Psoriasis Success Story

Greer M first came to Avail Dermatology with an all too familiar problem. An active and otherwise healthy woman, she knew about psoriasis from her mother, who had the disease. However it was not until 2008 that she noticed that she too was developing red, scaly raised patches on her skin. To her dismay, the patches rapidly spread over her body. They became more and more visible, and she found herself covering more and more of herself to go out into public.

Frustrated, she sought the aid of her local dermatologist. He tried the usual remedies: topical creams, sprays, and foams, which were expensive, time consuming to apply, messy, and in the end, only mildly helpful. While the spots were a little less thick and scaly, they still covered much of her body. She certainly didn’t look “normal.” A more aggressive treatment using ultraviolet light was added, but the psoriasis was still only partially improved. The minute she stopped using the treatments, she immediately worsened. Finally, the dermatologist recommended she start treatment with one of the new injectable psoriasis medications, Enbrel. The thought of injecting a powerful medication, which would cost well over $10,000/year, and which would suppress her immune system, made Greer uncomfortable, and she chose to continue coping with the psoriasis.

By October of 2009, though, the psoriasis had spread: there were almost no areas on her body that were not covered with the thick, scaly itchy patches. She decided to get a second opinion and visited Avail Dermatology. On arrival, she met Steven Nobles, one of our Physician’s Assistants. Steven assessed the situation and realized that this was truly a psoriasis “emergency.” He called in Dr. Mark Ling, who specialized in psoriasis. Dr Ling concurred with Steven, noting that a very high percentage of Greer’s body surface was covered, making her a candidate for the most aggressive treatment. Greer explained her worries about using drugs like Enbrel. Fortunately, Dr. Ling had an answer. He had been involved from the very earliest stages of research and development of Enbrel. Dr. Ling was one of a handful of dermatologists who conducted the earliest testing of the drug on psoriasis patients, and subsequently he was an investigator in every major Enbrel research study. Additionally, he is a recognized national expert in safety of biologics, the injectable drugs used to treat psoriasis. He gave Greer an in depth understanding of the real world experiences with Enbrel, and reassured her that with proper monitoring it could be a safe and effective treatment.

Greer started treatment. As predicted, there were no serious side effects. As the weeks wore on, and Greer continued her injections though, the expected improvements were slow to develop. After three months, she had improved less than 25%, a major disappointment to both her and Dr Ling. If a cutting edge drug like Enbrel was ineffective, what hope was there?

Dr. Ling had another answer. Medical research constantly evolves. Even after the successful debut of Enbrel, it was clear that there would be a need for other options, particularly for the most severe patients who did not respond to Enbrel. Again, Dr. Ling was able to draw on personal experience. He was one of a half dozen researchers nationwide who had been chosen to test a new psoriasis compound. Known then as CNTO1275, it was another injectable, but one that worked though a mechanism unlike any drug on the market. From the earliest testing on humans, Dr Ling was an investigator in all the major trials. After a half decade of research, the drug was approved by the FDA and renamed Stelara in November, 2009.

Dr. Ling advised that Greer consider Stelara. The decision relied on the fact that unlike other dermatologists, to whom the drug was a complete unknown, Dr. Ling was already caring for research patients who had been on Stelara continuously for 4 years or more. This rare hands-on experience convinced Dr. Ling that Stelara could offer Greer hope. One of the most unique features of Stelara is the dosing protocol. Rather than a shot twice a week as with Enbrel, patients receive an injection to start, a second injection a month later, and then from that time on, need only one injection every three months. Equally important is that Stelara often works extremely rapidly. Greer took her first injection in February, 2010. A month later she returned for her second shot, beaming. “My psoriasis is going away!” she stated, and Dr. Ling immediately agreed, estimating that she had improved well over 75% in just four weeks. He is now confident that further treatment with Stelara will have Greer ready to wear shorts and short sleeves this summer.

When asked how she feels about this, Greer replied “Just joyous!” Like so many of Dr Ling’s severe psoriasis patients, she said that she had not realized what a huge burden it had been living with this disfiguring disease. Only when that burden was lifted did she recognize the weight that she carried every day.

Psoriasis is still not a curable disease. Greer’s case is likely to be a long-term success story, but Dr Ling knows that there is never a perfect treatment. He continues his research, recently having been chosen by Amgen to be one of a handful of sites in the U.S. to participate in the first worldwide study of their newest psoriasis compound. That is one more reason that Avail Dermatology offers a level of expertise and care that is unmatched anywhere in the Atlanta area. Please contact us for more information about our psoriasis treatment program.