Beyond Biologics: Psoriasis Patients Can Still Benefit From Traditional Treatments

Main Category: Eczema / Psoriasis
Also Included In: Dermatology
Article Date: 20 Apr 2011 - 8:00 PDT


For patients with severe psoriasis, a new class of intravenous and injectable biological medicines known as "biologics" has brought about a near revolution in treatment.

But doctors at the University of Michigan Health System note that patients and their doctors should also consider long-established treatment alternatives. These can be far cheaper and avoid some of the risk factors associated with the immune system-suppressing biologics, such as increased risk of serious infection and lymphoma.

One of the oldest treatments for psoriasis is known as Goeckerman therapy. The process involves applying ointment made from coal tar to a patient's skin and exposing the patient to ultraviolet radiation with light therapy, which work together to clear the patients' skin.

The U-M Dermatology Day Treatment Center is among a small number of places in the country to offer a modernized version of the treatment, which dates back to the 1920s.

"Sometimes when new treatments come along, everyone jumps on the bandwagon," says Thomas Anderson, M.D., medical director of the Day Treatment Center and associate professor of dermatology at the U-M Medical School. "But Goeckerman has a lot of advantages over biologics. One of the biggest ones is that you're not on it forever."

Cost can also be an important factor in deciding whether to use biologics or seek alternatives. The average course of biologics is $22,000 to $59,700 per year, according to a recent article in the International Journal of Dermatology, while Goeckerman therapy costs $10,000 to $12,000.

"The modified Goeckerman treatment has some advantages and we see good remissions," says Allen Bruce, M.D., Ph.D., a psoriasis researcher and lecturer in the Department of Dermatology at the U-M Medical School. "It can be good for people who have certain risk factors, such as multiple sclerosis, cancer or a history of chronic infections. It's also a good option for people who would prefer, for a number of reasons, not to be on biologics."

The three-week tar and light therapy is intensive, but provides quick relief for many patients, allowing them to don shorts and participate in summer activities without being self-conscious about skin plaques. Remissions can last up to 10 years, but many patients require treatment every year or two.

According to a 2010 article in Pediatric Dermatology, Goeckerman therapy is unfairly considered a "lost art." Given its record of safety and effectiveness, the authors recommended "the current trend toward abandonment of this treatment should be reversed."

Psoriasis affects 7.5 million Americans, according to the National Psoriasis Foundation. Up to 30 percent of patients may also develop psoriatic arthritis, a painful joint condition.

Biologics can provide relief for patients with psoriatic arthritis, while Goeckerman treatment does not. Some patients pursue a combination of treatments that includes both biologics and Goeckerman.

Therapy at U-M's Day Treatment Center is done on an outpatient basis. Patients who live within 30 miles can return home at night and in many cases hotel stays for patients from farther away are provided as part of the treatment cost.

Along with psoriasis, the center also treats rare skin conditions including chronic atopic dermatitis, eczema, chronic contact dermatitis and cutaneous t-cell lymphoma.

Source:
University of Michigan Health System

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