Talk:Psoriasis

PASI score

PASI stands for Psoriasis Area and Severity Index. PASI includes the amount of body surface area that is affected by psoriasis in addition to three major symptoms: redness, inflammation, and the thickness of the scale on the skin. A patient is given a PASI score from 0-72 where 0 means no psoriasis and 72 means the most severe psoriasis. A PASI score is given to a patient before treatment and then after treatment to determine the effectiveness of the therapy. The goal of successful psoriasis treatment is to reduce the PASI score as close to 0 (no psoriasis) as possible.

Ultraviolet info seems self-contradictory

Ultraviolet wavelengths are subdivided into UVA (380–315 nm), UVB (315–280 nm), and UVC (< 280 nm). Ultraviolet B (UVB) (315–280 nm) is absorbed by the epidermis and has a beneficial effect on psoriasis. Narrowband UVB (311 to 312 nm), is that part of the UVB spectrum that is most helpful for psoriasis.

Query: If UVA is from 380-315 nm, it includes 311-312 nm. So how come Narrowband UV (311 to 312 nm) is supposed to be UVB instead of UVA?

Answer: 380-315nm does not included 311-312nm. 311-312 is less than 315.

Vitamin D therapy in psoriasis.

Araugo OE, Flowers FP, Brown K.

Vitamin D therapy in psoriasis.

DICP. 1991 Jul-Aug;25(7-8):835-9. Review.

PMID 1659041

Morimoto S, Yoshikawa K.

Psoriasis and vitamin D3. A review of our experience.

Arch Dermatol. 1989 Feb;125(2):231-4.

Abstract

Psoriasis is associated with abnormally exaggerated epidermal cellular turnover. Recent studies showed that calcitriol (1,25-dihydroxyvitamin D3) a calcitrophic hormone, regulates terminal differentiation of basal cells of epidermal keratinocytes. We administered active forms of vitamin D3 in both oral and topical ways in an open-design study to patients with psoriasis vulgaris. Significant improvement was observed at the end of the study periods in these patients, especially in those treated with topical application of calcitriol. We also found a significant negative correlation between the severity of psoriasis and the basal serum level of 1 alpha,25-dihydroxyvitamin D but not with those of other calcium-related parameters in psoriatic patients. These data suggest that exogenous active forms of vitamin D3 are effective for treatment of psoriasis and that the endogenous 1,25-dihydroxyvitamin D level also may be involved in the development of this skin disease.

PMID 2536537

Kamangar F, Koo J, Heller M, Lee E, Bhutani T.

Oral vitamin D, still a viable treatment option for psoriasis.

J Dermatolog Treat. 2012 Jan 21. [Epub ahead of print]

PMID 22103655

Grace K. Kim, DO

The Rationale Behind Topical Vitamin D Analogs in the Treatment of Psoriasis; Where Does Topical Calcitriol Fit In?

J Clin Aesthet Dermatol. 2010 August; 3(8): 46–53.

PMCID PMC2945865

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945865/ </ref>

"The therapeutic use of vitamin D dates back to the 1930s when it was used as an oral agent for osteoporosis on a psoriasis patient who subsequently experienced clearing of psoriatic skin lesions.10 Dermatological application of topical vitamin D3 centers on the fact that the skin is both a site of initial vitamin D biosynthesis and a target for vitamin D3 activity causing modulation of keratinocytes and inflammatory mediators.11" [1]

Cites in above block quote:

10: Nagpal S, Lu J, Boehm MF

Review Vitamin D analogs: mechanism of action and therapeutic applications.

Curr Med Chem. 2001 Nov; 8(13):1661-79.

PMID 11562285

11: Wolverton SE.

Comprehensive Dermatologic Drug Therapy. 2nd Edition.

Philadephia, PA: Saunders Elsevier; 2007.

Mention the generic (calcitriol) along with the patented (calcipotriol)?

Moisturizers and emollients such as mineral oil, petroleum jelly, calcipotriol or calcitriol, and decubal (an oil-in-water emollient) were found to increase the clearance of psoriatic plaques. Emollients have been shown to be even more effective at clearing psoriatic plaques when combined with phototherapy. However, certain emollients have no impact on psoriasis plaque clearance or may even decrease the clearance achieved with phototherapy. The emollient salicylic acid is structurally similar to para-aminobenzoic acid (PABA), commonly found in sunscreen, and is known to interfere with phototherapy in psoriasis. Coconut oil, when used as an emollient in psoriasis, has been found to decrease plaque clearance with phototherapy. Medicated creams and ointments applied directly to psoriatic plaques can help reduce inflammation, remove built-up scale, reduce skin turnover, and clear affected skin of plaques. Ointment and creams containing coal tar, dithranol, corticosteroids (i.e. desoximetasone), fluocinonide, vitamin D₃ analogs (for example, calcipotriol or calcitriol), and retinoids are routinely used. The use of the finger tip unit may be helpful in guiding how much topical treatment to use.

Note

Am moving this note here. A popular press article is not good for updating Wikipedia. We need to go with high quality reviews. Doc James (talk · contribs · email) 19:26, 18 June 2016 (UTC)

We mention IL17 inhibitors already of which this is one. Doc James (talk · contribs · email) 19:32, 18 June 2016 (UTC)

Frequently used

Were does this ref say apremilast is frequently used User:Kbojanowski? [1] Doc James (talk · contribs · email) 18:52, 6 November 2016 (UTC)

Do you have evidence that it is a "first line" agenet? Doc James (talk · contribs · email) 09:41, 7 November 2016 (UTC)

I don't have a problem with you modifying the verbiage of my edit so it does not suggest that apremilast is frequently used. However, why "apremilast may also be used" sentence was placed in the "biologicals" section. Could we put it in the "non biologicals" section and move on with our lives? Why my placement of this sentence in the "biologicals" section was undone and apremilast was put back in the section discussing antibodies? Kbojanowski (talk) 01:25, 9 November 2016 (UTC)kbojanowski

Okay so you added it to the sentence that says it is frequently used when evidence does not support frequent use.

That paragraph is about first line treatments. I am not seeing a ref that says it is a first line treatment. Doc James (talk · contribs · email) 11:27, 9 November 2016 (UTC)

A simple factual edit being unnecessarily blocked

I made a simple 100%-proven factual edit by adding Apremilast to the list of FDA-approved, non-biologic treatment modalities for psoriasis. The editor, calling himself Doc James modified it and moved to the paragraph describing the biological treatment modalities. I am fine with his modification but not with moving my edit to the "biologicals" section, because Apremilast is not a biologic. So I moved it back where it belongs. However, it was not only immediately moved back to the wrong section, but I was told that I started an edit war!

I don't think this kind of editorial supervising is in the best interest of Wikipedia. Experts in the field shouldn't be prevented from making 100% fact-proven edits by overzealous editors, who are obviously not experts in the field. Since it appears that I am prohibited from doing it myself by Doc James, I request that some authorized person place my edit back where it belongs - in the "non-biologics" section of the Psoriasis article.

Thank you very much in advance,

Dr. K. Bojanowski — Preceding unsigned comment added by Kbojanowski (talk • contribs) 23:38, 8 November 2016 (UTC)

Would you please read just above, and respond there? Thanks Jytdog (talk) 00:04, 9 November 2016 (UTC)