In a study published in the Journal of the American Academy of Dermatology, the use of tumor necrosis factor inhibitors was associated with an increase in body weight and body mass index. Consideration for other treatments should be considered for patients who are overweight or obese.
Commonly used tumor necrosis factor inhibitors:
Without question, it is ALWAYS best to see a well-trained, board-certified Dermatologist if one has any skin problems (rashes or growths). Although many PCPs and Urgent care centers can handle COMMON problems (i.e. Shingles, poison ivy and minor burns), but what happens when both you and the doctor does not know what is the diagnosis? In many of these cases, patients are treated with Lotrisone (clotrimazole/betamethasone cream), which I call the “I have no idea what you have so I will give you this” medication.
In short, this medication is RARELY ever used by Dermatologists for a couple of reasons. It is a combination of a VERY STRONG topical steroid with an old anti-fungal agent. If one really had a fungal infection, topical steroids actually stimulate the growth of fungi. For this reason, it is uncommon to use a very strong steroid with an anti-fungal drug. Additionally, the use of strong topical steroids can thin the skin if used for more than 2 weeks, especially if used in the armpits, groin, face, or neck. I see patients regularly who are prescribed this medication only to be left with thin skin or stretch marks that will not go away. Dermatologists do occasionally use topical steroids with anti-fungal creams, although usually they prescribe them both separately, which costs less and is safer.
In summary, if you have an acute problem, such as an infection, Shingles, a burn, or Poison Ivy, your PCP and/or local Urgent Care Center will likely be able to treat you effectively. For these acute problems, you do not want to delay treatment.
If you have a “rash” or “growth” and do not know the cause, your best bet is to find a good Dermatologist. In my experience, it is far less costly to pay more for a visit with a Specialist than to be ineffectively treated with medications that can be costly. For example, a 15g tube (tiny) of generic Lotrisone can cost $131 compared with a 85g tube of another steroid that costs $12.
Most importantly, Emergency Rooms are for just that–life threatening emergencies. Nearly all skin conditions are NOT life-threatening, and unless one has reason to suspect otherwise (many blisters, sheets of skin coming off, or suspected serious infection), one should not seek advice for skin conditions in an Emergency Room Setting. There are times when one might be prompted to go to the Emergency Room. An example of such would be a diabetic who thinks that he/she has cellulitis who calls his/her PCP for advice and is then directed to go to the Emergency Room for evaluation.
In an article published in the Journal of the American Academy of Dermatology, individuals “with psoriasis who were treated with biologics had an increased incidence of cutaneous squamous cell carcinoma.” The risk increased by over 42% in those exposed to the TNF-alpha biololics, which include:
infliximab[7] (Remicade), adalimumab (Humira), certolizumab pegol (Cimzia), and golimumab (Simponi), or with a circulating receptor fusion protein such as etanercept (Enbrel) which may also affect skin cancer risk.
Thalidomide (Immunoprin) and its derivatives lenalidomide (Revlimid) and pomalidomide (Pomalyst, Imnovid) are also active against TNF and may affect skin cancer rates.
Xanthine derivatives[8] (e.g. pentoxifylline)[9] and bupropion.[10] Bupropion is the active ingredient in the smoking cessation aid Zyban and the antidepressants Wellbutrin and Aplenzin and may have an effect on skin cancer rates.
AFP-Relaxnews (2/3) reported findings in a study published online in the Journal of Dermatological Treatment, psoriasis “treatments are only effective for 20%” after 3 months of treatment. The study authors “suggest that patients with moderate to severe psoriasis using conventional systemic treatments should consider biologics,” while “patients already receiving biologics should envisage new therapeutic strategies.”
What does this mean for psoriasis patients?
Patience. Have patience. I tell my patients that there are thousands of prescription and over-the-counter psoriasis products. It is basically trial and error to find the most effective treatment for an individual. Treatment failure does not mean that the doctor did something wrong or was a “bad doctor”, which I hear often. This study confirms that in fact, most patients (4/5) will not have success.
In a study published in JAMA, persons with Type II diabetes or obesity were at significantly increased risk of developing psoriasis.
Obesity is a significant risk factor for type II diabetes as well.
Therefore, eating a good healthy diet that is low in saturated fats and simple carbohydrates, exercising regularly, and maintaining an ideal weight is beneficial to one’s skin.
In a study published online in JAMA Dermatology, psoriasis patients who were put on a low-calorie diet had improvement of their quality of life and their psoriasis severity. These findings, although encouraging, were not statistically significant. For those suffering from psoriasis who can afford to lose a few lbs., here is another reason to get started on that diet.
Total Skin Care with Robert S. Bader, M.D. 