New Psoriasis Hope

Psoriasis protein could be key to improved treatment

/ Author:  / Reviewed by: Joseph V. Madia, MD

For those without psoriasis, the common autoimmune condition that generally manifests as raised red skin with silver-white patches of dead skin, the condition may appear to be just a minor cosmetic annoyance.

But those with the condition also are at an increased risk of heart disease and are more prone to depression, a result of low self-esteem from the scaly patches covering their skin.

A new finding may foreshadow a new treatment that could help millions worldwide. A protein being studied in Sweden could be key.

Lead researcher Dr. Charlotta Enerbäck, a professor from the department of clinical and experimental medicine and division of cell biology and dermatology at Linköping University in Sweden, said that researchers are still examining the psoriasin protein in pre-clinical studies, but what they have found so far has her optimistic.

New Possibilities

A unique component of psoriasis is the psoriasin protein, which is found in large quantities in the skin of those with psoriasis, but rarely in those without the condition.

In a pre-clinical study of cultured skin cells, Dr. Enerbäck and her team of investigators found that it is the interaction between psoriasin, oxygen free radicals and vascular endothelial growth factors (VEGF) that leads to a substantial increase in cell division and new blood vessel growth.

Dr. Enerbäck said this finding is significant because the scaly, itchy patches of skin that are the hallmark of psoriasis are caused by cells dividing freely and without restraint as new blood vessels continue to form, also called angiogenesis, among deep layers of skin.

However, when the formation of psoriasin was blocked, VEGF expression also decreased, suggesting that the protein could offer potential for development of an effective drug.

In the study recently published in journal Breast Cancer Research and Treatment, she notes that the psoriasin protein also is believed to be a factor in breast cancer. A drug developed also may possibly aid breast cancer patients.

"We want to examine the ability of psoriasin as a target for therapy. By inhibiting psoriasin, we believe we can reduce vascular formation and thus the proliferation of the disease's magnitude and intensity," Dr. Enerbäck said. "We are currently performing further preclinical studies regarding the association between psoriasin and the angiogenesis in psoriasis."

Studies in mice conducted previously suggested angiogenesis inhibitors were capable of reducing the proliferation of blood vessel formation, inflammation and excessive cell division.

"Since psoriasin expresses itself specifically only in the diseased psoriatic skin, we expect that inhibitors against this are highly selective and effective against the disease, and that the risk for side effects is minimal," Dr. Enerbäck said, noting she is uncertain how far away an actual treatment as a result of the study could be.

What is Psoriasis?

So, what exactly is psoriasis? It's a chronic skin condition that happens when the immune system transmits faulty signals that result in an accelerated growth cycle of skin cells. It can appear slowly or suddenly. It could even disappear and then return later.

The condition isn't contagious,but according to the National Psoriasis Foundation as many as 7.5 million Americans suffer from psoriasis.

Though there are five types of the condition, plaque psoriasis, which appears as swollen red patches covered with a silver-white scaly-looking build up of dead skin cells, often on the elbows, knees and scalp, is by far the most common type. About 80 percent of individuals that suffer from psoriasis have this type.

Less common types include guttate psoriasis, which often starts in childhood and appears as individual red dots on the skin, usually affecting the trunk and limbs; and inverse psoriasis, usually manifesting as shiny bright red lesions in skin folds such as the armpits, genitals and buttocks.

Pustular psoriasis appears as white pus-filled blisters surrounded by red skin, while erythrodermic psoriasis presents as bright skin redness, with scales that often shed in large sheets. Erythrodermic psoriasis is the most inflammatory type and can be associated with severe pain and itching as well as fluid loss that can lead to severe illness, potentially requiring hospitalization.

Psoriasis appears to be inherited. The National Psoriasis Foundation estimates that at least 10 percent of the population inherits at least one gene that would make them susceptible to developing the condition. About 2 percent to 3 percent of the population suffer from psoriasis, possibly because in addition to inheriting the gene, individuals may also need to be exposed to certain triggers.

Triggers are wide and varied and range from stress, dry skin and bacterial infections to certain medications such as beta blockers to lower blood pressure, sunburn or drinking too much alcohol.

A skin biopsy to rule out other medical conditions could be used, but most often doctors can diagnose psoriasis simply by examining the skin.

Treating Psoriasis

The new research finding is important because, though a plethora of psoriasis treatments are available, not all successfully aid patients. Some, such as newer biological agents are more expensive and can come with bothersome side effects.

The first line of defense in treating psoriasis is usually a topical treatment that could include creams or ointments that contain cortisone, coal tar or anthralin. Other creams can aid in removing scaling.

Some patients also have success with dandruff shampoos to treat psoriasis on the scalp, moisturizers, prescription drugs containing vitamin A or D, or even phototherapy in which the skin is exposed to ultraviolet light.

If these therapies are not successful or if the psoriasis is very severe, newer biologics that suppress the immune system's faulty response are often utilized. These medicines, which are injected or given through an intravenous infusion, generally contain methotrexate or cyclosporine.

Biologics that have been approved by the U.S. Food and Drug Administration include adalimumab (Humira), alefacept (Amevive), etanercept (Enbrel), infliximab (Remicade) and ustekinumab (Stelara.) While these drugs are more powerful and capable of treating the effects of psoriasis across the entire body, they do come with potentially serious, or even fatal, side effects.

Biologics can increase a patient's risk of serious infections, such as tuberculosis, or certain types of cancer, including lymphoma. Invasive fungal infections, skin irritation and rashes also can be caused by biologics.

In addition, some biologics are expensive and may require frequent monitoring through blood tests during the course of treatment. However, the evidence suggests they are an effective treatment option and pose fewer risks than many other therapies.

Review Date: 
March 17, 2012