NICE Begins Approval Process for New Treatment for Severe Psoriasis

Draft guidelines that back the use of Almirall’s new product Skilarence, for the treatment of moderate or severe plaque psoriasis by the National Health Service in the United Kingdom, have been issued by the National Institute for Health and Care Excellence (NICE). The drug is being recommended for use by the Institute only in those adults who have the severe form of the disease or are unable to take, or have failed to respond to, different systemic non-biological treatments.

Psoriasis: What is it?

There are a number of different kinds of psoriasis, with most people only having one at any particular time, although it is possible for two different kinds to strike at once. Some can actually change into a different type, or end up becoming more serious. The great majority of psoriasis cases go through cycles, often causing difficulties for sufferers for several weeks or months but then stopping or easing. If you believe you may be suffering from psoriasis then you should see your GP or start a consultation here.

Psoriasis types

The most common type of psoriasis is plaque psoriasis, which presents with symptoms such as red, dry skin lesions that are covered with silver scales. These lesions are referred to as plaques and generally materialise on the elbows, scalp, lower back and knees but can actually appear anywhere on the body. These plaques can be sore or itchy or sometimes both, and the skin around joints may bleed and crack in severe cases.

Another form of psoriasis is scalp psoriasis, which can only appear on the scalp and in some cases may even cover the whole area. This form of psoriasis results in red skin patches that are covered with silvery-white thick scales. In some cases the patches cause no discomfort, but some people can find them extremely itchy. Hair loss can be the result in extreme cases, but this is normally a temporary effect.

Fifty percent of people afflicted with psoriasis develop nail psoriasis, which as the name suggests affects the nails. Tiny pits or dents can develop in the nails, and they may grow in an abnormal manner or become discoloured. Nails may also loosen from the nail bed and in severe cases crumble.

Gutatte psoriasis results in small drop-shaped sores appearing on the arms, legs, scalp and chest, and sometimes develops following a streptococcal throat infection. Many cases disappear in a couple of weeks but sufferers can go on to develop plaque psoriasis. It is particularly common in teenagers and children.

Inverse psoriasis affects the creases or folds of the skin, such as underneath breasts, between buttocks and around the groin and armpits, resulting in smooth, large red patches. Sweating and friction worsen the condition, making it particularly irritating during hotter weather.

Other, less common forms of psoriasis include pustular psoriasis, where blisters filled with pus appear on the skin; generalised pustular psoriasis, which also causes blisters and can cause chills, fatigue, fever and weight loss; palmoplantar pustular psoriasis, where pustules appear on the soles of the feet and the palm of the hands; acropustulosis, where pustules materialise on toes and fingers; and erythrodermic psoriasis, a very rare form where all the body’s skin can be affected, causing intense burning or itching and sometimes resulting in additional problems such as dehydration, hypothermia, malnutrition, infection and even heart failure.

The recommendation

The National Institute for Health and Care Excellence says that the results of clinical trials have demonstrated that Skilarence, otherwise known as dimethyl fumarate, is able to improve severe cases of psoriasis more than is the case with placebos. However, it is less effective in indirect comparison with systemic biological therapies as well as apremilast, otherwise known as Celgene’s Otezia. The drug’s incremental cost ratio, followed up with best supporting care, falls into the threshold of what is deemed a cost-effective use of the resources of the NHS in this setting, being £23,115 per QALY gained, in comparison with just best supporting care on its own. 

The recommendation also comes with a further condition, that the Skilarence treatment should be halted after sixteen weeks in the event of an inadequate response. This is defined as a reduction of 75 percent in the PASI score from the commencement of treatment, or a reduction of 50 percent in the same score, coupled with a reduction of five points within the Dermatology Quality of Life index. An estimated 951,000 people in the whole of England suffer from psoriasis, with 90 percent of those suffering from plaque psoriasis.

We are sorry to report that Trimovate is again out of stock and there is not currently a date from the manufacturer as to when this item will be back. There have been on-going manufacturing problems with this often-prescribed topical medication. Trimovate contains a corticosteroid along with an antifungal and an antibacterial.

There used to be another product called Dermovate NN that was a good alternative to Trimovate. Although Dermovate NN has been discontinued, there is a generic version available and we can prescribe this as an alternative to Trimovate. This special generic is quite expensive but it is the only alternative that contains the three active ingredients of a corticosteroid, antibacterial and antifungal. You can create a skin consultation by clicking on the button below.

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Psoriasis has been associated in the past with being overweight. A new study has sought to explore this phenomenon further.

Dr. Jensen et al. have thought about expanding this further to see exactly what kind of an impact obesity has on the skin condition whereby a type of white blood cells (T-cells) start, erroneously, to damage normal skin cells. They divided the sample group in two and they asked the first group to continue eating healthily while they gave the second group (the test group) a specific low-energy diet. As predicted, the second group lost more weight and this caused, in turn, an improvement of their psoriasis condition. Researchers measured the improvement by two different means: the Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI).

Findings were significantly different when comparing the second group to the first group through the DLQI. The second group in fact, scored better than the first. However, even though the PASI test showed insightful results (the second group showing more improvements than the first), the findings through this metric were not statistically significant. Therefore, this study should be replicated in order to test out its validity and reliability. The findings also suggest that obesity is not the only factor that affects psoriasis, and that further research is needed to study additional factors that might relieve symptoms of psoriasis on individuals suffering from the condition.

Inasmuch as this study did not reach unanticipated results, it has highlighted that it is important for patients with psoriasis, who are also overweight, to seriously consider reducing their weight, as this is more likely to improve their skin health as well as their general wellbeing.

A topic that has received some attention with research regarding acne is whether diet plays a role in the pathogenesis of acne. A recently published literature review elegantly explains how the majority of studies regarding diet and acne have been flawed in the past, but that new studies indicate that a diet focused on Glycemic Load (GL) or dairy may be a worthwhile area to reconsider in research.

The review, which was published in Journal of the Academy of Nutrition and Dietetics, critically evaluated 27 studies that had considered the relationship between diet and development of acne. The majority of these studies were poorly designed, and often relied on self-report, lacked criteria for evaluating changes in acne development and had limited samples (who were often only males). Moreover, the same research teams, who repeatedly made the same methodological errors, conducted many of the included studies. However, the authors also highlighted some recent studies that had a better design and statistical measurement of the results. Overall, the researchers argued that diet does not cause acne, but that the potential relationship between diet and acne is worthy of investigation especially when it comes to consumption of dairy products and diets focused on GL levels.

For instance, in the case of dairy products, it was noted that excessive amounts of dairy seemed to be related to a higher amount of acne. Although this was a consistent finding between the studies, there were no specifications as to whether this relationship was direct or indirect. Similarly, the specific ingredient within dairy products that would play a key role was not specified. What surprised us the most was that none of the studies included cut-off points for when dairy or GL would become problematic, but mentioned that their participants had an excessive use of both.

We agree with the authors that more robust research, preferably randomised controlled trials, is needed in order to establish whether diet can play a role in developing acne. These studies would also need to pay greater attention to patients’ current and previous acne medications, and demographic factors such as race, sex and age. Including all of the aforementioned would enable more high quality comparison of studies.

We do not consider it unlikely that a diet would play a part in acne development, given that current research suggests several pathways to pathogenesis of acne. If future research were to present reliable findings, then this could have implications for recommending a certain diet in conjunction with acne medications.

The Online Clinic is now treating fungal nail infections with prescription treatment that are available for next day delivery. Fungal nail infections are very common and tend to afflict the toenails more than the finger nails as the toe nails provide a better breeding ground for the fungal spores. The sort of infections that affect the nails can be remedied with a prescription cream or oral tablets of terbinafine. You can read more about fungal nail infections here. You can apply for treatment by clicking on the free consultation button below.