Psoriasis Guru

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Immunosuppressants

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Methotrexate — More isn’t Better

Monday, November 2nd, 2009

According a recent study done by researchers in Berlin, if a patient taking methotrexate (MTX) for psoriasis does not show significant improvement in after 12 weeks, then increasing dosage will most likely not improve their condition.  According to this report, the maximum dosage recommended for anyone taking MTX for psoriasis is 20 mg per week.  This weekly dose should be split up into at least two administrations to minimize immediate side effects such as nausea.

How does methotrexate work?

MTX hinders cell reproduction by blocking DNA synthesis (this is a vital part in in the cellular reproductive process).  It is especially adept at blocking hyper-proliferating cells such as those affected by psoriasis or cancer.  It is also used as an immunosuppressant to battle conditions that affect the immune system such as arthritis, Crohn’s disease or psoriasis.

How is methotrexate administered?

MTX can be administered either orally or via injection.  Taking it in pill form is most common when it is used to treat psoriasis.

Why are doctors hesitant to prescribe more than 20 mg of methotrexate per week?

MTX is also used to treat cancer, and you have probably heard of the some of the harsh side-effects that cancer treatments tend to have.   In smaller doses, which are appropriate for psoriasis patients, it still can cause some serious side effects, including long-term liver damage and drops in white blood cell counts.  The main benefit of methotrexate — that is hinders cell re-production — can also wreak havoc on other parts of the body.

What are some of the brands names used to market methotrexate?

MTX is marketed under the brand names Trexall and Rheumatrex.

A syringe filling with methotrexate solution (courtesy of Flickr):
methotrexate syringe injection

Expensive Psoriasis Shampoos Vs. Holistic Treatments

Sunday, October 25th, 2009

psoriasis shampoos

You don’t have to be a math whiz to figure out that medicated psoriasis shampoos are a lot more expensive than standard shampoos.  Whereas basic shampoo brands such as Suave can go for about 99 cents for a bottle, you would be lucky to find any kind of psoriasis shampoo for five bucks (or less).  Occasionally my local grocery store, Fry’s, puts T/Gel on sale for about 5 dollars a bottle, but I have come to expect about 6 dollars a pop.  As you can see in the picture above, such pricing leads me to leave the shampoo bottles upside down until I can squeeze every last drop out of them.

Included in the picture above:

  • T/Gel — Extra Strength (4% Neutar) and Stubborn Itch Control (2% Neutar as well as menthol)
  • T/Sal — Active ingredient: Salicylic acid.
  • Selsun Blue, with menthol and 1% selenium sulfide, which is a common dandruff medication

Cost is a major factor that must, by necessity, be calculated into one’s daily psoriasis-battling regimen.  If insurance doesn’t cover a certain medication, if copays add up to too much or if you don’t have any insurance at all then, short of taking up a life of crime, you will have to seek out other options to treat your psoriasis.  It is because of such resource limitations that holistic treatments (changing your entire lifestyle to treat psoriasis) are sometime necessary.  This can be a good thing much of the time since treating psoriasis generally involves becoming more healthy all-around.

In addition to being more affordable, holistic, herbal and generally more natural treatments can be more effective in the long run for treating your psoriasis.  If your body is equipped from the inside-out to fight off this condition, then additional brute-force drugs such as steroids or immunosuppressants will become unnecessary.

This is similar to the effect that drinking less caffeine has on my ability to concentrate and work effectively.  It’s nice to get that jolt of energy, but there is inevitably a let-down afterward, during which work seems even more difficult than before.  During the let-down phase I feel compelled to drink more caffeine, thus increasing my dependence on this drug.  But, when I opt for sleeping enough and drinking more water, my brain works better over longer periods of time.

The theory behind holistic psoriasis medications is similar to the principal of sleeping more rather than drinking caffeine.

Modern medicine is adapting to the fact that the body is, much of the time, better equipped to deal with biological issues than any man-made drug.  This points to the general fact that you, if you are suffering from psoriasis, should use shampoos such as those listed above but, at the same time, keep exercising, eating right and maintain a healthy state of mind to the best of your ability.

Is the Swine Flu (H1N1) Vaccine Safe for People Suffering from Psoriasis?

Wednesday, October 21st, 2009

Would it be dangerous for a person with psoriasis to take a Swine Flu (H1N1) shot?

You should ask your doctor whether taking the Swine Flu vaccine would clash with your current psoriasis medications, especially if you are taking immunosuppressants such as Humira or Enbrel.  Immunosuppressants can be very effective at clearing up moderate to severe psoriasis since they inhibit the body’s defenses from over-reacting (thus preventing scaling, irritation and swelling), but this inhibition can make the body vulnerable to other infections.

If you’re pressed for time try calling a nurse / medical professional hot-line if your insurance company provided you with one (I know Blue Cross does this).  You can also call the National Psoriasis Foundation at 503-244-7404 or 800-723-9166 (phone numbers from their website).

Any medication, including supplements, could potentially react badly when another medication is thrown into the mix.  A vaccination is not a medication per se, but it is designed to change some of the body’s fundamental chemistry and can cause minor side effects while the immune system is acclimating to the shot.

Would the Swine Flu itself cause your psoriasis to flare up?

Anything that detracts from your immune system can potentially lead to a psoriasis flare-up.  Holistic therapies that seek to make the body better equipped to fight off psoriasis using natural means depend on the immune system doing its natural job.  Thus, a slight handicapped, or preoccupied defense system in the body might give the psoriasis disease the opening it needs to break out again.

Some of the more notorious psoriasis agitators:

  • Retroviruses such as HIV, which break down the immune system.
  • Bacteria such as strep throat (streptococcus pyogenes)
  • Fungi, in particular Malassezia, which is best known for causing itching and dandruff.

What is Cyclosporine?

Monday, October 12th, 2009

Cyclosporine is an immunosuppressant that, in addition to treating psoriasis, is also used to prevent the rejection of transplanted organs.

Cyclosporine suppresses the development of psoriasis by hindering certain aspects of the immune system.  In particular, it throws a wrench in the process by which T-cells respond to perceived infection, thus helping to minimize inflammation and the proliferation of skin cells.

Interesting: Drinking grapefruit juice while taking an oral dose of cyclosporine amplifies the drug’s potency by preventing the digestion system from destroying as much of it.

As with most immunosuppressants, cyclosporine can be an effective treatment for severe psoriasis, but at the same time it can also cause some severe side effects.  Of note however is that test groups for this drug have, for the most part, demonstrated mild side effects.

Side-effects include fever, headaches, nausea, excessive hair growth and dizziness.  It has also caused some people to have respiratory issues, convulsions and high blood pressure.  There is also the risk of infection from other diseases as well as kidney and liver damage. 

Cyclosporine can send psoriasis into remission after a relatively short amount of time – about 16 weeks – at which point medication can be tapered off and replaced with something less harsh.  The risks associated with cyclosporine increase the longer a person takes it.

Of course cyclosporine is available by prescription only.  This gives the doctor a chance to discover any factors that might lead to extremely adverse reactions to the drug such as the presence of other medications or pre-existing health conditions.