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DAKOTA DUNES | A woman sits in her hair stylist's chair and brushes her long auburn locks back to reveal red, scaly patches on her neck.

Embarrassed, she visits her doctor and is prescribed Humira. After injecting herself with the biologic drug, the woman's plaque psoriasis on her body gradually disappears with every subsequent trip to the salon. A voice-over spouts the message, "Clearer skin is possible."

This is one of many commercials for biologic medications to recently hit the airwaves. A TV ad for Enbrel stars pro-golfer Phil Mickelson, while a Stelara commercial features CariDee English, a sufferer of plaque psoriasis and winner of America's Next Top Model.

"If there's any time in history that you would want to get psoriasis, now's the time," said Indy Chabra, a dermatologist at Midlands Clinic in Dakota Dunes.

Chabra said a "renaissance" in psoriasis treatment is underway and more and more medications are expected to come down the pipeline in the future to manage the autoimmune disease that causes the body's immune system to attack the skin. About 2 percent of the population, he said, suffers from psoriasis.

Creams, ointments, light therapy and oral medications are available to help manage the condition, as well as powerful new biologic drugs administered via injection. While there is no cure for psoriasis, Chabra said these treatments can clear it up.

"If you have it, we can help you. You don't have to suffer," he said.

AGGRESSIVE TREATMENT

Red, scaly spots covered with silver-white patches typically appear on a person's skin in their 20s and 40s.

Classic areas of the body affected by psoriasis include the scalp, ears, elbows, knees and nails -- where tiny pits form. Psoriasis can also appear on the face and groin.

"In some people it's always the same areas. It's localized to the scalp or ears. With other people it can spread," Chabra explained. "There are many different types of psoriasis from plaque psoriasis to pustular psoriasis, where you can actually get pus bumps on your hands and feet."

Chabra said psoriasis can also cause stiffness and swelling around the joints and lead to increased risk of heart attack and stroke.

"Basically you have all this inflammation in the body and more and more we're finding out that cardiovascular disease is not just cholesterol. It's not just fat. It's inflammation," he said.

Most cases of psoriasis can be diagnosed just by looking at the skin, according to Chabra. Sometimes, he said a skin biopsy is needed. Treatment varies and depends on the severity of psoriasis and how much it affects that patient's quality of life.

"If someone has psoriatic arthritis you usually need something by mouth or a biologic," he said. "You may have a little bit of psoriasis, but if you have joint pain, you got to treat it aggressively. That's the standard of care around the world."

Biologic drugs are injected with a needle that is hidden inside a plastic cartridge. The patient holds the cartridge against their leg and pushes a button to fire the needle.

Enbrel, Chabra said, is administered once or twice a week, Humira every three weeks and Stelara every three months.

Although biologics are "fairly safe," Chabra said he wouldn't prescribe them to a patient with just a little psoriasis on their elbows and knees. Enbrel, Stelara, Humira and other biologics calm the immune system and therefore increase a person's risk of infection. These drugs can reactivate tuberculosis, fungal infections and food-borne illnesses such as listeria and salmonella.

"I tell patients not to drink unpasteurized milk. Don't go and eat sushi. Deli meats you gotta heat up," Chabra said.

Other risk factors for biologic drugs include developing lymphoma, a type of blood cell cancer, and demyelinating diseases such as multiple sclerosis. Chabra said this is "very rare."

Another downside to biologic medication is the high cost. A year's supply of Stelara runs around $12,000, while Enbrel is $9,000.

Chabra said insurance plans often cover these drugs and some of the drug companies, he said, also offer free or reduced cost medications through charity programs. Expect to spend between $10 and 50 a month.

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