University of Virginia Health System

Men's Health

New Treatments Help People Manage Psoriasis

August Is Psoriasis Awareness Month

New breakthrough treatments, along with existing remedies, should mean more help for people with mild and even severe forms of psoriasis.

"We're not only making a tremendous amount of progress understanding the immunology of psoriasis but also the genetics of psoriasis," says Dr. Paul Cabiran, a dermatologist with the Ochsner Clinic in New Orleans.

"Before, treatments were more generalized, and now they're more specific,” Dr. Cabiran says. “They're getting much more sophisticated.”

That is a message health officials want to communicate during August, which has been designated Psoriasis Awareness Month by the US Department of Health and Human Services (HHS).

Skin Production Moves into Overdrive

An estimated 5.5 million Americans suffer from psoriasis, which affects men and women equally, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

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.

People with psoriasis may suffer discomfort, including pain and itching, restricted motion in their joints, and emotional distress.

Experts say these symptoms mark an immune process gone awry.

Defective immune system cells trigger a cascade of events that results in the skin's outer layer growing at a much faster rate than normal.

"In some cases, it's seven or eight times the normal rate of skin growth," Dr. Cabiran explains. "The process is accelerated tremendously so the dead layers build up too quickly."

So quickly, that there is not enough time for the old layers to slough off to make room for the new, hence the scaly, thick patches or "plaques." The red color comes from the increased blood supply that rapidly growing cells need for fuel.

The majority of psoriasis cases seem to have a genetic component, though scientists are still working to find the problem gene - or genes.

The relatively recent discovery that psoriasis is an immune-based disease has paved the way for breakthroughs in treatment for more severe forms of the disease.

"That understanding has led people to say, 'Let's see what we can do to have more effective therapy,'" says Dr. Kenneth Gordon, an associate professor at the Loyola University Stritch School of Medicine in Chicago and chairman of the research committee of the National Psoriasis Foundation.

Therapies Improve with New Understanding

An estimated 25 percent to 33 percent of people with psoriasis suffer from more severe forms of the disease, which is measured by how much of their body surface is affected.

Traditionally, these individuals have been treated with high-octane drugs that affect the whole body, not just the area requiring care.

One of the most common treatments is methotrexate, a chemotherapy drug most often used against cancer of the lymph system.

Another common drug is cyclosporine, which suppresses the immune system and is used to prevent organ rejection in transplant patients.

The problem is that, over the long term, these therapies can increase the risk of cancer and may have adverse affects on the liver, kidney, and blood pressure, Dr. Gordon says.

"We've been limited, and many physicians have felt uncomfortable treating [psoriasis] aggressively," Dr. Gordon says.

In March, however, the Food and Drug Administration (FDA) approved the first biologic treatment for psoriasis. Alefacept (called Amevive®), is widely considered by experts to be a breakthrough drug.

A study in the Archives of Dermatology found that people taking 15 milligrams of alefacept had a 75 percent reduction in their Psoriasis Area and Severity Index (PASI), a measure of the clinical severity of the condition.

Alefacept halts the overproduction of skin cells by destroying the defective immune cells that are responsible.

"These biologic medications are designed to attack a very specific part of the immune system and leave the rest of the body intact," Dr. Gordon says. "The true benefit of these medications, we think, is this ability to use them with a high level of security about safety for long periods of time.

"Many patients get psoriasis when they're young," Dr. Gordon says. "What you have is a situation where people are going to have a disease for 30, 40, 50 years so long-term safety is paramount."

Another biologic drug, etanercept (called Enbrel®), has also been approved by the FDA for psoriatic arthritis.

For milder forms of the disease, different treatments are available.

"Topical therapies [creams] are more reasonable with people with less body area involved because it takes less time to cover themselves with creams every day," Dr. Gordon says.

Dr. Cabiran says steroid creams and topical Vitamin D are a common first step for people who simply have a little patch on the elbow or knees or scalp.

People with larger areas affected might benefit from phototherapy - light therapy.

"One of the most successful types is narrow-band UVB, which is a very specific wave length of UVB light," Dr. Cabiran says. "You turn the light on for a few minutes. It's a really great way to treat the whole body."

Always consult your physician for a diagnosis.

What Is Psoriatic Arthritis?

Psoriatic arthritis is a form of arthritis associated with psoriasis, a chronic skin and nail disease characterized by red, scaly rashes and thick, pitted fingernails. The disease is similar to rheumatoid arthritis in symptoms, characterized by joint inflammation.

However, psoriatic arthritis tends to affect fewer joints than rheumatoid arthritis and does not produce the typical rheumatoid arthritis antibodies. The arthritis associated with psoriatic arthritis comes in five forms including the following:

• arthritis that affects the small joints in the fingers and/or toes
  
  
• asymmetrical arthritis of the joints in the extremities
  
  
• symmetrical polyarthritis, a type of arthritis similar to rheumatoid arthritis
  
  
• arthritis mutilans, a rare type of arthritis that destroys and deforms joints
  
  
• psoriatic spondylitis, arthritis of the sacroiliac sac (in the lower back) and the spine

Always consult your physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)

Archives of Dermatology

Centers for Disease Control and Prevention (CDC)

Food and Drug Administration (FDA)

Healthfinder, US Department of Health and Human Services (HHS)

Men's Health Network

National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)

National Institutes of Health (NIH)

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

August 2003

New Treatments Help People Manage Psoriasis

Skin Production Moves into Overdrive

Therapies Improve with New Understanding

What Is Psoriatic Arthritis?

Erectile Dysfunction: Learn More Because It Could Save Your Life

Vascular Health Is Important

Healthy Habits Count

Risk Factors for Erectile Dysfunction

Online Resources

Erectile Dysfunction: Learn More Because It Could Save Your Life

Erectile dysfunction or ED, the inability to have an erection or sustain one long enough for intimate relations, is a condition that regularly affects some 30 million American men.

While once believed to be a largely unavoidable rite of passage into the senior years, chronic erectile dysfunction is now showing up in much younger men, often beginning as early as 40 years old, experts say.

"It's an important barometer of a man's overall health - particularly the health of the blood vessels," says Dr. Andrew McCollough, director of Sexual Health, Fertility, and Microsurgery at New York University Medical Center. "So if a man is at risk for any type of vascular disease, he is also at risk for ED, regardless of his age."

Vascular Health Is Important

One reason: erections are closely tied to vascular health.

For an erection to occur, a man must experience a series of brain signals that combine with local nerve stimulation to relax a pair of smooth muscles that run the length of the inside of the penis. This, in turn, lets blood flow from nearby vessels, into two tissue-filled chambers, also located inside the organ.

The force of the blood creates a pressure that lets the penis expand, creating an erection. A thin membrane helps trap the blood and keep it in the penile chambers, long enough to sustain the erection.

The entire process reverses when the muscles in the penis contract.

"Obviously, anything that impedes that entire process, particularly anything which affects the ability of blood to flow freely into the penis, has the potential to cause ED," Dr. McCullough says.

Not only is the problem almost always the result of a physical condition, most men are surprised to learn that some very common conditions, including high blood pressure, high cholesterol, obesity, and diabetes, are often a major cause, experts say.

"Frequently, erectile dysfunction is the first sign of these problems, and it can show up long before any typical symptoms develop," says Dr. Natan Bar-Chama, director of male reproductive medicine and surgery at Mount Sinai Medical Center in New York City.

Healthy Habits Count

Diagnosing and treating these common health problems, particularly in their early stages, can not only protect a man's overall health, it can often have a remarkable effect on erectile dysfunction, Dr. McCollough says.

Experts say most men are very surprised to discover that by simply lowering their cholesterol or their blood pressure - often through simple measures such as diet and exercise - they can also boost their virility, says Dr. Bar-Chama. The same is true, he says, of men who lose weight and cut back on cigarettes and alcohol.

"This is particularly true at the start of these conditions, before any real damage is done to the blood vessels," Dr. McCollough adds.

Still, experts say most men are resistant about seeing a physician for erectile dysfunction, or even their general health. And physicians do not always make it easy for men to come forward with their problems.

This, he says, not only means that erectile dysfunction goes untreated, but that sometimes, other health problems are also overlooked at their earliest, most easily treated stages.

Both Drs. Bar-Chama and McCollough warn men against obtaining drugs for treatment of erectile dysfunction without first receiving a physical examination, including important blood tests.

"You should never attempt to treat chronic ED on your own," Dr. McCollough says.

Always consult your physician for more information.

Risk Factors for Erectile Dysfunction

According to the National Institutes of Health (NIH), erectile dysfunction is a symptom in many disorders and diseases.

Direct risk factors for erectile dysfunction may include the following:

• prostate problems
• type 2 diabetes
• hypogonadism in association with a number of endocrinologic conditions
• hypertension (high blood pressure)
• vascular disease and vascular surgery
• high levels of blood cholesterol
• low levels of HDL (high-density lipoprotein)
  drugs
• neurogenic disorders
• Peyronie's disease (distortion or curvature of the penis)
• priapism (inflammation of the penis)
• depression
• alcohol ingestion
• lack of sexual knowledge
• inadequate interpersonal relationships
• many chronic diseases, especially renal failure and dialysis
• smoking

Age appears to be a strong indirect risk factor in that it is associated with increased likelihood of direct risk factors, some of which are listed above.

Always consult your physician for more information.