Taking A Shot At Psoriasis

Biologic medication eases aggravating, unsightly symptoms.

Charles feels comfortable wearing shorts now that his psoriasis is under control.

Hospitality is in Charles Flanders’ blood. He inherited a flair for the hospitality trade from his parents, who owned several cozy inns in New England. Charles turned that flair into a vocation.

“I’ve worked in the food and beverage division of the hotel industry my entire career,” Charles elaborates. “I’m now semi-retired. I have my own business doing private consulting within the hospitality industry.”

Born in Vermont and raised in New Hampshire, Charles lived most of his life in the northeastern United States. Ultimately, he grew tired of the frigid winters and opted to relocate to the warmer climate of the Sunshine State.

“My family owned property in the Venice area for more than 40 years, so I knew the area well,” relates Charles, 61. “When my wife and I got sick of shoveling snow, we thought, Where do we want to go? Since we knew Venice so well, we decided to move to Florida to be close to my mother. We’ve been in Florida for about 18 years.”

Four years ago, Charles developed an aggravating skin condition that made the hospitality specialist feel something less than hospitable. The condition, which runs in his family, steadily intensified.

“At the time, I had psoriasis over a large portion of my body,” Charles shares. “It was all over my back, legs and arms. It was even on my scalp. The psoriasis looked like a very bad rash with spots that itched. If I bumped or scratched the spots, they bled. If my back rubbed against the seat in the car, the spots would start bleeding.

“The rash was unsightly. I wore pants and a long-sleeved shirt for a long time because I didn’t want people to see it, and I was uncomfortable wearing a swimsuit. My father had eczema and psoriasis, and my sister had it as well. I never had it until three, four years ago, but that’s what led me to Family Dermatology.”

When Charles arrived at Family Dermatology, he met with Alla Gruman, MD, a board-certified dermatologist.

“When Mr. Flanders first came to us four years ago, he had small psoriasis patches primarily on his arms but also a few on his body, and we treated them with topical steroids,” Dr. Gruman reveals. “Over about a year’s time, Mr. Flanders’ condition worsened to include additional patches, and he stopped responding to the topical medication.

“We had several discussions about systemic therapies for psoriasis, but Mr. Flanders was unwilling to try them, mainly because the older medications have many side effects. When I told him about the safety profile of TREMFYA®, which is a biologic given by injection, he agreed to give the medication a try.”

Cytokine Cascade

“Before I can explain how TREMFYA works, it is important to understand how psoriasis works, how it affects the body,” Dr. Gruman contends. “Psoriasis is a chronic inflammatory disease. It is primarily a disorder of abnormal cell keratinization, or hardening, but it also involves a dysregulated immune-mediated disorder. It is essentially a double-hitter.”

People with psoriasis have a high number of activated T cells, which are a type of immune system cell. This situation increases the quantity of inflammatory proteins called cytokines, which are responsible for many of the symptoms of psoriasis, such as the hard, scaly patches on the skin and swollen or stiff joints.

Psoriasis primarily affects the skin and joints, but it also can negatively impact blood pressure, blood glucose, body fat and cholesterol levels, Dr. Gruman observes. This group of symptoms is associated with a condition called metabolic syndrome. This syndrome increases the risk for heart attack and stroke.

“Within a couple of months of beginning TREMFYA, I started seeing a change in my skin.” – Charles

“In the old days, we treated psoriasis with medications such as methotrexate or cyclosporine, which suppress the entire immune system,” the dermatologist discloses. “But as we’ve learned more about how psoriasis affects the immune system, the treatments have become more targeted.

“Today, the medications are aimed at specific cytokines we know are causing the psoriasis symptoms. These medications are known as biologics. They work by blocking certain cytokines called interleukins. The most common are interleukin-17 and interleukin-23. TREMFYA blocks interleukin-23 and prevents the cytokine cascade that causes psoriasis symptoms.”

In cases of psoriasis, the abnormal immune response causes skin cell production to speed up. Typically, skin cells grow in the deep layers of the skin and rise to the surface. As old skin cells crumble and fall away, they are replaced by new cells. This process typically takes place over the course of about a month.

“With psoriasis, this process takes place in just a few days,” Dr. Gruman explains. “As a result, the old skin cells don’t have time to slough off, so skin cells build up and form the hard, scaly patches, which can then crack and bleed. TREMFYA effectively prevents this acceleration of skin cell development from occurring.”

Still, Dr. Gruman stresses, psoriasis is not just a simple skin disease.

“Psoriasis requires attention from multiple specialists,” she insists. “That’s why we screen patients with psoriasis for joint psoriasis as well as metabolic syndrome. We always monitor for medication side effects as well. There is a risk for candida, or fungal infections, with all the biologics, not just TREMFYA. The risk, however, is small.

“We are very optimistic about the future of psoriasis treatment as the newer therapies become even more refined and more targeted.”

“The Rash is Gone”

“Dr. Gruman and I talked about TREMFYA a couple of times, but I held off trying it because I was afraid of the side effects,” Charles recalls. “Finally I said, We’ve tried every topical on the market. Let’s move ahead with the TREMFYA. Since then, my psoriasis has been under control.”

“Charles experienced “a remarkable response” to the TREMFYA, Dr. Gruman confirms.

“He’s been using it for several years and is doing very well,” she says. “He’s been clear of his psoriasis symptoms since beginning the medication and doesn’t require additional medication on a daily basis. We are very happy to have found something that works for him.”

Initially, Dr. Gruman tried multiple topical medications to calm Charles’ psoriasis and ease his symptoms. None were effective. It wasn’t until the dermatologist began treating Charles with TREMFYA that he noticed a significant difference in his symptoms.

“Within a couple of months of beginning TREMFYA, I started seeing a change in my skin,” Charles enthuses. “Today, the psoriasis rash is gone. I don’t have a rash anywhere on my body. It’s been cleared up for more than a year, and I’m now comfortable wearing shorts and a swimsuit.”

Not only is Charles happy about his outcome, he’s also pleased with the dermatologist that treated him and her practice.

“I’m absolutely thrilled with the way Dr. Gruman and Family Dermatology helped me,” he says.

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. mkb
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    • Family Dermatology

      The staff of Family Dermatology have a mission to deliver state-of-the-art medical care in a compassionate and comfortable environment. They are committed to providing patient-centered, individualized care while demonstrating the highest lev... Read More

    • Alla Gruman, MD

      Alla Gruman, MD, is board certified in pediatrics and dermatology. Dr. Gruman completed her undergraduate studies in mathematics and biology at New York University. She earned her medical degree at The Johns Hopkins University School of M... Read More