Under Your Skin

Biologic injectables offer sweet relief for common skin ailments.

BY CATHERINE JOZWIK

Skin conditions such as rosacea, atopic dermatitis (eczema) and psoriasis can often be a source of discomfort, pain and embarrassment for those who suffer from them.

Until recently, treatments for these diseases were fairly limited. Patients now have a variety of options, from topical creams to laser treatments to biologic injections — many of which have been developed in the last few years.

“Injections have been massive in dermatology,” says Dr. Shilpa Sawardekar, a dermatologist with Forefront Dermatology, a Milwaukee-area medical group headquartered in Manitowoc. “This has been a real breakthrough.”

“Injections have been massive in dermatology. This has been a real breakthrough.”

— Dr. Shilpa Sawardekar

When it comes to treating conditions like psoriasis, symptoms of which include flaky, inflamed skin, biologic injections containing proteins can prove quite effective in patients who have moderate to severe forms of the disease. Dr. Bradley Straka, a dermatologist with Waukesha’s Highlander Dermatology, says that those with skin diseases may also have other medical and psychiatric conditions, including obesity, hay fever, cardiovascular problems and depression.

Straka, who has been practicing medicine for 17 years, says many people have misconceptions or may simply not know much about certain skin conditions. For example, some mistakenly believe that eczema — a disease which causes rashes and dry, itchy skin — is contagious. Patients may be ashamed of their condition and attempt to hide it as much as possible, avoiding activities like swimming in public pools. 

“It can be discomforting, and socially stigmatizing,” Straka says.

Dupixent, the first biologic approved by the Food and Drug Administration (FDA) to treat eczema, can also help treat other conditions that may accompany eczema and psoriasis, such as asthma and inflammatory arthritis. 

“Rather than controlling the disease by 40 percent to 60 percent, the rate is about 90 percent,” says Straka. “These newer medications are causing tremendous gains and benefits. It’s pretty amazing.” 

Straka also notes that although biologic medications can be quite costly, many manufacturers have “phenomenal” discount programs available for patients with private insurance which make the medications affordable — sometimes as little as $25 per injection.

“We have been very lucky with drug programs,” Straka notes. Patients with state insurance, Medicare and Medicaid are ineligible for these discount programs.

Biologics such as Dupixent, plus Cosentyx and Tremfya injections which treat psoriasis, can be administered at home by patients themselves, after the first injection is given at a dermatologist’s office. Time between injections varies, from once every two weeks to once every three months. And it’s important to note that some biologics have been linked to an increased risk of serious infection and other adverse effects, so a thorough screening by your doctor is imperative.

The injections come in pen form with a short, retractable needle. People simply hold the pen to their skin and press a button, a reassuring feature for those with a needle phobia. “They are very shallow, pain-free injections,” Straka says. 

Besides biologics, plenty of other treatment options exist.

For rosacea, a skin condition characterized by facial redness and acne-like bumps, pulsed-dye laser treatments can help alleviate symptoms.

“Laser is a good option, for sure,” says Sawardekar. “It works really well for controlling the background redness.”

Straka agrees. However, he recommends that people seek out dermatology offices that offer multiple laser systems. “Laser [treatments] have a very narrow scope for which they are best,” he explains. 

Laser procedures, among them miraDry which was approved by the FDA in 2011, can also be effective for treating hyperhidrosis, or excessive underarm sweating, permanently eliminating odor-producing sweat glands.  “It’s a permanent solution to the problem,” Sawardekar says. 

Topical creams also continue to be widely prescribed for common skin conditions. 

“Topicals tend to be prescribed because they are affordable and covered by insurance,” says Sawardekar, adding that newer topical creams like Soolantra and Rhofade and gels like Metrogel can help alleviate symptoms of rosacea. 

Because steroids can thin skin and be addictive, Eucrisa, a non-steroidal topical medication, is often prescribed to children and adults who have eczema, which Straka says has “really revolutionized topical care.”

Besides topicals and biologics, Otezla, the first pill to treat psoriasis, offers another treatment option. And, says Straka, three skin condition medications are waiting to be approved by the FDA. The doctor says he’s pleased with the sheer amount of medications currently available to treat dermatological diseases.

“I’m so excited with what we’ve been able to provide patients within the last five years,” Straka adds. “It has been life-changing for these individuals.” MKE

border