What are some of the latest treatments for psoriasis that seem to have been successful?
To put it briefly, the latest treatment for severe psoriasis are biologics – that is, biological therapies, for those who meet the criteria for those. But we still also use topical treatments, still use phototherapy and there are several traditional systemic agents that can be effective in people.
What is some of the latest research into psoriasis?
The latest research shows that 1 in 3 people will develop arthritis – psoriatic arthritis. There are a range of comorbidities more common in people with psoriasis: arthritis, hypertension, diabetes, and what’s called dyslipidaemia – a disturbance of cholesterol and glycerides. There’s also obesity, liver disease, some forms of cancer, inflammatory bowel disease, Uveitis and heart disease.
In patients with moderate to severe psoriasis, there are higher rates of mental health issues, particularly anxiety and depression. There’s a lot of research looking at cardiovascular disease in psoriasis.
And a lot of work that shows the immune pathway that is often referred to as interleukin 23 / THC 17 cell / interleukin 17 axis is a critical pathway. There’s lots of research into treatments.
Why does psoriasis occur and why is it incurable?
It’s genetically determined, so it’s about who inherits the genes. There are more than 60 different genes involved. It’s like the letters of an alphabet, and when you spell the wrong word, or wrong combination of letters, that gives you your form of psoriasis.
It’s genetic, so it’s not curable, unlike rare diseases, where there’s just one gene involved so you can target that one gene.
There’s not one treatment because so many genes are involved, and everyone is genetically different. It’s also related to the immune pathway.
Is severe psoriasis more common in men or women generally?
There are rates of psoriasis in men and women. Women tend to develop earlier than men. There is one recent study out of Sweden that suggested men tend to have more severe disease in that specific group of patients. That at the severe end of the spectrum, men outnumber women.
I should add that the Swedish study has not been replicated.
What lifestyle measures can lessen the effects of psoriasis?
There are a range of lifestyle measures that can improve psoriasis. Aiming for and maintaining ideal body weight by modifying diet and regular exercise. Cigarette smoking is associated with psoriasis and makes it more difficult to treat. Heavy alcohol consumption is associated, or vice versa.
So, weight reduction, a balanced diet, regular exercise, stopping smoking, moderate alcohol consumption, they all help.
In terms of new biologic therapies, most people will be completely clear of psoriasis – will see no psoriasis – while taking them, but it’s not a cure. More than 70% report as clear or almost clear of symptoms. If they stop the treatment, the majority of people see a return.
Does there need to be more government funding when it comes to psoriasis research, or support for sufferers?
In terms of laboratory-based research, there’s not a lot happening here. It'd be great if we could get more government funding for clinical research – to look at cardiovascular disease and arthritis and mental health, as would government support of patient support groups like Psoriasis Australia.