Talk:Psoriasis

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[edit] The process

I read about the process that occurs during psoriasis and I think it's quite interesting and should be added to the article. Especially because it gives laypeople a sense of what's going on. http://www.ehealthmd.com/library/psoriasis/PSO_causes.html

The fact that immunosuppressive drugs help to cure psoriasis does not make psoriasis an autoimmune disease. Likewise psoriasis is no cortisone deficiency syndrome. This are merely secondary phenomena.

There is NO cure. Only temporary relief.

[edit] A new theory about the origin of Psoriasis

In M. D. Anderson researchers discover key protein in psoriasis (12-Dec-2004) you find a detailled new explanation. Due to a small injury the production of a protein called STAT3 is started but it will not be stopped. The healing process will not be finished. The growing of skin cells and the inflation is not ending. I find this very convincing, more than the simple theory of something going wrong with the autoimmun system.-- 82.82.129.112 00:18, 13 Jan 2005 (UTC)

Interesting, but it doesn't explain psoriatic arthritis. Why couldn't it be a combination of factors? 151.203.241.164 18:52, 27 May 2005 (UTC)
The researchers don't say that humans continue to express active STAT3 after healing process finished. They only found active STAT3 in psoriatic skin and that's what you would expect as psoriatic skin is lesioned skin.

[edit] PASI score

In a Clinical Trial Update news item in Genetic Engineering News (vol 25, #3, 2005, pg 5), I noted the following passage "...data from 10 patients with moderate-to-severe psoriasis demonstrated a reduction in the PASI score (a symptom severity score in psoriatic patients) by an avera of 50% ..." (bold added by me). I thought I'd look in Wikipedia for more details on the PASI score and couldn't find any. Is this something that should/could be added here by someone with knowledge of the measure? Courtland 17:53, 2005 Feb 15 (UTC)


[edit] PASI score

PASI stands for Psoriasis Area and Severity Index. PASI includes the amount of body surface area that is affected by psoriasis in addition to three major symptoms: redness, inflammation, and the thickness of the scale on the skin. A patient is given a PASI score from 0-72 where 0 means no psoriasis and 72 means the most severe psoriasis. A PASI score is given to a patient before treatment and then after treatment to determine the effectiveness of the therapy. The goal of successful psoriasis treatment is to reduce the PASI score as close to 0 (no psoriasis) as possible.

[edit] consistency

In Psoriasis#Calcipotriol/Calcipotriene (Daivonex/Dovonex) I read:

[This drug] is sometimes combined with topical corticosteroids to reduce irritation.

but the following section says:

Calcipotriol/Calcipotriene based ointments are usually not to be mixed with corticosteroids at the same time due to problems with the active substances interfering with each other.

These two statements appear to be flatly contradicting each other. Hv 14:19, 31 July 2005 (UTC)

In regard to consistency, the dermatologist will usually recommend the patient use the calcipotriol and the topical steroid daily, but at different times--for example, the calcipotriol in the morning and the topical steroid at night. It is true that mixing the medications is not advised, both for inactivation of the ingredients and because it dilutes each.24.94.5.149 23:05, 23 October 2005 (UTC)

[edit] What is "Pustubeular"?

Google doesn't recognize this word. Typed in by itself it doesn't give any suggestions, but "Pustubeular Psoriasis" gives the suggestion "Pustular Psoriasis", which has many hits, but before I just change the header, I wanted to ask here if anyone knew what the original author might have been going for, in case there is an implied distinction between Pustular and the word the original author meant. --Arcadian 00:43, 8 December 2005 (UTC)

Pustulobullar? JFW | T@lk 21:18, 8 January 2006 (UTC)

[edit] Etanercept

A phase III trial with etanercept showed 50% disease score improvement (but not 75%, which was the primary end point) but also marked improvement in fatigue (and less so, depression) associated with psoriasis[1]. JFW | T@lk 21:18, 8 January 2006 (UTC)

[edit] With our thoughts we create our world!

There has been a lot of talk about the origin of psoriasis. Some say the autoimmune system, some say with genetics. But how true are all of these theories? I think Buddha said that what we are today is a result of what we were! Our thoughts create our world, nothing else does. Searching for a beginning to anything is a fruitless journey. Where did a tree begin? Some self-rightious Christians want us to believe that some super-human God created everything. But from even a cursory glance, this just doesn't hold water. Everything exists because of something else. Read my article at http://www.psoriasis-free.org.

I am starting to edit this material to make it more factual. Philiphughesmd 04:37, 8 March 2006 (UTC)

[edit] To what the last guy said-->

I would disagree with the last statement made. I believe to find a cure for Psoriasis we should be looking in history. For if you find the roots of the problem the solution not far off. With today's world adding in more synthetic materials to our foods, more hormones, and chemicals we need to find what time period Psorasis came about. If then we can find that gap in time, we could start clinical studies to find out just exactly what is causing this problem. After all if we could find a cure for AIDS the same way do you think it would not be worth it? ------Problems tend to worsen over time( like autism ). I would not be surprised 10 years from now(2017)if the number of Psoriasis cases had risen from the 2-3% (now) to an estimated 8-10%.

t r u s h a f t y 3 8 @ h o t m a i l ..com 4.188.255.224 20:58, 1 June 2006 (UTC)shafty

[edit] What on earth?

I think the term 'aggressive food' is a little bit too ambiguous...what on earth is an agressive food? Is it going to try to eat me? Jokes aside, maybe another word would be better...such as 'high GI food' 'known allergenic foods'. Something a little more specific.

—The preceding unsigned comment was added by Nicgeorge (talk • contribs). 7 June 2006
Welcome Nicgeorge - I agree a poor term, but I have no idea what is actually being implied here. A reference might have helped clarify , plus of course help verify a possible alternative health claim. David Ruben Talk 13:31, 7 June 2006 (UTC)

[edit] psoriasisdating.com

i tried to add a link to the dating website psoriasisdating.com but it was removed. there is a small membership fee to the site to use certain features, but it's not a pay site. i think it's an incredibly important link to have on this page. most of the people accessing this page are probably people with psoriasis (like myself) who are trying to cope with the frustrations and depression that come along with the disease. the emotional impact of psoriasis is probably the worst affect of the disease. meeting others who have it is life altering. i actually met my boyfriend on that site and it really changed my life. i think it's an important resource related to this issue, especially because it's not a well known site.

—The preceding unsigned comment was added by 199.243.154.211 (talk • contribs). 17:17, 7 June 2006
If by your own admission it is "not a well known site", then it is hardly notable to the wider community of those with psoriaisis. I can appreciate your position (as you set out) and that the site therefore been of benefit to you. An individual merely suggesting that a site is good (whether or not the case) counts as a personal opinion; which is excluded by WP:No original research. Forums and blog sites are generally considered not to be WP:Appropriate sources. To be worthy of encyclopedic inclusion, one must be able to WP:Cite another appropriate source to WP:Verify that it has WP:Notability, otherwise it will not merit inclusion in wikipedia. Hope this helps clarify the wikipedia framework.David Ruben Talk 17:10, 7 June 2006 (UTC)

[edit] photo

Could this photo be of use in the article? The Wednesday Island 03:26, 8 June 2006 (UTC)

Enlarge
It is a good picture of psoriasis. However I'm not sure what wiki policy is (if there is one) on pictures of patients. The image itself is tagged as being created by your partner, so no copyright issues. However does not some indication need to be made as to the patient's consent for its wider viewing. The patient obviously consented for a photograph to be taken for some purpose, but did this included the widest possible distrubtion (they may have only consented to use for medical studients or as a "snapshot" of their condition for their own confidential medical records). David Ruben Talk 17:04, 8 June 2006 (UTC)
Sorry, I should have been more clear: I'm the model, and I'm quite happy for it to be used. (The upload form only asked who the creator was, so I only mentioned that.) The Wednesday Island 18:23, 8 June 2006 (UTC)
OK - Thank you for the generosity of the photo. Can you please then edit the Images's Summary section here to add this info and your consent :-). Then we can add the image, thumbnailled down, into the article). David Ruben Talk 19:30, 8 June 2006 (UTC)
Done. Thank you for your help! The Wednesday Island 19:50, 8 June 2006 (UTC)

This picture is perfect. It represents psoriasis better than any of the close up shots I'm used to seeing. Rocketqueen 14:50, 9 June 2006 (UTC)


[edit] Fumaric acid therapy in psoriasis

I think it is important to tell you about this almost 50 years old therapy, because it is still quite unknown outside of Germany. It might be the best cure for severe! psoriasis on the market. The drug is called Fumaderm in Germany and it (or an offspring) might be released in other countries soon.

Please add the Fumaric acid therapy to the list of Systemic Treatment. My english is not good enough.

- A study at the Ruhr University Bochum, Germany showed it to be save and efficient.

- It can be used for long term therapy (some people used it for 15 years).

- It works on psoriasis arthritis too.

- The pioneer Dr. Schaefer used it over decades on thousands of patients, 2 year old children, people with only one kidney, with great success.

- Fumaric acid is a natural substance occuring in the body (in the citric acid cycle).

- The side-effects are mainly flushing and gastrointestinal complaints. The concentrations of some substances in the blood change in the beginning of the therapy. The blood must be controlled continuously. I told you it is for severe psoriasis only.

[edit] Other stuff

I just have some other things that might be worth addressing from my own experience with psoriasis. I was wondering if someone with psoriasis might be more prone to develop other skin-related things. I have psoriasis, and I have also been affected by a secondary skin infection on two separate occasions, as well as having chronic dandruff. I also noticed that the article didn't mention anything about whether or not the seasons has any effect upon the intensity of psoriasis. DroEsperanto 16:10, 19 June 2006 (UTC)

[edit] Anthralin

The active compound of Anthralin is Dithranol. The article states that it often fails to adequately improve the skin. This is pessimistic. There are many clinical trials that proof it to be as efficient as PUVA, corticosteroids or calcipotriol. Dithranol causes skin irritation if not used proper, but long term side effects are unknown in contrast to most other medicaments mentioned here.

________

Comment on the above:

Dithranol is a brand name; anthralin is the generic name. The active ingredient in Dithranol is anthralin, which is a synthetic version of chrysarobin, which in turn is a constituent of "Goa powder" derived from the bark of the araroba tree - found principally in Brazil. Anthralin compounds can be effective, but anthralin, (and corticosteroids and Dovonex) are not even close to being in the same class of efficacy as PUVA.

—The preceding unsigned comment was added by 71.139.168.11 (talk • contribs). 10:09, 21 September 2006
Disagree - British National Formulary clearly confirms Dithranol as International Nonproprietary Name with Anthralin being a older depreciated term. BNF lists Dithranol therefoe as generic name (UK brands are Dithrocream, Micanol & Psorin). David Ruben Talk 10:51, 21 September 2006 (UTC)
In line with Wikipedia:WikiProject Drugs/General/Naming of drug pages policy, I have been WP:BOLD and moved Anthralin to the INN Dithranol. David Ruben Talk 03:16, 22 September 2006 (UTC)
I just registered in order to continue the conversation I started above without being anonymous. I see three issues: 1) The original statement is incorrect because it implies dithranol is a constituent of anthralin and/or that anthralin is a brand name. Anthralin is the original generic name for 9(10H)-Anthracenone, 1,8-dihydroxy-. 2) You're right - dithranol is not a brand name - I confused it with drithrocreme, which is a brand name. 3) I'm not as familiar with the term "dithranol", because I'm in the U.S. The U.S. National Institutes of Health use "anthralin" as the principal term for the substance, and only lists "dithranol" as a synonym. [See http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202048.html] The U.S. Federal Drug administration does not use the term "dithranol" in any of their drug databases and formularies; only the term "anthralin" is used. I now understand that the term "anthralin" has been superceded by "dithranol" in the UK and the EU, but if you want this page to be understood by readers from the U.S., then you'll make some type of regional distinction. Edv3 04:53, 26 September 2006 (UTC)
Welcome Edv3. I've tidied up the Dithranol article to both make clearer that Anthralin is current USAN, and also eliminate possible double or nested brackets. David Ruben Talk 12:47, 26 September 2006 (UTC)

[edit] Problems with this article

This article does not describe the the process which generates psoriasis. It concentrates too much on treatments for the disease and their side effects.

The article is taking shape. Most of the concerns raised in the discussions above have been addressed. There is still plenty of scope to tidy up, add further information and references, and to remove superfluous info. Personally I think that the treatment section is too long and reads like a cookbook of therapies. I don't think that the efficacy and side effect need to be stated for each treatment. Especially since the systemic drugs, for example, are linked to other Wikipedia pages. The article should be indepth about psoriasis not about individual therapeutic agents. I don't think the balance is quite right yet.
I suggest a ruthless cull of the individual medicines in the treatment section.
Batrobin 17:40, 11 August 2006 (UTC)
I appreciate the sentiments, but I would not be overly harsh in deleting details of treatment - this article acts also as an overview of treatments (what is used, for which types of psoriasis and pros/cons that affect decisions whether to use or not). What would not be good would be to have this article just mentioning the disease process and merely having a list of linked drug names without any overview as set out above or as currently the case. I think the depth of discussion about various treatmens is about right - however as this is now getting a long article, one approach might be to have a brief summary here that is linked to a separate article of Psoriasis treatment. David Ruben Talk 00:27, 14 August 2006 (UTC)

[edit] External links

Some editors seem to have an annoying discussion about which external links are actually helpful and which ones are SPAM. I say we reach a consensus here. Further links should be listed here and discussed or may be removed on sight if they look like spam. Sign your name with four tildes ~~~~.--Steven Fruitsmaak (Reply) 18:35, 12 September 2006 (UTC)

The WP:EL guidelines are quite clear and there isn't much to discuss IMO. Web forums are specifically banned (unless the forum is the topic of the article itself) and sites that require registration are also strongly discouraged. The "helpful"ness of a web site (or the organisation behind it) is not relevant to Wikipedia. As per WP:NOT, we are not a directory listing of useful charities and support groups. Google does that job quite adequately, as do other directory projects. So, of the current crop of external links, the only valid entry would be National Psoriasis Foundation since that site contains "neutral and accurate material not already in the article" which can't be incorporated into the article since it "has a level of detail which is inappropriate for the Wikipedia article" (see WP:EL). The EL could be phrased e.g. "The National Psoriasis Foundation have further information for patients and medical providers on their web site". Colin Harkness°Talk 13:00, 25 September 2006 (UTC)

[edit] Babycenter.com

Psoriasis Forum for Parents with Children/Babies with Psoriasis

  • Remove as SPAM
  1. It is NOT a resource, it's a forum.
  2. It contains unverified original thought.
  3. You are not neutral.
  4. It contains lots of advertisement and you need a login to participate.
--Steven Fruitsmaak (Reply) 18:35, 12 September 2006 (UTC)
  • Remove as SPAM. This is a highly commercial site with little scientific information. I think linking to it is spam. Please state how you have found it useful or it will be removed. Batrobin 23:40, 13 September 2006 (UTC)
  • Remove Agree poor choice of site to list - WP is not a directory listings. David Ruben Talk 23:25, 24 September 2006 (UTC)
  • Remove per the above. This link to a web forum does not meet the guidelines at WP:EL.-AED 20:39, 25 September 2006 (UTC)
  • Pile-on Remove - forum site; fails WP:EL -- MarcoTolo 01:53, 26 September 2006 (UTC)
  • Remove as It is NOT a resource, it's a forum. NCurse work 05:46, 30 September 2006 (UTC)

[edit] AskYourDrOnline.com

Advice for Psoriasis Patients Patient Queries on Psoriasis answered by Dermatologists & alternative medicine specialists

  • Remove as SPAM. --Steven Fruitsmaak (Reply) 18:35, 12 September 2006 (UTC)
  • Remove as SPAM. A commercial site, which is not particularly useful. Quirky, perhaps, but not suitable to be an external link. Batrobin 23:40, 13 September 2006 (UTC)
  • Remove per the above. This link to a web forum does not meet the guidelines at WP:EL.-AED 20:40, 25 September 2006 (UTC)
  • Remove. Semi-forum format. AskYourDrOnline.com also often seems to attract a significant number of fringe-medicine practitioners; not encyclopedic, in any case -- MarcoTolo 01:53, 26 September 2006 (UTC)
  • Remove as SPAM, it can't be a source. NCurse work 05:46, 30 September 2006 (UTC)

[edit] National Psoriasis Foundation

National Psoriasis Foundation "The National Psoriasis Foundation is the world's largest nonprofit organization dedicated to educating, serving and empowering people with psoriasis and psoriatic arthritis" The web site contains extensive pages of information for patients and medical professionals. It is not a commercial site (it neither buys nor sells goods, is a non-profit organization and is largely funded by donation.)[2]

  • Keep As an EL meeting requirements. In particular that it contains "neutral and accurate material not already in the article" which can't be incorporated into the article since it "has a level of detail which is inappropriate for the Wikipedia article". This link was removed by User:167.136.225.247 after I remove one of their links (cause-and-effect not implied per WP:AGF), which is why I won't continue this into an edit war by restoring it. Link may be restored if there is a consensus for it. Personally, I don't mind if all the ELs go – we all have Google. Colin Harkness°Talk 18:42, 25 September 2006 (UTC)
  • Keep per Colin Harkness, WP:EL, and WP:POINT: Don't disrupt Wikipedia to illustrate a point. -AED 20:43, 25 September 2006 (UTC)
  • Keep. Almost a textbook case of an appropriate external link. -- MarcoTolo 01:53, 26 September 2006 (UTC)
  • Remove. I found that this site is commercial and makes money by memberships. I am with the above statement about no links. This is a definition website and you either have links or no links. If you want certain links then it is your opinion as to which links are posted just as it will be others that visit this site to put links on. So....I say no links. Otherwise put up all the links. JMO —The preceding unsigned comment was added by 71.55.157.16 (talk • contribs). 04:21, 26 September 2006
  • Keep. I've done volunteer work for the Foundation, but I'm unfamiliar with the Wikipedia criteria for linking or not linking. For that reason, I wasn't going to participate in this thread. However, the above statement is false and requires correction. A donation of any amount will achieve membership, and the main difference between membership and non-membership online is access to chat and to the Foundation's bi-monthly magazine. All other resources are accessible without a donation, including pdf versions of their printed pamphlets and their peer-reviewed magazine for health care providers. These facts can be easily verified by visiting the web site as a non-member. Edv3 07:20, 26 September 2006 (UTC)
  • Remove. I too see that a membership "donation" is REQUIRED to join. Donation or dues...They are getting paid and that is commercial by the definition. I too say all or none for links. If the whopping 5 links can be reposted I woudl agree that http://www.psoriasis.org should go at the top as is does seem to be the best of the links. PS-I also see http://www.psoriasis.org has a forum. I thought wiki did not link to forums as others here say? —The preceding unsigned comment was added by 167.136.225.247 (talk • contribs). 13:37, 26 September 2006
  • Comment. Those claiming it is "commercial" should consult a dictionary. A non-profit is entitled to raise funds by various means (including selling charity christmas cards, etc). A commercial organisation is in the business of making a profit by means of trading goods or services. There are quite strict rules in most countries as to what is considered commercial and what is non-profit/charity. This is definately non-profit. If they have a forum, then the forum part of the site should not be directly linked to. Ideally, only the "reference" material on the site should be linked to. Unfortunately, I haven't found a better top-level page for such material than the home page. The other sites above have too little reference material IMO. WP:EL does not endorse an all or nothing stance – it is guidance on what to include and what to exclude. I hope those participating in this discussion will accept any consensus that emerges, whilst keeping within policy requirements. Colin Harkness°Talk 12:52, 26 September 2006 (UTC)
  • Comment. Membership donation is NOT required to join. You can join as a web only member by just creating an online account with them and get most of the same benefits. While there are considerable resources available to non-members of either flavor. Truly commercial sites don't let you access anything, or only a small teaser sample, until you pay. As to forums - including a forum is not the same as being a forum. It's the content such as disease and treatment overviews, or research updates that you'd be linking to.Malincholia 03:21, 28 September 2006 (UTC)
  • Comment. Has anyone else bothered to view this log: http://en.wikipedia.org/w/index.php?title=Special:Contributions&target=167.136.225.247 ? A reverse DNS lookup combined with viewing and carefully reading the four entries spanning September 25 and September 26 in chronological order may explain exactly what's going on here.Edv3 08:17, 28 September 2006 (UTC)
  • Keep. NCurse work 05:46, 30 September 2006 (UTC)
  • Remove. It is heavily funded by drug companies, especially those companies involved in the production of biologics. It is not neutral and promotes the use of biologic treatment. Advocacy is not a neutral position. 86.1.203.57 08:45, 30 September 2006 (UTC)

[edit] Autoimmune vs Immune-mediated

Psoriasis is not yet defined as an autoimmune disease. This is because it is not known what initiates the immune reactions which occur in psoriasis. If the initiating agent is foreign to the body then psoriasis is not an autoimmune disease - it is simply immune mediated. If the initiating agent is internal (ie part of the body) then psoriasis is an autoimmune disease but it is also immune mediated. Autoimmune diseases are a subset of immune-mediated diseases. Batrobin 07:55, 21 September 2006 (UTC)

Agree immune-mediated. The eMedicine link states "Current research suggests that the inflammatory mechanisms are immune based..." =not that an auto-immune disorder. Whereas the Diseases Database link categorises it as "Autoimmune diseases", but that said I am not sure how fine its category splitting is. Need some dermatologists I think to confirm what majority consensus is amongst physicians. David Ruben Talk 23:28, 24 September 2006 (UTC)
I third that.--Steven Fruitsmaak (Reply) 00:10, 25 September 2006 (UTC)

[edit] problems with this article, part II

I have to assume that the general public is more likely to use this article for reference rather than a medical doctor--why is the vocabulary so thick? Is it not possible to simplify a little for the rest of us? —The preceding unsigned comment was added by 70.73.80.248 (talk) 02:47, 26 September 2006 UTC.

Yes, that's a problem with dermatology articles in general I think. Point out any specific paragraphs and I'll see what I can do.--Steven Fruitsmaak (Reply) 14:11, 26 September 2006 (UTC)

[edit] Positive correlation between psoriasis and myocardial infarction

Interesting article in the Journal of the American Medical Association:

http://jama.ama-assn.org/cgi/content/full/296/14/1735

This is probably worth adding to the article. - FlyingOrca 17:57, 12 October 2006 (UTC)

But be careful with No original research... --Steven Fruitsmaak (Reply) 15:47, 13 October 2006 (UTC)
Um, I might be misunderstanding your caution... would you not consider JAMA a reliable source for citation? As I read WP:NOR, it means that I can't submit my own original non-peer-reviewed research. This is a peer-reviewed medical journal, and I had nothing to do with the research. - FlyingOrca 21:07, 13 October 2006 (UTC)
You're right, I ment this: WP:MEDMOS#General_pointers, although it's not a guideline yet, I think it's a sensible comment. --Steven Fruitsmaak (Reply) 23:26, 13 October 2006 (UTC)
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