Psoriasis is a common skin disease that causes red scaly patches all over the body. Northern University researchers have found a means of helping people with the disease. They report that the drug Etanercept, an FDA approved drug for adults that has never been tested in children, dramatically reduces psoriasis flare-ups.
"These kids' lives have been changed by being in this study and then staying on the drug," said lead investigator Amy Paller, M.D., a professor of dermatology and of pediatrics, and the chair of dermatology at the Feinberg School.
About 7.5 million people in the United States have psoriasis, a disease in which the immune system causes skin cells to grow at an accelerated rate. One third of those cases begins in childhood, sometimes as young as infancy. The often itchy, painful and disfiguring red scales can cover the scalp, face, arms, legs, feet and even the genital area.
Many of the Chicago area trial participants were long-time patients of Paller, who is a physician at Children's Memorial Hospital. "They are doing better now than they've done with any other treatment," she said. A total of 211 pediatric psoriasis patients from 42 sites in the United States and Canada participated in the 48-week study.
The randomized, double-blind, controlled trial showed 57 percent of patients on etanercept for 12 weeks achieved a 75 percent or greater improvement in symptoms compared to 11 percent of patients who received a placebo. A 75 percent improvement is considered "the gold standard" in psoriasis care, Paller said.
Etanercept is a type of protein that blocks the action of a substance produced by the immune system called tumor necrosis factor (TNF). People with immune diseases such as plaque psoriasis have too much TNF in their bodies.
The new drug option is significant because existing treatments for children and adolescents are limited, inconvenient and carry risks. They also do not work effectively for all children.
Some treatments include greasy topical steroids or ultraviolet light therapy, which carries the risk of skin cancer. Another option is chemotherapy drugs, which suppress the immune system and can potentially damage the liver and the kidneys, or cause hypertension.
"From what we can see so far, etanercept is a much safer alternative," Paller said. She hopes the study results will spur the drug's approval by the FDA for pediatric use.
"Psoriasis can be extremely alienating for children," Paller noted. "I've had patients, especially during teenage years, who have been quite depressed by their disease. If they're being teased or excluded by other kids, or have to exclude themselves from sports because it's uncomfortable, that has profound implications on their ego development."
In fact, children with psoriasis have a higher risk of depression and obesity, Paller said. Although it is unclear whether there is a metabolic or psychological basis to the increased risk of obesity, Paller wonders if starting young psoriasis patients on etanercept will lower their risk for being overweight.
Anichini said her years of struggling with psoriasis might have affected her personality as she grew up. "I'm not that outgoing and maybe that's because of the psoriasis," she said. "I never wanted to put myself out there and be the center of attention. I'd stay in the shadows."
But that's changing for her. "The drug has made it a lot easier to be social and put myself out in the world," Anichini said. "I feel like a whole load has been lifted off my chest. I can dress like everyone else. I feel normal."