Friday, April 29, 2011

Duplicate Posting from GotClearSkin.com

Sorry for the Duplicate Postings yesterday from GotClearSkin.com

Appears that our PostLing Tool did not work too well with Google Chorme / we are now using firefox.

Have a wonderful day!

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Thursday, April 28, 2011

Mushatts @ Market Point Pharmacy Ireland

Mushatts for Psoriasis Management and Treatment is now available at Martket Point Pharmacy, Ireland
Please visit http://www.GotClearSkin.com to purchase Mushatts Online within the USA
Mushatts #9 available at (GCS) GotClearSkin.com
Read more about the 1 year aniversary of Market Point Pharmacy below:
quoted from 1st Anniversary for Market Point Pharmacy
1st Anniversary for Market Point Pharmacy Just one short year ago – September 8th, 2008, to be exact – Mullingar pharmacist John Keane M.P.S.I. opened the doors […]

Saturday, February 5, 2011

OTC Treatment

Moisturizers:

Moisturizers help control scaling and dryness and may improve associated itching. They should be applied immediately after bathing and at other times during the day. Moisturizers should be applied in the direction of the hairs to minimize the risk of pimple like eruptions. Vaseline®, Eucerin® and Aquaphor® are all occlusive sticky products that can be of benefit.

Tars:

Tars are available as shampoos, soaps, gels, lotions, creams, ointments, and bath oils. Coal tar has been used since at least the beginning of the last century. These products can be combined with topical corticosteroids. These products make the skin sensitive to ultra violet-A light waves (UVA). They are often used in combination with ultra violet-B light waves (UVB). Folliculitis can be a side effect.

Tar shampoos are commonly used to treat scalp psoriasis however, they may discolor white hair turning it a yellowish color. Side effects are related to skin irritation and staining of skin and clothing.

They also tend to have an unpleasant odor.

Salicylic Acid:

Salicylic acid moisturizers and shampoos help remove some of the scales seen in psoriasis, it may be useful in reducing the thickness of psoriatic scale, but care must be taken to be gentle to the skin to prevent flaring of the psoriasis. It may be combined with tar, anthralin, and topical corticosteroids.

It is true that compounding calcipotriol and salicylic acid is not recommended because calcipotriol could be inactivated in an acidic environment. However, application of salicylic acid to the skin does not influence skin surface pH enough to influence the stability of calcipotriol in its in vivo situation. A combination treatment of Dovonex* and Psorimed® (10% salicylic acid, marketed by LEO Pharma in Germany) is actually recommended for the treatment of scalp psoriasis: Dovonex* is used in the morning and salicylic acid in the evening for the first 3-4 days; or salicylic acid is applied for 3-4 days followed by Dovonex* twice daily with no expected special risk of accelerated calcipotriol breakdown.

Other Shampoos:

There are many over the counter dandruff shampoos which can improve scalp psoriasis, particularly the scaling. They include the tar and salicylic acid shampoos listed above, ketoconazole and zinc pyrithione also.

Hydrocortisone Cream:

Hydrocortisone cream may improve psoriasis on the face and in the skin folds and improve itching. A stronger prescription topical corticosteroid is usually required to improve psoriasis lesions elsewhere.

(GCS) GotClearSkin.com | Great products for Management of Psoriasis

Topical Treatment

Topical psoriasis treatment includes corticosteroids, calcipotriol/calcipotriene, tazarotene, tars, and anthralin. Tars and anthralin are discussed above.

Calcipotriol and Betamethasone Dipropionate (Dovobet®)

Calcipotriol is safe and an effective treatment for psoriasis when used along but the onset of action is slower than that of topical corticosteroids. Skin irritation may also limit its use for some patients. Topical steroids are effective for the treatment of psoriasis by reducing the inflammatory process. The risk of side effects increases with increasing potency of the steroid as well as the duration of their use.

Combining both corticosteroid and calcipotriol has been shown to be effective. However, extemporaneous compounding of these products is a problem because of stability issues. Calcipotriol needs a basic pH environment whereas betamethasone dipropionate requires an acidic medium. A new vehicle was created in order to satisfy the needs of both of these molecules. This combination product is available in Canada as Dovobet®.

Studies show that Dovobet® is more effective than calcipotriol or betamethasone dipropionate alone. In one clinical trial, after 1 week of treatment, the percentage of reductions in PASI scores were 28% in the calcipotriol trial group, 44% in the betamethasone group and 48% in the Dovobet® group.

Dovobet® is as effective when used once daily compared with twice daily. In addition to the adverse effects which may be seen with calcipotriol and topical corticosteroids, Dovobet® is known to cause itching at the site of application. The itching is usually mild with no need to stop treatment. For patients that have been prescribed Dovonex* or Dovobet®, you can access more product information by clicking either of these links and entering the DIN Number from your prescription: www.dovobet.ca or www.dovonex.ca.

Topical Calcipotriol/Calcipotriene (Dovonex®):

Calcipotriol/calcipotriene is a derivative of vitamin D, and it is available in a cream, ointment, and scalp solution. The mechanism of action is unknown, but it is known to slow the excessive turnover of epidermal cells, by influencing keratinocyte differentiation.
The improvement usually starts within 2-3 weeks. The full effect may require up to 2 months. This is effective in a large number of psoriatic with mild to moderate disease. The full effect may require up to 2 months. It is usually effective and safe for long term use. Calcipotriol is an effective treatment in a large number of psoriatic patients with mild to moderate disease. There is a risk of hypercalcaemia if calcipotriol is used extensively, but at dosages of less than 100 gm per week calcium metabolism is not affected. Since it may cause irritation, calcipotriol is not usually used on the face, genitals, or in skin folds.

This can be used in combination with other topical agents as well as photo therapy, (PUVA or UVB) and systemic therapies such as cyclosporine A or acitretin. The use of calcipotriol in combination with other treatments (i.e. topical steroids, cyclosporin, acitretin, PUVA phototherapy or UVB phototherapy) improves efficacy allowing for dosage reduction of the other treatments. However, since the stability of calcipotriol in its marketed formulations may be affected by other compounds, mixtures of calcipotriol and other topical agents should not be prepared.

Anthralin (Dithranol®):

This is derived from chrysarobin, from the bark of the Araroba tree. Anthralin is available as a cream, ointment, and scalp lotion. Lower concentrations can be left on overnight, while stronger ones (1% or higher) should be left on for 15-30 minutes. It is used to treat plaque and guttate psoriasis. Short contact with a high concentration works better than longer contact with a low concentration.

Anthralin slows down the growth of the skin cells and has anti-inflammatory actions. Anthralin can cause staining (purple/brown color) of your clothes, skin, and hair, which limits its use, irritation may also occur, but this can be minimized by applying the anthralin only to the psoriasis patches and avoiding uninvolved skin. You should not use anthralin on the face, genitals, or in the skin folds.

In hospital, administration of anthralin often will clear psoriasis within 2 weeks. Short contact anthralin is effective in a large number of individuals with mild to moderate psoriasis.

In hospital and Day Care Ingram regime involves anthralin paste, coal tar baths as well as ultraviolet light. Short contact anthralin can be administered at home and is good for localized areas of psoriasis. It may be used in combination with both UVB and PUVA.

A product developed in Sweden called Micanol® is designed for short contact use. The anthralin does not stain if it is washed off with cool water.

The mechanism of action is unknown. They may effect expression of genes for cytokines and cell adhesion molecules.

Dithrocreme® 0.1%, 0.25%, 0.5%
DithrocremeHP® 1%
Dithroscalp® 0,25% 0,5%
Micanol® 1%
Topical Corticosteroids (Diprosone®, Valisone®):

Topical steroids are the most commonly prescribed psoriasis medications and they are available as creams, ointments, gels, lotions, solutions, oils, and shampoos. They can be used anywhere on the body and work quite quickly, often within 1-2 weeks. However, with long term use, steroids often lose their effectiveness.

Usually you won't have any side effects with short term use. However, longer use particularly with stronger preparations, may cause thinning of the skin, stretch marks, dilated blood vessels, rosacea, perioral dermatitis, bruising, and hair growth. Progression to a more active form of psoriasis for example, pustular or erythrodermic psoriasis, increased susceptibility to infections, and a flare up of the psoriasis when the medication is stopped.

Topical corticosteroids can be absorbed into the blood circulation and cause a number of side effects in your body, particularly if you are treating large areas and/or using strong steroids. Only mild steroids should be used on the more sensitive skin, such as your face, and in skin folds. Stronger steroids are usually required elsewhere. Pulsed betamethasone diproprionate used three times, 12 hours apart is shown to be useful in maintaining psoriasis. This regimen is suitable for weekend use while non-cortisone can be used during the weekdays.

Topical Tazarotene (Tazorac®):

Tazarotene is a selective retinoid with properties that are similar to vitamin A. Tazarotene is available as a cream and gel. It is effective in the treatment of psoriasis, acne, and photoaging. In the treatment of psoriasis, it may be used by itself, or in combination with a corticosteroid cream or ointment, calcipotriol/calcipotriene or light treatment (UVB, PUVA).

Irritation is common with tazarotene, but you can minimize this by applying a thin layer of the medication only to the patches and avoiding the uninvolved surrounding skin and/or protecting the surrounding skin with petrolatum. You should not use tazarotene on the genitals or in the skin folds. You should not use this medication if you are pregnant.

The mechanism of action is unknown. It may induce growth suppressor genes in keratinocytes. The efficacy is usually slow and starts with reduction of plaque thickness and some improvement in redness and scaling usually occurs after 3 months.

Side effects include redness and burning. It should not be used in women who wish to become pregnant.

Application is usually used daily.

(GCS) GotClearSkin.com

Etanercept (Enbrel)

This is a fusion protein. This is a TNF-alpha receptor fused onto human IgG. It acts by inhibiting TNF-alpha activity.

It is used for rheumatoid arthritis,juvenile rheumatoid arthritis as well as psoriatic arthritis. This shows good activity against psoriatic arthritis with eighty-seven percent of patients in one study showing significant improvement compared to twenty-three percent in the placebo group. In patients with skin psoriasis about one quarter showed seventy-five percent improvement in their PASI scores.

Dosage

Etanercept is given as a 25 mg twice weekly dose injected subcutaneously at home. This drug should be avoided in patients with a history of multiple sclerosis.

Side Effects

The common side effect is at the site of injection. These reactions are usually mild to moderate and diminish in frequency after the first month of treatment. Redness, itching, pain and swelling were described. There is a slight increase in the incidence of upper respiratory tract infections. It should not be used in those with congestive heart disease. There is a risk of re-activating tuberculosis so therefore it is avoided in individuals with positive tuberculin skin tests. There is a small series of patients who have developed signs of drug induced systemic lupus. It is possible that this drug may unmask multiple sclerosis.

Drug Interactions

This drug has been used in combination with both cyclosporine and methotrexate.

(GCS) GotClearSkin.com

Efalizumab (RAPTIVA®)

RAPTIVA® is a recombinant humanized monoclonal antibody that binds specifically to the CD11a subunit of LFA-1 (lymphocyte function-associated antigen-1), a leukocyte cell surface protein. By this mechanism, efalizumab:

inhibits the primary T lymphocyte activation in lymph nodes (including T lymphocyte proliferation, interleukin-2 (IL-2) receptor expression, CD11a expression, and cytokine release);
inhibits T lymphocyte binding to endothelial cells and trafficking to psoriatic lesions;
inhibits T lymphocyte reactivation in dermis/epidermis and interaction with keratinocytes.
RAPTIVA® is indicated for the treatment of patients with moderate-to-severe chronic plaque psoriasis in adult patients (18 years or older) who are candidates for systemic therapy or phototherapy. It has also been studied in refractory patients who were not controlled by, contraindicated to, or intolerant to two or more systemic therapies (CLEAR study).

Clinical trial data

The efficacy of RAPTIVA® is largely based on 7 key studies that included more than 3,200 patients: 5 placebo controlled studies, plus two extension studies ranging from 12 weeks to 1 year and a long term open label trial for treatment up to 27 months. Patients randomized to the RAPTIVA® dose group achieved statistically significantly better responses than placebo on the primary endpoint, i.e., achieving a greater or equal to 75% improvement in PASI score compared to baseline in all studies. For example, in one study of 339 patients, 41% achieved PASI-75 and 82% achieved PASI-50 at week-12.

The improvement in PASI score in the RAPTIVA® arm relative to the placebo arm was seen as early as Week 2 of treatment and increased over time.

Dosing

RAPTIVA® is intended for use under the guidance and supervision of a health care professional. RAPTIVA® is administered as a subcutaneous injection and patients may self-inject following proper training in measurement of the correct dose and injection technique. Injection sites should be rotated. RAPTIVA® should be administered as an initial single 0.7 mg/kg body weight dose followed by weekly injections of 1.0 mg/kg body weight. The maximum single dose should not exceed a total of 200 mg.

Safety

The most common adverse drug reactions observed during RAPTIVA® therapy were mild to moderate dose-related acute flu-like symptoms including headache, fever, chills, nausea and myalgia. In large placebo-controlled clinical studies, these reactions were observed in approximately 17% of subjects in excess of placebo-treated patients over 12 weeks of treatment. Headache was the most prevalent type of flu-like symptoms. These reactions were greatest with the first dose administration, decreasing with the second and subsequent doses. Severe acute events of headache, chills, fever and myalgia were reported only in the RAPTIVA®-treated subjects affecting 3.6% of subjects.

Duration of Response

RAPTIVA® is best used as a continuous therapy. The median time to relapse among PASI responders who discontinued treatment after 12 weeks is approximately 67 days (time to relapse [= 50% loss of improvement] was evaluated in patients who were classified as responders [= 75% improved on PASI] after 12 weeks of treatment.). The majority of responding patients who were responders at the end of 12 weeks and continued RAPTIVA® treatment, maintained this response at 24 weeks. Extended treatment showed additional benefit for subjects who, at the end of the initial 12-week treatment, were either non-responders (subjects who did not achieve a PASI 50 response) or partial responders (subjects who achieved a PASI 50 but not a PASI 75 response). RAPTIVA® re-treatment was effective in subjects whose psoriasis recurred after RAPTIVA® withdrawal.

Drug Interactions

There have been no formal drug interaction studies conducted with RAPTIVA®. No data are available on the effects of vaccination or on the secondary transmission of infection by live vaccines in patients receiving RAPTIVA®. Patients should not receive acellular, live and live-attenuated vaccines during RAPTIVA® treatment.

The interaction of RAPTIVA® with other systemic antipsoriatic therapies, such as cyclosporin, methotrexate or oral retinoids, has not been formally studied. Limited data from clinical studies has been accumulated on concomitant use of RAPTIVA® and methotrexate, oral retinoids, UVB phototherapy, non steroidal anti inflammatory drugs (NSAIDs) and topical antipsoriastic agents. RAPTIVA® should be administered with caution in combination with these medications.

Given the mechanism of action of RAPTIVA® it is not recommended to use RAPTIVA® in combination with other immunosuppressive drugs.

(GCS) GotClearSkin.com

Biologic Drugs and How They Work

We are entering a very exciting stage in medical treatment in that drugs have been designed to specifically hit immunological targets that are involved in specific conditions. Previous immune therapy has involved drugs that have a general suppressing effect on the immune system which consequently prevents high doses being used because of the fear of side effects. Theoretically the more specific the target to be blocked, the less interference with other biological functions - making the drug safer.

These new drugs are known as biological drugs. They are created in living cells. The technique has been used for a long time for drugs such as insulin or interferon.

There are a number of new biologic drugs that are currently used in psoriasis.

Alefacept (Amevive)
Efalizumab (Raptiva)
Inflixiamab (Remicaide)
Etanercept (Enbrel)
Explanation of the difficult drug names:

The suffix denotes the drug class.

Mab = monoclonal antibody

Ximab = chimeric(mouse-human) monoclonal antibody

Zumab = Humanized monoclonal antibody-ie. Reducing the amount of mouse to under10%

Umab = Human monoclonal antibody

Cept = receptof –antibody fusion protein that mimics an immunoglobulin

These drugs can target different steps in the pathway of producing psoriasis. The following general targets have been identified and can be blocked.

T-cell activation
Inhibiting memory or activated T-cells
Blocking the migration of T-cells into the skin
Inhibiting the chemicals or cytokines produced eg. tumor necrosis factor
Blocking conversion of one cytokine into another

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