7 Foods To Eat And 7 To Avoid For Psoriasis

From healthdigest.com

Imagine you have a friend (we'll call her Jill) who confides in your that she has been getting rashes, but she can't figure out why. Jill explains that they come and go, and are itchy and sore; sometimes, her skin gets so cracked that it bleeds. Of course, if anyone comes to you with a health problem, you should recommend that they seek out a healthcare professional for a diagnosis. With that said, if you or a friend or a family member is experiencing the above symptoms, they could be signs of psoriasis (via the Mayo Clinic).

Psoriasis can come with a number of symptoms, which tend to occur as flare ups that can last for months. Often, a psoriasis patient will experience rashes on their knees, scalp, elbows, and torso, although it's possible to experience a patchy rash all over most of one's body. Not surprisingly, there are different types of psoriasis, which in some cases are more likely to occur on certain areas of the body. Additionally, psoriasis can go hand in hand with other health problems like psoriatic arthritis and heart disease (via Healthline).

At this time, we are still learning about psoriasis and haven't discovered a cure for it (per the Mayo Clinic). However, that doesn't mean there aren't options for managing psoriasis, including making certain dietary changes. 

Avoid: Sugar

If you have psoriasis, it would likely benefit you to avoid added sugars (as opposed to the natural kinds found in, say, fruits) in your diet (via Johns Hopkins). So, you might have to cut out foods like baked goods, soda, and candy.

Large amounts of added sugar can be a very bad choice for a psoriasis patient, since our bodies store that excess sugar in our fat cells. This can lead to the fat tissue becoming inflamed, which is the last thing someone with psoriasis needs. Additionally, added sugar can raise the amount of a type of protein called cytokines. And not only can cytokines cause inflammation, but some believe they might also increase cholesterol and blood sugar levels, creating the perfect storm of events for non-alcoholic fatty liver disease or NAFLD (per WebMD). In fact, Dr. Rheinchard Reyes, a family medicine doctor specializing in adult medicine, says on his website that patients typically have both psoriasis and NAFLD. 

With that said, he also noted that the findings of a study from the University of California-San Francisco School of Medicine's Department of Dermatology pointed to reducing consumption of other foods and beverages (like alcohol and gluten) to help psoriasis symptoms. The bottom line is, we cannot say for certain that every person with psoriasis who eats added sugar will experience worsened symptoms. Nevertheless, reducing the added sugar in one's diet is, in general, usually recommended for one's health.

Try: Cherries

If you have psoriasis, then there's one word you should keep in mind — inflammation. While we are still learning about psoriasis, some patients find incorporating more foods that might reduce inflammation into their diet helps them manage their psoriasis better (via WebMD). Case in point: Cherries could be a good anti-inflammatory food for a psoriasis-friendly meal plan.

While it's possible to confuse cherries for berries because of their size, cherries are actually drupes or stone fruits like peaches and olives, per Britannica. According to Harvard Health, stone fruits are good sources of vitamin C. And as WebMD points out, there is research supporting vitamin C being a good nutrient for psoriasis patients. Plus, cherries are loaded with inflammation-reducing phenolic compounds, which are phytochemicals (via ScienceDirect). As the name suggests, phytochemicals are compounds found naturally in plants, per another ScienceDirect article.

Additionally, there's research that cherries might be beneficial for people with health issues concerning cholesterol, blood sugar, and blood pressure (per Harvard Health). They may also reduce one's chances of having an attack from gout. And if you find you're sore after exercising, snacking on cherries might help reduce that post-workout discomfort. Plus, like other stone fruits, cherries have both fibre and potassium. However, even though cherries are potentially good for psoriasis, a slice of cherry pie probably has added sugar, which could be bad for a psoriasis patient, via Johns Hopkins.

Avoid: Alcohol

Even if someone with psoriasis is just an occasional drinker, even a small amount of alcohol can be enough to affect their skin condition in more than one way, via WebMD. First, alcohol can interact with medication used to treat psoriasis, making it less effective. Second, alcohol might not only trigger the symptoms of psoriasis, but may also lead to less symptom-free time between flare-ups.

Alcohol might worsen inflammation, which in turn can worsen the effects of psoriasis. To be fair, there is debate with some members of the scientific community believing that more research is needed into factors like whether or not certain types of alcohol are more likely to trigger psoriasis-related health issues. But with that said, there is a theory that alcohol's effect on certain chemicals in the brain could be why it potentially worsens inflammation and, in the process, impacts psoriasis.

It's important to keep in mind that psoriasis can be difficult not just physically, but also psychologically. Psoriasis can lead to low self-esteem, which can result in depression and anxiety. This can lead to the patient drinking alcohol more often, and that might trigger psoriasis flare ups. In other words, a psoriasis patient can find themselves in a vicious cycle.

Try: Onions

A classic gag in animation is using onions to make someone cry. Of course, anyone who's ever tried to cut an onion gets the joke right away. But whether onions are your favourite food or not, they could be a good addition to a psoriasis management diet.

As Good Housekeeping explains, a major reason why onions might help with psoriasis is because they have quercetin, a compound that might help reduce inflammation. According to a study in the European Journal of Pharmacology, quercetin can have an antioxidant effect on the body. This means that it could help your body fight off harmful molecules called free radicals, which could lower inflammation (via Healthline). And in case you were wondering, yes, quercetin is also in other potentially-good-for-psoriasis foods like cherries and berries (per Current Opinion in Clinical Nutrition and Metabolic Care).

Although eating foods that contain quercetin might help with psoriasis, Healthline notes that we're still exploring quercetin as an anti-inflammatory treatment, and that there's a need to conduct more studies into its impact on humans. With that said, if you want to talk to your doctor about adding onions to your psoriasis-friendly diet, you might want to also ask about garlic, since it also contains quercetin (via Good Housekeeping). Lastly, quercetin is available as a supplement, but as always, check with a medical professional before using any supplement.

Avoid: Fried foods

If you've ever been to a fair, chances are you at least saw (if not tried) a variety of different types of fried foods. From vegetables to desserts, just about any type of food can be fried (with varying results). But when you cook even healthy foods in hot oil, it changes them not just in terms of their taste and appearance, but also in terms of fat content, via GoodRx. And that can make a big difference when it comes to psoriasis.

So, here's a little cooking 101. As GoodRx explains, frying foods in oil results in the food absorbing the oil, which is why fried foods are higher in fat than their non-fried counterparts. The process also raises the number of calories. And as dermatologist Dr. Anthony Fernandez told the Cleveland Clinic, foods that are high in calories can lead to an increase in body fat. Since body fat and inflammation can go hand in hand, that means fried foods — and in particular, the kinds served at fast food establishments — might be bad choices for someone with psoriasis. In fact, Windsor Dermatology notes that regularly consuming fried food can result in more inflammation and worse psoriasis symptoms.

Besides potentially be bad for psoriasis, fried foods can also raise cholesterol, which can damage blood vessels and put strain on one's heart (per GoodRx). Higher cholesterol levels can lead to a stroke or a heart attack.

Try: Fish

It's possible that when it comes to "surf and turf" meals, you're more into the turf and less into the surf. But for someone with psoriasis, fish can be a great choice, since fish contain omega-3 fatty acids (via Healthline). In fact, two of the three main kinds of omega-3s — eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — are found in fish.

To understand how omega-3s might help with psoriasis, think for a moment about the Tin Man in the classic movie "The Wizard of Oz." When we first meet him, he needs his joints lubricated with oil in order to function properly. Now, of course, unlike the Tin Man, we don't have to worry about our bodies rusting. But omega-3s do lubricate our cells, which can help lower inflammation and in turn possibly improve symptoms of psoriasis. And of the three types of omega-3s, the two found in fish have really captured the attention of the scientific community, in part because of their ability to reduce inflammation.

So, does that mean any fish will do if you want to increase your omega-3 fatty acids? Basically, but there are some standouts for their omega-3 content. These include herring, cod, salmon, sardines, and mackerel. Additionally, the American Heart Association recommends black cod, as well as striped bass, anchovies, whitefish, cobia, and bluefin tuna. And while shellfish and fish are different types of animals, shellfish do contain DHA as well.

Avoid: Gluten

This next suggestion will probably only help certain psoriasis patients — namely, those individuals who have problems digesting gluten, a protein sometimes found in food products like bread (via the American Academy of Dermatology Association or AAD). But if you have gluten sensitivity or celiac disease, then there is evidence supporting that going gluten-free might help with psoriasis flare-ups.

As the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) explains, celiac disease is an immune disorder where eating gluten results in damage to one's small intestine. According to the AAD, celiac disease symptoms can include belly pain, extreme tiredness, flatulence, and often experiencing diarrhoea. However, a person doesn't have to have celiac disease to experience problems digesting gluten. Fortunately, a medical professional can run tests to determine if someone has celiac disease or gluten sensitivity.

So, how effective can a gluten-free diet be at managing psoriasis? One study involved 39 psoriasis patients, 33 with problems digesting gluten and six without (via AAD). Even though all 39 patients went on a gluten-free diet, the six patients with no problems eating gluten didn't experience less psoriasis. Of the remaining 33 patients, 73% saw a difference in their psoriasis. So, even if you have either celiac disease or gluten sensitivity as well as psoriasis, going gluten-free may help improve your psoriasis.

Try: Walnuts

If you search online for foods that might be good for psoriasis, chances are a number of websites will recommend nuts. As Healthline explains, walnuts in particular are usually highly recommended in general for psoriasis patients. However, not everyone is in agreement about these little nuts.

Nuts are good sources of omega-3 fatty acids, and omega-3s might be good for reducing inflammation and supporting your immune system. In fact, a study in the Journal of the American Academy of Dermatology concluded that taking omega-3s in supplement form along with using topical treatments for psoriasis could help reduce symptoms. And since walnuts are not only a convenient snack but also ingredients in various meal options, this might seem like an ideal food to add to one's psoriasis management diet.

But not so fast. As Healthline points out, walnuts have a type of omega-3 fatty acid called alpha-linolenic acid (ALA). When your body consumes ALA, it can change it into eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), per Mount Sinai. The problem is, there's evidence that only a very small amount of ALA becomes effective EPA and DHA in the body. So, since EPA and DHA are both available in fish, you might find that having salmon for dinner does more to manage your psoriasis than walnuts as a snack.

Avoid: Refined grains

Usually, the word "refined" hints at something positive. Someone with "refined taste" or a "refined sense of style" tends to be thought of as cultured and learned. But when it comes to psoriasis, seeing "refined" on a food label for grains might not be a good thing.

As the Mayo Clinic explains, grains are seeds of grasses and are made up of three parts: the bran, the germ, and the endosperm. When a manufacturer makes refined grains, they remove the bran and the germ and, in the process, a good number of the grains' nutrients. This is the case with white flour and white rice, which (according to WebMD) are lacking in nutrients and fibre, especially when compared to their whole-grain counterparts. This means they get processed by the body more quickly, which can cause blood sugar spikes and possibly inflammation. Other foods that might be made from refined grains include bread, crackers, pastries, desserts, and cereals.

Of course, some refined grains (and even some whole grains) are fortified with nutrients, including some that might not occur in the grain in nature, per the Mayo Clinic. These grains are usually called enriched grains. It's possible for a product to have a combination of refined and whole grains, though, so it's important to be a conscientious consumer and check Nutrition Facts labels carefully (via MyPlate).

Try: Turmeric

Not everyone is a fan of foods seasoned with certain herbs and spices. But as Good Housekeeping points out, these dashes of flavour might help reduce inflammation. So, if you have psoriasis and are making adjustments to your diet, you might want to consider adding herbs like turmeric to your meal plan. However, there are some things to keep in mind, especially if you want to try turmeric supplements.

According to Mount Sinai, turmeric contains an antioxidant called curcumin. Antioxidants may not only help defend your body against potentially inflammation-causing free radicals, but also aid in repairing the damage caused by them. Additionally, curcumin can help reduce the levels of two types of enzymes that can be the culprit behind inflammation.

Although there has been research supporting turmeric's ability to reduce inflammation, not all studies have reached this conclusion. And like other herbs, turmeric can interact with medications, supplements, and even fellow herbs. For example, Mount Sinai advises speaking with a medical professional about turmeric and curcumin if you're on blood thinners, different medications used to treat diabetes, or drugs that reduce stomach acid. Also, turmeric and curcumin supplements have the potential to cause stomach ulcers if they're taken in large quantities for an extended period of time.

Avoid: Dairy

Here's the good news: Even if you have psoriasis, you might not need to completely cut all dairy out of your diet. But if you suspect that dairy might be worsening your symptoms, there are a couple of things to consider.

First, as Johns Hopkins notes, the fat content of dairy can make a difference when it comes to psoriasis. Fat can trigger inflammation in one's body, which is certainly not good for psoriasis. Thus, dairy products that are loaded with fat might not be good choices for a psoriasis patient. Also, being lactose intolerant (which is when a person doesn't have enough of an enzyme needed to break down the sugar in milk, per the Mayo Clinic) can worsen inflammation and contribute to psoriasis-related health problems. In addition, someone might have problems digesting a protein called casein, which is found in milk. And just like with lactose intolerance, this health issue can worsen inflammation.

Of course, if you suspect you're having any of the above health problems, you should make an appointment with a healthcare professional right away for a professional diagnosis. And if it's determined that your psoriasis is being aggravated by the high amounts of fat in certain dairy products, you might still be able to eat smaller amounts of low-fat dairy foods, depending on what your doctor recommends (per Johns Hopkins).

Try: Blueberries

There's nothing quite like blueberries at breakfast time. From having them in muffins and pancakes to just throwing a handful into a bowl of cereal, these little berries are definitely a great food to start anyone's day. But if you're only eating them first thing in the morning, you might want to explore adding them to other meals if you have psoriasis.

As Health Central explains, blueberries can be an excellent part of a psoriasis-friendly diet, since they are known for reducing inflammation. Blueberries contain compounds called flavonoids that might have an antioxidant effect on the body (via Medical News Today). Plus, blueberries are an excellent source of vitamin C, which might also be beneficial for someone with psoriasis. According to Nutrition Data, you can get 24% of the recommended daily amount of vitamin C from a single cup of blueberries.

Beyond possibly being beneficial for psoriasis patients, blueberries can also be good for a heart-healthy diet (per Medical News Today). This is significant, as having psoriasis and developing heart disease can go hand in hand (via Healthline). But with all that said, if you're on blood thinners, then you should speak with your doctor before adding blueberries to your diet. Because blueberries have vitamin K, a nutrient that helps our blood clot. This means eating blueberries could interfere with blood thinning medication.

Avoid: Processed meats

Complete this sentence: Processed meats are a) cured, b) smoked, c) salted, d) preserved, or e) any of the above. If you guessed e, you're absolutely right. As Southeast Dermatology Specialists explains, a manufacturer might use any of those processes on muscle or organ meat to produce processed meat. And there's no denying that some of these meats are quite popular, but they also can be problematic for psoriasis patients.

According to Good Housekeeping, the additives and preservatives used to turn regular meat into processed meat can also cause inflammation. These include salts, which can draw water out of skin cells and cause dehydration and damage, per Southeast Dermatology Specialists. Plus, processed meats can contain sugars, and that can lead to increases in blood glucose levels. This, in turn, can result in higher levels of a fatty lubricant matter called sebum, which could worsen psoriasis. In fact, there is concern that even unprocessed meats might still have hormones that could increase the body's sebum production.

Additionally, processed meats are usually loaded with saturated fat, which can also increase the amount of inflammation in one's body (via Good Housekeeping). So, if you always have a hot dog at a baseball game or enjoy having a slice of pepperoni pizza or a sub loaded with deli meat when eating out with friends, you might have to give those up if you have psoriasis.

Try: Olive oil

When it comes to healthy eating choices, olive oil usually makes the "good foods" list. And there is evidence supporting that it might be helpful if you have psoriasis. However, not every study supports olive oil as a psoriasis treatment.

As WebMD explains, olive oil contains omega-3 fats, making it potentially a good addition to a psoriasis-friendly diet. This is why some psoriasis patients look into the Mediterranean Diet, since olive oil tends to be a major part of it. Per research, eating foods that are typically allowed on the Mediterranean diet (like olive oil, fish, fruits, and vegetables) might help someone with severe psoriasis lessen their symptoms. In fact, a study in JAMA Dermatology found a possible connection between not following the Mediterranean Diet and having severe psoriasis. However, a study in International Immunopharmacology involving mice found that eating olive oil actually worsened the mice's psoriasis symptoms.

The bottom line: Scientists are still exploring olive oil's potential impact on psoriasis as both an oral and topical treatment. According to research in Dermatology Research and Practice, multiple studies have concluded that applying olive oil to skin affected by psoriasis could be beneficial. RxConnected advises that using olive oil on scalp psoriasis might help keep one's skin moisturized, as well as loosen skin flakes.

https://www.healthdigest.com/1017935/foods-to-eat-and-to-avoid-for-psoriasis/

Why Not Treating Your Psoriasis Goes Beyond Your Skin

From healthline.com

You might assume that psoriasis only affects your skin. After all, you see it appear on your skin as scales, plaques, and pustules. But psoriasis affects other parts of your body, too.

Managing psoriasis is important in preventing it from getting worse or affecting other parts of your body.

Most doctors use a combination of treatments to help psoriasis. New medications are targeting the condition in more effective ways than before.

Why is there no cure for psoriasis?

One of the main reasons there’s no cure for psoriasis is that experts don’t know exactly what causes it.

Psoriasis is a condition that requires individual treatment plans because its causes are unknown. Research suggests that this condition could be caused by:

• your immune system
• your genes
• environmental factors

The importance of treatment

Psoriasis is a chronic autoimmune condition that can’t be cured. It begins when your immune system essentially fights against your own body. This results in skin cells that grow too quickly, causing flares on your skin.

The effects of this condition include more than just skin lesions. Other conditions can result, such as psoriatic arthritis (PsA).

PsA is a disease that affects the joints. Symptoms include pain, inflammation, and stiffness in your joints. It affects approximately 30% of those with psoriasis.

Other health conditions — called comorbidities — may arise with psoriasis, such as:

• cardiovascular conditions
• cancers, such as lymphoma
• diabetes
• inflammatory bowel disease
• liver conditions
• kidney disease
• metabolic diseases
• mental health conditions like depression
• obesity
• erectile dysfunction
• alcoholism

These wide-ranging health implications require you to manage your psoriasis effectively. Most likely, this will involve a variety of treatments.

Delaying treatment or ignoring symptoms can lead to your condition worsening, which is why you should talk with your doctor when symptoms develop. Your doctor will work with you to create an effective treatment plan.

Managing psoriasis

This lack of understanding about the cause of psoriasis means that there is no one-size-fits-all treatment for it at this time.

Treatment plans are evolving as researchers discover more about the condition. Traditional treatments from many years ago mainly targeted the skin.

Now treatment plans for moderate to severe psoriasis target many areas of the body. The newest drugs for psoriasis can even target specific partsTrusted Source of the immune system rather than the entire immune system. This evolution of psoriasis treatment is helping researchers better understand psoriasis.

It’s now recommended that doctors approach psoriasis treatment at many levels. Doctors should look at a variety of factors when managing psoriasis, including:

• screening for comorbidities
• screening for PsA
• screening for current medications you take
• screening for triggers, such as stress, infections, obesity, and smoking
• using a combination of treatment methods

This treatment approach reflects how complicated psoriasis is and how many factors lie beyond your skin.

Combination therapy is typical for psoriasis. This approach incorporates a variety of treatment methods to manage your psoriasis. Your doctor may use several approaches, such as:

• topical treatments
• oral medications
• light therapy
• biologic therapy

Some believe complementary and alternative therapiesTrusted Source can help psoriasis. Some of these options lack scientific backing. Methods thought to improve psoriasis include:

• maintaining a nutritious diet
• exercising regularly
• using stress-reduction techniques
• adding dietary supplements

Talk with your doctor before trying complementary therapies because they may impact your management plan.

Treatments for mild psoriasis

Your doctor may decide your mild psoriasis only needs first-line treatments. Several options exist.

You may start with an over-the-counter topical like:

• fragrance-free moisturizers
• shampoos or body creams that contain salicylic acid or coal tar

A prescription topical may be better for your psoriasis. Prescription topicals have a higher concentration of active ingredients. Some contain steroids.

Light therapy can be administered at your doctor’s office or even at your house with the right equipment. Ultraviolet light therapy can improve psoriasis but should be done with guidance from your doctor.

Mild psoriasis still requires careful monitoring by you and your doctor. Schedule regular appointments to review your treatment plan.

Treatments for moderate to severe psoriasis

More widespread psoriasis will require medications that treat your immune system and other parts of your body to keep the condition from getting worse or causing other health issues.

Systemic medications are commonly used for people with moderate to severe psoriasis.

Some systemic medications have been available for decades. You can take them orally or through an injection or intravenously. They target your entire body and suppress your immune system. You’ll likely need regular bloodwork to monitor for side effects.

Biologics are the most recent treatment developed for psoriasis. They are made from living cells and target specific parts of your immune system, like T cells and proteins known to trigger psoriasis. These drugs are administered via injection or intravenously.

Using this treatment method is thought to help improve and control psoriasis, as well as decrease the risk for other comorbid conditions, giving you a higher quality of life.

The takeaway

It’s imperative that your doctor consider many factors when treating psoriasis. On the surface, it seems like just a skin condition. But there can be more serious implications if you don’t treat it.

Unmanaged or undermanaged psoriasis can lead to the condition getting worse. It can also lead to the development or worsening of PsA and other comorbidities.

Here are ways you can manage your psoriasis:

• Make sure your doctor creates a management plan that works for you.
• Follow the treatment plan.
• Update your doctor frequently on how the treatments work and suggest modifying them if needed.
• Contact your doctor when you experience a psoriasis flare.

https://www.healthline.com/health/psoriasis/moderate-to-severe/why-not-treating-your-psoriasis-goes-beyond-your-skin?slot_pos=article_1&utm_source=Sailthru%20Email&utm_medium=Email&utm_campaign=psoriasis&utm_content=2022-09-20&apid=39239719&rvid=058431b717dcfa59c0cdd27cd0a9313769e8b3dd4ad59d88efd0ded7ddb4774e

 

USA: FDA Approves First Once-Daily Oral Plaque Psoriasis Drug

From verywellhealth.com

Key Takeaways

• Regulators approved an oral once-daily drug, called Sotyktu (ducravacitinib) for treating moderate to severe plaque psoriasis.
• Clinical trials showed that the drug is more effective and better tolerated than the twice-daily oral psoriasis drug, Otezla (apremilast).
• An oral medication may be easier for patients to take than injectable biologics.
• 

  Lara Antal / Verywell

Last week, the FDA approved Sotyktu (deucravacitinib), a once-daily oral pill by Bristol Myers Squibb for people with moderate to severe plaque psoriasis—a chronic, systemic, immune-mediated disease.

The medication is meant to treat adults who have plaque psoriasis severe enough to make them candidates for systemic therapy and phototherapy.

Many of the drugs that are available to treat severe cases of plaque psoriasis are biologics that are injected or administered intravenously. These can be expensive and often require patients to routinely visit a provider to be treated and monitored. Even oral immunosuppressant options can increase the risk of infection and other undesirable side effects.

Deucravacitinib is the first oral treatment for plaque psoriasis that can be taken just once daily and the first oral medication approved for the disease in a decade. In clinical trials, the drug appeared to be more effective than the popular psoriasis drug, Otezla (apremilast).

More than 7.5 million U.S. adults live with psoriasis, according to the National Psoriasis Foundation. As many as 90% of those patients have plaque psoriasis, characterized by raised patches of inflamed and discoloured skin, and nearly a quarter of those have moderate to severe cases.

Unlike existing treatment for this population, deucravacitinib doesn’t require laboratory follow-up and seems to be well-tolerated, said April Armstrong, MD, MPH, professor of dermatology and associate dean of clinical research at the University of Southern California, who led the clinical trials.

“This is a breakthrough medication and, in my opinion, this drug will be the leading oral agent for our patients with psoriasis because of its robust efficacy and good safety profile,” Armstrong told Verywell. “I'm very excited to talk to my patients about this drug.”

Clinical Trials Show Significant Plaque Improvement

The FDA approved the drug based on two clinical trials, which compared deucravacitinib to apremilast in nearly 1,700 adults with a mean age of 46 years.

These participants all had moderate to severe plaque psoriasis. On average, they experienced psoriasis for 17 years on a quarter of their bodies. More than a fifth had clinically severe psoriasis and nearly 40% had used biological therapies to control their condition.

One group took a 6-milligram tablet of deucravacitinib once per day. Other participants took 30 milligrams of apremilast twice daily or received a placebo.

By month four, nearly 60% of patients achieved a meaningful benchmark: Psoriasis Area and Severity Index (PASI) 75. This is a measurement indicating 75% improvement in the amount of skin surface area covered by plaques. In comparison, fewer than 13% in the placebo group and 35% in the apremilast group reached PASI 75.

Additionally, plaques cleared or nearly cleared in more than half of the people treated with deucravacitinib. That’s in contrast to only about 7% of people in the control group.

Patients who took deucravacitinib continued to improve over time. After six months of treatment, 69% reached PASI 75 compared with 38% of those who took apremilast.

More Accessible, Fewer Side Effects

For people with moderate to severe plaque psoriasis, providers often prescribe injections or biologics which can alter the immune system to slow or stop disease progression. (Topical treatments are typically reserved for plaque psoriasis that only covers a small part of someone's body.)

There are some existing psoriasis treatments that can be given orally, such as Trexall (methotrexate) and Gengraf, Neoral, or Sandimmue (cyclosporine), but they tend to be less effective or lead to more serious side effects than the injectable options.

Biologic drugs are given by injection or intravenously and target specific portions of the immune system. These include Humira (adalimumab), Enbrel (etanercept), and Stelara (ustekinuman). These options can be expensive and may not be covered by insurance.

Both biologic and non-biologic immunosuppressant drugs often raise the risk of infection and other health problems. Patients who take them often need to be monitored routinely.

Deucravacitinib, meanwhile, more specifically targets a key enzyme rather than suppressing the immune system broadly. This approach, Armstrong said, makes it a safer alternative to the other available drugs.

How Does Deucravacitinib Work?

The drug is the first to target tyrosine kinase 2 (TYK2), an enzyme that is linked to susceptibility for psoriasis. 

TYK2 is a member of the Janus kinase (JAK) family. Many treatments for autoimmune disorders target JAKs, but most JAK inhibitors don’t do much to affect TYK2. By blocking this specific enzyme, the drug interrupts some of the cellular processes that are key for forming psoriatic lesions.

Plus, a TYK2 inhibitor drug could be safer because it has a narrow target, compared to other JAK inhibitors, which can have a broad effect on the immune system.  

“By having more specific targeting of the pathways that are involved in psoriasis, we avoid essentially hitting the other pathways that are important for our normal human functions,” Armstrong said. These include the effects on blood cell counts, lipid and other types of metabolism, and other types of immunity.

Deucravacitinib works similarly to the widely-used psoriasis biologic agent Stelara (ustekinumab). But that drug is a monoclonal antibody that needs to be injected in a hospital setting. Deucravacitinib, on the other hand, comes as an oral pill that patients can easily take at home or while travelling.

How to Take It

Deucravacitinib is much simpler to take than most of the other injectable biologic drugs currently on the market. The 6-milligram pill is taken once a day. It can be taken with or without food.

The drug should be most effective after five to six months of treatment, but most patients will start to see improvement within just a few weeks, Armstrong said.

There are no known drug-drug interactions, so patients can use deucravacitinib alongside treatments for other conditions.

In clinical trials, patients who took deucravacitinib were less likely to discontinuation the treatment than those taking apremilast.

“Patients—once they are on the medication—tend to stay on the medication," Armstrong said.

As with many chronic conditions, pausing or stopping treatment may allow the condition to re-emerge.  

Known Side Effects

In clinical trials, the most common adverse events associated with deucravacitinib were the common cold, upper respiratory tract infection, headache, diarrhoea, and nausea.

More than 1% of patients who took deucravacitinib experienced upper respiratory infection, increased levels of creatine phosphokinase (CK) in the blood, herpes simplex, mouth ulcers, acne, or inflammation of the hair follicles (folliculitis).

More people who took deucravacitinib experienced adverse events than those who took the placebo. However, only 2% of participants stopped the treatment due to serious adverse events compared with 4% in the placebo group.

Additionally, there were no herpes zoster infections, opportunistic infections, thromboembolic events, hematologic or lipid abnormalities that are characteristic of JAK1, JAK2, and JAK3 inhibitors.

Armstrong said people with severe liver disease should not take deucravacitinib. It should also not be taken along with other immunosuppressants.

What This Means For You

If you have moderate to severe plaque psoriasis, talk with a health provider about whether you should take deucravacitinib to control your condition.

https://www.verywellhealth.com/fda-approves-first-once-daily-oral-plaque-psoriasis-drug-6735912

Which Psoriasis Treatment is Right for You?

From menshealth.com

This common skin condition shows up in many different ways, and there are many different ways to treat it. Here’s what’s what. 

You’ve likely heard of the dermatologic disease psoriasis, which affects about three percent of the population. What you might not know: Your psoriasis likely doesn’t look or feel like your co-worker’s psoriasis or like the case you read about in the pamphlet at the doctor’s office.

“Psoriasis is just a word,” says Adnan Nasir, M.D., Men’s Health advisor and a dermatologist in Raleigh, NC. “It comes from the Greek word psōra, which means ‘itch’ — but not all psoriasis itches.”

There are all different kinds of psoriasis.

There’s plaque psoriasis, the most common type, which causes dry, itchy, scaly patches of skin. There’s guttate psoriasis, which might pop up after strep throat, and the list goes on.

And because psoriasis looks so different, it also has many different forms of treatment: topical creams, phototherapy (light therapy), traditional meds including steroids, and newer at-home injectables called biologics. Biologics target specific parts of the immune system directly impacted by psoriasis, and they’re a big deal in both the medical community and to many with psoriasis.

“Biologics are probably the most important advancement in the field of dermatology over the last 30 years,” says Evan A. Rieder, M.D., a dermatologist at NYU Langone. “They've revolutionized the way that we treat psoriasis and some other conditions of the skin such as eczema.”

But are they for you? Here’s what you need to know about choosing a treatment path for your psoriasis.

Treatment Options for Psoriasis

Medical treatment options for psoriasis generally fall into a few different categories.

Topical therapies

These are your creams or lotions (corticosteroids, synthetic forms of vitamin D, retinoids, and more) which are applied a few times a day and are best reserved for localized psoriasis — psoriasis that’s, say, only on your elbows or knees. “Generally, the rule of thumb is that if less than 10 percent of body surface area is affected by psoriasis, topical therapy is first-line treatment,” says Dr. Nasir.

Phototherapy

This form of light therapy uses particular wavelengths of ultraviolet light to treat psoriasis. Phototherapy works for small areas (your hands) and big ones (your trunk, legs, or arms). It’s especially effective if you notice that your psoriasis improves in sunlight or in the summer months and worsens in the winter. Phototherapy quells the overactive immune system that contributes to psoriasis. “The largest immune system in the body is the skin immune system,” explains Dr. Nasir. “Ultraviolet light causes a temporary, localized suppression of the immune system just on the patch that the light was shining on.”

You don’t need a prescription for phototherapy and you can buy the units online (companies such as Davlin, BioTech UV, or National Biological Corporation sell them for a couple hundred bucks). “The units that are ideal for psoriasis are tagged with the label ‘narrowband UVB unit,” says Dr. Nasir. Sometimes it's abbreviated ‘nb UVB.’ For the right candidates, standing in front of the lights for 30 or 40 seconds a few times a week is usually enough to “take care of quite severe, quite widespread psoriasis,” Dr. Nasir says.

Oral or injected medications

Medications you take by mouth or injection are known as “systemic” treatments. One of these systemic treatments is biologics. “Biologics suppress the cytokines, or messenger molecules, that are typically elevated in psoriasis,” says Dr. Nasir. They’re different from more traditional systemic drugs (which impact your whole immune system) because they target only the specific parts of the immune system that are impacted by psoriasis.

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Are Biologics Right for Me?

It really depends. When it comes to treating psoriasis, it’s important to have a conversation with your doctor about your specific condition. That said, biologics are often a solid option for many people.

“I think biologics should be considered for any patient that has disease that is not localized,” says Corey L. Hartman, M.D., Men’s Health advisor and founder of Skin Wellness Dermatology in Birmingham, AL.

If your psoriasis impacts areas that are harder to reach with topicals (your nails or scalp), docs often consider biologics.

Some biologics can also slow or stop the process of joint damage, making them a good pick for those with joint pain or psoriatic arthritis, a form of arthritis that can impact those with psoriasis.

“Most of the biologics were actually approved for psoriatic arthritis first. If you're treating for psoriasis, you're treating for potential arthritis, too,” says Dr. Hartman. After all, sometimes, joint changes can be irreversible, he says, so prevention is key.

Biologics are also convenient. When they first came out, the injectables were administered in-office, but now they are available for home use and one injection can sometimes last months. “Insurance coverage has also changed a lot over the years,” adds Dr. Hartman, “opening the treatment up many more people.”

That said, they’re not for everyone. “We don't want to give someone systemic therapy unless they're a candidate for systemic therapy,” explains Dr. Nasir. “If somebody has psoriasis that affects two or three percent of their body surface area, even if they're put on the strongest biologic, they might only get that down to one and a half to two percent of their body surface. If somebody has psoriasis that impacts 80 percent of their body surface area, a biologic may take that down to two or three percent.”

Are There Downsides to Biologics?

As with any drug, there are some downsides to biologics. Typically, the downsides are related to the immune system’s surveillance function. “Biologics try to suppress the messengers that are typically associated with psoriasis — and for the most part, these messengers are associated with psoriasis and nothing else,” says Dr. Nasir. “But in a small number of cases, there is some spillover.” That means you may see immune system suppression in areas that don’t have to do with psoriasis. “This can lead to an increased risk of infection, autoimmune disease, or malignancy,” Dr. Nasir says.

Some early studies suggested that biologic use suppressed the immune system’s ability to spot and destroy damaging cells, increasing the risk of cancer three-fold. Other more recent research suggests no link between biologic use and cancer risk.

Dr. Rieder calls the newer generation of biologics “exceedingly safe.” He adds that side effects related to immune system suppression are rare. “These are not thought to be medications that suppress the immune system in a meaningful way to increase the risk of having infections.”

Experts like Dr. Hartman note that one day, there will be genetic testing that allows physicians to map specific disease and pair it with hyper-targeted medications, lowering any existing risks even more.

If you have certain types of heart disease, like congestive heart failure, there are some biologics you’d need to avoid, too, as some can increase heart muscle contractility and efficiency, says Dr. Nasir.

Biologics also, by their nature, require an injection (often a small auto-injector), which can be a turnoff if you don’t like needles. But dermatologists who prescribe biologics are, as Dr. Rieder notes, well-versed in “teaching people how to use them in a way that relieves their anxiety.”

If You Take Biologics, Would You Need to Take Them Forever?

It’s hard to say. On one hand, there is no cure for psoriasis, so if you opt for biologics, it’s likely something that you would continue as long as you want to control the disease, says Dr. Hartman. On the other hand, Dr. Hartman says that he has had patients with well-controlled psoriasis who “take breaks” from biologics or reduce the frequency of their injections with some success.

As you get older, psoriasis also tends to get better because your immune system weakens, says Dr. Nasir. “It's not just able to mount as robust of an autoimmune response. I always tell people, ‘You're likely to outgrow this.’”

The Bottom Line

The truth of the matter is that psoriasis affects everyone differently — and it’s best to discuss treatment strategies and timelines with your individual provider, checking in on what’s working and what’s not as the years go on.

https://www.menshealth.com/health/a41216990/psoriasis-treatments/