Psoriasis: Young M

Pariser DM, Bagel J, Gelfand JM, Korman NJ, Ritchlin CT, Strober BE, Van Voorhees AS, Young M, Rittenberg S, Lebwohl MG, Horn EJ, Anonymous00184. · Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA. · Arch Dermatol. · Pubmed #17310004 links to  free full text

Abstract: OBJECTIVES: A task force of the National Psoriasis Foundation Medical Board was convened to evaluate the current severity criteria of mild, moderate, and severe psoriasis and to make recommendations concerning a 2-tiered categorization of severity based on current clinical practice and related to intent to treat. PARTICIPANTS: This volunteer task force, led by David M. Pariser, MD, included Jerry Bagel, MD, Joel M. Gelfand, MD, MSCE, Neil J. Korman, MD, PhD, Christopher T. Ritchlin, MD, Bruce E. Strober, MD, PhD, Abby S. Van Voorhees, MD, and Melodie Young, MSN, RN, ANP. Meetings were held by teleconference and were coordinated and funded by the National Psoriasis Foundation. EVIDENCE: This task force reviewed psoriasis severity criteria and other published psoriasis consensus statements. Current standards of care and expert opinion were used to inform the process. CONSENSUS PROCESS: Based on meetings of the task force and under the guidance of David M. Pariser, MD, a statement was drafted by Elizabeth J. Horn, PhD, presented to the task force, and reviewed and approved by the task force. This statement was then reviewed and approved by Robert E. Kalb, MD, Gerald G. Krueger, MD, and Alan Menter, MD. The National Psoriasis Foundation Medical Board reviewed and endorsed this statement by a majority vote on March 2, 2006, at the medical board meeting. CONCLUSIONS: This clinical consensus statement proposes a 2-tiered system for plaque psoriasis therapy that reflects more accurately than the current system how patients are treated in clinical practice. This statement, focused on plaque psoriasis, is intended to assist medical professionals and insurance payers in understanding these 2 categories of patients with psoriasis and choosing appropriate therapies for these patients.

Riddle C, Young M, Menter A. · Department of Internal Medicine, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA. · Dermatol Clin. · Pubmed #15450344 No free full text.

Abstract: Exciting new therapies are becoming available that allow dermatologists and patients safe and effective alternatives to traditional psoriasis therapy. Because these new biologic drugs are parenterally administered, practical aspects of their integration into clinical practice must be addressed. This article offers guidelines for incorporating subcutaneous,intramuscular, and intravenous injectables into dermatology offices. Several tiers of psoriasis care are outlined to encourage individual physicians to choose the optimum level of service compatible with their individual practices.

Lebwohl M, Drake L, Menter A, Koo J, Gottlieb AB, Zanolli M, Young M, McClelland P. · Department of Dermatology, Mount Sinai School of Medicine, New York University 10029-6574, USA. · J Am Acad Dermatol. · Pubmed #11568745 No free full text.

Abstract: Although adjunctive treatment with retinoids in concert with either psoralen-ultraviolet A (PUVA) or ultraviolet B (UVB) phototherapy has been a treatment option for chronic, moderate to severe plaque psoriasis for nearly two decades, acitretin-UV therapy is an underutilized therapeutic modality. According to a recent member survey by the National Psoriasis Foundation, many psoriasis patients are frustrated with available treatment options, which they perceive as ineffective, inconvenient, and/or excessively conservative. Treatment of psoriasis with acitretin in concert with UVB or PUVA is emerging as a viable clinical strategy. Compared with either acitretin or UV light monotherapy alone, the combination regimen enhances efficacy and limits treatment frequency, duration, and cumulative doses. These effects translate into care that is more effective, better tolerated, more convenient, less costly, and, perhaps, safer during long-term treatment than phototherapy alone. Drawing from an extensive literature search and the expertise of its participants, this consensus conference advances clinical recommendations as well as "clinical pearls" for health providers who treat patients with chronic, moderate to severe plaque psoriasis and suggests avenues for future research.

Strober B, Berger E, Cather J, Cohen D, Crowley JJ, Gordon KB, Gottlieb A, Horn EJ, Kavanaugh AF, Korman NJ, Krueger GG, Leonardi CL, Menter A, Schwartzman S, Sobell JM, Young M. · Department of Dermatology, New York University Medical Center, New York, NY, USA. · J Am Acad Dermatol. · Pubmed #19527820 No free full text.

Abstract: Clinical trials for systemic psoriasis therapy typically enroll healthy patients and exclude patients with cardiovascular disease, latent tuberculosis, liver disease, histories of malignancies, viral infections, children, and pregnant or breast-feeding women. Physicians often require guidance for optimum management of severe psoriasis in patients that have a combination of underlying disease states. To provide treatment recommendations for complex psoriasis scenarios, a consensus panel comprising 15 experts in psoriatic disease convened to review and discuss available evidence-based data and to arrive at a consensus for treatment options of difficult cases. An application of the Delphi Method was used to select case scenarios, provide medical treatment options, present the case study with existing medical evidence, and anonymously vote on treatment options. The top 10 treatment options were ranked and statistically analyzed to compare the differences between treatments. The final rankings and analysis provide guidance for practical, safe, and efficacious treatment options in a number of complex psoriasis scenarios.

Chan CS, Van Voorhees AS, Lebwohl MG, Korman NJ, Young M, Bebo BF, Kalb RE, Hsu S. · Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030, USA. · J Am Acad Dermatol. · Pubmed #19375191 No free full text.

Abstract: BACKGROUND: The scalp is the most commonly affected part of the body in patients with psoriasis. Signs and symptoms of scalp psoriasis vary significantly for individual patients. OBJECTIVE: A task force of the National Psoriasis Foundation was convened to evaluate treatment options. Our aim was to achieve a consensus for scalp psoriasis therapy. METHODS: Reports in the medical literature were reviewed regarding scalp psoriasis therapy. LIMITATIONS: There is a paucity of evidence-based and double-blind studies in the treatment of scalp psoriasis particularly for long-term therapy. Many of the studies in scalp psoriasis were designed to attain Food and Drug Administration approval for a medication and not to provide treatment guidance. CONCLUSIONS: The recommended short-term or intermittent therapy for scalp psoriasis is topical corticosteroids. The primary alternatives are topical retinoids, vitamin D analogues, and salicylic acid. Combination therapy has many advantages. The choice of an appropriate vehicle is crucial to increase patient compliance. While scalp psoriasis can often be adequately treated with topical therapy, recalcitrant disease may require more aggressive approaches, including systemic agents.

Kalb RE, Bagel J, Korman NJ, Lebwohl MG, Young M, Horn EJ, Van Voorhees AS, Anonymous00091. · Department of Dermatology, State University of New York School of Medicine and Biomedical Sciences, Buffalo, New York, USA. · J Am Acad Dermatol. · Pubmed #19103363 No free full text.

Abstract: BACKGROUND: Involvement of areas of the skin fold is common in patients with psoriasis although the exact incidence is unknown. This report summarizes studies regarding the therapy of intertriginous psoriasis. OBJECTIVE: A task force of the National Psoriasis Foundation Medical Board was convened to evaluate treatment options. Our aim was to arrive at a consensus on therapy for intertriginous or inverse psoriasis. METHODS: Reports in the literature were reviewed regarding psoriasis affecting the skin-fold areas and its therapy. LIMITATIONS: There are few evidence-based studies on the treatment of intertriginous psoriasis. RESULTS: The recommended short-term (2-4 weeks) therapy for inverse psoriasis is low- to mid-potency topical steroids. For long-term therapy, topical calcipotriene (calcipotriol) or one of the immunomodulating agents, pimecrolimus or tacrolimus, is favored. CONCLUSIONS: Low- to mid-potency topical steroids are recommended as first-line, short-term treatment. It is recommended that their use should either be of limited duration (less than 2-4 weeks) or that the lowest effective strength be used intermittently for long-term care to minimize the potential for risks. Calcipotriene (calcipotriol), pimecrolimus, and tacrolimus, while not as highly efficacious as topical steroids, are associated with fewer long-term risks and are therefore recommended for long-term therapy when feasible.

Lebwohl M, Bagel J, Gelfand JM, Gladman D, Gordon KB, Hsu S, Kalb RE, Kimball AB, Korman NJ, Krueger GG, Mease P, Morison WL, Paller A, Pariser DM, Ritchlin C, Strober B, Van Voorhees A, Weinstein GD, Young M, Horn L. · Department of Dermatology, Mount Sinai School of Medicine, New York, New York, USA. · J Am Acad Dermatol. · Pubmed #17980456 No free full text.

Abstract: BACKGROUND: Biologics are widely used in the treatment of psoriasis and psoriatic arthritis. OBJECTIVE: Our aim was to arrive at a consensus on the kind of monitoring and the vaccinations that should be performed before and during biologic therapy. METHODS: Medical literature and data presented at meetings were reviewed and a consensus conference was held by members of the Medical Board of the National Psoriasis Foundation. RESULTS: Consensus was established on monitoring and vaccination practices that included discussion and recognition of variations in those practices. History, physical examination, chemistry screen with liver function tests, complete blood cell count, and platelet count and tuberculosis testing are widely obtained at baseline and with variable frequencies thereafter. Patients treated with efalizumab have platelet counts checked more often; liver function tests are repeated more frequently in patients treated with infliximab; patients taking tumor necrosis factor blockers undergo tuberculosis testing more often; and patients treated with alefacept have CD4 counts checked approximately every 2 weeks. Avoidance of live vaccines during biologic therapy and administration of essential vaccines before biologic therapy were discussed, although vaccination is performed only to a variable degree. There was no consistency in the measurement of antinuclear antibodies among the experts. LIMITATIONS: There are few evidence-based studies on monitoring practices for patients with psoriasis taking biologic therapies. CONCLUSIONS: In patients taking biologic therapies for psoriasis, monitoring of blood chemistries, blood counts, CD4 counts, antinuclear antibodies, tuberculin skin tests, history, and physical examination may be warranted depending on the particular therapy and the particular patient. Vaccination practices are also addressed.

Fretzin S, Crowley J, Jones L, Young M, Sobell J. · Indiana University Medical Center, Indianapolis, IN, USA. · J Drugs Dermatol. · Pubmed #17039648 No free full text.

Abstract: Hand and foot psoriasis can appear in a plaque-type or pustular-type form. Any form of psoriasis that occurs on the hands and feet can have a debilitating effect on the patient's daily functions. Here we present a case series of patients with plaqueor pustular-type hand and foot psoriasis whose conditions were successfully managed with the biologic agent efalizumab. In many of these patients, the disease was refractory to multiple systemic psoriasis treatments. Treatment with efalizumab was effective and well-tolerated, with few adverse events. Many of the patients described here reported an improvement in both their physical functioning and health-related quality of life. The efficacy of efalizumab in treating these cases of hand and foot psoriasis suggests that it may provide therapeutic benefit.

Young M. · The University of Texas at Arlington, Graduate School of Nursing, Arlington, TX, USA. · Dermatol Nurs. · Pubmed #15782923 No free full text.

Abstract: Psoriasis imposes psychological and social burdens on sufferers, in addition to the physical toll. A recent survey of 502 people with moderate-to-severe psoriasis discovered that 38% of patients with psoriasis experience disease-related disruption in day-to-day activity, including work, school, interpersonal relationships, recreational activities, and intimacy. Discrimination, lack of self-confidence, and feelings of isolation, anger, and hopelessness are also quite common. In addition, another survey of 1000 adult Americans without psoriasis was conducted to determine the awareness of psoriasis by the general public. This survey confirmed a low level of awareness and understanding of the disease among people without psoriasis, suggesting that a lack of sensitivity may contribute to the social burdens of suferers.

Craze M, Young M. · Texas Dermatology Associates, 5310 Harvest Hill, Suite 260, Dallas, TX 75230, USA. · J Am Acad Dermatol. · Pubmed #12894138 No free full text.

Abstract: This article discusses the issues involved in the integration of biologic therapies for psoriasis into a dermatology practice. The requirements for staff, space, and other office adaptations are reviewed for infliximab, efalizumab, etanercept, and alefacept in their current injectable forms. Dermatologists will likely elect to offer some or all of these therapies depending on the adjustments necessary within their current practice, patient satisfaction, and the economic possibilities. This article provides information needed to guide dermatology practices in practical decisions regarding the use of biologic therapies.