from the basal cell layer to the stratum corneum normally is 14 days, during which the keratinocyte undergoes a complex series of changes in gene expression resulting in cell death--"terminal differentiation." In a psoriasis patient, the epidermal turnover time is 2 days, with marked increase in proliferation of keratinocytes, which are subsequently shed in a relative immature, or less differentiated, form. ... Currently, there is no long-term cure for psoriasis. Treatments include coal tar preparations (natural coal tar or the distillate anthralin), topical corticosteroids, mechanical treatments to remove scale, and antimetabolites such as methotrexate. The photosensitizing drug, psoralen, combined with long wavelength ultraviolet light (PUVA), and synthetic retinoids also are used. While mild to moderate cases can be treated somewhat effectively, more extensive cases are difficult and tend to be resistant to either topical therapy or ultraviolet phototherapy. Moreover, systemic use of traditional antipsoriatic drugs, or prolonged use of topical steroids, can lead to undesirable side effects or rebound worsening of psoriasis. ... Genetic analysis indicates that at least some forms of psoriasis include an inherited component, and intense efforts are underway to locate "psoriasis susceptibility genes." The similarity to autoimmune diseases, and the increased incidence of HLA-13, HLA-17, HLA-Cw6, and HLA-DRw7 in affected individuals has focused attention on on immunomodulatory strategies and the development of new drugs which decrease T-cell activation or deplete activated T-cell pools. Research has been severely impeded, however, by the lack of an animal model which reflects all the diverse clinical and cellular changes present in psoriatic plaques. Web site: http://www.delphion.com/details?pn=US06288025__

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Use of calendula glycosides for the treatment of psoriasis Inventor(s): Habtemarium; Solomon (Glasgow, GB), Stimson; William Howard (Glasgow, GB), Gray; Alexander Irvine (Glasgow, GB), Anand; Chaman Lal (Glasgow, GB), Waterman; Peter George (Johnstone, GB) Assignee(s): University of Strathclyde (Glasglow, GB) Patent Number: 6,225,342 Date filed: May 21, 1998 Abstract: A method and compound for the treatment of disease involving hyperproliferation of dermis cells is provided. In particular, compounds isolated from the species of plants known as calendula have been found to be beneficial in the treatment of psoriasis. An extract of plant material obtained from calendula officinalis has been found to be advantageous as an active compound in medicaments for use in the treatment of psoriasis. Excerpt(s): The present invention relates to compounds, and plant extracts containing compounds which are indicated as having an inhibiting effect on cell proliferation. More specifically, the invention relates to glycosidic compounds derivable from Calendula species, the plant glycosides having a cytostatic effect on cells, and their use as cytostatic agents, in particular in the treatment of psoriasis. ... International Patent application WO 91/15218 teaches a therapeutic composition against psoriasis comprising as active ingredient a solvent extract of at least six different herbs. This application teaches that marigold decoctions can be used against gastric and intestinal ulcers externally as well as for packing slowly healing wounds and ulcers. Nowhere is it stated that marigold extract is in fact used by itself as the active component in a therapeutical composition against psoriasis. ... Pizza C., and de Tommasi N., Phytochemistry, Vol. 27, number 7, pp 2205-2208 (1988) teaches the isolation and structure of a sesquiterpene glycoside from Calendula Arvensis. It is stated that Calendula Arvensis L. (compositae) is a herbaceous plant used in Italian folk medicine as an anti-inflammatory and anti-pyretic remedy. There is no suggestion that the sesquiterpene glycosides obtained has cytostatic activity or could be used in the treatment of psoriasis. Web site: http://www.delphion.com/details?pn=US06225342__

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Transgenic animals as model of psoriasis Inventor(s): Watt; Fiona M. (London, GB), Carroll; Joseph M. (London, GB) Assignee(s): Imperial Cancer Research Technology Limited (London, GB) Patent Number: 6,187,993 Date filed: November 3, 1997 Abstract: A nucleic acid construct comprising a promoter capable of directing expression in the suprabasal cells of the epidermis and means to cause expression of an integrin subunit in the suprabasal cells. Preferably the means to cause expression of an integrin subunit is an integrin subunit coding sequence. A transgenic animal which expresses an .alpha. subunit and a .beta. subunit of integrin in the suprabasal cells of the epidermis and methods for making the transgenic animals. At least some of the transgenic animals are useful models of human disease, especially psoriasis. A method of treating psoriasis comprising administering to the patient a compound which modulates integrin function. Excerpt(s): The present invention relates to transgenic animals which can act as a model for a human disease state. In particular, the invention relates to transgenic mammals which can serve as a non-human model for psoriasis. ... Psoriasis is a skin condition that affects around 2% of the world's population and is characterized clinically by the presence of rounded, circumscribed, erythematous, dry, scaling patches of various sizes, covered by greyish white or silvery white, umbilicated and lamellar scales, which have a predilection for the exterior surfaces, nails, scalp, genitalia and lumbosacral region. ... In the earliest stages of psoriasis mild epidermal hyperplasia occurs, including mis-expression of keratins 6 and 16, and increased proliferation in the basal layer. Capillaries in the dermis become enlarged due to immune infiltrate, and mild inflammation is noticed in the epidermis as well as the dermis. The numbers and types of localised T-cell present are increased in both these tissues. In epidermis, regions of parakeratosis alternate with regions of hyperkeratosis. Mitotic activity in the dermis also has been found to increase. Web site: http://www.delphion.com/details?pn=US06187993__

Patents 125

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Topical treatment of psoriasis Inventor(s): Albazi; Rakhi (4344 Moorpark Ave. #1, San Jose, CA 95117), Albazi; Hermiz (4344 Moorpark Ave. #1, San Jose, CA 95117) Assignee(s): none reported Patent Number: 6,153,197 Date filed: April 27, 1999 Abstract: A pharmaceutical composition for treatment of psoriasis is a mixture of garlic (Allium sativum) and seeds of the radish plant (Raphanus sativus) in dilute acetic acid, preferably in the form of white wine vinegar, which is pulverized and blended into a paste. For maximum potency, the composition is preferably prepared immediately before use from fresh ingredients in an amount sufficient for a single treatment. Alternatively, the composition may be prepared ahead of time and stored in a sealed, refrigerated container or otherwise preserved. In the method of treatment, the paste-like composition is applied topically directly to psoriatic plaques on the patient. The composition is allowed to dry on the patient's skin and is left in place for a period of approximately 24 to 72 hours, after which the composition is washed off. The composition is repeatedly applied at intervals of approximately one week over a three to six week period until the desired results are obtained. Typically, the patient's skin will begin to show signs of improvement after the first application of the composition and, after the course of the treatment, the plaque-like lesions will be replaced by healthy, normal skin. The method of treatment is effective on new cases of psoriasis and on long-standing intractable cases of psoriasis, which have not responded to other methods of treatment. Longterm follow-up of patients has shown relatively complete remission of the disease and restoration of normal skin growth for extended periods without recurring symptoms. Excerpt(s): The present invention relates to a composition and method for topical treatment of skin disorders, in particular, for the treatment of psoriasis. ... Psoriasis is a chronic skin disease long recognized for its peculiar clinical symptoms characterized by circumscribed red patches covered with white scales, and often accompanied by varying degrees of discomfort. It has been determined that the disease is not contagious; however, its cause and mechanism have not yet been elucidated. See, Kruger, G. G., "Psoriasis: Current Concepts of its Etiology and Pathogenesis", The Year Book of Dermatology (1981). Due to the characteristic formation of skin lesions and eruptions, psoriasis gives its victims an unfavorable psychological outlook on life. Among people in Western countries, about 2% of the total population suffer from the disease. ... Psoriasis is considered to be a pluricausal hereditary disease

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whose onset occurs due to the genetic makeup in the body, and which is stimulated by the action of various other factors, such as infection, drugs, food, climate and stress, any one of which can trigger the genetic cause. Since it is known that psoriasis has a close relationship with histocompatibility antigen (HLA) which exhibits polymorphism due to the variation of the HLA gene, it is clear that psoriasis is a hereditary disease. Web site: http://www.delphion.com/details?pn=US06153197__ ·

Oral 1.alpha.-hydroxyprevitamin D in composition and method for treating psoriasis Inventor(s): Knutson; Joyce C. (Madison, WI), Valliere; Charles R. (Madison, WI), Bishop; Charles W. (Verona, WI) Assignee(s): Bone Care International, Inc. (Madison, WI) Patent Number: 6,147,064 Date filed: June 7, 1995 Abstract: Method of treating psoriasis by administering orally a 1.alpha.hydroxyprevitamin D. This previtamin D form treats psoriasis without significant risk of hypercalcemia associated with other oral dosing of vitamin D forms. The 1.alpha.-hydroxyprevitamin is compounded into a pharmaceutical composition in combination with a pharmaceutically acceptable excipient. Excerpt(s): Such a wide range of biological actions suggests that the activated forms of vitamin D compounds should be valuable therapeutic agents for a wide range of maladies such as metabolic bone disease, osteoporosis, psoriasis, psoriatic arthritis, breast cancer and HIV infection. Unfortunately, when these agents are administered orally, the potent stimulation of calcium absorption by activated vitamin D can readily cause a dangerous hypercalcemia before the desired therapeutic response is obtained. For this reason, the activated vitamin D compounds are generally considered to have a low therapeutic to toxic ratio or low therapeutic index. Additionally, the presently known oral formulations when administered produce an unphysiologically rapid increase in the blood level of both calcium and activated vitamin D hormone followed by an almost as rapid decrease in the blood level of activated vitamin D hormone. Such rapid peaks and valleys of either the blood calcium or the activated vitamin D hormone are undesirable and perhaps harmful. ... In yet another aspect, the invention is a method for treating osteoporosis by administering orally an effective amount of 1.alpha.-hydroxyprevitamin D. In a further aspect, the invention is a method of treating psoriasis by

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orally administering an effective amount of 1.alpha.-hydroxyprevitamin D. ... Treatment of psoriasis. Web site: http://www.delphion.com/details?pn=US06147064__ ·

Method and composition for treating psoriasis Inventor(s): Mantynen; Philip R. (2515 Departure Bay Rd., Nanaimo, British Columbia, CA) Assignee(s): none reported Patent Number: 6,107,349 Date filed: April 16, 1998 Abstract: This invention pertains to the novel combination of Vitamin E, evening primrose oil and B-complex vitamins as a treatment for patients afflicted with psoriasis. It is postulated that the above compounds act synergistically to provide the cofactors required for normal skin production and repair in psoriatic patients. Excerpt(s): This invention pertains to the use of a novel composition comprising Vitamin E, evening primrose oil and B-complex vitamins for treatment of patients afflicted with psoriasis. It is postulated that the above compounds act synergistically to provide the cofactors required for normal skin production in psoriatic patients. ... The skin is the largest organ in the human body and is in a state of constant turnover. This is accomplished by the outward movement of the basal layer keratinocytes at a rate that varies with age, sex, position on the body and other conditions. Psoriasis, an affliction of the epidermis, is a common disorder present in approximately 6.4 million people in the United States according to the National Psoriasis Foundation. The frequency of the disease varies with race, age, skin location and other conditions. The characteristic feature of psoriasis is hyperproliferation of the keratinocytes, first described by Van Scott and Ekel..sup.1 There is evidence of significant shortening of the epidermal cell cycle (36 hours versus 311 hours for normal tissue) in the involved skin of patients with psoriasis. In addition there is a doubling of the proliferative cell population and it appears that in psoriatic skin 100% of the germinative cells of the epidermis enter the growth fraction, compared to 60 to 70% for normal skin of non-psoriatic patients. It is felt that as a result of these changes there is an increase in size and in cohesiveness of corneocytes..sup.2 Transplantation studies of normal and psoriatic human skin to congenitally athymic nude mice have found that, although epidermal proliferation remains above normal in the transplanted psoriatic skin, the absence of clinical lesions (erythema, induration and

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scaling) suggests that epidermal proliferation does not itself give rise to psoriasis. ... The fundamental cellular and metabolic defects underlying psoriasis are not well understood. Endothelial cells, mast cells and fibroblasts have been implicated in the pathogenesis of the disease..sup.3 Granulocytes are present in the spongioform microabscesses that constitute a hallmark of psoriasis and activation of isolated peripheral granulocytes correlates with disease severity. Web site: http://www.delphion.com/details?pn=US06107349__ ·

Methods for the treatment of psoriasis and genital warts Inventor(s): Chu; Chung K. (Athens, GA), Cheng; Yung-Chi (Woodbridge, CT) Assignee(s): The University of Georgia Research Foundation Center (Athens, GA), Yale University (New Haven, CT) Patent Number: 6,063,787 Date filed: January 26, 1998 Abstract: The present invention relates to the use of (-)-(2S,4S)-1-(2hydroxymethyl-1,3-dioxolan-4-yl) cytosine to treat psoriasis, genital warts and other hyperproliferative keratinocyte diseases such as hyperkeratosis, ichthyosis, keratoderma or lichen planus. Excerpt(s): In an alternative embodiment, the compounds disclosed herein can be used to treat conditions, specifically those other than tumors or cancer, that involve the abnormal or undesired proliferation of cells. Examples include skin disorders such as hyperkeratosis (including ichthyosis, keratoderma, lichen, planus, and psoriasis), warts, including genital warts, and blisters, as well as any abnormal or undesired cellular proliferation that can be treated with methotrexate. The active compounds disclosed herein can also be used to induce or facilitate abortion. ... In an alternative embodiment, the compounds disclosed herein can be used to treat conditions, specifically those other than tumors or cancer, that involve the abnormal or undesired proliferation of cells. Examples include skin disorders such as hyperkeratosis (including ichthyosis, keratoderma, lichen planus, and psoriasis), warts, including genital warts, and blisters, as well as any abnormal cellular proliferation that can be treated with methotrexate. The active compounds disclosed herein can also be used to induce or facilitate abortion. Web site: http://www.delphion.com/details?pn=US06063787__

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Patent Applications on Psoriasis As of December 2000, U.S. patent applications are open to public viewing.25 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to psoriasis: ·

Compositions and Methods of Paclitaxel for Preventing Psoriasis Inventor(s): Hunter, William L. ; (Vancouver, Ca) Correspondence: Seed Intellectual Property Law Group PLLC; 701 Fifth Ave; Suite 6300; Seattle; WA; 98104-7092; US Patent Application Number: 20020037919 Date filed: December 1, 1997 Abstract: The present invention provides methods for treating or preventing inflammatory diseases such as psoriasis or multiple sclerosis, comprising the step of delivering to the site of inflammation an antimicrotubule agent, or analogue or derivative thereof. Excerpt(s): Inflammatory diseases, whether of a chronic or acute nature, represent a substantial problem in the healthcare industry. Briefly, chronic inflammation is considered to be inflammation of a prolonged duration (weeks or months) in which active inflammation, tissue destruction and attempts at healing are proceeding simultaneously (Robbins Pathological Basis ofDisease by R. S. Cotran, V. Kumar, and S. L. Robbins, W. B. Saunders Co., p. 75, 1989). Although chronic inflammation can follow an acute inflammatory episode, it can also begin as an insidious process that progresses with time, for example, as a result of a persistent infection (e.g., tuberculosis, syphilis, fungal infection) which causes a delayed hypersensitivity reaction, prolonged exposure to endogenous (e.g., elevated plasma lipids) or exogenous (e.g., silica, asbestos, cigarette tar, surgical sutures) toxins, or, autoimmune reactions against the body's own tissues (e.g., rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, psoriasis). Chronic inflammatory diseases therefore, include many common medical conditions such as rheumatoid arthritis, restenosis, psoriasis, multiple sclerosis, surgical adhesions, tuberculosis, and chronic inflammatory lung diseases (e.g., asthma, pneumoconiosis, chronic obstructive pulmonary disease, nasal polyps and pulmonary fibrosis). ... Psoriasis is a common, chronic inflammatory skin disease characterized by raised, inflamed, thickened and scaly lesions, which itch, bum, sting and bleed easily. In

25

This has been a common practice outside the United States prior to December 2000.

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approximately 10% of patients, psoriasis is accompanied by pronounced arthropathic symptoms that are similar to the changes seen in rheumatoid arthritis. Approximately 2 to 3% of the U.S. population suffers from psoriasis, with 250,000 new cases being diagnosed each year. ... At present, the cause of psoriasis is unknown, although there is considerable evidence that it is a polygenic autoimmune disorder. In addition, there is currently no cure for psoriasis. Available treatments include topical therapies such as steroid creams and ointments, coal tar and anthralin, and systemic treatment such as steroids, ultra violet B, PUVA, methotrexate and cyclosporin. However, unsatisfactory remission rates and/or potentially serious side effects characterize most antipsoriatic therapies. The overall cost of treating psoriasis in the United States is estimated at between $3 to $5 billion per year, making psoriasis a major health care problem. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Compositions, kits, and methods for identification, assessment, prevention, and therapy of psoriasis Inventor(s): Trepicchio, William L. ; (Andover, MA), Oestreicher, Judith L. ; (Portsmouth, NH), Dorner, Andrew J. ; (Lexington, MA), Krueger, James G. ; (New York, NY) Correspondence: Lahive & Cockfield; 28 State Street; Boston; MA; 02109; US Patent Application Number: 20020037538 Date filed: May 9, 2001 Abstract: The invention relates to compositions, kits, and methods for detecting, characterizing, preventing, and treating psoriasis. A variety of markers are provided, wherein changes in the levels of expression of one or more of the markers is correlated with the presence of psoriasis. Excerpt(s): Psoriasis is a chronic skin disorder characterized by thickened, erythematous, well-demarcated areas of skin covered by silvery scales. The extent of involvement ranges from isolated, small lesions confined to knees, elbows, and scalp, to the whole body surface. There are several clinical forms of psoriasis, ranging from stable plaque lesions to an unstable form typified by eruptive inflammatory lesions. Psoriasis is not a static disease: seasonal fluctuations, spontaneous remission, and physical and emotional well-being all affect the disease and hence its management. The disease is emotionally and physically debilitating for the subject, detracting significantly from the quality of life. Between one and three million individuals in the United States have psoriasis with

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nearly a quarter million new cases occurring each year. Conservative estimates place the costs of psoriasis care in the United States currently at $248 million a year. ... Psoriasis is characterized by hyper-proliferation and incomplete differentiation of epidermal keratinocytes. There are two major hypotheses concerning the pathogenesis of psoriasis. The first is that genetic factors determine abnormal proliferation of epidermal keratinocytes. The cells no longer respond normally to external stimuli such as those involved in maintaining epidermal homeostasis. Abnormal expression of cell membrane cytokine receptors or abnormal transmembrane signal transduction might underlie cell hyperproliferation. Inflammation associated with psoriasis is secondary to the release of pro-inflammatory molecules from hyperproliferative keratinocytes. ... Keratinocyte hyperplasia in psoriasis has been linked to overproduction of cytokines such as TGF.alpha. and interleukin-6 (IL-6) and overexpression of epidermal growth factor receptor (EGF-R) in affected skin (Krueger, et al., J. Invest. Dermatol., 94:1355-1405, 1990). EGF-R is a 180-kD cell-surface receptor whose activity is regulated by both EGF and TGF.alpha.. In psoriasis vulgaris, EGF-R persists throughout the epidermis from the basal layers to the stratum corneum. Such persistent EGF-R has been shown to be biologically active in vivo in nude mice (Nanney, et al., J. Invest. Dermatol., 98:296-301, 1992). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

CD40 antagonists for use in treating psoriasis and other inflammatory skin conditions Inventor(s): Pasch, M. C. ; (Almere, NL), Bos, J.D. ; (Heemstede, NL), Thomas, David ; (Houston, TX) Correspondence: Tanox, Inc.; 10301 Stella Link; Houston; TX; 77025; US Patent Application Number: 20020031512 Date filed: April 19, 2001 Abstract: A method of treating psoriasis and other inflammatory conditions of the skin by administering anti-CD40 molecules, such as mAb 5D12, in an amount sufficient to inhibit the immunological activation of keratinocytes. These anti-CD40 molecules include antibodies, peptides, and other molecules. Excerpt(s): The invention relates to CD40 antagonists for treating psoriasis and other inflammatory conditions of the skin. ... Proliferative skin diseases are widespread throughout the world and afflict millions of humans and their domesticated animals. One example of a disease associated with keratinocyte hyperproliferation is psoriasis, a genetically

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determined disease the incidence of which is about 2% of the US population. Many pathologic features of psoriasis can be attributed to alterations in the growth and maturation of epidermal keratinocytes. Extensive scaling and a thickened epidermis are clinical hallmarks of this disease (G. D. Weinstein and J. L. McCullough, Cell Proliferation Kinetics, p. 327-342). The clinical manifestations are caused by hyperproliferation of epidermal cells. This hyperproliferation is also seen in non-psoriatic skin of psoriatic patients, indicating that the genetic defect is also present in apparently "normal" skin cells of psoriatic patients (Id.). ... Thus, interference with CD40 activity is potentially beneficial for antibody-mediated diseases such as autoimmunity, allergic diseases, and conditions in which immunogenic proteins are used therapeutically, such as in treatment with exogenous blood products or in gene therapy. Interference with CD40 activity could therefore be beneficial in treatment of cell-mediated immunological diseases, including psoriasis and other inflammatory conditions of the skin. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Treatment of psoriasis with matrix metalloproteinase inhibitors Inventor(s): Fleischmajer, Raul ; (Barnegat Light, NJ) Correspondence: Baker Botts L.L.P.; 44th Floor; 30 Rockefeller Plaza; New York; NY; 10112-4498; US Patent Application Number: 20020010162 Date filed: February 27, 2001 Abstract: The present invention relates to methods of treating psoriasis by inhibiting one or more matrix metalloproteinase enzymes ("MMPs"). It is based, at least in part, on the discovery that the expression patterns of certain MMPs and related molecules are altered in patients suffering from psoriasis, relative to normal subjects. Certain expression patterns are altered even in unaffected skin of psoriasis-afflicted patients, although aberrancies are more pronounced in psoriatic lesions. In various non-limiting embodiments, the present invention provides for methods of treating psoriasis, including preventing the development of new psoriatic lesions, comprising administering, to subjects in need of such treatment, effective concentrations of compounds which inhibit the enzymatic activity of one or more MMP. Suitable inhibitors include tetracycline and its derivatives and various hydroxymate, carboxylic acid, and phosphonic acid derivatives. Therapy may comprise systemic and/or local administration of inhibitor. In additional embodiments, the present invention provides for methods of diagnosing MMP inhibitor

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responsive skin lesions, for evaluating the level of disease activity in a subject, and for transgenic animal and tissue culture models of psoriasis. Excerpt(s): The present invention relates to methods of treating psoriasis by inhibiting matrix metalloproteinase enzyme(s). It is based, at least in part, on the discovery that the expression of certain matrix metalloproteinase enzyme(s) is increased in the epidermis of patients suffering from psoriasis, and particularly increased in psoriatic skin lesions. ... Psoriasis is a chronic skin disease characterized by red scaly patches that usually affect the scalp, elbows and knees, although any part of the skin may be involved. At the cellular level, psoriasis is a benign proliferative disease of keratinocytes of unknown etiology. It has been estimated that psoriasis affects about 2 percent of the population in Western countries, 0.1 to 0.3 percent in the Far East and is rather rare in persons of the black race (Krueger et al., 1984, J. Am. Acad. Dermatol. 11:937-947; Yui-Yip, 1984, J. Am. Acad. Dermatol. 10:965-968). Although the disease appears to be inherited, its mode of transmission is not known and more than one genetic locus may be involved (Henseler, 1997, J. Am. Acad. Dermatol. 37:S1-11). Furthermore, the disease can be triggered or exacerbated by external factors such as trauma, infection and drugs. ... Histologically, the skin pathology is characterized by acanthosis, thickening of the epidermis, angiogenesis of superficial blood vessels and an inflammatory response. It is not known whether the primary alteration in psoriasis resides in the keratinocytes or is the result of an autoimmune process. With regard to the latter alternative, there is evidence that an epidermal antigen triggers the appearance of neutrophils, macrophages and activated T-lymphocytes, mostly CD8+ T cells (Chang et al., 1994, Proc. Natl. Acad. Sci. (U.S.A.) 91:9283-9286). This immune response results in the release of various cytokines (IL-1, IL-6, IL-8, TNF-.alpha.) which may be responsible for keratinocyte proliferation and angiogenesis (Menssen et al., 1995, J. Immunol. 155:4078-4083). Another school of thought suggests that cell adhesion of keratinocytes may be altered in psoriasis and that these changes may involve cell-cell and cell-matrix interactions; studies have shown decreased adhesiveness between keratinocytes (Orfanos et al., 1973, Arch. Dermatol. 107:38-46) and alterations of the basement membrane at the epidermal-dermal interface(Mondello et al., 1996, Arch. Dermatol. Res. 288:527-531). In addition, redistribution of .alpha..sub.3.beta..sub.1 and .alpha..sub.6.beta..sub.4 integrins from basal to suprabasal keratinocyte layers was noted in both uninvolved and involved skin (Hertle et al., 1992, J. Clin. Invest. 89:1882-1901; Pellegrini et al., 1992, J. Clin. Invest. 89:1783-1795). It has also been shown that transgenic mice expressing integrins in the suprabasal layer of the epidermis developed a phenotype that closely resembled psoriasis (Carroll et al., 1995, Cell 83:957-968).

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Use of resveratrol for the treatment of exfoliative eczema, acne and psoriasis Inventor(s): Pelliccia, Maria Teresa ; (Avellino, IT), Giannella, Attilio ; (Codogno, IT), Giannella, Jenny ; (Codogno, IT) Correspondence: Young & Thompson; 745 South 23rd Street 2nd Floor; Arlington; VA; 22202 Patent Application Number: 20010056071 Date filed: March 22, 2001 Abstract: The use of resveratrol (3,4',5-trihydroxy-trans-stilbene) and derivatives thereof, for the preparation of medicaments for the treatment of exfoliative eczema, acne and psoriasis, topical pharmaceutical formulations containing resveratrol or derivatives thereof in combination with other active principles. Treatment consists in topical administrations of resveratrol at concentrations of 0.01 to 20%, in the form of lotions, creams or ointments, optionally in combination with other active principles such as melatonin, vitamins D, E and A and derivatives thereof, hormones, vegetable and/or animal extracts. Contrary to current therapies, the use of resveratrol has neither systemic nor topical effects during and after therapy. Excerpt(s): The present invention relates to the use of resveratrol (3,4',5trihydroxy-trans-stilbene) and derivatives thereof (esters, glycosides, 3'oxyresveratrol), for the preparation of medicaments for the treatment of exfoliative eczema, acne and psoriasis. ... In vitro and in vivo studies on resveratrol proved that the molecule: a) exerts protective action on the cardiovascular system, (Clin. Chim. Acta, 235:207, 1995) and decreases arteriosclerosis risks (Clin. Chim. Acta, 246:163, 1996); b) has vasal relaxing effect on the arteries (Gen. Pharm. 27:363, 1996); c) has antioxidant action which inhibits LDL cholesterol peroxidation (The Lancet, 341:1103, 1993); reduces oxidative stress (Neuroreport 8:1499, 1997); protects from the radical damage in cerebral ischemia (Chin. Pharm. Bull. 12:128, 1996); prevents the propagation of free radicals responsible for the molecular damage of the biological systems and for cell aging; d) modulates lipid synthesis, preventing the accumulation of cholesterol and fats in the liver, decreases the concentrations of blood triglycerids and of cholesterol in low-density LDL lipoproteins and reduces the atherogenic index (Chem Pharm. Bull. 30:1766, 1982); e) inhibits platelet aggregation, preventing the formation of thrombi (Int. J. Tiss. Reac. XVIII, 1, 1995; Thrombosis and Haemostasis, 76:818, 1996); f)

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inhibits the production of proatherogenic eicosanoids by platelets and neutrophils, exerting anti-inflammatory action (Biochem. Biophys. Acta, 834:275, 1985); g) inhibits protein-tyrosine kinase which modulates cell proliferation and differentiation and the signaling processes in the immune system cells, biological processes involved in the inflammatory response and in severe pathologies such as cancer, arteriosclerosis and psoriasis (J. Natural Products, 56:1805, 1993, Science 267:1782, 1995); h) has marked antimutagenic action, inhibiting the cell events connected with the initiation, promotion and progression of the tumor (Science 275:218, 1997, Anal. Biochem, 169:328, 1988, Proc. Natl. Acad. Sci USA, 91:3147, 1994, Proc. Natl. Acad. USA, 72:1848, 1975, Carcinogenesis, 8:541, 1987). The presence of resveratrol traces in red wines is believed to be the main cause of the beneficial nutritional effects thereof (Am, J. Enol. Vitic. 46:159, 1996, Clin. Chim. Acta, 246:183, 1996, Amer. J. Clin. Nutr., 55:1012, 1992). The poor concentrations of resveratrol in wine and in wine industry by-products have, until some time ago, remarkably restricted a wide use of this molecule in the pharmaceutical and nutritional fields. Recently, rhizomes of the Chinese plant Poligonum cuspidatum have been found to contain high amounts of resveratrol (more than about 400 times those in wine) thus inducing a strong commercial development of this molecule as alimentary supplement, in particular on the U.S. market. Lately, the actions of resveratrol for pharmacological or cosmetic use have been claimed (WO9959561; WO9958119; EP0773020; FR2766176; WO9904747). ... It has now been found that resveratrol can be effectively used in the treatment of exfoliative eczema, acne, psoriasis lesions and all the exfoliative skin diseases. The treatment according to the invention consists in the topical administration of resveratrol at concentrations of 0.01 to 20%, preferably of 1 to 5%, in the form of lotions, creams or ointments, also in combination with other active principles such as melatonin, vitamins D, E and A or derivatives thereof, hormones, vegetable and/or animal extracts, azadirachtin, retinoic acid or derivatives thereof, methotrexate or derivatives thereof, cyclosporin or derivatives thereof, palladium and/o ruthenium or derivatives thereof, immunosuppressors, anti-inflammatory agents, phototherapeutics and cell hyperproliferation modulators. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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·

Method for treatment of psoriasis Inventor(s): Jaros, Apolonia ; (Bosna, YU), Miketin, Bronhilda ; (Duluth, MN) Correspondence: Vidas, Arrett & Steinkraus, P.A.; 6109 Blue Circle Drive; Suite 2000; Minnetonka; MN; 55343-9185; US Patent Application Number: 20010016212 Date filed: December 14, 2000 Abstract: This invention relates to the natural topical treatment of portions of skin of a person afflicted with psoriasis or other skin disorders such as dry skin, eczema, itchy skin, red skin, itchy eczema, inflamed skin, and/or cracked skin for the removal of itch and the restoration of the affected areas of skin to a normal condition. The natural treatment of a skin disorder initially involves formation of a natural ointment from the ingredients identified as chicken and hen herb; ruta herb; pure unsalted natural butter; and pure natural beeswax. The natural ointment is formed by combination of the ingredients which includes heating and stirring. The ointment is then applied twice daily to affected areas of skin until a natural cure of the skin disorder is obtained. Excerpt(s): This is a continuation-in-part patent application claiming priority to U.S. Utility patent application filed Jan. 10, 2000, application Ser. No. 09/480,745 entitled "Composition and Method for Treatment of Psoriasis". ... The present invention relates to a topical composition for the treatment of psoriasis or other skin disorders such as dry skin, eczema, itchy skin, red skin, itchy eczema, inflamed skin, and/or cracked skin. Psoriasis is generally a skin disease evidenced by the presence of skin elevations and scales which may be silvery in appearance. Psoriasis in general is a disease which accelerates the epidermal proliferation and proliferation of capillaries in the dermal region. In addition, psoriasis frequently results in the evasion of the dermis and epidermis by inflammation of the affected cells. ... Areas of skin affected by psoriasis also frequently lose water significantly faster than normal healthy skin. The areas of skin affected by psoriasis therefore tend to have increased metabolic rates which in turn has a negative impact on tissue catabolism and potentially causes muscle wasting. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with psoriasis, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “psoriasis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on psoriasis. You can also use this procedure to view pending patent applications concerning psoriasis. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.

Vocabulary Builder Abortion: 1. the premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. premature stoppage of a natural or a pathological process. [EU] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Anionic: Pertaining to or containing an anion. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Asbestos: Asbestos. Fibrous incombustible mineral composed of magnesium and calcium silicates with or without other elements. It is relatively inert chemically and used in thermal insulation and fireproofing. Inhalation of dust causes asbestosis and later lung and gastrointestinal neoplasms. [NIH]

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Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Chlorophyll: Porphyrin derivatives containing magnesium that act to convert light energy in photosynthetic organisms. [NIH] Chloroquine: The prototypical antimalarial agent with a mechanism that is not well understood. It has also been used to treat rheumatoid arthritis, systemic lupus erythematosus, and in the systemic therapy of amebic liver abscesses. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cytosine: A pyrimidine base that is a fundamental unit of nucleic acids. [NIH] Dermatosis: Any skin disease, especially one not characterized by inflammation. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Excipient: Any more or less inert substance added to a prescription in order to confer a suitable consistency or form to the drug; a vehicle. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Glycoside: Any compound that contains a carbohydrate molecule (sugar), particularly any such natural product in plants, convertible, by hydrolytic cleavage, into sugar and a nonsugar component (aglycone), and named specifically for the sugar contained, as glucoside (glucose), pentoside (pentose), fructoside (fructose) etc. [EU]

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Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Haemostasis: The arrest of bleeding, either by the physiological properties of vasoconstriction and coagulation or by surgical means. [EU] Histocompatibility: The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [NIH] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Intramuscular: Within the substance of a muscle. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Leukocytosis: A transient increase in the number of leukocytes in a body fluid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU]

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Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5-lipoxygenase, arachidonate 12lipoxygenase, and arachidonate 15-lipoxygenase. ec 1.13.11.12. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]

Medicament: A medicinal substance or agent. [EU] Ocular: 1. of, pertaining to, or affecting the eye. 2. eyepiece. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Palladium: A chemical element having an atomic weight of 106.4, atomic number of 46, and the symbol Pd. It is a white, ductile metal resembling platinum, and following it in abundance and importance of applications. It is used in dentistry in the form of gold, silver, and copper alloys. [NIH] Pharyngitis: Inflammation of the pharynx. [EU] Pneumoconiosis: Condition characterized by permanent deposition of substantial amounts of particulate matter in the lungs, usually of occupational or environmental origin, and by the tissue reaction to its presence. [NIH] Polyarthritis: An inflammation of several joints together. [EU] Pulmonary: Pertaining to the lungs. [EU] Ruthenium: A hard, brittle, grayish-white rare earth metal with an atomic symbol Ru, atomic number 44, and atomic weight 101.07. It is used as a catalyst and hardener for platinum and palladium. [NIH] Serine: A non-essential amino acid occurring in natural form as the Lisomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Solvent: 1. dissolving; effecting a solution. 2. a liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Spondylitis: Inflammation of the vertebrae. [EU] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thioguanine: An antineoplastic compound which also has antimetabolite action. The drug is used in the therapy of acute leukemia. [NIH] Thrombosis: The formation, development, or presence of a thrombus. [EU]

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Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU]

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CHAPTER 6. BOOKS ON PSORIASIS Overview This chapter provides bibliographic book references relating to psoriasis. You have many options to locate books on psoriasis. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on psoriasis include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “psoriasis” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on psoriasis: ·

Epidemiology, Causes and Prevention of Skin Diseases Source: Oxford, England, Blackwell Science Ltd., 370 p., 1997.

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Contact: Blackwell Science, Inc., Commerce Place, 350 Main Street, Malden, MA 02148-5018. (800) 759-6102; (617) 388-8250. FAX: (617) 3888255. Summary: Epidemiology, Causes and Prevention of Skin Diseases covers the state of the art in this field for dermatologists who are interested in epidemiology and prevention, and for epidemiologists interested in skin disease. For students training in dermatology, this book was designed to familiarize the reader with the aspects of epidemiology and prevention, as they will be major themes in medicine in the next century. The first section, Epidemiology and Prevention, devotes five chapters to (1) an introduction; (2) the epidemiological bases for dermatology; (3) prevention, advantages, and limitations of screening; (4) evaluation of the quality of life in dermatology as applied to psoriasis; and (5) the study of genetic diseases. The second section discusses the (1) epidemiology of skin cancers, (2) sun exposure and skin cancers, (3) other environmental risk factors for skin cancers, (4) cutaneous melanoma and oral contraceptives, (5) epidemiology of melanocytic naevi, (6) prevention of melanoma, and (7) virus and skin cancers. The final section focuses on inflammatory dermatoses, including (1) psoriasis, (2) atopic dermatitis, (3) fungal skin diseases, (4) viral and bacterial skin diseases, (5) disorders due to drugs and chemical agents, and (6) other inflammatory dermatoses. ·

Diseases of the Oral Mucosa and the Lips Source: Orlando, FL: W.B. Saunders Company. 1993. 389 p. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522 (individuals) or (800) 782-4479 (schools); Fax (800) 874-6418 or (407) 3523445; http://www.wbsaunders.com. Price: $99.00 plus shipping and handling. ISBN: 0721640397. Summary: This book is a clinically oriented atlas and text covering the symptoms and diseases of the oral mucosa and perioral skin. The authors focus on the essential aspects of each illness, concentrating on the clinical features that are important in the differential diagnosis. The authors include not only diseases confined to the oral mucosa but also those oral problems that may be signs of accompanying cutaneous (skin) or systemic diseases. Sixty-seven chapters are presented in three sections: the normal oral mucosa, general aspects of oral pathology, and diseases of the oral mucosa and the lips. Specific topics are inflammation of the lips, acquired diseases of the tongue, gingival hyperplasia, enlargement of the parotid gland, aphthous ulcers (stomatitis), pyostomatitis vegetans, disorders of pigmentation, urticaria and angioedema, psoriasis, Reiter's

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syndrome, lichen planus, graft-versus-host disease, rosacea, perioral dermatitis, erythema multiforme, acute febrile neutrophilic dermatosis (Sweet's syndrome), vesicular and bullous autoimmune diseases, desquamative gingivitis, necrotizing sialometaplasia, oral mucosal hemorrhage, viral diseases, bacterial diseases, fungal diseases, protozoal and parasitic diseases, mechanical damage, trauma, allergic and toxic contact stomatitis, occupational diseases of the oral mucosa, drug reactions and side effects, morphea and scleroderma, lichen sclerosus et atrophicus, dermatomyositis, lupus erythematosus, Sjogren's syndrome, polyarteritis nodosa, giant cell arteritis, plasma cell gingivitis, oral submucous fibrosis, halitosis, xerostomia, sialorrhea, self-induced mucosal injuries, benign granulomatous processes, malignant granulomatoses, heterotopias and congenital malformations, genodermatoses and congenital syndromes, benign and malignant tumors, actinic keratosis, leukoplakia, paraneoplastic disorders, and oral signs of hematologic, nutritional, metabolic, and endocrine disorders. Each chapter includes full-color photographs and references are provided in individual sections. A subject index concludes the volume. (AA-M). ·

Practical Psoriasis Therapy. Second Edition Source: St. Louis, MO: Mosby-Year Book, Inc. 1993. 322 p. Contact: Available from Mosby-Year Book, Inc., 11830 Westline Industrial Drive, St. Louis, MO 63416. Summary: This book for health professionals serves as a guide for physicians who manage patients with psoriasis. Chapters explain the differential diagnosis of psoriasis; describe the histopathology of psoriasis; discuss the selection of therapy for psoriasis patients; and examine the use of topical steroids and other topical agents, Coal tars, keratolytics, emollients, anthralin, phototherapy, psoralen ultraviolet A (PUVA) therapy, synthetic retinoids, systemic chemotherapy, and cyclosporine in the treatment of psoriasis. Chapters also discuss psoriasis day care centers and therapies for childhood psoriasis, scalp psoriasis, pustular psoriasis, exfoliative and erythrodermic psoriasis, nail psoriasis, and psoriatic arthritis. Appendices provide patients with information and instructions concerning topical therapies, topical corticosteroids, anthralin, ultraviolet phototherapy, home ultraviolet therapy, psoralen phototherapy, etretinate, methotrexate, cyclosporine, childhood psoriasis, and arthritic psoriasis. Numerous references, 22 figures, and 58 tables.

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Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to psoriasis (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·

Psoriasis: Cell Proliferation by N. A. Wright (Editor) (1983); ISBN: 0443029636; http://www.amazon.com/exec/obidos/ASIN/0443029636/icongroupin terna

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Aetiological Studies of Psoriasis: A Survey by Flemming Brandrup (1985); ISBN: 8774925067; http://www.amazon.com/exec/obidos/ASIN/8774925067/icongroupin terna

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Arthritis, Rheumatism and Psoriasis (By Appointment Only) by Jan De Vries (1988); ISBN: 185158028X; http://www.amazon.com/exec/obidos/ASIN/185158028X/icongroupi nterna

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Psoriasis (1991); ISBN: 0824772954; http://www.amazon.com/exec/obidos/ASIN/0824772954/icongroupin terna

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An Atlas of Psoriasis (Encyclopedia of Visual Medicine Series) by Lionel Fry (1992); ISBN: 1850704104; http://www.amazon.com/exec/obidos/ASIN/1850704104/icongroupin terna

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Psoriasis by Charles Camisa (1993); ISBN: 0865422478; http://www.amazon.com/exec/obidos/ASIN/0865422478/icongroupin terna

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The Psoriasis Handbook: A Self-Help Guide by Muriel K. MacFarlane, L. E. Mills (Illustrator) (1995); ISBN: 1887053018; http://www.amazon.com/exec/obidos/ASIN/1887053018/icongroupin terna

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The Psoriasis Handbook by J. W. Psoriasis Fo Lewis (1996); ISBN: 0091809851; http://www.amazon.com/exec/obidos/ASIN/0091809851/icongroupin terna

Books 147

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Herbs for Healthy Skin, Hair & Nails: Banish Eczema, Acne and Psoriasis With Healing Herbs That Cleanse and Tone to Body Inside and Out (Keats Good h by Brigitte Mars (1998); ISBN: 0879838388; http://www.amazon.com/exec/obidos/ASIN/0879838388/icongroupin terna

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Psoriasis: a patients guide by Nicholas Lowe (1998); ISBN: 1853175994; http://www.amazon.com/exec/obidos/ASIN/1853175994/icongroupin terna

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Handbook of Psoriasis by Charles Camisa (1998); ISBN: 0865425582; http://www.amazon.com/exec/obidos/ASIN/0865425582/icongroupin terna

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The Psoriasis & Eczema Solution: New Hope for Physical & Emotional Relief by Daniel A. Lobovits, et al (1999); ISBN: 1890819069; http://www.amazon.com/exec/obidos/ASIN/1890819069/icongroupin terna

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Psoriasis - pocketbook by Christoph Griffiths (Author) (1999); ISBN: 185317873X; http://www.amazon.com/exec/obidos/ASIN/185317873X/icongroupi nterna

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Recent Advances in Psoriasis: The Role of the Immune System by Barbara S. Baker (2000); ISBN: 1860941206; http://www.amazon.com/exec/obidos/ASIN/1860941206/icongroupin terna

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Key Advances in the Effective Management of Psoriasis by C. Griffiths (Editor) (2000); ISBN: 1853153990; http://www.amazon.com/exec/obidos/ASIN/1853153990/icongroupin terna

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Psoriasis and Eczema by Lionel Fry (2000); ISBN: 0746200641; http://www.amazon.com/exec/obidos/ASIN/0746200641/icongroupin terna

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Dietas para combatir la psoriasis by Harry Clements (2001); ISBN: 8441402019; http://www.amazon.com/exec/obidos/ASIN/8441402019/icongroupin terna

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How I Overcame Psoriasis by Kent Trussell (2001); ISBN: 1863512837; http://www.amazon.com/exec/obidos/ASIN/1863512837/icongroupin terna

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Conquering Psoriasis: An Illustrated Guide to the Understanding and Control of Psoriasis by Eugene M. MD Farber, Lexie Nakk (2002); ISBN:

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0969778155; http://www.amazon.com/exec/obidos/ASIN/0969778155/icongroupin terna ·

Schuppen Flechte: Was Sie Schon Immer Uber Psoriasis Wissen Wollten by U. Mrowietz, G. Schmid Ott (2002); ISBN: 3805572883; http://www.amazon.com/exec/obidos/ASIN/3805572883/icongroupin terna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “psoriasis” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:26 ·

Atlas of psoriasis. Author: Lionel Fry; Year: 1992; Carnforth, Lancs, UK; Park Ridge, N.J., USA: Parthenon Pub. Group, 1992; ISBN: 1850704104 http://www.amazon.com/exec/obidos/ASIN/1850704104/icongroupin terna

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Book of psoriasis. Author: Charles Camisa; Year: 1998; Malden, MA.: Blackwell Science, 1998; ISBN: 0865425582 http://www.amazon.com/exec/obidos/ASIN/0865425582/icongroupin terna

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Clinical and experimental studies on the efficacy of 777 oil, a Siddha preparation in the treatment of kalanjagapadai (psoriasis). Author: Chernyshev, I. S; Year: 1987; New Delhi: Central Council for Research in Ayurveda and Siddha, Ministry of Health & Family Welfare, Govt. of India, 1987

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

26

Books 149

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Current concepts on pathogenesis of psoriasis. Author: edited by Yusho Miura; Year: 1985; Sapporo, Japan: Hokkaido University School of Medicine, 1985

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Current research problems in psoriasis: workshop. Author: organized by Robert Koch-Institut des Bundesgesundheitsamtes, Hautkliniken der Freien Universität Berlin, Deutscher Psoriasis-Bund; edited by H. Kröger and G. Stüttgen; Year: 1984; Berlin: Grosse, 1984; ISBN: 3880400415 (pbk.)

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Epidemiological survey of psoriasis in the greater Helsinki area. Author: by M. Könönen, J. Torppa, and A. Lassus; Year: 1986; Helsinki, Finland: [s.n.], 1986

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Evaluation of photochemotherapy in the treatment of discoid psoriasis. Author: by Dominic Vella Briffa; Year: 1982; Independence, Mo., U.S.A.: International University Press, 1982; ISBN: 0896970574

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Healing psoriasis: the natural alternative. Author: by John O.A. Pagano; foreword by Harry K. Panjwani; Year: 1991; Englewood Cliffs, N.J.: Pagano Organization, c1991; ISBN: 0962884707 http://www.amazon.com/exec/obidos/ASIN/0962884707/icongroupin terna

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Key advances in the effective management of psoriasis: proceedings of a symposium sponsored by LEO Pharmaceuticals and held at the Royal Society of Medicine, London, 14th January 1999. Author: edited by C. Griffiths and J. Barker; Year: 1999; London: Royal Society of Medicine Press, c1999; ISBN: 1853153990 http://www.amazon.com/exec/obidos/ASIN/1853153990/icongroupin terna

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Phototherapy treatment protocols: for psoriasis and other phototherapy responsive dermatoses. Author: Michael D. Zanolli and Steven R. Feldman, Adele R. Clark, Alan B. Fleischer, Jr; Year: 2000; New York: Parthenon Pub. Group, c2000; ISBN: 1850709920 http://www.amazon.com/exec/obidos/ASIN/1850709920/icongroupin terna

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Pocket guide to psoriasis. Author: Simon Davison, Thomas Poyner, Jonathan Barker; Year: 2000; London; Malden, MA, USA: Blackwell Science, 2000; ISBN: 0632052082 http://www.amazon.com/exec/obidos/ASIN/0632052082/icongroupin terna

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Practical psoriasis therapy. Author: Nicholas J. Lowe; Year: 1993; St. Louis: Mosby Year Book, c1993; ISBN: 0801671817 http://www.amazon.com/exec/obidos/ASIN/0801671817/icongroupin terna

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Programm und Auszüge. Author: II. Internationales Psoriasis Symposium der Sozialistischen Ländern; Year: 1985; Budapest: Ungarische Dermatologische Gesellschaft, 1985

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Psoriasis: past, present, and future. Author: P.D. Mier; Year: 1991; Nijmegen: Katholieke Universiteit Nijmegen, c1991; ISBN: 9037301150

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Psoriasis: professional education materials: an annotated bibliography. Author: National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse; Year: 1989; Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases, U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, [1989]

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Psoriasis: the Rowland remedy. Author: John Rowland; Year: 1986; Poole, Dorset: Javelin Books, 1986; ISBN: 0713716762 http://www.amazon.com/exec/obidos/ASIN/0713716762/icongroupin terna

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Psoriasis. Author: edited by Henry H. Roenigk, Jr., Howard I. Maibach; Year: 1998; New York: M. Dekker, c1998; ISBN: 0824701089 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824701089/icongroupin terna

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Psoriasis. Author: [edited by] Louis Dubertret; Year: 1994; Brescia, Italy: ISED, c1994; ISBN: 8886262007

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Psoriasis. Author: Charles Camisa; with contributions from Thomas N. Helm ... [et al.]; Year: 1994; Boston: Blackwell Scientific Publications, 1994; ISBN: 0865422478 http://www.amazon.com/exec/obidos/ASIN/0865422478/icongroupin terna

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Textbook of psoriasis. Author: edited by P.C.M. van de Kerkhof; Year: 1999; Oxford; Malden, MA: Blackwell Science, 1999; ISBN: 0632051663 http://www.amazon.com/exec/obidos/ASIN/0632051663/icongroupin terna

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Therapeutic potential of cyclosporin in severe psoriasis. Author: edited by Lionel Fry; Year: 1990; London; New York: Royal Society of Medicine Services, 1990; ISBN: 1853151319

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Therapy of moderate-to-severe psoriasis. Author: editors, Gerald D. Weinstein, Alice B. Gottlieb; Year: 1993; Portland, OR: National Psoriasis Foundation, c1993

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Third European Symposium on Psoriasis, Trieste, Italy, September 2325, 1988. Author: edited by C. Scarpa; Year: 1989; Stockholm, Sweden: Distributed by Almqvist & Wiksell Periodical Co., [1989]

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Tigason (etretinate): oral therapy of severe psoriasis. Author: by F. Schröpl; Year: 1984; Basle, Switzerland: Editiones Roche, c1984

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Treatment of psoriasis. Author: editors, Enno Christophers & Klaus Wolff; Year: 1999; Copenhagen: Munksgaard, c1999

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Treatment of psoriasis. Author: Davison, Simon; Year: 1998; Uppsala, Sweden: Läkemedelsverket, [1998]; ISBN: 9197286958

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What's new in the skin?: special reference on the current understanding of psoriasis. Author: editors, Akira Ohkawara ... [et al.]; Year: 1999; Sapporo, Japan: Hokkaido University School of Medicine, 1999

Chapters on Psoriasis Frequently, psoriasis will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with psoriasis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and psoriasis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “psoriasis” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on psoriasis: ·

Skin Disorders Source: in Mosby 's Patient Teaching Guides. St. Louis, MO: Mosby -Year Book, Inc. 1995. p. 113-33. Contact: Mosby -Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO. 63146. ISBN: 0815158629. Summary: This section of Mosby 's Patient Teaching Guides examines the following skin disorders: acne; cystic acne; rosacea ; the prevention of skin cancers such as basal cell carcinoma; malignant melanoma; contact dermatitis; atopic dermatitis; psoriasis and etretinate treatment; and scabies. Burn injuries and postoperative wound care at home are also addressed. Each section, where applicable, provides an explanation of the ailment, risk factors, diagnosis and treatment, and prevention tips.

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Skin and Rheumatic Disease Source: in Maddison, P.J.; et al., Eds. Oxford Textbook of Rheumatology. Volume 1. New York, NY: Oxford University Press, Inc. 1993. p. 99-107. Contact: Available from Oxford University Press, Inc., New York, NY. Summary: This chapter for health professionals focuses on the examination of the skin of a patient with rheumatic disease. Guidelines for examining the scalp, the face, the ears, the hands, the feet, and the nails are provided. Histological, microscopic, and other techniques that may provide useful information about the condition of a patient are described. The differential diagnosis of cutaneous abnormalities is discussed. These abnormalities include erythema, scaling skin, blisters and pustules, plaques, papules and nodules, purpura and telangiectasia, ulcers, oral and genital ulcers, pigmentary changes, induration or thickening of skin or subcutis, and hair abnormalities. The treatment of cutaneous manifestations of rheumatic diseases is discussed. The management of specific disorders is highlighted, focusing on cutaneous lupus, dermatomyositis, scleroderma, and psoriasis. The cutaneous side effects of nonsteroidal anti-inflammatory drugs, gold, D-penicillamine, sulphasalazine, antimalarials, corticosteroids, and immununosuppressive drugs are outlined. 10 references, 2 figures, 5 tables, and 7 plates.

·

Skin Diseases Source: in Scully, C. and Cawson, R.A. Medical Problems in Dentistry. 4th ed. Woburn, MA: Butterworth-Heinemann. 1998. p. 244-254. Contact: Available from Butterworth-Heinemann. 225 Wildwood Avenue, Woburn, MA 01801-2041. (800) 366-2665 or (781) 904-2500. Fax (800) 446-6520 or (781) 933-6333. E-mail: [email protected]. Website: www.bh.com. Price: $110.00. ISBN: 0723610568. Summary: Several skin diseases can involve the mouth or may influence dental treatment. Oral lesions sometimes herald some skin diseases or may be the main manifestation. This chapter on skin diseases is from a text that covers the general medical and surgical conditions relevant to the oral health care sciences. Topics include genetic disorders, such as ectodermal dysplasia, epidermolysis bullosa, multiple basal cell nevi syndrome, Gardner's syndrome (familial adenomatous polyposis coli), Cowden's syndrome, and the phakomatoses (neurodermatoses); and acquired skin disorders, including pemphigus, erythema multiforme, lichen planus, chronic ulcerative stomatitis, psoriasis, and desquamative gingivitis. For each condition, the authors discuss general aspects, diagnosis and management issues, dental aspects, and patient care

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strategies. The chapter includes a summary of the points covered. 3 figures. 5 tables. 31 references. ·

Chapter 48: Parapsoriasis Source: in Freedberg, I.M., et al., eds. Fitzpatrick's Dermatology in General Medicine. 5th ed., Vol. 1. New York, NY: McGraw-Hill. 1999. p. 546-553. Contact: Available from McGraw-Hill Customer Services. P.O. Box 548, Blacklick, OH 43004-0548. (800) 262-4729 or (877) 833-5524. Fax (614) 7593749 or (614) 759-3641. E-mail: [email protected]. Price: $395.00 plus shipping and handling. ISBN: 0070219435. Summary: This chapter provides health professionals with information on the incidence, diagnosis, etiopathogenesis, differential diagnosis, course, prognosis, and treatment of parapsoriasis. This group of disorders is characterized by a persistent, scaling, inflammatory eruption. Features that set the parapsoriasis group apart from other purely inflammatory dermatoses include the relation to malignant lymphoproliferative lesions and the coexistence or overlapping of entities in this group. The classification of parapsoriasis includes large plaque parapsoriasis (LPP), small plaque parapsoriasis (SPP), and pityriasis lichenoides. The peak incidence of LPP and SPP is in the fifth decade of life. The parapsoriasis group of diseases appear to be cutaneous T cell lymphoproliferative diseases. In some cases, LPP is a monoclonal proliferation of skin-associated lymphoid tissue T cells that have the capacity to move between the skin and extracutaneous sites. The chapter discusses the diagnosis of LPP and SPP in terms of clinical manifestations and histopathology. The differential diagnosis of LPP and SPP involves distinguishing LPP from SPP and mycosis fungoides and SPP from psoriasis. Both LPP and SPP may persist for years to decades with little change in clinical or histopathological appearance. Although LPP has the potential to become malignant, SPP is a clinically benign disorder. Treatment options for SPP include emollients, topical tar preparations, topical corticosteroids, and ultraviolet B (UVB) phototherapy. However, LPP requires more aggressive therapy, including high-potency topical corticosteroids with UVB phototherapy or psoralen and ultraviolet A. 10 figures, 2 tables, and 36 references.

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General Home References In addition to references for psoriasis, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Encyclopedia of Skin and Skin Disorders (The Facts on File Library of Health and Living) by Carol Turkington, Jeffrey S. Dover; Hardcover - 448 pages, 2nd edition (June 2002), Facts on File, Inc.; ISBN: 0816047766; http://www.amazon.com/exec/obidos/ASIN/0816047766/icongroupinterna · Your Skin from A to Z by Jerome Z. Litt, M.D.; Paperback (March 2002), Barricade Books; ISBN: 1569802165; http://www.amazon.com/exec/obidos/ASIN/1569802165/icongroupinterna · American College of Physicians Complete Home Medical Guide (with Interactive Human Anatomy CD-ROM) by David R. Goldmann (Editor), American College of Physicians; Hardcover - 1104 pages, Book & CD-Rom edition (1999), DK Publishing; ISBN: 0789444127; http://www.amazon.com/exec/obidos/ASIN/0789444127/icongroupinterna · The American Medical Association Guide to Home Caregiving by the American Medical Association (Editor); Paperback - 256 pages 1 edition (2001), John Wiley & Sons; ISBN: 0471414093; http://www.amazon.com/exec/obidos/ASIN/0471414093/icongroupinterna · Anatomica : The Complete Home Medical Reference by Peter Forrestal (Editor); Hardcover (2000), Book Sales; ISBN: 1740480309; http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna · The HarperCollins Illustrated Medical Dictionary : The Complete Home Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition (2001), Harper Resource; ISBN: 0062736469; http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna · Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems by Philip Hagen, M.D. (Editor), et al; Paperback - 279 pages, 2nd edition (December 15, 1999), Kensington Publishing Corp.; ISBN: 0962786578; http://www.amazon.com/exec/obidos/ASIN/0962786578/icongroupinterna · The Merck Manual of Medical Information : Home Edition (Merck Manual of Medical Information Home Edition (Trade Paper) by Robert Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages (2000), Pocket Books; ISBN: 0671027263; http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna

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Vocabulary Builder Angioedema: A vascular reaction involving the deep dermis or subcutaneous or submucal tissues, representing localized edema caused by dilatation and increased permeability of the capillaries, and characterized by development of giant wheals. [EU] Contraceptive: conception. [EU]

An agent that diminishes the likelihood of or prevents

Discoid: Shaped like a disk. [EU] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Febrile: Pertaining to or characterized by fever. [EU] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Halitosis: An offensive, foul breath odor resulting from a variety of causes such as poor oral hygiene, dental or oral infections, or the ingestion of certain foods. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Pemphigus: A group of chronic, relapsing, sometimes fatal skin diseases characterized clinically by the development of successive crops of vesicles and bullae, histologically by acantholysis, and immunologically by serum autoantibodies directed against antigens in the intracellular zones of the epidermis. The specific disease is usually indicated by a modifying term; but the term pemphigus is often used alone to designate pemphigus vulgaris. [EU] Penicillamine: 3-Mercapto-D-valine. The most characteristic degradation product of the penicillin antibiotics. It is used as an antirheumatic and as a chelating agent in Wilson's disease. [NIH] Perioral: Situated or occurring around the mouth. [EU] Postoperative: Occurring after a surgical operation. [EU] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of

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musculoskeletal disorders, such as arthritis. [NIH] Scabies: A contagious dermatitis of humans and various wild and domestic animals caused by the itch mite, Sarcoptes scabiei, transmitted by close contact, and characterized by a papular eruption over tiny, raised sinuous burrows (cuniculi) produced by digging into the upper layer of the epidermis by the egg-laying female mite, which is accompanied by intense pruritus and sometimes associated with eczema from scratching and secondary bacterial infection. Called also the itch and seven-year itch. [EU] Sialorrhea: Increased salivary flow. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Vesicular: 1. composed of or relating to small, saclike bodies. 2. pertaining to or made up of vesicles on the skin. [EU] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU]

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CHAPTER 7. MULTIMEDIA ON PSORIASIS Overview Information on psoriasis can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on psoriasis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.

Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on psoriasis is the Combined Health Information Database. You will need to limit your search to “video recording” and “psoriasis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “psoriasis” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on psoriasis:

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·

Vitamin D: Not Just for Bones Source: Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, 1992, 60 minutes. Contact: WIN, 1 WIN WAY, Bethesda, MD 20892-3665. Summary: In this lecture, Dr. DeLuca discusses the major functions of Vitamin D in the body; studies demonstrating potential therapeutic uses for synthetic Vitamin D compounds; and his own laboratory's progress on developing several such compounds. According to Dr. DeLuca, Vitamin D is, in fact, not a vitamin but a prohormone that remains inactive until metabolized in the liver and the kidney. The principal active metabolite of Vitamin D, calcitrol, acts with parathyroid hormone (PTH) to regulate the blood calcium level. It also plays a role in building up bone and is an important regulator of intestinal calcium absorption. Disturbance of this regulatory mechanism can result in osteoporosis (brittle bones), as well as in several disorders characterized by a deficiency or an oversupply of calcium or PTH in the blood (hypo- and hypercalcemia; hypo-and hyperparathyroidism). Vitamin D deficiency results in rickets (soft, weak bones) and osteomalacia in adults. Dr. DeLuca discusses several clinical studies demonstrating an age-related decline in formation of the active Vitamin D metabolite in response to PTH. He describes research he is conducting to develop synthetic Vitamin D compounds that would stimulate bone formation in osteoporotic patients without producing hypercalcemia. He predicts that within a decade these compounds will be important contributors to the treatment of postmenopausal and age-related osteoporosis. Dr. DeLuca goes on to discuss evidence strongly suggesting that Vitamin D influences other biologic processes, including cellular differentiation and regulation of the immune system. Work is ongoing in his laboratory to develop Vitamin D "differentiation compounds" that may have a future role in cancer therapy. The lecture concludes with a discussion of other potential therapeutic uses for Vitamin D, including the treatment of psoriasis, renal osteodystropy (bone disease found with kidney failure), and infertility.

Bibliography: Multimedia on Psoriasis The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.”

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Once in the search area, simply type in psoriasis (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on psoriasis. For more information, follow the hyperlink indicated: ·

Dermatology, a study in progress. Source: Walter J. Klein Company; Year: 1981; Format: Motion picture; Charlotte, N.C.: The Company, c1981

·

Dermatology. Source: American Medical Association; Year: 1996; Format: Electronic resource; Newton, MA: SilverPlatter Education, c1996

·

Dermatology. Source: Paul Lazar; Year: 1977; Format: Sound recording; [Park Ridge, Ill.]: ASCME, p1977

·

Outpatient phototherapy for psoriasis and other skin diseases. Source: with Lillian Freije and Jean Bolognia; Year: 1988; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1988

·

Practical dermatology for the primary care physician. Source: CME Conference Video, Inc.; sponsored by Eastern Virginia Medical School, August 18-21, 1994; Year: 1994; Format: Videorecording; Mount Laurel, NJ: CME Conference Video, 1994

·

Psoriasis : A to Z. Source: a presentation of Films for the Humanities & Sciences; ITN, Information Television Network; Year: 1997; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1997

·

Psoriasis : presentation, diagnosis, and therapy. Source: a production of the Emory Medical Television Network; Year: 1990; Format: Videorecording; [Atlanta, Ga.]: Emory University, c1990

·

Psoriasis; Papulosquamous diseases; Atopic dermatitis; Common pediatric skin problems. Source: produced for the Canadian Association of Professors of Dermatology by Roberta Ongley; Biomedical Communications, University of British Columbia; Year: 1993; Format: Videorecording; [Vancouver, B.C.]: The University, c1993

·

Psoriasis education program. Source: Sandoz; Year: 1995; Format: Electronic resource; East Hanover, N.J.: Sandoz Pharmaceuticals Corp., c1995

·

Psoriasis in the patient with HIV disease. Source: Madeleine Duvic; Year: 1996; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1996

·

Psoriasis. Source: [presented by] Medical Video Library; co-produced by IMS, Faculty of Medicine, University of Toronto and Medical Productions and Associates; Year: 1989; Format: Videorecording; [Toronto, Ont.]: Burn-Shield, [1989]

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·

Psoriasis. Source: presented by David R. Harris, Eugene M. Farber and Marion B. Sulzberger; produced by the Institute for Dermatologic Communication and Education; Year: 1973; Format: Slide; San Francisco: The Institute, c1973

·

Psoriasis. Source: University of Michigan Medical Center, Dept. of Postgraduate Medicine and Health Professions Education, Independent Study Unit; Year: 1976; Format: Slide; Ann Arbor, Mich.: The University: [for loan and sale by its] Media Library, c1976

·

Psoriatic arthritis and Reiter's syndrome. Source: Herbert S. Diamond; Year: 1979; Format: Slide; [New York]: Medcom, c1979

·

Recent advances in psoriasis therapy. Source: with Nicholas J. Lowe; Year: 1986; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1986

·

Skin. Source: University of Oxford & the Oxfordshire Health Authority; the Psoriasis Association, Northampton; produced by the Department of Medical Illustration, the John Radcliffe Hospital, Oxford, and the Psoriasis Association, Northampton; Year: 1982; Format: Slide; Oxford, England: Oxford Educational Resources, c1982

Vocabulary Builder Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Osteomalacia: A condition marked by softening of the bones (due to impaired mineralization, with excess accumulation of osteoid), with pain, tenderness, muscular weakness, anorexia, and loss of weight, resulting from deficiency of vitamin D and calcium. [EU] Photosensitivity: An abnormal cutaneous response involving the interaction between photosensitizing substances and sunlight or filtered or artificial light at wavelengths of 280-400 mm. There are two main types : photoallergy and photoxicity. [EU] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU]

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CHAPTER 8. PERIODICALS AND NEWS ON PSORIASIS Overview Keeping up on the news relating to psoriasis can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on psoriasis. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover psoriasis beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.

News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on psoriasis is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.

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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “psoriasis” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·

The Immune Response Corporation Granted Patent For T-Cell Receptor Peptide Vaccine to Treat Psoriasis Summary: Carlsbad, Calif., July 18 /PRNewswire-FirstCall/ -- The Immune Response Corporation (Nasdaq: IMNR) announced it was recently granted United States Patent Number 6,413,516 entitled "Peptides and Methods Against Psoriasis." The new patent includes composition and methods claims. The vaccine may suppress the activity of specific T cells that are thought to play a role in the development of psoriasis. "This U.S. patent for our psoriasis TCR peptide vaccine strengthens our worldwide intellectual property position in therapeutic vaccines for autoimmune diseases," said Dr. Dennis J. Carlo, president and chief executive officer of The Immune Response Corporation. "With the addition of this psoriasis patent, we now have coverage in the major world markets for our TCR peptide vaccine technology for all three of our autoimmune disease targets: rheumatoid arthritis, multiple sclerosis, and now psoriasis." Approximately 7 million people in the U.S. and 80 million people worldwide suffer from psoriasis, a chronic and often times painful skin disease characterized by scaling and inflammation. The disease occurs after defects in the immune system allow stimulation of specific T cells in the skin that trigger various reactions that culminate in rapid overproduction of skin cells, creating inflammation and the flaking characteristic of psoriasis lesions. "Many autoimmune diseases, including psoriasis, rheumatoid arthritis and multiple sclerosis, are initiated in part by proliferation of auto-

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reactive pathogenic T cells that incorrectly identify the body's own cells as foreign and seek to destroy them," said Dr. Richard Bartholomew, executive director of research operations of The Immune Response Corporation. "Our TCR peptide vaccines target these pathogenic T cells to interrupt the chain of events in the immune response that leads to diseases such as psoriasis." Co-founded by medical pioneer Dr. Jonas Salk and based in Carlsbad, Calif., The Immune Response Corporation is a biopharmaceutical company developing immune-based therapies designed to treat HIV, autoimmune diseases and cancer. The Company also develops and holds patents on several technologies that can be applied to genes in order to increase gene expression or effectiveness, making it useful in a wide range of therapeutic applications for a variety of disorders. Company information is available at http://www.imnr.com .

Reuters The Reuters' Medical News database can be very useful in exploring news archives relating to psoriasis. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “psoriasis” (or synonyms). The following was recently listed in this archive for psoriasis: ·

Genmab's HuMax-CD4 psoriasis drug shows long-term benefits Source: Reuters Industry Breifing Date: April 12, 2002 http://www.reuters.gov/archive/2002/04/12/business/links/20020412 drgd003.html

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Manufacturing comparability to delay filing of Xoma, Genentech psoriasis drug Source: Reuters Industry Breifing Date: April 05, 2002 http://www.reuters.gov/archive/2002/04/05/business/links/20020405 drgd006.html

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Biogen psoriasis drug will get FDA panel review in May Source: Reuters Industry Breifing Date: April 01, 2002 http://www.reuters.gov/archive/2002/04/01/business/links/20020401 rglt004.html

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Protein Design psoriasis drug fails in phase II Source: Reuters Industry Breifing Date: March 20, 2002 http://www.reuters.gov/archive/2002/03/20/business/links/20020320 drgd012.html

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Daclizumab for psoriasis fails in phase II Source: Reuters Medical News Date: March 20, 2002 http://www.reuters.gov/archive/2002/03/20/professional/links/20020 320drgd001.html

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Tanning beds provide cost-effective alternative to psoriasis treatment Source: Reuters Medical News Date: March 05, 2002 http://www.reuters.gov/archive/2002/03/05/professional/links/20020 305econ001.html

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Isis psoriasis results weak Source: Reuters Industry Breifing Date: February 25, 2002 http://www.reuters.gov/archive/2002/02/25/business/links/20020225 drgd001.html

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Investigational anti-ICAM-1 agent results weak for psoriasis Source: Reuters Medical News Date: February 25, 2002 http://www.reuters.gov/archive/2002/02/25/professional/links/20020 225drgd005.html

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Studies find arthritis drugs work for psoriasis Source: Reuters Health eLine Date: February 22, 2002 http://www.reuters.gov/archive/2002/02/22/eline/links/20020222elin 033.html

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Immunex's Enbrel effective against psoriasis in phase II Source: Reuters Industry Breifing Date: February 22, 2002 http://www.reuters.gov/archive/2002/02/22/business/links/20020222 drgd005.html

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SkyePharma, Astralis form psoriasis-vaccine alliance Source: Reuters Industry Breifing Date: December 12, 2001 http://www.reuters.gov/archive/2001/12/12/business/links/20011212 inds003.html

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·

Xoma sued for allegedly misleading investors over status of psoriasis drug candidate Source: Reuters Industry Breifing Date: November 16, 2001 http://www.reuters.gov/archive/2001/11/16/business/links/20011116 legl002.html

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Genentech, Xoma rename psoriasis drug, present new data Source: Reuters Industry Breifing Date: August 02, 2002 http://www.reuters.gov/archive/2002/08/02/business/links/20020802 drgd002.html

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Infliximab may be helpful in psoriasis Source: Reuters Industry Breifing Date: July 30, 2002 http://www.reuters.gov/archive/2002/07/30/business/links/20020730 drgd006.html

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Psoriasis treatment effect persists for many years Source: Reuters Health eLine Date: July 09, 2002 http://www.reuters.gov/archive/2002/07/09/eline/links/20020709elin 026.html

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Carcinogenic effects of psoriasis treatment persists for many years Source: Reuters Medical News Date: July 08, 2002 http://www.reuters.gov/archive/2002/07/08/professional/links/20020 708clin020.html

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Biogen earns FDA advisors' backing for psoriasis therapy Source: Reuters Industry Breifing Date: May 23, 2002 http://www.reuters.gov/archive/2002/05/23/business/links/20020523 rglt002.html

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Genentech, Xoma psoriasis drug delayed Source: Reuters Industry Breifing Date: October 05, 2001 http://www.reuters.gov/archive/2001/10/05/business/links/20011005 rglt003.html

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·

Biogen files psoriasis drug ahead of competition Source: Reuters Industry Breifing Date: October 05, 2001 http://www.reuters.gov/archive/2001/10/05/business/links/20011005 rglt005.html

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Severe psoriasis therapy raises skin cancer risk Source: Reuters Health eLine Date: September 28, 2001 http://www.reuters.gov/archive/2001/09/28/eline/links/20010928elin 004.html

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Cyclosporin increases skin cancer risk in PUVA-treated psoriasis patients Source: Reuters Medical News Date: September 27, 2001 http://www.reuters.gov/archive/2001/09/27/professional/links/20010 927epid003.html

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Immunex reports positive results from Enbrel psoriasis study Source: Reuters Industry Breifing Date: August 20, 2001 http://www.reuters.gov/archive/2001/08/20/business/links/20010820 drgd003.html

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Alefacept reduces severity of chronic plaque psoriasis Source: Reuters Medical News Date: July 26, 2001 http://www.reuters.gov/archive/2001/07/26/professional/links/20010 726drgd001.html

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New drug holds promise for treating psoriasis Source: Reuters Health eLine Date: July 25, 2001 http://www.reuters.gov/archive/2001/07/25/eline/links/20010725elin 011.html

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Severe psoriasis linked to higher cancer risk Source: Reuters Health eLine Date: July 19, 2001 http://www.reuters.gov/archive/2001/07/19/eline/links/20010719elin 002.html

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·

Isis launches phase II study of psoriasis drug Source: Reuters Industry Breifing Date: June 21, 2001 http://www.reuters.gov/archive/2001/06/21/business/links/20010621 drgd007.html

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Severe psoriasis linked with lymphoma, nonmelanoma skin cancer Source: Reuters Medical News Date: June 18, 2001 http://www.reuters.gov/archive/2001/06/18/professional/links/20010 618epid003.html

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Biogen psoriasis drug reaches endpoints; regulatory filings planned Source: Reuters Industry Breifing Date: June 12, 2001 http://www.reuters.gov/archive/2001/06/12/business/links/20010612 drgd001.html

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Infliximab appears to benefit patients with psoriasis Source: Reuters Industry Breifing Date: June 07, 2001 http://www.reuters.gov/archive/2001/06/07/business/links/20010607 drgd002.html

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Psoriasis therapy ups long-term melanoma risk Source: Reuters Health eLine Date: May 25, 2001 http://www.reuters.gov/archive/2001/05/25/eline/links/20010525elin 002.html

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Preliminary phase III data on Genentech, Xoma psoriasis drug positive Source: Reuters Industry Breifing Date: May 24, 2001 http://www.reuters.gov/archive/2001/05/24/business/links/20010524 drgd002.html

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CORRECTION: Intermittent cyclosporine improves safety of psoriasis therapy Source: Reuters Industry Breifing Date: April 12, 2001 http://www.reuters.gov/archive/2001/04/12/business/links/20010412 clin005.html

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·

Intermittent cyclosporine improves safety of psoriasis therapy Source: Reuters Industry Breifing Date: April 11, 2001 http://www.reuters.gov/archive/2001/04/11/business/links/20010411 clin008.html

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FDA approves Barr's Trexall for psoriasis, rheumatoid arthritis Source: Reuters Industry Breifing Date: March 22, 2001 http://www.reuters.gov/archive/2001/03/22/business/links/20010322 rglt011.html

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XOMA misses Street estimates, reports progress with psoriasis drug Source: Reuters Industry Breifing Date: March 14, 2001 http://www.reuters.gov/archive/2001/03/14/business/links/20010314 inds006.html

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Remicade shows promise as psoriasis treatment Source: Reuters Health eLine Date: March 07, 2001 http://www.reuters.gov/archive/2001/03/07/eline/links/20010307elin 034.html

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Investigational drug for severe psoriasis efficacious in early trial Source: Reuters Medical News Date: March 07, 2001 http://www.reuters.gov/archive/2001/03/07/professional/links/20010 307drgd004.html

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Infliximab shows promise as psoriasis treatment Source: Reuters Medical News Date: March 07, 2001 http://www.reuters.gov/archive/2001/03/07/professional/links/20010 307drgd003.html

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Centocor's Remicade shows promise as psoriasis treatment Source: Reuters Industry Breifing Date: March 07, 2001 http://www.reuters.gov/archive/2001/03/07/business/links/20010307 drgd007.html

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Novartis psoriasis drug shows promise in studies Source: Reuters Industry Breifing Date: March 06, 2001 http://www.reuters.gov/archive/2001/03/06/business/links/20010306 drgd003.html

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Biogen's psoriasis drug Amevive shows efficacy after retreatment Source: Reuters Industry Breifing Date: March 05, 2001 http://www.reuters.gov/archive/2001/03/05/business/links/20010305 drgd004.html

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Abgenix psoriasis drug promising in clinic, company deals with dosing issues Source: Reuters Industry Breifing Date: March 05, 2001 http://www.reuters.gov/archive/2001/03/05/business/links/20010305 drgd003.html

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Abgenix psoriasis drug promising in clinic; company deals with dosing issues Source: Reuters Medical News Date: March 05, 2001 http://www.reuters.gov/archive/2001/03/05/professional/links/20010 305drgd007.html

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Corixa tumbles, psoriasis drug fails trial Source: Reuters Industry Breifing Date: February 15, 2001 http://www.reuters.gov/archive/2001/02/15/business/links/20010215 inds011.html

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Thioguanine clears refractory psoriasis but increases risk of myelosuppression Source: Reuters Industry Breifing Date: February 09, 2001 http://www.reuters.gov/archive/2001/02/09/business/links/20010209 clin003.html

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Candela's laser system for psoriasis cleared by FDA Source: Reuters Industry Breifing Date: January 25, 2001 http://www.reuters.gov/archive/2001/01/25/business/links/20010125 rglt006.html

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Arakis, Bioglan to develop psoriasis treatment Source: Reuters Industry Breifing Date: January 15, 2001 http://www.reuters.gov/archive/2001/01/15/business/links/20010115 inds002.html

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ZymoGenetics researchers identify new molecule related to psoriasis Source: Reuters Industry Breifing Date: January 12, 2001 http://www.reuters.gov/archive/2001/01/12/business/links/20010112 scie006.html

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IDEC moves psoriasis treatment candidate into phase II trial Source: Reuters Industry Breifing Date: January 11, 2001 http://www.reuters.gov/archive/2001/01/11/business/links/20010111 drgd001.html

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Genmab begins Phase II study of human antibody for severe psoriasis Source: Reuters Industry Breifing Date: January 09, 2001 http://www.reuters.gov/archive/2001/01/09/business/links/20010109 drgd005.html

The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.

Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.

Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “psoriasis” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.

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Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “psoriasis” (or synonyms). If you know the name of a company that is relevant to psoriasis, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.

BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “psoriasis” (or synonyms).

Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “psoriasis” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on psoriasis: ·

Injury to the Skin: Understanding the Koebner Response Source: Psoriasis Resource. 3(2): 1,4-5. July 2001. Contact: Available from National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (800) 723-9166 or (503) 244-

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7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: Contact NPF for current pricing. Summary: This newsletter article uses a question and answer format to provide people who have psoriasis with information on the Koebner response. This phenomenon causes new lesions to develop on unaffected skin following skin injury. The lesions that develop usually match the pattern of the injury exactly. The Koebner response occurs in approximately 25 percent to 50 percent of people with psoriasis. Although the most common cause of the response is a cut or scratch, even injuries such as being bitten by an insect, shaving, or being rubbed by a wrist watch may result in lesions in susceptible people. However, an injury to a lesion can result in its disappearance. This observation of a reverse Koebner response led to the development of cryotherapy and several other surgical techniques for removing plaques, including dermabrasion and surgical shavings. People who have psoriasis and are considering any cosmetic procedure involving skin trauma should make sure their doctor knows they have psoriasis and take that into consideration. Chemical peels, bikini waxes, hair extensions, laser skin rejuvenation, laser hair removal, and collagen and Botox injections can be safe for people who have psoriasis. The best approach to reducing the risk of the Koebner response is minimizing events in which trauma to the skin can occur. Prevention involves immediately treating an area of the skin that has been injured. 1 figure. ·

Cleaning Up After Psoriasis Source: Psoriasis Resource. 3(2): 8-9. July 2001. Contact: Available from National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (800) 723-9166 or (503) 2447404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: Contact NPF for current pricing. Summary: This newsletter article provides people who have psoriasis with information on cleaning up shedding scales and dealing with the mess created by psoriasis treatments. The article outlines tips for dealing with the problem of shedding scales and offers suggestions on keeping grease or cosmetic coverups off clothing, bedding, or towels. In addition, the article provides guidelines on avoiding stains when using anthralin and coal tar. Anthralin, a synthetic substitute for chrysarobin, stains the skin a brown or purple color, which will eventually fade, but it can permanently stain bathroom fixtures, clothing, towels, and bedding. Use of petrolatum may protect the skin around the lesions from staining, and a product called CuraStain will limit staining. Coal tar products work best when they can be left on the skin for several hours, but some

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products can stain. Staining of bedding can be minimized by wearing old clothing over affected skin, and allowing the product to dry before putting on clothing can be helpful. In addition, the article lists tips on removing blood stains from clothes or bedding. ·

Keep an Eye on These Drugs: Possible Aggravators of Psoriasis Source: Psoriasis Resource. 3(2): 11. July 2001. Contact: Available from National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (800) 723-9166 or (503) 2447404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: Contact NPF for current pricing. Summary: This newsletter article provides people who have psoriasis with information on drugs that can worsen this condition. One such drug is lithium, which is used to treat manic depression and other psychiatric disorders and which aggravates psoriasis in about 50 percent of those who take it. However, several alternatives to lithium are available. Carbamazepine, which is sometimes prescribed for the same mood disorders as lithium, has no history of worsening psoriasis. Valproic acid is another anticonvulsant that has been used as an alternative to lithium. Other medications that can cause psoriasis to flare are antimalarials such as quinacrine, chloroquine, and hydroxychloroquine; Inderal; quinidine; and indomethacin.

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Nail Psoriasis: Always a Challenge Source: National Psoriasis Foundation Bulletin. 32(4): 9. July-August 2001. Contact: Available from National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (800) 723-9166 or (503) 2447404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: Contact NPF for current pricing. Summary: This newsletter article provides people who have psoriasis with information on effective therapies for this condition. Nail psoriasis is one of the most difficult and frustrating forms of psoriasis to treat. In a study of Tazorac, a prescription vitamin A derivative, 0.1 percent strength Tazorac gel improved pitting and onycholysis. Intralesional steroid injections are generally effective, but many people avoid them because they are commonly believed to be painful. However, if performed correctly, they should not be that uncomfortable. Severe nail psoriasis can be treated with the most potent psoriasis treatments, including psoralen plus ultraviolet A light and systemic medications such as methotrexate, oral retinoids, and cyclosporine. People who have

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psoriasis should be vigilant about getting a complete and accurate diagnosis because psoriasis of the nails can be difficult to distinguish from fungus of the nails. 1 figure. ·

Phototherapy for Atopic Dermatitis Source: The Advocate. 13(2): 1-2. Second Quarter 2001. Contact: Available from National Eczema Association for Science and Education (NEASE). 1220 SW Morrison, Suite 433, Portland, OR 97205. (800) 818-7546 or (503) 228-4430. Fax (503) 224-3363. E-mail: [email protected]. Website: www.eczema-assn.com. Summary: This newsletter article provides people who have atopic dermatitis (AD) with information on the use of phototherapy in the treatment of this skin disorder. Ultraviolet (UV) light is useful for treating skin diseases because it causes chemical changes in skin cells. The idea of treatment is to cause controlled damage to these cells so that the skin's natural healing capacities are activated. Short term adverse effects of UV radiation are local inflammation and cell destruction. Long term risks of UV radiation can be cell changes that may cause cancer. Total exposure over time is an important factor. Medical UV therapy is produced by special lamps that emit light of precise wavelengths and energies. People should undergo UV therapy under the close supervision of a physician. Types of UV therapy available include psoralen plus UVA (PUVA) and UVB. Although PUVA or photochemotherapy is very effective for treating psoriasis, it has limited usefulness in treating AD. UVB is shorter than UVA, so it penetrates the skin better and can be used therapeutically without the need for psoralen. Narrow band UVB is the newest approach to UV therapy. Climatotherapy is a special type of phototherapy that uses the natural light of the sun, often in conjunction with special baths and other methods, to treat AD.

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Skin Sarcoidosis Source: Sarcoidosis Networking. 7(4): 2. July-August 1999. Contact: Available from Sarcoidosis Networking. 13925 80th Street East, Puyallup, WA 98372-3614. (253) 845-3108. E-mail: [email protected]. Summary: This newsletter article provides people who have sarcoidosis with information on the skin lesions associated with this multisystem granulomatous disease of unknown cause. Skin lesions of sarcoidosis are classified as specific and nonspecific. Biopsy of lesions of the specific type show evidence of granulomas, whereas no granuloma tissue is found in the biopsy for the nonspecific type. Erythema nodosum is an example of

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this latter form. Papule lesions are the most common and usually have a brownish or reddish brown hue. The sarcoid lesions of lupus pernio, which are reddish, purple leash clusters, are more common among African Americans than Caucasians. Sarcoid granulomas found in scar tissue form bumps or nodules, making the scar appear reddish or purple. These are often called keloid formations. A very invasive form of sarcoidosis is a loss of hair where granulomas infiltrate and destroy the hair follicles. Ulcerative sarcoid lesions are mainly seen on lower extremities. Dairier-Roussy lesions are asymptomatic, subcutaneous lesions that can appear over the trunk and extremities under the surface skin. Psoriasiform changes, which are rare, look like psoriasis on the trunk and extremities. Treatment options include topical or systemic corticosteroids. Good personal hygiene is very important in preventing skin breakdown. ·

Importance of Maintenance Therapy for Psoriasis Source: Pharmacy News. 10(1):13-14; March 1998. Contact: National Psoriasis Foundation, 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (503) 244-7404. (800) 723-9166. (503) 245-0626 (fax). Summary: This newsletter article for individuals with psoriasis discusses the need for maintenance therapy. Most patients cannot sustain a treatment-free remission, so continuing maintenance therapy is necessary. In addition, such therapy is needed to decrease the likelihood of a flare of psoriasis and to improve the quality of the life of the psoriasis patient. Maintenance agents for psoriasis include topical therapies, phototherapy, and systemic agents. Combinations of therapies may be used to maximize benefit and reduce side effects, and therapies may be rotated to avoid accumulating side effects. 5 photographs.

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Erasing Psoriasis Lesions Source: Pharmacy News. 10(1):1-3; March 1998. Contact: National Psoriasis Foundation, 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (503) 244-7404. (800) 723-9166. (503) 245-0626 (fax). Summary: This newsletter article for individuals with psoriasis offers advice for using cosmetic cover-ups to mask psoriasis lesions. Although the typical inflammation of psoriasis and guttate and inverse psoriasis can be masked with special cosmetics, using a masking agent on pustular or erythrodermic forms of psoriasis may cause stinging and redness. Before using a cosmetic cover-up, as much of the psoriasis scale as

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possible should be removed either through occlusion or hydration. Once the scales are removed, a cover-up can be applied with the fingertips, a make-up sponge, or an applicator. A special finishing powder may help keep the cover-up from smearing or rubbing off. ·

Photodynamic Therapy Branches Out: Psoriasis, Alopecia Areata, Warts, and More Source: Dermatology Focus. 15(3):1,13-15; January 1997. Summary: This newsletter article for health professionals reports on the use of photodynamic therapy (PDT) in the treatment of various immunologic, dermatologic, and other conditions. The difference between PDT and cosmetic surgery is explained. The discovery of the principle of photodynamic action is discussed. First and second generation PDT agents are described. One of the most promising systemic agents is benzoporphyrin-derivative monoacid ring A (BPD). A promising topical photosensitizer is 5-aminolevulinic acid (ALA). Some research suggests that PDT, at certain lower dose photosensitizer/light combinations, targets activated T cells and may benefit conditions such as arthritis, psoriasis, and alopecia. Work with BPD and ALA in the treatment of psoriasis is highlighted. Evidence that suggests that topical ALA will be useful for treating alopecia areata is presented. In addition, other potential dermatologic applications of PDT are identified.

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Long-term PUVA Study Emphasizes Need for Regular Skin Examinations Source: National Psoriasis Foundation Bulletin. 28(3):6; May/June 1997. Contact: National Psoriasis Foundation, 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (503) 244-7404. (503) 245-0626 (fax). Summary: This newsletter article for individuals with psoriasis reports on the results of a 20-year prospective study of the combination of oral psoralen and ultraviolet light A (PUVA). The study is following 1,380 patients across the United States who received PUVA therapy starting in the mid-1970s. This study shows that, beginning 15 years after starting therapy, patients undergoing more than 250 high-dose PUVA treatments had a greater risk of developing malignant melanoma than the general population. Despite these findings, PUVA is an effective treatment for a group of psoriasis patients who have few treatment options. Therefore, physicians should use lower doses of UVA, rotate and combine treatments for severe psoriasis, and keep the number of treatments as low as possible.

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Psoriasis Patients Try the Alternatives Source: Skin and Allergy News. 28(3):1,25; March 1997. Summary: This newsletter article for health professionals focuses on alternative methods of treating psoriasis. Current knowledge about the effectiveness of various nontraditional therapies used to treat psoriasis is presented. These therapies include exorex emulsion and cream, Skin-Cap, nonprescription tanning, Dead Sea clinics, and magnetic therapy. Although there is some evidence to indicate that psoriasis improves in some individuals who use these therapies, there is a lack of published data on their safety and efficacy. 2 photographs.

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Glossary of Psoriasis-Related Terms Source: Pharmacy News. 6-7; November 1997. Contact: National Psoriasis Foundation, 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (503) 244-7404. (800) 723-9166. (503) 245-0626 (fax). Summary: This newsletter article for individuals with psoriasis presents a glossary of psoriasis-related terms to help them better express with their physician and explain psoriasis to others. Many terms are drugs or other modalities used to treat psoriasis. Other terms relate to the skin and various aspects of psoriasis.

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Adverse Effects of Systemic Psoriasis Treatments: Retinoids Source: National Psoriasis Foundation Forum. 3(4): 6-7. Winter 1997. Contact: Available from National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (503) 244-7404. Fax (503) 245-0626. Summary: This newsletter article provides health professionals with information on the adverse effects of retinoids. Etretinate and acitretin are the two retinoids currently approved for the treatment of psoriasis in the United States. Although retinoids are highly effective in treating pustular and erythrodermic psoriasis and beneficial when combined with types of PUVA or UVB phototherapy, that is therapy using types of ultraviolet light, in treating plaque-type or guttate psoriasis, teratogenicity is a serious concern. Etretinate is not recommended for women of child bearing potential because of its long half life. Although acitretin has a much shorter half life than etretinate, it is converted to etretinate in the presence of ethanol. Isotretinoin is effective for pustular psoriasis, but it should not be used during pregnancy. Common side effects of retinoids include hair loss, failure to develop normal nail plates,

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chapped lips, dry skin, and elevated serum lipids. Despite these side effects, retinoids are among the safest systemic treatments available for psoriasis. 6 tables. ·

Adverse Effects of Systemic Psoriasis Treatments: Methotrexate Source: National Psoriasis Foundation Forum. 3(4): 4-5. Winter 1997. Contact: Available from National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (503) 244-7404. Fax (503) 245-0626. Summary: This newsletter article provides health professionals with information on the adverse effects of methotrexate, which is one of the most effective drugs available for treating psoriasis. The main adverse effect is hepatoxicity, as confirmed by various studies. Patients who are alcoholic, obese, or diabetic are at greater risk of developing cirrhosis of the liver when treated with methotrexate. Other side effects include bone marrow suppression, gastrointestinal and pulmonary toxicity, phototoxicity, and malignancy. Methotrexate also poses risks for conception and pregnancy, with miscarriages and birth defects occurring if it is taken during pregnancy. In addition, it may temporarily affect male fertility. 10 tables.

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Facial Lesions May Indicate Severe Psoriasis Source: Skin and Allergy News. 28(12): 12. December 1997. Summary: This newsletter article provides health professionals with information about the indicators of severe psoriasis. The occurrence of psoriasis on the cheeks, forehead, or chin is a tip-off that a patient will have a longer and more severe course of the disease. The article presents evidence that psoriasis involving the face carries with it a higher degree of treatment resistance, recurrence, and involvement of the rest of the body. First, psoriasis of the face is not common. Second, psoriasis of the face is more common in children than it is in adults. It is known that childhood psoriasis usually indicates a more severe course than adult onset of the disease. Third, studies show that patients who have severe psoriasis are likely to have it on the face. Fourth, atypical psoriasis on the face is seen more frequently in patients who are undergoing psoralen plus ultraviolet light A therapy. Last, patients who have photosensitive psoriasis are very likely to have facial lesions. The article also discusses the presence of the Koebner phenomenon as a marker for psoriasis severity.

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Academic Periodicals covering Psoriasis Academic periodicals can be a highly technical yet valuable source of information on psoriasis. We have compiled the following list of periodicals known to publish articles relating to psoriasis and which are currently indexed within the National Library of Medicine's PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on psoriasis published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical's name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on psoriasis: ·

Acta Dermato-Venereologica. (Acta Derm Venereol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ac ta+Dermato-Venereologica&dispmax=20&dispstart=0

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Postgraduate Medical Journal. (Postgrad Med J) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Po stgraduate+Medical+Journal&dispmax=20&dispstart=0

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Postgraduate Medicine. (Postgrad Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Po stgraduate+Medicine&dispmax=20&dispstart=0

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Psychosomatic Medicine. (Psychosom Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ps ychosomatic+Medicine&dispmax=20&dispstart=0

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The Journal of Investigative Dermatology. (J Invest Dermatol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Investigative+Dermatology&dispmax=20&dispstart=0

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Vocabulary Builder Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Hydration: The condition of being combined with water. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Isotretinoin: A topical dermatologic agent that is used in the treatment of

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acne vulgaris and several other skin diseases. The drug has teratogenic and other adverse effects. [NIH] Keloid: A sharply elevated, irregularly- shaped, progressively enlarging scar due to the formation of excessive amounts of collagen in the corium during connective tissue repair. [EU] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Manic: Affected with mania. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alpha-adrenergic neurotransmission. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU]

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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.

NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.nih.gov/niams/healthinfo/

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.27 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:28 ·

Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 28 See http://www.nlm.nih.gov/databases/databases.html. 27

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

While all of the above references may be of interest to physicians who study and treat psoriasis, the following are particularly noteworthy.

The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and psoriasis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “psoriasis” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with psoriasis. The following is a sample result:

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Phototherapy: UVB, Home Phototherapy, Lasers, PUVA Source: Portland, OR: National Psoriasis Foundation. 2002. 24 p. Contact: Available from National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (800) 723-9166 or (503) 2447404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: Contact NPF for current pricing. Summary: This booklet provides people who have psoriasis with information on the use of phototherapy in the treatment of this skin disease. Phototherapy involves exposing the skin to wavelengths of ultraviolet light in a medical setting or at home. This type of therapy is very effective for psoriasis, and the key to success is consistency. Different types of phototherapy are used to treat psoriasis, including ultraviolet light B (UVB), home phototherapy, laser therapy, and psoralen plus ultraviolet light A (PUVA) therapy. The booklet describes the forms of UVB therapy and explains who is eligible for UVB therapy and how UVB is administered. Other topics related to UVB therapy include the Goeckerman regimen, treatment at a day center or hospital, the side effects of UVB, and maintenance treatments. Home phototherapy is discussed in terms of unit selection and insurance coverage for a unit. Topics related to laser therapy include the use of targeted UVB therapy and pulsed dye lasers. In addition, the booklet explains what PUVA is, who is eligible for PUVA, and how PUVA is administered. Other topics include the short and long term side effects of PUVA and ways to minimize these risks. Long term side effects include skin cancer, freckling or premature skin aging, and cataracts. The booklet concludes by offering tips for protecting the body during phototherapy, including covering sensitive areas, reporting the use of any new medications, and avoiding sunbathing. The booklet also includes information on the National Psoriasis Foundation and a list of home UVB equipment manufacturers. 3 figures and 1 table.

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Alternative Approaches Source: Portland, OR: National Psoriasis Foundation. 2001. 32 p. Contact: Available from National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (800) 723-9166 or (503) 2447404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: Contact NPF for current pricing. Summary: This booklet provides people who have psoriasis with information on alternative approaches to treating psoriasis or psoriatic arthritis. The term alternative applies to any approach that is outside the mainstream of typical psoriasis treatments. There are several schools of

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medicine outside of Western medicine, including naturopathic medicine, homeopathic medicine, Ayurvedic medicine, Chinese medicine, acupuncture, and chiropractic. The booklet defines each of these disciplines and explains the manner in which each one treats disease. This is followed by a discussion of practices that promote relaxation and stress reduction, including meditation, hypnosis, massage, yoga, and biofeedback. The booklet then examines dietary regimens that have been promoted as treatments for psoriasis, including the Pagano diet and the consumption of sun sensitizing foods. Another topic is the use of dietary supplements such as fish oil, evening primrose oil, shark cartilage, herbal remedies, and vitamin supplements. The booklet also describes climatotherapy at the Dead Sea in Israel, the Blue Lagoon in Iceland, and Soap Lake in Washington State. Other therapies considered include the use of topical products made from apple cider vinegar, witch hazel, tea tree oil, neem oil, mahonia aquifolium, emu oil, aloe, capsaicin, oat extracts, and evening primrose oil. In addition, the booklet discusses substances or techniques reported to be beneficial for people with psoriatic arthritis, including glucosamine and chondroitin, methylsulfonylmethane, S-adenosylmethionine, magnet therapy, and balneotherapy. The booklet includes a list of additional resources on alternative therapies and a list of National Psoriasis Foundation resources, as well as information about the National Psoriasis Foundation. ·

Adventures of G. Wow, The Source: Portland, OR: National Psoriasis Foundation. 2001. 16 p. Contact: Available from National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (800) 723-9166 or (503) 2447404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: Contact NPF for current pricing. Summary: This illustrated booklet tells the story of a young girl with psoriasis to show children living with this chronic skin condition how to cope with their disease. The girl demonstrates how she copes with other people's reactions to her skin problem and emphasizes that her psoriasis is only a small part of who she is. The booklet identifies the National Psoriasis Foundation as a source of additional information.

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Bernie's Secret Source: Portland, OR: National Psoriasis Foundation. 2001. 20 p. Contact: Available from National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (800) 723-9166 or (503) 244-

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7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: Contact NPF for current pricing. Summary: This illustrated booklet tells the story of a young boy with psoriasis to show children living with this chronic skin condition how to cope with their disease. The boy, who is going to a new school, is afraid the other children will tease him about his psoriasis. Even though it is hot, the boy dresses in a long sleeved shirt and jeans to cover his skin. When he introduces himself during class, some of the other children ask him if he is hot and try to help him roll up his sleeves, exposing his red and flaky skin. Although he is initially very upset that the other children have found out about his psoriasis, once he explains his condition, they are very accepting. The booklet identifies the National Psoriasis Foundation as a source of additional information. ·

Topical Calcipotriene Source: Portland, OR: National Psoriasis Foundation. 2000. 8 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: Contact NPF for current pricing. Summary: This brochure provides people who have psoriasis with information on the use of topical calcipotriene in the treatment of this skin disease. Calcipotriene (Dovonex), a vitamin D derivative, was approved in 1993 by the U.S. Food and Drug Administration for the treatment of mild to moderate psoriasis. Dovonex is also sold in cream and scalp solution formulations. All calcipotriene products, which come in 0.005 percent strength by prescription, are odorless and nonstaining. The brochure explains how the product works; how well it works; and how to use it on the skin, scalp, and nails. In addition, the brochure identifies common minor side effects; explains when the product should not be used; and discusses its use with other therapies such as topical steroids, nonsteroidal therapies, ultraviolet light B, cyclosporine, and acitretin. The brochure also includes information on the National Psoriasis Foundation.

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UVB [Ultraviolet Light B Phototherapy] Source: Portland, OR: National Psoriasis Foundation. 1999. 12 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available.

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Summary: This pamphlet uses a question and answer format to provide people who have psoriasis with information on treatment with ultraviolet light B (UVB) phototherapy, which involves exposing the skin to a particular wavelength of ultraviolet light in a medical setting under a physician's direction. UVB therapy can be used by adults and children who have thin plaques, moderate to severe disease, and responsiveness to natural sunlight. The pamphlet explains what UVB treatment is like, how well it works, and what happens when the skin clears. Other topics include the side effects of phototherapy, the long-term risks of exposure, and signs of skin cancer. In addition, the pamphlet describes the Goeckerman regimen, and its variations, and narrow band UVB phototherapy. The pamphlet concludes with information on the National Psoriasis Foundation. 1 figure. ·

PUVA [Psoralen Plus Ultraviolet Light A Phototherapy] Source: Portland, OR: National Psoriasis Foundation. 1999. 12 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available. Summary: This pamphlet provides people who have psoriasis with information on treatment with psoralen combined with exposure to ultraviolet light A (PUVA). Psoralen interacts with UVA radiation exposure to the skin to slow down the process that causes psoriatic lesions. The pamphlet describes the PUVA regimen, presents the features of patients who should and should not consider PUVA, and identifies its side effects. The long-term risks posed by PUVA, including skin cancer, freckling or premature skin aging, and cataracts, are highlighted. Other topics include ways doctors minimize PUVA risks and PUVA therapy during pregnancy. The pamphlet also offers tips on protection and comfort while undergoing PUVA, including protecting sensitive areas, reporting the use of any new medications, avoiding sunbathing, and reducing nausea.

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Cyclosporine Source: Portland, OR: National Psoriasis Foundation. 1999. 8 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available.

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Summary: This pamphlet uses a question and answer format to provide people who have psoriasis with information about the use of Neoral, a form of cyclosporine, in treating psoriasis. This oral drug was approved by the Food and Drug Administration in June 1997 as a treatment option for nonimmunocompromised adults with severe, recalcitrant psoriasis. Cyclosporine, the active ingredient in Neoral, selectively inhibits specific immune activity, thus slowing the abnormally rapid skin cell turnover and reducing the number of activated inflammatory cells in the skin. The pamphlet discusses Neoral's effectiveness, the time needed to notice results, and the optimal and less than optimal candidates for Neoral therapy. Other topics include the steps that will be taken to reduce the risks associated with Neoral before the initiation of therapy, side effects, drugs that interact with cyclosporin, pregnancy, and administration. The pamphlet concludes with information on the National Psoriasis Foundation. ·

Things To Consider Source: Portland, OR: National Psoriasis Foundation. 1999. 12 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available. Summary: This pamphlet provides people who have psoriasis with information on issues they should consider in managing their disorder: there are selecting a doctor, learning to communicate with him or her, making educated treatment decisions as a team, and knowing one's rights as a patient. The pamphlet presents guidelines on finding the right doctor and establishing a good relationship and learning as much as possible about psoriasis. In addition, the pamphlet outlines the information that physicians use to plan a course of action, explains how patients can help themselves with regard to their medical care, lists questions that may be helpful in making a therapy decision, discusses the need for patients to stay with a treatment plan, presents a Bill of Rights for people who have psoriasis, concludes with information about the National Psoriasis Foundation.

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Topical Vitamin D3 Source: Portland, OR: National Psoriasis Foundation. 1999. 8 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax

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(503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available. Summary: This pamphlet provides people who have psoriasis with information on treatment with topical vitamin D3. Calcipotriene topical ointment, the first synthetic form of vitamin D3 approved for psoriasis, is sold by prescription in 0.005 percent strength under the brand name Dovonex. The drug is approved for long-term control of psoriasis because it does not have the side effects of steroids. The pamphlet explains how calcipotriene works, how to use it, and when to avoid it. Other topics include effectiveness; the use of Dovonex for scalp and nails; side effects; and combination therapy with Dovonex and topical steroids, other topical therapies, ultraviolet light therapy, and systemic treatments. The pamphlet concludes with information on the National Psoriasis Foundation. ·

Psoriatic Arthritis Source: Portland, OR: National Psoriasis Foundation. 1999. 12 p. Contact: National Psoriasis Foundation. 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223-7195. (800) 723-9166 or (503) 244-7404. Fax (503) 2450626. E-mail: [email protected]. Website: www.psoriasis.org. Summary: This booklet for individuals with psoriasis presents an overview of psoriatic arthritis (PA). It lists the symptoms of PA; explains how a diagnosis of PA is made; and describes localized mild PA, generalized disabling PA, symmetric arthritis, asymmetric arthritis, distal interphalangeal predominant arthritis, spondylitis, and arthritis mutilans. The booklet discusses various treatments for PA, including aspirin, nonsteroidal anti-inflammatory drugs, sulfasalazine, gold, methotrexate, azathioprine, steroids, photochemotherapy, antimalarials, cyclosporine, retinoids, diet or climate changes, surgery, exercise, physical therapy, and splints. In addition, it lists educational literature available from the National Psoriasis Foundation.

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Living With Eczema: Seborrheic Dermatitis Source: Portland, OR: National Eczema Association for Science and Education (NEASE). 1999. 8 p. Contact: Available from National Eczema Association for Science and Education (NEASE). 1220 SW Morrison, Suite 433, Portland, OR 97205. (800) 818-7546 or (503) 228-4430. Fax (503) 224-3363. E-mail: [email protected]. Website: www.eczema-assn.org. Price: $25.00 per 100, plus shipping and handling; contact for other quantities.

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Summary: This patient education pamphlet, one of a series of educational pamphlets developed by the National Eczema Association for Science and Education (NEASE), uses a question and answer format to provide people who have seborrheic dermatitis (SD) and their families with information on the etiology, symptoms, and treatment of this common skin disorder. This noncontagious condition, which causes flaking and redness of the skin, usually occurs when there is inflammation in areas of the skin where sebaceous glands are concentrated. Although the exact cause of SD is unknown, a yeast called Pityrosporum ovale may be a factor in its development. SD that occurs in infants is known as cradle cap. This condition is very common and usually responds well to simple treatment or clears up with no treatment within a few months after birth. In adults, SD is more common among the elderly, people who are immunocompromised, or people who have chronic neurological conditions. In addition, people who have had a traumatic medical crisis can also develop SD. There are differences between SD and other skin conditions such as dandruff, psoriasis, and eczema. Although SD cannot be prevented or cured, it can be treated and controlled. Treatment varies depending on the affected areas and the severity of the condition. Mild cases can be treated with medicated shampoos and nonprescription hydrocortisone cream. In more severe cases, prescription medications such as topical steroids may be needed. ·

Home Phototherapy Source: Portland, OR: National Psoriasis Foundation. 1998. 12 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available. Summary: This pamphlet uses a question and answer format to provide people who have psoriasis with information on using home phototherapy to treat moderate to severe disease. Phototherapy involves exposing the skin to an ultraviolet B (UVB) light source for a specific length of time on a regular schedule. Although most UVB treatments are administered in a medical setting, some people give themselves treatments at home with their own equipment. The pamphlet discusses the effectiveness of home UVB therapy, explains how it works, identifies sources of equipment, and offers tips on buying and using a home UVB unit. Other topics include determining whether an insurance company will pay for the cost of home equipment, building one's own home UVB unit, and using small units to treat localized psoriasis. The pamphlet also provides information about the lifespan of a UVB lamp, lists home UVB

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equipment manufacturers, and concludes with information on the National Psoriasis Foundation. 1 figure. ·

Topical Tazarotene Source: Portland, OR: National Psoriasis Foundation. 2001. 12 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: Contact NPF for current pricing. Summary: This brochure provides people who have psoriasis with information on the use of topical tazarotene in the treatment of this skin disease. Tazarotene (Tazorac), available in gel and cream forms, was the first vitamin A derivative approved by the U.S. Food and Drug Administration for the treatment of plaque psoriasis. Tazorac gel is a water based emollient that is available in 0.05 percent and 0.1 percent formulations. Tazorac cream is also available in 0.05 percent and 0.1 percent strengths. The brochure explains how the product works; how well it works; and how to use it on the skin, scalp, and nails. In addition, the brochure offers practical tips on using Tazorac; identifies common minor side effects; explains when the product should not be used; and discusses its use with other therapies such as topical steroids, phototherapy, and calcipotriene. The brochure also includes information on the National Psoriasis Foundation.

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Anthralin Source: Portland, OR: National Psoriasis Foundation. 1998. 12 p. Contact: Available from National Psoriasis Foundation. P.O. Box 9009, Portland, OR 97207-9009. (800) 723-9166 Ext. 12 or (503) 244-7404. Fax (503) 245-0626. E-mail: [email protected]. Website: www.psoriasis.org. Price: $0.35 each plus shipping and handling; bulk orders available. Summary: This pamphlet uses a question and answer format to provide people who have psoriasis with information on using anthralin to treat this noncontagious, chronic skin disorder. Anthralin, a synthetic substitute for chrysarobin that is very effective in treating plaque psoriasis, is used in either the Ingram regimen for widespread, severe psoriasis or at home for milder, localized psoriasis. The pamphlet describes the use of the Ingram regimen in either a hospital or day treatment program and the use of short-contact anthralin therapy in the home. Suggestions on home use of anthralin cream or ointment are offered. The pamphlet discusses the use of Micanol, a relatively new anthralin formulation designed to reduce the risk of staining and

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irritation, and presents tips on its use. Other topics include when to avoid the anthralin, its side effects, and the formulations available, as well as ways to remove anthralin and Micanol stains. The pamphlet concludes with information on the National Psoriasis Foundation.

The NLM Gateway29 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM's information resources or databases.30 One target audience for the Gateway is the Internet user who is new to NLM's online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.31 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “psoriasis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 31 Other users may find the Gateway useful for an overall search of NLM's information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 29 30

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Results Summary Category Items Found Journal Articles 345501 Books / Periodicals / Audio Visual 2567 Consumer Health 294 Meeting Abstracts 3093 Other Collections 100 Total 351555

HSTAT32 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.33 HSTAT's audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ's Put Prevention Into Practice.34 Simply search by “psoriasis” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Coffee Break: Tutorials for Biologists35 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 34 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 35 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 32 33

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recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.36 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.37 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

·

Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center's MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.

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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

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MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.

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Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see http://www.lexical.com/Metaphrase.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 37 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 36

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The Genome Project and Psoriasis With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to psoriasis. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.

Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).38 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI's Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “psoriasis” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for psoriasis: ·

Mental Retardation Associated with Psoriasis Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?309480

·

Psoriasis Susceptibility Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?177900

Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

38

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·

Psoriasis Susceptibility 2 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?602723

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Psoriasis Susceptibility 3 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?601454

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Psoriasis Susceptibility 4 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?603935

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Psoriasis Susceptibility 5 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?604316

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Psoriasis Susceptibility 6 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?605364

·

Psoriasis Susceptibility 7 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?605606 Genes and Disease (NCBI - Map)

The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·

Cancer: Uncontrolled cell division. Examples: Breast And Ovarian Cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html

·

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn's disease, DiGeorge syndrome, familial Mediterranean fever,

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immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html ·

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

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Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

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Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich's ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html

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Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

·

Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson's disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html

Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·

PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

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·

Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

·

Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

·

Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

·

Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

·

ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

NCBI's Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/ To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “psoriasis” (or synonyms) and click “Go.”

Jablonski's Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database39 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html.

39

Physician Guidelines and Databases 201

is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At the following Web site you can also search across syndromes using an index: http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html. You can search by keywords at this Web site: http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database40 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB's mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “psoriasis” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.

Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission.

40

202 Psoriasis

Specialized References The following books are specialized references written for professionals interested in psoriasis (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Atlas of Clinical Dermatology by Du Vivier; Hardcover, 3rd edition (June 3, 2002), Churchill Livingstone; ISBN: 0443072205; http://www.amazon.com/exec/obidos/ASIN/0443072205/icongroupinterna · Clinical Dermatology by John A. Hunter, et al; Paperback, 3rd edition (June 2002), Blackwell Science Inc; ISBN: 0632059168; http://www.amazon.com/exec/obidos/ASIN/0632059168/icongroupinterna · Clinical Dermatology: A Color Guide to Diagnosis and Therapy by Thomas P. Habif; Hardcover, 4th edition (July 15, 2002), Mosby-Year Book; ISBN: 0323013198; http://www.amazon.com/exec/obidos/ASIN/0323013198/icongroupinterna · Common Skin Diseases by Thomas F. Poyner; Paperback - 176 pages, 1st edition (March 15, 2000), Blackwell Science Inc.; ISBN: 0632051345; http://www.amazon.com/exec/obidos/ASIN/0071054480/icongroupinterna · Dermatology (Pocket Brain) by Kimberly N. Jones; Hardcover (March 2002); ISBN: 0967783925; http://www.amazon.com/exec/obidos/ASIN/0967783925/icongroupinterna · Dermatology for Clinicians by Massad G. Joseph; Hardcover - 320 pages (June 5, 2002), CRC Press-Parthenon Publishers; ISBN: 1842141260; http://www.amazon.com/exec/obidos/ASIN/1842141260/icongroupinterna · Essential Dermatopathology by Ronald P. Rapini; Hardcover (August 2002), Mosby-Year Book; ISBN: 0323011985; http://www.amazon.com/exec/obidos/ASIN/0323011985/icongroupinterna · Evidence-Based Dermatology by Maibach; Hardcover (March 2002), B C Decker; ISBN: 1550091727; http://www.amazon.com/exec/obidos/ASIN/1550091727/icongroupinterna · A Multi-Cultural Atlas of Skin Conditions by Darya Samolis, Yuri N. Perjamutrov; Paperback - 120 pages (March 19, 2002); ISBN: 1873413424; http://www.amazon.com/exec/obidos/ASIN/1873413424/icongroupinterna · Treatment of Skin Disease by Mark Lebwohl, et al; Hardcover - 600 pages, 1st edition (March 27, 2002), Mosby, Inc.; ISBN: 0723431981; http://www.amazon.com/exec/obidos/ASIN/0723431981/icongroupinterna

Physician Guidelines and Databases 203

Vocabulary Builder Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Hydrocortisone: The main glucocorticoid secreted by the adrenal cortex. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions. [NIH]

Dissertations 205

CHAPTER 10. DISSERTATIONS ON PSORIASIS Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master's dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to psoriasis. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.

Dissertations on Psoriasis ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to psoriasis. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with psoriasis:

206 Psoriasis

·

Association of Hl-a17 and Hl-a13 with Guttate Psoriasis: the Autoimmune Reaction As a Mechanism of Differential Disease Susceptibility. by Williams, Robert Charles, Phd from The University of Michigan, 1976, 246 pages http://wwwlib.umi.com/dissertations/fullcit/7619274

·

The Asebia Mouse a New Animal Model Psoriasis by Brown, William Roy; Phd from University of Guelph (canada), 1983 http://wwwlib.umi.com/dissertations/fullcit/NK63428

Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to psoriasis is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.

207

PART III. APPENDICES

ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with psoriasis and related conditions.

Researching Your Medications 209

APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with psoriasis. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for psoriasis. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of psoriasis. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

210 Psoriasis

Your Medications: The Basics41 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of psoriasis. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with psoriasis take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·

Ask about all parts of your treatment, including diet changes, exercise, and medicines.

·

Ask about the risks and benefits of each medicine or other treatment you might receive.

·

Ask how often you or your doctor will check for side effects from a given medication.

Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for psoriasis. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·

The name of the medicine and what it is supposed to do.

·

How and when to take the medicine, how much to take, and for how long.

·

What food, drinks, other medicines, or activities you should avoid while taking the medicine.

·

What side effects the medicine may have, and what to do if they occur.

·

If you can get a refill, and how often.

41

This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.

Researching Your Medications 211

·

About any terms or directions you do not understand.

·

What to do if you miss a dose.

·

If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).

Do not forget to tell your doctor about all the medicines you are currently taking (not just those for psoriasis). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·

Name of medicine

·

Reason taken

·

Dosage

·

Time(s) of day

Also include any over-the-counter medicines, such as: ·

Laxatives

·

Diet pills

·

Vitamins

·

Cold medicine

·

Aspirin or other pain, headache, or fever medicine

·

Cough medicine

·

Allergy relief medicine

·

Antacids

·

Sleeping pills

·

Others (include names)

Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for psoriasis. One such source is

212 Psoriasis

the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration's (FDA) Drug Approvals database.42 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of psoriasis. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to psoriasis: Acitretin ·

Systemic - U.S. Brands: Soriatane http://www.nlm.nih.gov/medlineplus/druginfo/acitretinsystemi c203365.html

Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.

42

Researching Your Medications 213

Amiodarone ·

Systemic - U.S. Brands: Cordarone http://www.nlm.nih.gov/medlineplus/druginfo/amiodaronesyst emic202029.html

Anthralin ·

Topical - U.S. Brands: Drithocreme; Dritho-Scalp; Micanol http://www.nlm.nih.gov/medlineplus/druginfo/anthralintopical 202048.html Azathioprine ·

Systemic - U.S. Brands: Imuran http://www.nlm.nih.gov/medlineplus/druginfo/azathioprinesys temic202077.html

Calcipotriene ·

Topical - U.S. Brands: Dovonex http://www.nlm.nih.gov/medlineplus/druginfo/calcipotrienetop ical202730.html

Coal Tar ·

Topical - U.S. Brands: Alphosyl; Aquatar; Estar; Fototar; Lavatar; Medotar; Psorigel; Taraphilic; Tarbonis http://www.nlm.nih.gov/medlineplus/druginfo/coaltartopical20 2158.html

Corticosteroids ·

Dental - U.S. Brands: Kenalog in Orabase; Orabase-HCA; Oracort; Oralone http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsd ental202010.html

·

Inhalation - U.S. Brands: AeroBid; AeroBid-M; Azmacort; Beclovent; Decadron Respihaler; Pulmicort Respules; Pulmicort Turbuhaler; Vanceril; Vanceril 84 mcg Double Strength http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsi nhalation202011.html

·

Nasal - U.S. Brands: Beconase; Beconase AQ; Dexacort Turbinaire; Flonase; Nasacort; Nasacort AQ; Nasalide; Nasarel; Nasonex; Rhinocort; Vancenase; Vancenase AQ 84 mcg; Vancenase pockethaler http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsn asal202012.html

214 Psoriasis

·

Ophthalmic - U.S. Brands: AK-Dex; AK-Pred; AK-Tate; Baldex; Decadron; Dexair; Dexotic; Econopred; Econopred Plus; Eflone; Flarex; Fluor-Op; FML Forte; FML Liquifilm; FML S.O.P.; HMS Liquifilm; Inflamase Forte; Inflamase Mild; I-Pred; Lite Pred; Maxidex; Ocu-Dex; Ocu-Pred; Ocu-Pr http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidso phthalmic202013.html

·

Otic - U.S. Brands: Decadron http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidso tic202014.html

·

Rectal - U.S. Brands: Anucort-HC; Anu-Med HC; Anuprep HC; Anusol-HC; Anutone-HC; Anuzone-HC; Cort-Dome; Cortenema; Cortifoam; Hemorrhoidal HC; Hemril-HC Uniserts; Proctocort; Proctosol-HC; Rectosol-HC http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsr ectal203366.html

Cyclosporine ·

Systemic - U.S. Brands: Neoral; Sandimmune; SangCya http://www.nlm.nih.gov/medlineplus/druginfo/cyclosporinesys temic202176.html

Hydroxyurea ·

Systemic - U.S. Brands: Droxia; Hydrea http://www.nlm.nih.gov/medlineplus/druginfo/hydroxyureasys temic202291.html

Lithium ·

Systemic - U.S. Brands: Cibalith-S; Eskalith; Lithane; Lithobid; Lithonate; Lithotabs http://www.nlm.nih.gov/medlineplus/druginfo/lithiumsystemic 202330.html

Methotrexate for Noncancerous Conditions ·

Systemic - U.S. Brands: Folex; Rheumatrex http://www.nlm.nih.gov/medlineplus/druginfo/methotrexatefor noncancerouscon202356.html

Researching Your Medications 215

Methoxsalen ·

Systemic - U.S. Brands: 8-MOP; Oxsoralen-Ultra http://www.nlm.nih.gov/medlineplus/druginfo/methoxsalensys temic202357.html

Mometasone ·

Nasal - U.S. Brands: Nasonex http://www.nlm.nih.gov/medlineplus/druginfo/mometasonenas al203589.html

Phenolsulfonphthalein ·

Nasal - U.S. Brands: http://www.nlm.nih.gov/medlineplus/druginfo/mometasonenas al203589.html

Potassium Iodide ·

Systemic - U.S. Brands: Pima http://www.nlm.nih.gov/medlineplus/druginfo/potassiumiodid esystemic202472.html

Resorcinol ·

Topical - U.S. Brands: RA http://www.nlm.nih.gov/medlineplus/druginfo/resorcinoltopica l202507.html

Salicylates ·

Systemic - U.S. Brands: Acuprin 81; Amigesic; Anacin Caplets; Anacin Maximum Strength; Anacin Tablets; Anaflex 750; Arthritis Pain Ascriptin; Arthritis Pain Formula; Arthritis Strength Bufferin; Arthropan; Aspergum; Aspirin Regimen Bayer Adult Low Dose; Aspirin Regimen Bayer R http://www.nlm.nih.gov/medlineplus/druginfo/salicylatessyste mic202515.html

Salicylic Acid ·

Topical - U.S. Brands: Antinea; Duofilm; Freezone; Gordofilm; Hydrisalic; Keralyt; Lactisol; Mediplast; P&S; Paplex; Salac; Salacid; Saligel; Salonil; Sebucare; Trans-Plantar; Trans-Ver-Sal; Viranol; XSeb http://www.nlm.nih.gov/medlineplus/druginfo/salicylicacidtopi cal202516.html

216 Psoriasis

Salicylic Acid, Sulfur, and Coal Tar ·

Topical - U.S. Brands: Sebutone; Vanseb-T http://www.nlm.nih.gov/medlineplus/druginfo/salicylicacidsulf urandcoaltart202518.html

Sodium Chloride ·

Topical - U.S. Brands: http://www.nlm.nih.gov/medlineplus/druginfo/salicylicacidtopi cal202516.html

Sulfapyridine ·

Topical - U.S. Brands: http://www.nlm.nih.gov/medlineplus/druginfo/salicylicacidtopi cal202516.html

Sulfonamides ·

Ophthalmic - U.S. Brands: Ak-Sulf; Bleph-10; Cetamide; Gantrisin; Isopto-Cetamide; I-Sulfacet; Ocu-Sul-10; Ocu-Sul-15; Ocu-Sul-30; Ocusulf-10; Ophthacet; Sodium Sulamyd; Spectro-Sulf; Steri-Units Sulfacetamide; Sulf-10; Sulfair; Sulfair 10; Sulfair 15; Sulfair Forte; Sulfamide; http://www.nlm.nih.gov/medlineplus/druginfo/sulfonamidesop hthalmic202539.html

·

Systemic - U.S. Brands: Gantanol; Gantrisin; Thiosulfil Forte; Urobak http://www.nlm.nih.gov/medlineplus/druginfo/sulfonamidessy stemic202540.html

·

Vaginal - U.S. Brands: AVC; Sultrin; Trysul http://www.nlm.nih.gov/medlineplus/druginfo/sulfonamidesva ginal202541.html

Tacrolimus ·

Systemic - U.S. Brands: Prograf http://www.nlm.nih.gov/medlineplus/druginfo/tacrolimussyste mic202914.html

·

Topical - U.S. Brands: Protopic http://www.nlm.nih.gov/medlineplus/druginfo/tacrolimustopic al500279.html

Researching Your Medications 217

Tazarotene ·

Topical - U.S. Brands: Tazorac http://www.nlm.nih.gov/medlineplus/druginfo/tazarotenetopic al203118.html

Vitamin D and Related Compounds ·

Systemic - U.S. Brands: Calciferol; Calciferol Drops; Calcijex; Calderol; DHT; DHT Intensol; Drisdol; Drisdol Drops; Hectorol; Hytakerol; Rocaltrol; Zemplar http://www.nlm.nih.gov/medlineplus/druginfo/vitamindandrel atedcompoundssys202597.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor's office.

Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters' database as associated with psoriasis (including those with contraindications):43 ·

Capsaicin http://www.reutershealth.com/atoz/html/Capsaicin.htm

·

Chloroquine http://www.reutershealth.com/atoz/html/Chloroquine.htm

·

Colchicine http://www.reutershealth.com/atoz/html/Colchicine.htm

·

Cyclosporine http://www.reutershealth.com/atoz/html/Cyclosporine.htm

·

Cyclosporine(Cyclosporin A) http://www.reutershealth.com/atoz/html/Cyclosporine(Cyclosporin_ A).htm

43

Adapted from A to Z Drug Facts by Facts and Comparisons.

218 Psoriasis

·

Hydrocortisone (Cortisol) http://www.reutershealth.com/atoz/html/Hydrocortisone_(Cortisol).htm

·

Hydroxychloroquine Sulfate http://www.reutershealth.com/atoz/html/Hydroxychloroquine_Sulfat e.htm

·

Hydroxyurea http://www.reutershealth.com/atoz/html/Hydroxyurea.htm

·

Lithium http://www.reutershealth.com/atoz/html/Lithium.htm

·

Methotrexate http://www.reutershealth.com/atoz/html/Methotrexate.htm

·

Propranolol HCl http://www.reutershealth.com/atoz/html/Propranolol_HCl.htm

·

Sirolimus http://www.reutershealth.com/atoz/html/Sirolimus.htm

·

Sulfasalazine http://www.reutershealth.com/atoz/html/Sulfasalazine.htm

Mosby's GenRx Mosby's GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.

Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.

Researching Your Medications 219

Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.

Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with psoriasis--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat psoriasis or potentially create deleterious side effects in patients with psoriasis. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it's especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take.

220 Psoriasis

The package insert provides more information about potential drug interactions.

A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with psoriasis. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with psoriasis. The FDA warns patients to watch out for44: ·

Secret formulas (real scientists share what they know)

·

Amazing breakthroughs or miracle cures (real breakthroughs don't happen very often; when they do, real scientists do not call them amazing or miracles)

·

Quick, painless, or guaranteed cures

·

If it sounds too good to be true, it probably isn't true.

If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

Comprehensive Dermatologic Drug Therapy by Stephen E. Wolverton (Editor); Paperback - 656 pages (March 15, 2001), W B Saunders Co; ISBN: 0721677282; http://www.amazon.com/exec/obidos/ASIN/0721677282/icongroupinterna

This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.

44

Researching Your Medications 221

·

Drug Eruption Reference Manual 2000, Millennium Edition by Jerome Z. Litt, M.D. (Editor); Paperback - 662 pages (April 15, 2000), Parthenon Pub Group; ISBN: 185070788X; http://www.amazon.com/exec/obidos/ASIN/185070788X/icongroupinterna

·

Pocket Guide to Medications Used in Dermatology by Andrew J. Scheman, David L. Severson; Paperback - 230 pages, 6th edition (June 15, 1999), Lippincott Williams & Wilkins Publishers; ISBN: 0781721008; http://www.amazon.com/exec/obidos/ASIN/0781721008/icongroupinterna

·

Complete Guide to Prescription and Nonprescription Drugs 2001 (Complete Guide to Prescription and Nonprescription Drugs, 2001) by H. Winter Griffith, Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/039952634X/icongroupinterna

·

The Essential Guide to Prescription Drugs, 2001 by James J. Rybacki, James W. Long; Paperback - 1274 pages (2001), Harper Resource; ISBN: 0060958162; http://www.amazon.com/exec/obidos/ASIN/0060958162/icongroupinterna

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Handbook of Commonly Prescribed Drugs by G. John Digregorio, Edward J. Barbieri; Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/0942447417/icongroupinterna

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Johns Hopkins Complete Home Encyclopedia of Drugs 2nd ed. by Simeon Margolis (Ed.), Johns Hopkins; Hardcover - 835 pages (2000), Rebus; ISBN: 0929661583; http://www.amazon.com/exec/obidos/ASIN/0929661583/icongroupinterna

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Medical Pocket Reference: Drugs 2002 by Springhouse Paperback 1st edition (2001), Lippincott Williams & Wilkins Publishers; ISBN: 1582550964; http://www.amazon.com/exec/obidos/ASIN/1582550964/icongroupinterna

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PDR by Medical Economics Staff, Medical Economics Staff Hardcover 3506 pages 55th edition (2000), Medical Economics Company; ISBN: 1563633752; http://www.amazon.com/exec/obidos/ASIN/1563633752/icongroupinterna

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Pharmacy Simplified: A Glossary of Terms by James Grogan; Paperback 432 pages, 1st edition (2001), Delmar Publishers; ISBN: 0766828581; http://www.amazon.com/exec/obidos/ASIN/0766828581/icongroupinterna

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Physician Federal Desk Reference by Christine B. Fraizer; Paperback 2nd edition (2001), Medicode Inc; ISBN: 1563373971; http://www.amazon.com/exec/obidos/ASIN/1563373971/icongroupinterna

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·

Physician's Desk Reference Supplements Paperback - 300 pages, 53 edition (1999), ISBN: 1563632950; http://www.amazon.com/exec/obidos/ASIN/1563632950/icongroupinterna

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Amiodarone: An antianginal and antiarrhythmic drug. It increases the duration of ventricular and atrial muscle action by inhibiting Na,K-activated myocardial adenosine triphosphatase. There is a resulting decrease in heart rate and in vascular resistance. [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Liquifilm: A thin liquid layer of coating. [EU] Phenolsulfonphthalein: Red dye, pH indicator, and diagnostic aid for determination of renal function. It is used also for studies of the gastrointestinal and other systems. [NIH] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Salicylates: The salts, esters of salicylic acids, or salicylate esters of an organic acid. Some of these have analgesic, antipyretic, and antiinflammatory activities by inhibiting prostaglandin synthesis. [NIH] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Sulfacetamide: An anti-infective agent that is used topically to treat skin infections and orally for urinary tract infections. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU]

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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to psoriasis. Finally, at the conclusion of this chapter, we will provide a list of readings on psoriasis from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine's (NCCAM) overview of complementary and alternative medicine.

What Is CAM?45 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 45

Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.

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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.

What Are the Domains of Alternative Medicine?46 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are

46

Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.

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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India's traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body's defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.

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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind's capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.

Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine's use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.

Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body's systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.

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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient's recovery and that healing is promoted when the body's energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.

Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.47

47

Adapted from http://www.4woman.gov/faq/alternative.htm.

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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.

Finding CAM References on Psoriasis Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for psoriasis. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.

The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “psoriasis” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·

Alternative Medicine Digest: The Voice of Alternative Medicine Source: Alternative Medicine Digest. 1994. 6 issues per year. [115 pages average].

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Contact: Available from Future Medicine Publishing, Inc. Subscriptions: Alternative Medicine Digest, 1640 Tiburon Blvd., Suite 2, Tiburon, CA 94920-2523. 800-513-4325//415-435-1779// FAX: 415-789-9138. Price: $20.00. ISSN: 10814000. Summary: This magazine provides information about alternative medicine and related health care issues for consumers. A typical issue may contain articles about the potentially toxic effects of certain dental procedures and substances; a celebrity's experience with breast implants; the healing effects of oxygen for people with acquired immunodeficiency syndrome (AIDS), cancer, and multiple sclerosis; alternative therapies for anorexia nervosa, arthritis, and morning sickness; energy medicine for healing psoriasis; and reversing diabetes with Chinese medicine. Regular features include letters from readers; columns on natural treatments, products, and services; a column on healing foods; a column on alternative pet care; news and commentaries on the politics of medicine; and book reports.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine's databases to allow patients to search for articles that specifically relate to psoriasis and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “psoriasis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to psoriasis: ·

"Doctor fish" and psoriasis. Author(s): Undar L, Akpinar MA, Yanikoglu A. Source: Lancet. 1990 February 24; 335(8687): 470-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1968187&dopt=Abstract

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A Chinese cream (fu suo) for psoriasis. Author(s): Bonnetblanc JM, Marquet P. Source: Dermatology (Basel, Switzerland). 1996; 192(3): 294. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8726658&dopt=Abstract

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A comparison of bathwater and oral delivery of 8-methoxypsoralen in PUVA therapy for plaque psoriasis. Author(s): Cooper EJ, Herd RM, Priestley GC, Hunter JA. Source: Clinical and Experimental Dermatology. 2000 March; 25(2): 111-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10733632&dopt=Abstract

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A comparison of PUVA-etretinate and PUVA-placebo for palmoplantar pustular psoriasis. Author(s): Lawrence CM, Marks J, Parker S, Shuster S. Source: The British Journal of Dermatology. 1984 February; 110(2): 221-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6696838&dopt=Abstract

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A comparison of the effect of narrow-band ultraviolet B in the treatment of psoriasis after salt-water baths and after 8methoxypsoralen baths. Author(s): Arnold WP, van Andel P, de Hoop D, de Jong-Tieben L, Visser-van Andel M. Source: The British Journal of Dermatology. 2001 August; 145(2): 352-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11531811&dopt=Abstract

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A controlled trial of acupuncture in psoriasis: no convincing effect. Author(s): Jerner B, Skogh M, Vahlquist A. Source: Acta Dermato-Venereologica. 1997 March; 77(2): 154-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9111831&dopt=Abstract

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A double-blind study comparing oleum horwathiensis with placebo in the treatment of psoriasis. Author(s): Lassus A, Forsstrom S. Source: J Int Med Res. 1991 March-April; 19(2): 137-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1864450&dopt=Abstract

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A pilot study of hypnosis in the treatment of patients with psoriasis. Author(s): Tausk F, Whitmore SE.

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Source: Psychotherapy and Psychosomatics. 1999; 68(4): 221-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10396014&dopt=Abstract ·

A trial of oral zinc supplementation in psoriasis. Author(s): Burrows NP, Turnbull AJ, Punchard NA, Thompson RP, Jones RR. Source: Cutis. 1994 August; 54(2): 117-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7956335&dopt=Abstract

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Acupuncture treatment for psoriasis: a retrospective case report. Author(s): Liao SJ, Liao TA. Source: Acupunct Electrother Res. 1992 July-September; 17(3): 195-208. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1357925&dopt=Abstract

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Acute methyl salicylate toxicity complicating herbal skin treatment for psoriasis. Author(s): Bell AJ, Duggin G. Source: Emergency Medicine (Fremantle, W.A.). 2002 June; 14(2): 188-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12147116&dopt=Abstract

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Advances in experimental studies on treatment of psoriasis by traditional Chinese medicine. Author(s): Zhang H, Qu X. Source: J Tradit Chin Med. 2002 March; 22(1): 61-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11977526&dopt=Abstract

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Alternative therapies commonly used within a population of patients with psoriasis. Author(s): Fleischer AB Jr, Feldman SR, Rapp SR, Reboussin DM, Exum ML, Clark AR. Source: Cutis. 1996 September; 58(3): 216-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8886537&dopt=Abstract

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Alternative therapy for atopic dermatitis and psoriasis: patientreported motivation, information source and effect. Author(s): Jensen P.

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Source: Acta Dermato-Venereologica. 1990; 70(5): 425-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1980978&dopt=Abstract ·

An hypothesis explaining the successful treatment of psoriasis with thermal biofeedback: a case report. Author(s): Goodman M. Source: Biofeedback Self Regul. 1994 December; 19(4): 347-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7880910&dopt=Abstract

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An update on common skin diseases. Acne, psoriasis, contact dermatitis, and warts. Author(s): Millikan LE, Shrum JP. Source: Postgraduate Medicine. 1992 May 1; 91(6): 96-8, 101-4, 107-10 Passim. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1533716&dopt=Abstract

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Antiangiogenic properties of a novel shark cartilage extract: potential role in the treatment of psoriasis. Author(s): Dupont E, Savard PE, Jourdain C, Juneau C, Thibodeau A, Ross N, Marenus K, Maes DH, Pelletier G, Sauder DN. Source: Journal of Cutaneous Medicine and Surgery. 1998 January; 2(3): 146-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9479080&dopt=Abstract

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Association of etretinate and fish oil in psoriasis therapy. Inhibition of hypertriglyceridemia resulting from retinoid therapy after fish oil supplementation. Author(s): Frati C, Bevilacqua L, Apostolico V. Source: Acta Derm Venereol Suppl (Stockh). 1994; 186: 151-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8073820&dopt=Abstract

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Balneophototherapy of psoriasis: highly concentrated salt water versus tap water--a randomized, one-blind, right/left comparative study. Author(s): Gambichler T, Rapp S, Senger E, Altmeyer P, Hoffmann K.

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Source: Photodermatology, Photoimmunology & Photomedicine. 2001 February; 17(1): 22-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11169172&dopt=Abstract ·

Balneophototherapy--combined treatment of psoriasis vulgaris and atopic dermatitis with salt water baths and artificial ultraviolet radiation. Author(s): Gambichler T, Kuster W, Kreuter A, Altmeyer P, Hoffmann K. Source: Journal of the European Academy of Dermatology and Venereology : Jeadv. 2000 September; 14(5): 425-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11305394&dopt=Abstract

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Balneotherapy of psoriasis in Lipova lazne. Author(s): Prokes P. Source: Acta Univ Carol [med] (Praha). 1986; 32(3-4): 255-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3434485&dopt=Abstract

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Bath PUVA: an effective treatment for psoriasis. Author(s): Fairlie C, Baldwin L, Vear L, Rogers C. Source: Dermatology Nursing / Dermatology Nurses' Association. 1998 August; 10(4): 285-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9849172&dopt=Abstract

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Bath-5-methoxypsoralen-UVA therapy for psoriasis. Author(s): Calzavara-Pinton PG, Zane C, Carlino A, De Panfilis G. Source: Journal of the American Academy of Dermatology. 1997 June; 36(6 Pt 1): 945-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9204060&dopt=Abstract

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Bathing for psoriasis in the Dead Sea. Author(s): Montgomery BJ.

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Source: Jama : the Journal of the American Medical Association. 1979 January 19; 241(3): 227-31. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=758522&dopt=Abstract ·

Bath-photo-therapy with the thermal water of Comano: treatment of psoriasis. Author(s): Zumiani G, Zanoni M, Lo Brutto R, Cristofolini P, Tasin L. Source: Acta Derm Venereol Suppl (Stockh). 1989; 146: 122-3; Discussion 124. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2609852&dopt=Abstract

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Bath-water compared with oral delivery of 8-methoxypsoralen PUVA therapy for chronic plaque psoriasis. Author(s): Collins P, Rogers S. Source: The British Journal of Dermatology. 1992 October; 127(4): 392-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1419760&dopt=Abstract

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Bath-water delivery of 8-methoxypsoralen therapy for psoriasis. Author(s): Collins P, Rogers S. Source: Clinical and Experimental Dermatology. 1991 May; 16(3): 165-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1934565&dopt=Abstract

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Behaviour therapy of psoriasis--a hypnoanalytic and counterconditioning technique. Author(s): Waxman D. Source: Postgraduate Medical Journal. 1973 August; 49(574): 591-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4788839&dopt=Abstract

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Biofeedback and control of skin cell proliferation in psoriasis. Author(s): Benoit LJ, Harrell EH. Source: Psychol Rep. 1980 June; 46(3 Pt 1): 831-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7394097&dopt=Abstract

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Biofeedback and psychotherapeutic treatment of psoriasis: a brief report. Author(s): Hughes HH, England R, Goldsmith DA. Source: Psychol Rep. 1981 February; 48(1): 99-102. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7232633&dopt=Abstract

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Can psychotherapy help patients with psoriasis? Author(s): Price ML, Mottahedin I, Mayo PR. Source: Clinical and Experimental Dermatology. 1991 March; 16(2): 114-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2032371&dopt=Abstract

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Cancer incidence among Finnish psoriasis patients treated with 8methoxypsoralen bath PUVA. Author(s): Hannuksela-Svahn A, Pukkala E, Koulu L, Jansen CT, Karvonen J. Source: Journal of the American Academy of Dermatology. 1999 May; 40(5 Pt 1): 694-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10321595&dopt=Abstract

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Climate therapy for psoriasis at the Dead Sea, Israel. Author(s): Azizi E, Kushelevsky AP, Avrach W, Schewach-Millet M. Source: Isr J Med Sci. 1982 February; 18(2): 267-70. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7068358&dopt=Abstract

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Climatotherapy of psoriasis and hypertension in elderly patients at the Dead-Sea. Author(s): Kushelevsky AP, Harari M, Hristakieva E, Shani J. Source: Pharmacological Research : the Official Journal of the Italian Pharmacological Society. 1996 July-August; 34(1-2): 87-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8981562&dopt=Abstract

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Clinical and biological effects of balneotherapy with selenium-rich spa water in patients with psoriasis vulgaris. Author(s): Pinton J, Friden H, Kettaneh-Wold N, Wold S, Dreno B, Richard A, Bieber T.

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Source: The British Journal of Dermatology. 1995 August; 133(2): 344-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7547424&dopt=Abstract ·

Clinical and experimental investigations on the effect of cytostatic drugs in psoriasis. Author(s): Caccialanza P, Finzi AF. Source: Ital Gen Rev Dermatol. 1974 January-April; 11(1): 37-46. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4143394&dopt=Abstract

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Clinical evaluation of a more rapid and sensitive Psoriasis Assessment Severity Score (PASS), and its comparison with the classic method of Psoriasis Area and Severity Index (PASI), before and after climatotherapy at the Dead-Sea. Author(s): Harari M, Shani J, Hristakieva E, Stanimirovic A, Seidl W, Burdo A. Source: International Journal of Dermatology. 2000 December; 39(12): 913-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11168660&dopt=Abstract

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Clinical trial and experimental study on treating psoriasis with camptothecine. Author(s): Lin XR, Huang TA, Yang CM, Tu CX, Yang GL. Source: Chin Med J (Engl). 1988 June; 101(6): 427-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3146474&dopt=Abstract

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Commercial tanning bed treatment is an effective psoriasis treatment: results from an uncontrolled clinical trial. Author(s): Fleischer AB Jr, Clark AR, Rapp SR, Reboussin DM, Feldman SR. Source: The Journal of Investigative Dermatology. 1997 August; 109(2): 170-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9242503&dopt=Abstract

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Comparison of heat delivery systems for hyperthermia treatment of psoriasis. Author(s): Orenberg EK, Noodleman FR, Koperski JA, Pounds D, Farber EM. Source: International Journal of Hyperthermia : the Official Journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group. 1986 July-September; 2(3): 231-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3794419&dopt=Abstract

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Comparison of narrow-band (311 nm) UVB and broad-band UVA after oral or bath-water 8-methoxypsoralen in the treatment of psoriasis. Author(s): Ortel B, Perl S, Kinaciyan T, Calzavara-Pinton PG, Honigsmann H. Source: Journal of the American Academy of Dermatology. 1993 November; 29(5 Pt 1): 736-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8227546&dopt=Abstract

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Comparison of trioxsalen bath and oral methoxsalen PUVA in psoriasis. Author(s): Turjanmaa K, Salo H, Reunala T. Source: Acta Dermato-Venereologica. 1985; 65(1): 86-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2578716&dopt=Abstract

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Complement C3 proteins in psoriasis. Author(s): Acevedo F, Hammar H. Source: The British Journal of Dermatology. 1989 September; 121(3): 32935. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2508741&dopt=Abstract

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Cost-effectiveness of Dead-Sea climatotherapy and balneophototherapy of psoriasis. Author(s): Gambichler T, Altmeyer P, Hoffmann K. Source: International Journal of Dermatology. 2001 February; 40(2): 158-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11328403&dopt=Abstract

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Current treatment options in psoriasis. Author(s): Khachemoune A, Phillips TJ. Source: Hosp Pract (Off Ed). 2000 July 15; 35(7): 93-6, 101-4, 107. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10916507&dopt=Abstract

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Dead-Sea climatotherapy versus other modalities of treatment for psoriasis: comparative cost-effectiveness. Author(s): Shani J, Harari M, Hristakieva E, Seidl V, Bar-Giyora J. Source: International Journal of Dermatology. 1999 April; 38(4): 252-62. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10321939&dopt=Abstract

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Dealing with the disadvantaged: psoriasis. Author(s): Henley LA. Source: British Medical Journal (Clinical Research Ed.). 1981 June 6; 282(6279): 1851-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6786650&dopt=Abstract

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Dietary supplementation with a combination of n-3 and n-6 fatty acids (super gamma-oil marine) improves psoriasis. Author(s): Kragballe K. Source: Acta Dermato-Venereologica. 1989; 69(3): 265-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2566241&dopt=Abstract

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Differences in efficacy between intention-to-treat and per-protocol analyses for patients with psoriasis vulgaris and atopic dermatitis: clinical and pharmacoeconomic implications. Author(s): Schiffner R, Schiffner-Rohe J, Gerstenhauer M, Hofstadter F, Landthaler M, Stolz W. Source: The British Journal of Dermatology. 2001 June; 144(6): 1154-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11422035&dopt=Abstract

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Eczema, ichthyosis, psoriasis: conditions of cornification. Author(s): Burdette-Taylor SR.

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Source: Ostomy Wound Manage. 1995 August; 41(7): 36-8, 40, 42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7662092&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.thedacare.org/healthnotes/

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Open Directory Project: http://dmoz.org/Health/Alternative/

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TPN.com: http://www.tnp.com/

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs

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WellNet: http://www.wellnet.ca/herbsa-c.htm

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

The following is a specific Web list relating to psoriasis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·

General Overview Acne Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000254.html

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Allergies and Sensitivities Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Allergies.htm Candidiasis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Can didiasiscc.html Dermatitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Der matitiscc.html Photodermatitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Skin DisordersPhotodermatitiscc.html Psoriasis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Psoriasis.htm Psoriasis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/ psoriasis.html Psoriasis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Psor iasiscc.html

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Psoriasis Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000301.html Skin Disorders, Dermatitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Der matitiscc.html Skin Disorders, Photodermatitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Skin DisordersPhotodermatitiscc.html Sunburn Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Skin DisordersPhotodermatitiscc.html Yeast Infection Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Can didiasiscc.html ·

Alternative Therapy Acupuncture Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Therapy/Acupuncture.htm

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Aromatherapy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Aro matherapycm.html Light therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 713,00.html Meditation Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 717,00.html Relaxation Techniques Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Rela xationTechniquescm.html ·

Homeopathy Arsenicum album Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Arsenicu m_album.htm Calcarea carbonica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Calcarea _carbonica.htm

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Graphites Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Graphite s.htm Mercurius solubilis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Mercuriu s_solubilis.htm Mezereum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Mezereu m.htm Petroleum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Petroleu m.htm Rhus toxicodendron Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Rhus_tox icodendron.htm Sepia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Sepia.ht m Staphysagria Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Staphysa gria.htm

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Sulphur Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Sulphur. htm ·

Herbs and Supplements Adrenal Extract Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Adrenal_Extract.htm ALA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Al phaLinolenicAcidALAcs.html Aloe Alternative names: Aloe vera L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Aloe Alternative names: Aloe vera, Aloe barbadensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Aloe.htm Aloe Alternative names: Aloe vera, Aloe barbadensis, Aloe ferox , Aloe Vera Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Aloech.h tml Aloe Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000091.html

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Aloe Vera Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Aloech.h tml Aloe vera Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10001,00.html Alpha-Linolenic Acid (ALA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Al phaLinolenicAcidALAcs.html Anthralin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Anthralin.htm Arnica Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 753,00.html Barberry Alternative names: Berberis vulgaris Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Barberry.htm Barberry Alternative names: Berberis vulgaris, Berberry Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Barberry ch.html

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Berberis vulgaris Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Barberry ch.html Berberry Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Barberry ch.html Beta-Carotene Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000104.html Beta-carotene Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10103,00.html Blue Flag Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm Blue-green Algae Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/S pirulinacs.html

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Brahmi Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKol ach.html Burdock Blend Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm Calciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Calcitrol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Calendula Alternative names: Calendula officinalis L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Capsaicin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cayenne ch.html

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Capsicum frutescens Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cayenne ch.html Cayenne Alternative names: Capsicum annuum, Capsicum frutescens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Cayenne.htm Cayenne Alternative names: Capsicum frutescens, Capsicum spp., Capsaicin, Chili Pepper, Red Pepper Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cayenne ch.html Cayenne Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 765,00.html Centella Alternative names: Gotu Kola; Centella asiatica (Linn.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Centella Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKol ach.html

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Centella asiatica Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKol ach.html Chamomile, German Alternative names: Matricaria recutita Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Chamom ileGermanch.html Chickweed Alternative names: Stellaria media Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Chickweed.htm Chili Pepper Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cayenne ch.html Cholecalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Cleavers Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm

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Coleus Alternative names: Coleus forskohlii Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Coleus.htm Coleus forskohlii Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000136.html Corticosteroids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Corticosteroids.htm Docosahexaenoic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/DHA.htm Eicosapentaenoic Acid (EPA) Alternative names: EPA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/EicosapentaenoicAcidEPAcs.html Eicosapentaenoic Acid (EPA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ei cosapentaenoicAcidEPAcs.html EPA Alternative names: Eicosapentaenoic Acid (EPA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/EicosapentaenoicAcidEPAcs.html

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EPA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ei cosapentaenoicAcidEPAcs.html Erocalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Forskolin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10025,00.html Fumaric Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Fumaric_Acid.htm German Chamomile Alternative names: Matricaria recutita Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Chamom ileGermanch.html Glutamine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10030,00.html

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Gotu Kola Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKol ach.html Grape seed extract Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 793,00.html Green-Lipped Mussel Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Green_Lipped_Muss el.htm Hydrocotyle Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKol ach.html Indian Pennywort Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKol ach.html Juniperus Alternative names: Juniper; Juniperus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/

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Licorice Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000144.html Mahonia Alternative names: Mahonia aquifolium Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Marsh Pennywort Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKol ach.html Matricaria recutita Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Chamom ileGermanch.html Methotrexate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Methotrexate.htm Methotrexate Alternative names: Rheumatrex Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000324.html Milk Thistle Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000209.html

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Milk thistle Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10044,00.html NAC (N-acetylcysteine) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 809,00.html Oral Corticosteroids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Corticosteroids_Oral. htm Oregon Grape Alternative names: Berberis aquifolium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Oregon_Grape.htm Organ Mountain Crape Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsm-o.htm Pregnenolone Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Pregnenolone.htm Red Clover Alternative names: Trifolium pratense Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Red_Clover.htm

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Red Clover Alternative names: Trifolium pratense , beebread, cow clover, cow grass, meadow clover, purple clover Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/RedClov erch.html Red Clover Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000227.html Red Pepper Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cayenne ch.html Sarsaparilla Alternative names: Smilax spp. Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Sarsaparilla.htm Sarsaparilla Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbss-v.htm Shark Cartilage Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/C artilagecs.html

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Spirulina Alternative names: Blue-green Algae Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/S pirulinacs.html Taurine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000196.html Topical Corticosteroids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Corticosteroids_Topic al.htm Yellow Dock Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsw-z.htm Zizyphus Alternative names: Jujube; Ziziphus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/

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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Skin Cancer Answer by I. William Lane, et al; Paperback - 160 pages (February 1999), Avery Penguin Putnam; ISBN: 0895298651; http://www.amazon.com/exec/obidos/ASIN/0895298651/icongroupinterna · Smart Medicine for Your Skin: A Comprehensive Guide to Understanding Conventional and Alternative Therapies to Heal Common Skin Problems by Jeanette Jacknin, M.D.; Paperback - 414 pages (August 6, 2001), Avery Penguin Putnam; ISBN: 1583330984; http://www.amazon.com/exec/obidos/ASIN/1583330984/icongroupinterna · Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·

Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna

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Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna

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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna

· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·

Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001),

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Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna ·

New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna

· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Capsicum: A genus of Solanaceous shrubs that yield capsaicin. Several varieties have sweet or pungent edible fruits that are used as vegetables when fresh and spices when the pods are dried. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]

Cholecalciferol: An antirachitic oil-soluble vitamin. [NIH] Forskolin: Potent activator of the adenylate cyclase system and the biosynthesis of cyclic AMP. From the plant Coleus forskohlii. Has

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antihypertensive, positive ionotropic, platelet aggregation inhibitory, and smooth muscle relaxant activities; also lowers intraocular pressure and promotes release of hormones from the pituitary gland. [NIH] Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] Graphite: Graphite. An allotropic form of carbon that is used in pencils, as a lubricant, and in matches and explosives. It is obtained by mining and its dust can cause lung irritation. [NIH] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH]

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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with psoriasis. Any dietary recommendation is based on a patient's age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with psoriasis may be given different recommendations. Some recommendations may be directly related to psoriasis, while others may be more related to the patient's general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of psoriasis. We will then show you how to find studies dedicated specifically to nutrition and psoriasis.

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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·

Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.

·

Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.

·

Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.

·

Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.

Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·

Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.

·

Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.

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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from

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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·

Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains

·

Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.

·

Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.

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Vitamin C allows the body's immune system to fight various diseases, strengthens body tissue, and improves the body's use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.

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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.

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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.

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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.

·

Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.

It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·

Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.

·

Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.

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·

Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.

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Iodine helps regulate the body's use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.

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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.

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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.

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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.

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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.

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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.

The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:48 ·

DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.

·

DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.

48

Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.

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·

RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”

·

RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?49

Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”50 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.51 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 50 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail: [email protected]. 51 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 49

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the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail: [email protected]

Finding Studies on Psoriasis The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.52 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

52

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periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “psoriasis” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on psoriasis: ·

Mahonia ointment in the treatment of Psoriasis. Source: Leigh, E. HerbalGram. Austin, TX : American Botanical Council and the Herb Research Foundation. Spring 1998. (42) page 17. 0899-5648

·

Vitamin D and psoriasis. Author(s): Department of Biochemistry, University of California, Riverside 92521. Source: Lowe, K E Norman, A W Nutr-Revolume 1992 May; 50(5): 138-42 0029-6643

The following information is typical of that found when using the “Full IBIDS Database” when searching using “psoriasis” (or a synonym): ·

A clinical evaluation of tazarotene 0.1% gel, with and without a highor mid-high-potency corticosteroid, in patients with stable plaque psoriasis. Author(s): Department of Dermatology, George Washington University, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA. Source: Green, Lawrence Sadoff, Wendy J-Cutan-Med-Surg. 2002 MarApril; 6(2): 95-102 1203-4754

·

A comparative study of calcipotriol and anthralin for chronic plaque psoriasis in a day care treatment center. Author(s): Division of Dermatology, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Canada. Source: Dutz, J P Lui, H Int-J-Dermatol. 1998 January; 37(1): 51-3 00119059

·

A comparison of treatment with dithranol and calcipotriol on the clinical severity and quality of life in patients with psoriasis. Author(s): Health Centre, Woking, Surrey, U.K. Source: Wall, A R Poyner, T F Menday, A P Br-J-Dermatol. 1998 December; 139(6): 1005-11 0007-0963

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·

A corticosteroid-induced flare of psoriasis. How to control or, better yet, avoid. Author(s): Northeastern Ohio Universities College of Medicine, Rootstown, USA. [email protected] Source: Brodell, R T Williams, L Postgrad-Med. 1999 December; 106(7): 31-2 0032-5481

·

A double blind, randomized, controlled clinical trial to assess the efficacy of a new coal tar preparation (Exorex) in the treatment of chronic, plaque type psoriasis. Author(s): Skin Therapy Research Unit, St John's Institute of Dermatology, St Thomas' Hospital, UK. Source: Smith, C H Jackson, K Chinn, S Angus, K Barker, J N Clin-ExpDermatol. 2000 November; 25(8): 580-3 0307-6938

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A high prevalence of cytomegalovirus antigenaemia in patients with moderate to severe chronic plaque psoriasis: an association with systemic tumour necrosis factor alpha overexpression. Author(s): Department of Dermatology, Medical School Charite, Humboldt University Berlin, Schumannstrasse 20/21, D-10098 Berlin, Germany. Source: Asadullah, K Prosch, S Audring, H Buttnerova, I Volk, H D Sterry, W Docke, W D Br-J-Dermatol. 1999 July; 141(1): 94-102 0007-0963

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A multicentre, parallel-group comparison of calcipotriol ointment and short-contact dithranol therapy in chronic plaque psoriasis. Author(s): Department of Dermatology, Leicester Royal Infirmary, U.K. Source: Berth Jones, J Chu, A C Dodd, W A Ganpule, M Griffiths, W A Haydey, R P Klaber, M R Murray, S J Rogers, S Jurgensen, H J Br-JDermatol. 1992 September; 127(3): 266-71 0007-0963

·

A review of the epidemiology of psoriasis vulgaris in the community. Author(s): University of Melbourne, Department of Medicine (Dermatology), St Vincent's Hospital, Fitzroy, Victoria, Australia. Source: Plunkett, A Marks, R Australas-J-Dermatol. 1998 November; 39(4): 225-32 0004-8380

·

An update on common skin diseases. Acne, psoriasis, contact dermatitis, and warts. Author(s): Department of Dermatology, Tulane University School of Medicine, New Orleans. Source: Millikan, L E Shrum, J P Postgrad-Med. 1992 May 1; 91(6): 96-8, 101-4, 107-10 passim 0032-5481

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Antiangiogenic properties of a novel shark cartilage extract: potential role in the treatment of psoriasis. Author(s): Les Laboratoires Aeterna, Ste-Foy, PQ, Canada.

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Source: Dupont, E Savard, P E Jourdain, C Juneau, C Thibodeau, A Ross, N Marenus, K Maes, D H Pelletier, G Sauder, D N J-Cutan-Med-Surg. 1998 January; 2(3): 146-52 1203-4754 ·

Better patient compliance in psoriasis. Author(s): Section of Dermatology, Imperial College of Science, Technology & Medicine, Hammersmith Hospital, London. Source: Chu, T Practitioner. 2000 March; 244(1608): 238-42, 244 0032-6518

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Calcipotriene ointment and halobetasol ointment in the long-term treatment of psoriasis: effects on the duration of improvement. Author(s): Mount Sinai Medical Center, New York, New York 10029, USA. Source: Lebwohl, M Yoles, A Lombardi, K Lou, W J-Am-Acad-Dermatol. 1998 September; 39(3): 447-50 0190-9622

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Calcipotriol ointment for plaque psoriasis. Source: Anonymous Drug-Ther-Bull. 1992 March 2; 30(5): 17-8 0012-6543

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Calcipotriol. A review of its pharmacological properties and therapeutic use in psoriasis vulgaris. Author(s): Adis International Limited, Auckland, New Zealand. Source: Murdoch, D Clissold, S P Drugs. 1992 March; 43(3): 415-29 00126667

·

Calcitriol 3 microg g-1 ointment in combination with ultraviolet B phototherapy for the treatment of plaque psoriasis: results of a comparative study. Author(s): University Hospital of Dermatology, Hamburg, Germany. JohannesRing@lrz/tu.muenchen.de Source: Ring, J Kowalzick, L Christophers, E Schill, W B Schopf, E Stander, M Wolff, H H Altmeyer, P Br-J-Dermatol. 2001 March; 144(3): 495-9 0007-0963

·

Clinical pharmacokinetics and drug metabolism of tazarotene: a novel topical treatment for acne and psoriasis. Author(s): Department of Pharmacokinetics and Drug Metabolism, Allergan, Irvine, California 92612, USA. [email protected] Source: Tang Liu, D D Matsumoto, R M Usansky, J I Clin-Pharmacokinet. 1999 October; 37(4): 273-87 0312-5963

·

Combination phototherapy of psoriasis with narrow-band UVB irradiation and topical tazarotene gel. Author(s): Department of Dermatology, University of Ulm, Germany. Source: Behrens, S Grundmann Kollmann, M Schiener, R Peter, R U Kerscher, M J-Am-Acad-Dermatol. 2000 March; 42(3): 493-5 0190-9622

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·

Combination therapy with tazarotene plus a topical corticosteroid for the treatment of plaque psoriasis. Author(s): Department of Dermatology & Venereology, Otto-vonGuericke-Universitat, Magdeburg, Germany. Source: Gollnick, H Menter, A Br-J-Dermatol. 1999 April; 140 Suppl 541823 0007-0963

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Comparative efficacy of calcipotriol (MC903) cream and betamethasone 17-valerate cream in the treatment of chronic plaque psoriasis. A randomized, double-blind, parallel group multicentre study. Calcipotriol Study Group. Author(s): Department of Dermatology, Orebro Medical Center Hospital, Sweden. Source: Molin, L Cutler, T P Helander, I Nyfors, B Downes, N Br-JDermatol. 1997 January; 136(1): 89-93 0007-0963

·

Comparison of calcipotriol and coal tar in conjunction with sun exposure in chronic plaque psoriasis: a pilot study. Author(s): Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Source: Kaur, I Saraswat, A KuMarch, B J-Dermatol. 2001 August; 28(8): 448-50 0385-2407

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·

healthfinder®, HHS's gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture's Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration's Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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·

The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.thedacare.org/healthnotes/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDÒHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

The following is a specific Web list relating to psoriasis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·

Vitamins Folic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Folic_Acid.htm

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Pantothenic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB5PantothenicAcidcs.html Vitamin A Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000230.html Vitamin A Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10066,00.html Vitamin B complex Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 962,00.html Vitamin B5 (Pantothenic Acid) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB5PantothenicAcidcs.html Vitamin D Alternative names: Calciferol, Calcitrol, Cholecalciferol, Erocalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Vitamin D Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000129.html

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Vitamin D Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 905,00.html Vitamin E Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000092.html ·

Minerals Chromium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000131.html Folate Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000161.html Quercetin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Q uercetincs.html Retinol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminARetinolcs.html Selenium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Se leniumcs.html

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Selenium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000233.html Selenium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10055,00.html Vitamin A (Retinol) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminARetinolcs.html Zinc Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000128.html Zinc Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10071,00.html Zinc/copper Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 938,00.html ·

Food and Diet Barley Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Barley.htm

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Burdock Alternative names: Arctium lappa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Burdock.htm Burdock Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000118.html Cartilage Alternative names: Shark Cartilage Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/C artilagecs.html Cartilage Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000116.html Gluten-Free Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Gluten_Free_Diet.htm Omega-3 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/O mega3FattyAcidscs.html Omega-3 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/Omega3FattyAcidscs.html

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Omega-3 fatty acids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 992,00.html Omega-6 fatty acids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 1037,00.html Polyunsaturated Fats Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Polyunsaturat ed_Fats.htm Rye Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Rye.htm Wheat Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Wheat.htm

Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU]

Researching Nutrition 277

Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]

Finding Medical Libraries 279

APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM's interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.53

53

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):54 ·

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

·

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM

·

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

·

California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html

·

California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html

·

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

·

California: Gateway Health Library (Sutter Gould Medical Foundation)

·

California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/

54

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries 281

·

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

·

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

·

California: San José PlaneTree Health Library, http://planetreesanjose.org/

·

California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html

·

California: University of California, Davis. Health Sciences Libraries

·

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html

·

California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/

·

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm

·

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

·

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

·

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml

·

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm

·

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html

·

Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

·

Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp

·

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/

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·

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm

·

Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html

·

Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/

·

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm

·

Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/

·

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/

·

Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/

·

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm

·

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html

·

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm

·

Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/

·

Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library

·

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10

·

Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html

·

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

·

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml

Finding Medical Libraries 283

·

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

·

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

·

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html

·

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

·

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp

·

Massachusetts: St. Luke's Hospital Health Sciences Library (St. Luke's Hospital), http://www.southcoast.org/library/

·

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

·

Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/

·

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

·

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

·

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

·

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm

·

Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html

·

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41

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·

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

·

National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

·

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

·

Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm

·

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

·

New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm

·

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm

·

New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/

·

New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

·

New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/

·

New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html

·

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

·

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

·

Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp

Finding Medical Libraries 285

·

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/

·

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/

·

Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml

·

Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html

·

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html

·

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

·

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp

·

Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm

·

Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/

·

South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm

·

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

·

Texas: Matustik Family Resource Center (Cook Children's Health Care System), http://www.cookchildrens.com/Matustik_Library.html

·

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

·

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/

Your Rights and Insurance 287

APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with psoriasis faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.

Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.55 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·

Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.

55Adapted

from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.

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·

Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.

·

Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.

·

Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.

Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·

Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.

·

Women's health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women's healthcare services.

·

Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan's network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.

·

Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health

Your Rights and Insurance 289

plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·

Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.

Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·

Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.

·

Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.

·

Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.

·

Discuss all current treatments a consumer may be undergoing.

·

Discuss all risks, nontreatment.

·

Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.

benefits,

and

consequences

to

treatment

or

290 Psoriasis

·

Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.

·

Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.

Health plans, health providers, and healthcare facilities should: ·

Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.

·

Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers' ability to communicate with and advise patients about medically necessary treatment options.

·

Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.

Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·

Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

·

Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information

Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable

Your Rights and Insurance 291

healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient's Bill of Rights is available from the American Hospital Association.56

Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”57 In a healthcare system that protects consumers' rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·

Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.

·

Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.

·

Disclose relevant information and clearly communicate wants and needs.

·

Use your health insurance plan's internal complaint and appeal processes to address your concerns.

·

Avoid knowingly spreading disease.

56 To order your free copy of the Patient's Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient's Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 57 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1.

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·

Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.

·

Be aware of a healthcare provider's obligation to be reasonably efficient and equitable in providing care to other patients and the community.

·

Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.

·

Show respect for other patients and health workers.

·

Make a good-faith effort to meet financial obligations.

·

Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.

Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.58 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.59 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer's human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.

More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 59 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 58

Your Rights and Insurance 293

3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan's summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse's employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer's plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan's notice. Be sure to follow up with your plan sponsor if you don't receive notice, and make sure you respond within the allotted time.

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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer's human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan's decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.

Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation's largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful

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contact information on how to find more in-depth information about Medicaid.60

Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·

You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.

·

You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.

·

You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if: ·

You have received Social Security or Railroad Retirement Board disability benefit for 24 months.

·

You are a kidney dialysis or kidney transplant patient.

Medicare has two parts: ·

Part A (Hospital Insurance). Most people do not have to pay for Part A.

·

Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)

Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.

This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.

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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The

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phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.

Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare's premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·

Part A (Hospital Insurance),

·

Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and

·

A monthly income that is below certain limits.

For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.

NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.61 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.

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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.

Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:62 ·

Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html

·

Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html

·

HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html

·

Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html

·

Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html

·

Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html

·

Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html

·

Patient's Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html

·

Veteran's Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html

You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.

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Vocabulary Builder Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] HLA Antigens: Antigens determined by leukocyte loci found on chromosome 6, the major histocompatibility loci in humans. They are polypeptides or glycoproteins found on most nucleated cells and platelets, determine tissue types for transplantation, and are associated with certain diseases. [NIH] Hypopigmentation: A condition caused by a deficiency in melanin formation or a loss of pre-existing melanin or melanocytes. It can be complete or partial and may result from trauma, inflammation, and certain infections. [NIH]

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

·

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

·

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

·

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

·

On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/

·

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

·

Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html

Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to psoriasis and keep them on file. The NIH, in particular, suggests that patients with psoriasis visit the following Web sites in the ADAM Medical Encyclopedia:

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·

Basic Guidelines for Psoriasis AIDS Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000594.htm Psoriasis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000434.htm Psoriasis - guttate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000822.htm Psoriasis - resources Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002197.htm

·

Signs & Symptoms for Psoriasis Erythema Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Eye burning, itching and discharge Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003034.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Genital lesions (male) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003221.htm

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Hypopigmentation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003224.htm Itching Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003217.htm Joint pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003261.htm Muscle aches Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003178.htm Nail abnormalities Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003247.htm Obesity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003101.htm Onycholysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003247.htm Papule Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003233.htm Patches Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003231.htm Patchy loss of skin color Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003224.htm

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Pruritus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003217.htm Pustules Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003234.htm Rash Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Scales Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003226.htm Skin lesion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Skin lesions Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Skin redness or inflammation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Stria Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003287.htm Sunburn Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003227.htm

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Tearing, increased Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003036.htm ·

Diagnostics and Tests for Psoriasis Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm HLA antigens Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003550.htm Hyperplasia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003441.htm Rheumatoid factor Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003548.htm Sedimentation rate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm Skin biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003840.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm

·

Nutrition for Psoriasis Well-balanced diet Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002449.htm

·

Background Topics for Psoriasis

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Aggravated by Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002227.htm Alcohol consumption Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001944.htm Analgesics Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm Burns Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000030.htm Chemotherapy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002324.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Inflammatory response Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000821.htm Insect bites Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000033.htm Intravenous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002383.htm

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Phenol Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002903.htm Psoriasis - support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002197.htm Respiratory Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002290.htm Scales Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003226.htm Scaling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003226.htm Secondary infections Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002300.htm Stress management Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001942.htm Support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002150.htm Systemic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002294.htm

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Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

·

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

·

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

·

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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PSORIASIS GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abortion: 1. the premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. premature stoppage of a natural or a pathological process. [EU] Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Acitretin: An oral retinoid effective in the treatment of psoriasis. It is the major metabolite of etretinate with the advantage of a much shorter half-life when compared with etretinate. [NIH] Acne: An inflammatory disease of the pilosebaceous unit, the specific type usually being indicated by a modifying term; frequently used alone to designate common acne, or acne vulgaris. [EU] Acrodermatitis: Inflammation involving the skin of the extremities, especially the hands and feet. Several forms are known, some idiopathic and some hereditary. The infantile form is called Gianotti-Crosti syndrome. [NIH] Acyclovir: Functional analog of the nucleoside guanosine. It acts as an antimetabolite, especially in viruses. It is used as an antiviral agent, especially in herpes infections. [NIH] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]

Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Allylamine: Possesses an unusual and selective cytotoxicity for vascular

310 Psoriasis

smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alopecia: Baldness; absence of the hair from skin areas where it normally is present. [EU] Amiodarone: An antianginal and antiarrhythmic drug. It increases the duration of ventricular and atrial muscle action by inhibiting Na,K-activated myocardial adenosine triphosphatase. There is a resulting decrease in heart rate and in vascular resistance. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Angioedema: A vascular reaction involving the deep dermis or subcutaneous or submucal tissues, representing localized edema caused by dilatation and increased permeability of the capillaries, and characterized by development of giant wheals. [EU] Anionic: Pertaining to or containing an anion. [EU] Ankle: That part of the lower limb directly above the foot. [NIH] Anogenital: Pertaining to the anus and external genitals. [EU] Anorexia: Lack or loss of the appetite for food. [EU] Anthralin: An anti-inflammatory anthracene derivative used for the treatment of dermatoses, especially psoriasis. It may cause folliculitis. [NIH] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antigen: Any substance which is capable, under appropriate conditions, of

Glossary 311

inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Antiproliferative: Counteracting a process of proliferation. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Aromatic: Having a spicy odour. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arthropathy: Any joint disease. [EU] Asbestos: Asbestos. Fibrous incombustible mineral composed of magnesium and calcium silicates with or without other elements. It is relatively inert chemically and used in thermal insulation and fireproofing. Inhalation of dust causes asbestosis and later lung and gastrointestinal neoplasms. [NIH] Aspiration: The act of inhaling. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Atopic: Pertaining to an atopen or to atopy; allergic. [EU] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU]

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Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Balanitis: Inflammation of the glans penis; it is usually associated with phimosis. [EU] Bandages: Material used for wrapping or binding any part of the body. [NIH] Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for medical purposes with the addition of therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Blister: Visible accumulations of fluid within or beneath the epidermis. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Capsicum: A genus of Solanaceous shrubs that yield capsaicin. Several varieties have sweet or pungent edible fruits that are used as vegetables when fresh and spices when the pods are dried. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars,

Glossary 313

celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]

Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cheilitis: Inflammation of the lips. It is of various etiologies and degrees of pathology. [NIH] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Chlorophyll: Porphyrin derivatives containing magnesium that act to convert light energy in photosynthetic organisms. [NIH] Chloroquine: The prototypical antimalarial agent with a mechanism that is not well understood. It has also been used to treat rheumatoid arthritis, systemic lupus erythematosus, and in the systemic therapy of amebic liver abscesses. [NIH] Cholecalciferol: An antirachitic oil-soluble vitamin. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: Persisting over a long period of time. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal

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microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Clotrimazole: An imidazole derivative with a broad spectrum of antimycotic activity. It inhibits biosynthesis of the sterol ergostol, an important component of fungal cell membranes. Its action leads to increased membrane permeability and apparent disruption of enzyme systems bound to the membrane. [NIH] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [EU] Contraceptive: conception. [EU]

An agent that diminishes the likelihood of or prevents

Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytosine: A pyrimidine base that is a fundamental unit of nucleic acids. [NIH] Cytostatic: An agent that suppresses cell growth and multiplication. [EU] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU]

Glossary 315

Dendritic: 1. branched like a tree. 2. pertaining to or possessing dendrites. [EU]

Depigmentation: Removal or loss of pigment, especially melanin. [EU] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Dermatophytosis: Any superficial fungal infection caused by a dermatophyte and involving the stratum corneum of the skin, hair, and nails. The term broadly comprises onychophytosis and the various form of tinea (ringworm), sometimes being used specifically to designate tinea pedis (athlete's foot). Called also epidermomycosis. [EU] Dermatosis: Any skin disease, especially one not characterized by inflammation. [EU] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH]

Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Discoid: Shaped like a disk. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Econazole: A broad spectrum antimycotic with some action against Gram positive bacteria. It is used topically in dermatomycoses also orally and parenterally. [NIH] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents, characterized in the acute stage by erythema, edema associated with a serous exudate between the cells of the epidermis (spongiosis) and an inflammatory infiltrate in the dermis, oozing and vesiculation, and crusting and scaling; and in the more chronic stages by lichenification or thickening or both, signs of excoriations, and hyperpigmentation or hypopigmentation or both. Atopic dermatitis is the most common type of dermatitis. Called also eczematous dermatitis. [EU] Emollient: Softening or soothing; called also malactic. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the

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Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Erythrasma: A chronic, superficial bacterial infection of the skin involving the body folds and toe webs, sometimes becoming generalized, caused by Corynebacterium minutissimum, and characterized by the presence of sharply demarcated, dry, brown, slightly scaly, and slowly spreading patches. [EU] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Etretinate: An oral retinoid used in the treatment of keratotic genodermatosis, lichen planus, and psoriasis. Beneficial effects have also been claimed in the prophylaxis of epithelial neoplasia. The compound may be teratogenic. [NIH] Excipient: Any more or less inert substance added to a prescription in order to confer a suitable consistency or form to the drug; a vehicle. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Febrile: Pertaining to or characterized by fever. [EU] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Fluconazole: Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in AIDS. [NIH] Fluocinonide: A topical glucocorticoid used in the treatment of eczemas. [NIH]

Glossary 317

Folliculitis: Inflammation of a follicle or follicles; used ordinarily in reference to hair follicles, but sometimes in relation to follicles of other kinds. [EU]

Forskolin: Potent activator of the adenylate cyclase system and biosynthesis of cyclic AMP. From the plant Coleus forskohlii. antihypertensive, positive ionotropic, platelet aggregation inhibitory, smooth muscle relaxant activities; also lowers intraocular pressure promotes release of hormones from the pituitary gland. [NIH]

the Has and and

Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH]

Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoside: Any compound that contains a carbohydrate molecule (sugar), particularly any such natural product in plants, convertible, by hydrolytic cleavage, into sugar and a nonsugar component (aglycone), and named specifically for the sugar contained, as glucoside (glucose), pentoside (pentose), fructoside (fructose) etc. [EU]

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Gonadal: Pertaining to a gonad. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Graphite: Graphite. An allotropic form of carbon that is used in pencils, as a lubricant, and in matches and explosives. It is obtained by mining and its dust can cause lung irritation. [NIH] Griseofulvin: An antifungal antibiotic. Griseofulvin may be given by mouth in the treatment of tinea infections. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH] Haemostasis: The arrest of bleeding, either by the physiological properties of vasoconstriction and coagulation or by surgical means. [EU] Halitosis: An offensive, foul breath odor resulting from a variety of causes such as poor oral hygiene, dental or oral infections, or the ingestion of certain foods. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Histocompatibility: The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. [NIH] HLA Antigens: Antigens determined by leukocyte loci found on chromosome 6, the major histocompatibility loci in humans. They are polypeptides or glycoproteins found on most nucleated cells and platelets, determine tissue types for transplantation, and are associated with certain diseases. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hydration: The condition of being combined with water. [EU]

Glossary 319

Hydrocortisone: The main glucocorticoid secreted by the adrenal cortex. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions. [NIH] Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydroxyurea: An antineoplastic agent that inhibits DNA synthesis through the inhibition of ribonucleoside diphosphate reductase. [NIH] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hyperhidrosis: Excessive perspiration. polyhidrosis, and polyidrosis. [EU]

Called

also

hyperidrosis,

Hyperhomocysteinemia: An inborn error of methionone metabolism which produces an excess of homocysteine in the blood. It is often caused by a deficiency of cystathionine beta-synthase and is a risk factor for coronary vascular disease. [NIH] Hyperkeratosis: 1. hypertrophy of the corneous layer of the skin. 2a. any of various conditions marked by hyperkeratosis. 2b. a disease of cattle marked by thickening and wringling of the hide and formation of papillary outgrowths on the buccal mucous membranes, often accompanied by watery discharge from eyes and nose, diarrhoea, loss of condition, and abortion of pregnant animals, and now believed to result from ingestion of the chlorinated naphthalene of various lubricating oils. [EU] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU]

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Hyperthermia: Abnormally high body temperature, especially that induced for therapeutic purposes. [EU] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypopigmentation: A condition caused by a deficiency in melanin formation or a loss of pre-existing melanin or melanocytes. It can be complete or partial and may result from trauma, inflammation, and certain infections. [NIH] Ichthyosis: A group of cutaneous disorders characterized by increased or aberrant keratinization, resulting in noninflammatory scaling of the skin. Many different metaphors have been used to describe the appearance and texture of the skin in the various types and stages of ichthyosis, e.g. alligator, collodion, crocodile, fish, and porcupine skin. Most ichthyoses are genetically determined, while some may be acquired and develop in association with various systemic diseases or be a prominent feature in certain genetic syndromes. The term is commonly used alone to refer to i. vulgaris. [EU] Immunosuppressant: An agent capable of suppressing immune responses. [EU]

Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Induration: 1. the quality of being hard; the process of hardening. 2. an abnormally hard spot or place. [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU]

Glossary 321

Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]

Inhalation: The drawing of air or other substances into the lungs. [EU] Intertrigo: A superficial dermatitis occurring on apposed skin surfaces, such as the axillae, creases of the neck, intergluteal fold, groin, between the toes, and beneath pendulous breasts, with obesity being a predisposing factor, caused by moisture, friction, warmth, and sweat retention, and characterized by erythema, maceration, burning, itching, and sometimes erosions, fissures, and exudations and secondary infections. Called also eczema intertrigo. [EU] Intramuscular: Within the substance of a muscle. [EU] Intravenous: Within a vein or veins. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isotretinoin: A topical dermatologic agent that is used in the treatment of acne vulgaris and several other skin diseases. The drug has teratogenic and other adverse effects. [NIH] Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH]

Keloid: A sharply elevated, irregularly- shaped, progressively enlarging scar due to the formation of excessive amounts of collagen in the corium during connective tissue repair. [EU] Keratolytic: An agent that promotes keratolysis. [EU] Keratosis: Any horny growth such as a wart or callus. [NIH] Ketoconazole: Broad spectrum antifungal agent used for long periods at high doses, especially in immunosuppressed patients. [NIH] Kinetic: Pertaining to or producing motion. [EU] Laceration: 1. the act of tearing. 2. a torn, ragged, mangled wound. [EU] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Leukapheresis: The preparation of leukocyte concentrates with the return of

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red cells and leukocyte-poor plasma to the donor. [NIH] Leukocytosis: A transient increase in the number of leukocytes in a body fluid. [NIH] Lichenification: Hypertrophy of the epidermis, resulting in thickening of the skin with exaggeration of the normal skin markings, giving the skin a leathery barklike appearance, which is caused by prolonged rubbing or scratching. It may arise on seemingly normal skin, or it may develop at the site of another pruritic cutaneous disorder. [EU] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5-lipoxygenase, arachidonate 12lipoxygenase, and arachidonate 15-lipoxygenase. ec 1.13.11.12. [NIH] Liquifilm: A thin liquid layer of coating. [EU] Lithium: Lithium. An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]

Lymphokines: Soluble protein factors generated by activated lymphocytes that affect other cells, primarily those involved in cellular immunity. [NIH] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU]

Glossary 323

Maceration: The softening of a solid by soaking. In histology, the softening of a tissue by soaking, especially in acids, until the connective tissue fibres are so dissolved that the tissue components can be teased apart. In obstetrics, the degenerative changes with discoloration and softening of tissues, and eventual disintegration, of a fetus retained in the uterus after its death. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Malondialdehyde: The dialdehyde of malonic acid. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medicament: A medicinal substance or agent. [EU] Melanoma: A tumour arising from the melanocytic system of the skin and other organs. When used alone the term refers to malignant melanoma. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Metabolite: process. [EU]

Any substance produced by metabolism or by a metabolic

Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Methoxsalen: A naturally occurring furocoumarin compound found in several species of plants, including Psoralea corylifolia. It is a photoactive substance that forms DNA adducts in the presence of ultraviolet A irradiation. [NIH] Miconazole: An imidazole antifungal agent that is used topically and by intravenous infusion. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Necrosis: The sum of the morphological changes indicative of cell death and

324 Psoriasis

caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurodermatitis: An extremely variable eczematous dermatosis presumed to be a cutaneous response to prolonged vigorous scratching, rubbing, or pinching to relieve intense pruritus, having the potential to produce polymorphic lesions at the same or different times, and varying in severity, course, and morphologic expression in different individuals. It is believed by some authorities to be a psychogenic disorder. The term is also used to refer to lichen simplex chronicus (circumscribed n.) and sometimes to atopic dermatitis (disseminated n.). [EU] Neuropharmacology: The branch of pharmacology dealing especially with the action of drugs upon various parts of the nervous system. [NIH] Neutrophil: Having an affinity for neutral dyes. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nickel: Nickel. A trace element with the atomic symbol Ni, atomic number 28, and atomic weight 58.69. It is a cofactor of the enzyme urease. [NIH] Nystatin: Macrolide antifungal antibiotic complex produced by Streptomyces noursei, S. aureus, and other Streptomyces species. The biologically active components of the complex are nystatin A1, A2, and A3. [NIH]

Ocular: 1. of, pertaining to, or affecting the eye. 2. eyepiece. [EU] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Ophthalmic: Pertaining to the eye. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Osteomalacia: A condition marked by softening of the bones (due to impaired mineralization, with excess accumulation of osteoid), with pain, tenderness, muscular weakness, anorexia, and loss of weight, resulting from deficiency of vitamin D and calcium. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU]

Glossary 325

Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins c-mos. [NIH] Palladium: A chemical element having an atomic weight of 106.4, atomic number of 46, and the symbol Pd. It is a white, ductile metal resembling platinum, and following it in abundance and importance of applications. It is used in dentistry in the form of gold, silver, and copper alloys. [NIH] Papillomavirus: A genus of papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH]

Papule: A small circumscribed, superficial, solid elevation of the skin. [EU] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Parathyroid: 1. situated beside the thyroid gland. 2. one of the parathyroid glands. 3. a sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Pemphigus: A group of chronic, relapsing, sometimes fatal skin diseases characterized clinically by the development of successive crops of vesicles and bullae, histologically by acantholysis, and immunologically by serum autoantibodies directed against antigens in the intracellular zones of the epidermis. The specific disease is usually indicated by a modifying term; but the term pemphigus is often used alone to designate pemphigus vulgaris. [EU] Penicillamine: 3-Mercapto-D-valine. The most characteristic degradation product of the penicillin antibiotics. It is used as an antirheumatic and as a chelating agent in Wilson's disease. [NIH] Perioral: Situated or occurring around the mouth. [EU] Peroxidase: A hemeprotein from leukocytes. Deficiency of this enzyme leads to a hereditary disorder coupled with disseminated moniliasis. It catalyzes the conversion of a donor and peroxide to an oxidized donor and water. EC 1.11.1.7. [NIH] Petrolatum: A colloidal system of semisolid hydrocarbons obtained from petroleum. It is used as an ointment base, topical protectant, and lubricant. [NIH]

Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Pharmacologic:

Pertaining to pharmacology or to the properties and

326 Psoriasis

reactions of drugs. [EU] Pharyngitis: Inflammation of the pharynx. [EU] Phenolsulfonphthalein: Red dye, pH indicator, and diagnostic aid for determination of renal function. It is used also for studies of the gastrointestinal and other systems. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Photochemotherapy: Therapy using oral or topical photosensitizing agents with subsequent exposure to light. [NIH] Photosensitivity: An abnormal cutaneous response involving the interaction between photosensitizing substances and sunlight or filtered or artificial light at wavelengths of 280-400 mm. There are two main types : photoallergy and photoxicity. [EU] Phototherapy: Treatment of disease by exposure to light, especially by variously concentrated light rays or specific wavelengths. [NIH] Pityriasis: A name originally applied to a group of skin diseases characterized by the formation of fine, branny scales, but now used only with a modifier. [EU] Plague: An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plasminogen: The inactive precursor of plasmin (=enzyme that catalyses the hydrolysis of peptide bonds at the carbonyl end of lysine or arginine residues). [EU] Pneumoconiosis: Condition characterized by permanent deposition of substantial amounts of particulate matter in the lungs, usually of occupational or environmental origin, and by the tissue reaction to its presence. [NIH] Polyarthritis: An inflammation of several joints together. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]

Glossary 327

Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Prophylaxis: The prevention of disease; preventive treatment. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]

Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: 1. itching; an unpleasant cutaneous sensation that provokes the desire to rub or scratch the skin to obtain relief. 2. any of various conditions marked by itching, the specific site or type being indicated by a modifying term. [EU] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]

Pulmonary: Pertaining to the lungs. [EU] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Pustular: Pertaining to or of the nature of a pustule; consisting of pustules (= a visible collection of pus within or beneath the epidermis). [EU] Pyoderma: Any purulent skin disease. Called also pyodermia. [EU] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and

328 Psoriasis

potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alpha-adrenergic neurotransmission. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refractory: Not readily yielding to treatment. [EU] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Ruthenium: A hard, brittle, grayish-white rare earth metal with an atomic symbol Ru, atomic number 44, and atomic weight 101.07. It is used as a catalyst and hardener for platinum and palladium. [NIH] Salicylates: The salts, esters of salicylic acids, or salicylate esters of an organic acid. Some of these have analgesic, antipyretic, and anti-

Glossary 329

inflammatory activities by inhibiting prostaglandin synthesis. [NIH] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Scabies: A contagious dermatitis of humans and various wild and domestic animals caused by the itch mite, Sarcoptes scabiei, transmitted by close contact, and characterized by a papular eruption over tiny, raised sinuous burrows (cuniculi) produced by digging into the upper layer of the epidermis by the egg-laying female mite, which is accompanied by intense pruritus and sometimes associated with eczema from scratching and secondary bacterial infection. Called also the itch and seven-year itch. [EU] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Serine: A non-essential amino acid occurring in natural form as the Lisomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU]

330 Psoriasis

Sialorrhea: Increased salivary flow. [NIH] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Solvent: 1. dissolving; effecting a solution. 2. a liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spermidine: A polyamine formed from putrescine. It is found in almost all tissues in association with nucleic acids. It is found as a cation at all pH values, and is thought to help stabilize some membranes and nucleic acid structures. It is a precursor of spermine. [NIH] Spermine: A biogenic polyamine formed from spermidine. It is found in a wide variety of organisms and tissues and is an essential growth factor in some bacteria. It is found as a polycation at all pH values. Spermine is associated with nucleic acids, particularly in viruses, and is thought to stabilize the helical structure. [NIH] Spondylitis: Inflammation of the vertebrae. [EU] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Squamous: Scaly, or platelike. [EU] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters.

Glossary 331

Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH]

Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Sulfacetamide: An anti-infective agent that is used topically to treat skin infections and orally for urinary tract infections. [NIH] Sulfapyridine: Antibacterial, potentially toxic, used to treat certain skin diseases. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Sunburn: An injury to the skin causing erythema, tenderness, and sometimes blistering and resulting from excessive exposure to the sun. The reaction is produced by the ultraviolet radiation in sunlight. [NIH] Superantigens: Microbial antigens that have in common an extremely potent activating effect on T-cells that bear a specific variable region. Superantigens cross-link the variable region with class II MHC proteins regardless of the peptide binding in the T-cell receptor's pocket. The result is a transient expansion and subsequent death and anergy of the T-cells with the appropriate variable regions. [NIH] Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU] Tachyphylaxis: 1. rapid immunization against the effect of toxic doses of an extract or serum by previous injection of small doses. 2. rapidly decreasing response to a drug or physiologically active agent after administration of a

332 Psoriasis

few doses. [EU] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thimerosal: A topical antiseptic used on skin and mucous membranes. It is also used as a preservative in pharmaceuticals. [NIH] Thioguanine: An antineoplastic compound which also has antimetabolite action. The drug is used in the therapy of acute leukemia. [NIH] Thrombosis: The formation, development, or presence of a thrombus. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxic: Pertaining to, due to, or of the nature of a poison or toxin; manifesting the symptoms of severe infection. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Trioxsalen: Pigmenting photosensitizing agent obtained from several plants, mainly Psoralea corylifolia. It is administered either topically or orally in conjunction with ultraviolet light in the treatment of vitiligo. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH]

Glossary 333

Tumour: 1. swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. a new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Urticaria: Pathology: a transient condition of the skin, usually caused by an allergic reaction, characterized by pale or reddened irregular, elevated patches and severe itching; hives. [EU] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Venereology: A branch of medicine which deals with sexually transmitted disease. [NIH] Vesicular: 1. composed of or relating to small, saclike bodies. 2. pertaining to or made up of vesicles on the skin. [EU] Vitiligo: A disorder consisting of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck, and in skin folds. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent state is reached. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH]

Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU]

334 Psoriasis

General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna

·

Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna

·

A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna

·

Dorland's Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna

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Dorland's Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna

·

Dorland's Pocket Medical Dictionary (Dorland's Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618

·

Melloni's Illustrated Medical Dictionary (Melloni's Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna

·

Stedman's Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna

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·

Stedman's Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna

·

Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna

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INDEX A Abortion ...............106, 128, 137, 309, 319 Acetylcysteine......................................254 Acitretin.....16, 24, 57, 60, 73, 76, 98, 177, 188 Acne .30, 32, 35, 134, 151, 181, 269, 309, 321, 328 Acrodermatitis..................................24, 71 Acyclovir ................................................70 Adhesions............................................129 Adolescence ..................................33, 309 Alimentary..............................33, 135, 311 Alopecia...................................71, 75, 176 Analgesic .....................................222, 328 Analogous..............................................83 Anemia ..........................................16, 199 Angioedema ........................................144 Anionic .........................................120, 121 Ankle......................................................76 Anogenital..............................................78 Anorexia ..............................160, 229, 324 Anthralin .....13, 14, 15, 22, 26, 72, 74, 77, 79, 117, 122, 130, 145, 172, 193, 267 Antibiotic ...36, 70, 92, 106, 109, 140, 318, 324, 330, 332 Antibody..48, 56, 65, 81, 84, 88, 104, 108, 119, 132, 170, 311, 314, 323, 329 Anticonvulsant .....................173, 180, 312 Antigen ...48, 58, 65, 82, 86, 88, 108, 118, 126, 133, 310, 323, 329 Antimicrobial ..........................................26 Antioxidant...........................................134 Antiproliferative......................................74 Antiviral ..........................56, 103, 258, 309 Anus ......................................23, 104, 310 Arginine .................................87, 109, 326 Aromatic ..............................................102 Arteries ..................................34, 134, 314 Asbestos ..............................................129 Aspiration...............................................55 Assay.....................................................81 Asymptomatic ......................................175 Atopic....... 71, 87, 89, 108, 144, 151, 174, 231, 233, 238, 324 Atrophy ..........................................74, 199 Atypical ................................................178 Autoimmunity.................................38, 132 B Bandages ..............................................58 Baths .............................24, 174, 230, 233 Benign .................................133, 145, 153

Biochemical......................................... 116 Biopsy ..... 11, 53, 54, 58, 72, 73, 174, 305 C Candidiasis ........................... 71, 105, 316 Capsules ............................................. 265 Carbohydrate ...................... 138, 264, 317 Carcinoma............................... 79, 93, 151 Cardiovascular .................................... 134 Carotene ............................................. 246 Catabolism .......................................... 136 Cataract ...................................... 203, 313 Cerebral .............................................. 134 Cheilitis ................................................. 75 Chemotaxis ........................................... 81 Chlorine................................................. 22 Chlorophyll .......................... 117, 180, 317 Chloroquine................................. 117, 173 Cholesterol... 36, 134, 139, 262, 264, 322, 331 Chromosomal ....................................... 82 Cirrhosis.............................................. 178 Clotrimazole .......................................... 71 Coal.... 13, 14, 15, 26, 72, 73, 77, 79, 117, 122, 130, 172, 268, 270 Collagen..... 138, 172, 180, 181, 203, 314, 316, 319, 321 Conception.... 27, 137, 155, 178, 309, 314 Conjugated............................................ 87 Conjunctivitis......................................... 25 Coronary ....................................... 34, 319 Cutaneous.... 60, 71, 75, 77, 83, 104, 106, 107, 108, 110, 140, 144, 152, 153, 160, 312, 320, 322, 324, 326, 327 Cytokines .. 81, 89, 91, 131, 133, 222, 330 Cytomegalovirus ................................. 268 Cytosine .............................................. 128 Cytostatic .................................... 123, 236 Cytotoxic ............................................... 77 D Degenerative ...... 108, 155, 263, 323, 328 Dendritic................................................ 88 Depigmentation....................... 48, 71, 333 Dermatology.............. 39, 40, 98, 144, 159 Dermatophytosis ................................... 71 Dermatosis.................. 108, 118, 145, 324 Dermis...... 34, 81, 87, 105, 115, 116, 123, 124, 136, 155, 310, 315 Diarrhea .............................................. 262 Discoid ................................................ 149 Distal ...... 33, 82, 110, 119, 191, 222, 311, 327, 328

Index 337

Dysplasia .....................................152, 199 E Econazole..............................................71 Eczema.....30, 71, 78, 107, 118, 120, 134, 136, 156, 174, 191, 192, 321, 329 Emollient........................35, 117, 193, 324 Endogenous ..........................34, 129, 315 Enzyme.......104, 109, 110, 133, 138, 140, 314, 316, 322, 324, 325, 326, 327 Epidemiological ...................................144 Epidermal ...72, 77, 82, 84, 87, 90, 91, 93, 95, 112, 114, 116, 119, 122, 124, 127, 131, 132, 133, 136, 333 Erythema ......34, 36, 71, 75, 81, 107, 127, 145, 152, 315, 321, 331 Erythrasma ............................................71 Etretinate ......32, 57, 73, 76, 98, 145, 151, 177, 230, 232, 309 Excipient ......................................117, 126 Exogenous.....34, 129, 132, 138, 315, 316 Extracellular...........90, 138, 139, 316, 318 F Facial .......................................25, 78, 178 Fatigue...................................................15 Febrile..................................................145 Fibroblasts ...........................................128 Fibrosis .......103, 129, 145, 180, 181, 310, 314, 329 Fluconazole ...........................................72 Fluocinonide ..........................................80 Folliculitis .......................................33, 310 Friction ...................................12, 107, 321 Fungus.................................104, 174, 312 G Gastrointestinal...137, 178, 180, 222, 311, 316, 317, 326 Genotype .....................................109, 326 Gingivitis ......................................145, 152 Glycine...................................................58 Glycoside.............................................123 Gonadal .........................................36, 331 Granulocytes .......................................128 Griseofulvin............................................71 Groin ....................23, 24, 70, 80, 107, 321 H Halitosis ...............................................145 Hemorrhage.........................145, 155, 327 Herpes ...................70, 103, 106, 309, 318 Histocompatibility.........115, 126, 299, 318 Homeostasis........................................131 Hydration .............................................176 Hydrocortisone ....................................192 Hydrogel ..............................................118 Hydrophilic...........................101, 139, 319 Hydroxyurea ..............................15, 16, 27 Hypercalcemia.......................80, 126, 158

Hyperhidrosis ........................................ 75 Hyperkeratosis ..... 74, 91, 106, 124, 128, 319 Hyperpigmentation........................ 34, 315 Hyperplasia ... 77, 110, 124, 131, 144, 329 Hypersensitivity................................... 129 Hypertension................................. 16, 235 Hyperthermia ...................................... 237 Hypertriglyceridemia ..................... 98, 232 Hypopigmentation......................... 34, 315 I Ichthyosis .................... 106, 128, 238, 320 Immunization ........ 58, 111, 112, 329, 331 Immunosuppressant ..... 35, 222, 323, 330 Incision........................................ 180, 321 Induction ................................... 66, 89, 90 Induration .............. 81, 110, 127, 152, 329 Infertility............................................... 158 Infiltration .............................. 91, 115, 122 Infusion ........................... 53, 83, 108, 323 Ingestion ....... 79, 106, 155, 265, 318, 319 Intertrigo................................ 71, 107, 321 Intramuscular ...................................... 116 Intravenous ......... 53, 70, 83, 86, 108, 323 Invasive............................................... 175 Iodine .................................................. 117 Ischemia.............................................. 134 K Keloid .................................................. 175 Keratolytic ............................................. 74 Keratosis ............................................. 145 Ketoconazole .................................. 70, 71 L Lesion ...... 75, 85, 93, 105, 108, 116, 119, 172, 304, 316, 322 Leukocytosis ....................................... 119 Lichenification ......................... 34, 75, 315 Lipid .............................. 94, 134, 139, 322 Lipoprotein .................................. 139, 322 Lipoxygenase...................................... 121 Lithium ...................... 11, 35, 91, 173, 322 Localization ..................... 82, 90, 277, 325 Lupus .......... 129, 138, 145, 152, 175, 313 Lymphokines......................................... 90 Lymphoma .................. 167, 181, 198, 322 M Maceration ............................ 71, 107, 321 Malondialdehyde................................... 94 Manic .................................... 35, 173, 322 Mediate ........................................... 74, 84 Medicament ........................................ 117 Melanoma .. 15, 30, 35, 79, 144, 151, 167, 176, 198, 323 Membrane............. 78, 104, 131, 133, 314 Metabolite ......... 32, 57, 75, 158, 265, 309

338 Psoriasis

Methotrexate.....15, 16, 22, 24, 26, 27, 28, 72, 73, 77, 79, 83, 91, 122, 128, 130, 135, 145, 173, 178, 191 Methoxsalen ........................................237 Miconazole ............................................71 Molecular ..58, 89, 92, 110, 112, 134, 184, 196, 197, 328, 332 Monotherapy..........................................75 Morphogenesis ......................................90 N Necrosis...............................181, 268, 329 Neural ..................................................263 Neurodermatitis .....................................96 Neuropharmacology ............................102 Niacin...................................................263 Nickel.....................................................75 Nystatin..................................71, 109, 324 O Ocular ..................................................120 Ointments .13, 24, 25, 36, 70, 73, 79, 130, 134, 135, 330 Ophthalmic ............................................25 Osteomalacia.......................................158 Osteoporosis ...............................126, 158 Overdose .............................................263 P Paclitaxel ...............................................53 Palladium.............................................135 Parasitic ...............................................145 Parathyroid 55, 66, 92, 158, 160, 325, 328 Pemphigus...........................152, 155, 325 Penicillamine .......................................152 Perioral ................................................144 Peroxidase.......................................94, 99 Petrolatum .....................................85, 172 Pharmacokinetics ................................269 Pharmacologic.......................................79 Pharyngitis...........................................119 Phenotype ...............83, 91, 109, 133, 326 Phosphorylation.....................................90 Photochemotherapy .....27, 77, 78, 96, 99, 100, 149, 174, 191 Pityriasis ........................................71, 153 Plague ...................................85, 109, 326 Plasminogen..........................................98 Pneumoconiosis ..................................129 Polyarthritis..........................................119 Postmenopausal..................................158 Postoperative.......................................151 Predisposition ................................79, 119 Prednisone ............................................76 Prevalence...............................77, 92, 268 Prophylaxis ................35, 66, 70, 316, 328 Protease ........................................98, 122 Proteins ....58, 65, 81, 104, 111, 132, 237, 262, 264, 311, 314, 331

Proximal ................................ 71, 105, 315 Pruritic..................... 34, 78, 107, 315, 322 Pruritus.. 78, 108, 110, 156, 324, 327, 329 Psychiatric........................................... 173 Psychosomatic...................................... 98 Psychotherapy .................................... 235 Pulmonary..... 33, 129, 139, 178, 313, 318 Purpura ............................................... 152 Pustular ....... 12, 24, 28, 71, 76, 145, 175, 177, 230 Pyoderma.............................................. 71 Q Quinidine............................................. 173 R Receptor .... 65, 74, 79, 84, 88, 90, 91, 92, 111, 114, 131, 311, 331 Recurrence ................................... 16, 178 Refractory ..................................... 72, 169 Remission . 35, 56, 75, 125, 130, 175, 328 Retinoids .... 13, 15, 22, 23, 26, 27, 28, 30, 72, 74, 77, 79, 122, 145, 173, 177, 191 Rheumatoid.... 41, 89, 129, 138, 162, 168, 313 Riboflavin ............................................ 262 Ruthenium........................................... 135 S Saline ...................................... 58, 66, 320 Sarcoidosis ......................................... 174 Sarcoma................................................ 70 Scabies ............................................... 151 Sclerosis ............... 89, 129, 162, 199, 229 Secretion......................... 87, 91, 110, 329 Selenium ......................... 71, 99, 235, 264 Serine.................................................. 122 Serology................................................ 41 Serum .... 48, 83, 111, 112, 119, 155, 178, 325, 329, 331 Sialorrhea............................................ 145 Soaps................................ 25, 35, 78, 330 Solvent ................................ 123, 180, 316 Species .. 36, 71, 108, 109, 111, 123, 141, 181, 323, 324, 327, 330, 331, 332 Spectrum....... 14, 39, 104, 105, 107, 314, 315, 321 Spermidine............................ 97, 111, 330 Spermine............................... 97, 111, 330 Spondylitis................................... 119, 191 Sporadic................................................ 82 Squamous....................................... 15, 79 Stasis .................................................... 78 Steroid..... 25, 26, 110, 116, 130, 173, 328 Stomatitis .................................... 144, 152 Sunburn .............................. 12, 13, 26, 76 Superantigens....................................... 91 Synovial ................................................ 55

Index 339

T Tachyphylaxis........................................74 Teratogenic..............66, 74, 181, 316, 321 Tetracycline .........................................132 Thermal .......................137, 232, 234, 311 Thermoregulation ................................262 Thimerosal.............................................58 Thioguanine.........................................117 Thyroxine.............................................264 Toxic ....... 16, 66, 87, 111, 112, 126, 145, 229, 263, 329, 331, 332 Toxicity ......................54, 87, 89, 178, 231 Toxin..................................36, 88, 92, 332 Transplantation............................299, 318 Trioxsalen ....................................100, 237 Tuberculosis ........................129, 140, 322

Tumour.................. 35, 110, 268, 323, 329 Tyrosine .............................................. 135 U Urticaria................................... 75, 78, 144 V Vaccine ....................... 112, 162, 164, 333 Vascular ... 34, 78, 91, 103, 105, 155, 222, 309, 310, 315, 319 Venereal...................................... 111, 331 Vesicular ............................................. 145 Vitiligo ................................... 71, 112, 332 W Warts....................... 70, 72, 128, 232, 268 X Xerostomia.......................................... 145

340 Psoriasis

Index 341

342 Psoriasis

The 2002 Official Patient's Sourcebook on Psoriasis: A Revised and Updated Directory for the Internet Age