Now Enrolling! 

Subjects from this Area are Needed 

Have you been diagnosed with Psoriatic Arthritis? 

A clinical research study is being conducted to evaluate the safety and effectiveness of a new, investigational medication for the treatment of Psoriatic Arthritis. 

To be eligible for the study you must:

-         Be eighteen years or older

-         Have been diagnosed as having Psoriatic Arthritis for at least six months

 Eligible participants will receive study-related procedures and study medication at no charge.

For more information on the study, please contact:

The Guenther Dermatology Research Centre at 519-435-0127 

Dr. Lyn Guenther

At the 3^rd International Congress on Psoriasis 2010 meeting in Paris July 1-3, 2010 and Canadian Dermatology Association’s 85^th Annual Conference June 30-July 4, 2010 in St. John’s Newfoundland, Dr. Guenther presented a poster on sustained efficacy of ustekinumab, an approved injectable biologic agent used to treat moderate to severe psoriasis.

Dr. Guenther has participated as an investigator in a number of clinical trials involving this compound.

Ustekinumab was given by subcutaneous injection initially as 2 doses 4 weeks apart, then every 12 weeks. Efficacy of ustekinumab was generally sustained at high rates. Discontinuation of the drug led to loss of response over time.

St. John's, Newfoundland

At the Canadian Dermatology Association’s 85^th Annual Conference June 30-July 4, 2010 in St. John’s Newfoundland, Dr. Guenther presented a poster on the effectiveness of alitretinoin, a vitamin A derivative, in the treatment of chronic hand dermatitis which did not respond to strong topical steroids. Dr. Guenther was an investigator in clinical trials with this compound.

The studies showed that once daily intermittent treatment was very efficacious with almost 1 in 2 patients having clear/almost clear hands.

Dr. Lyn Guenther

At the 3^rd International Congress on Psoriasis meeting in Paris July 1-3, 2010 and the Canadian Dermatology Association’s 85^th Annual Conference June 30-July 4, 2010 in St. John’s Newfoundland, Dr. Guenther presented a poster on infection rates in ustekinumab-treated psoriasis patients with up to 3 years of follow-up.

Ustekinumab is an approved injectable biologic agent used to treat moderate to severe psoriasis. Dr. Guenther has participated as an investigator in a number of clinical trials involving this compound.

The rates of infection remained stable and did not increase with increased exposure to ustekinumab. The rates of serious infections were similar to expected rates for patients with psoriasis treated with systemic agents.

Dr. Lyn Guenther

On October 21, 2010 at the 19^th Regional Conference of Dermatology 2010 and 2^nd annual meeting of the Asian Academy of Dermatology and Venereology in Koto Kinabalu Malaysia, Dr. Guenther gave a presentation on “Scalp psoriasis – An overview.”

The scalp is often the first site of involvement in patients with plaque psoriasis. Up to 80% of patients have scalp disease and approximately 25% only have psoriasis on the scalp. The scales on clothing, itching and visible lesions negatively affect quality of life, rendering patients self conscious, embarrassed, frustrated and depressed. The disease can vary from mild with slight fine scaling, to severe with sharply demarcated, red, scaly, crusted plaques covering the entire scalp. In half of patients, more than 50% of the scalp is involved. Scalp lesions often extend beyond the hairy area to the face or behind the ears. Itching is common; hair loss is rarely seen.

Scalp disease is often difficult to manage acutely as well as chronically. Since there is no cure, long-term control is needed. The scalp is relatively inaccessible and topical treatments often stay on the hair. In addition, since the scalp abuts on sensitive facial skin, topical treatment may cause irritation. Topical treatment should ideally not affect hair grooming and should not be smelly. The use of a shower cap can lower self-esteem. Patient compliance can be a challenge. Compliance  increases with first-time use, once-daily treatment, simple regimes, when there are fewer adverse effects and high efficacy, and in the case of topical treatment, when treatment is cosmetically elegant.

The 2009 published US treatment algorithm recommends first line treatment with topical corticosteroids short-term or intermittently, vitamin D analogues, salicylic acid, anthralin, coal tar shampoo, topical retinoid (tazarotene) and combination topical therapy (e.g. Xamiol®. Intralesional corticosteroids are second line, while phototherapy, conventional systemics (methotrexate, cyclosporine, acitretin) and biologics are third line.

The 2009 European maintenance algorithm recommends intermittent as needed use of potent to very potent corticosteroids and/or vitamin D3 analogs when symptoms recur, or continuously twice a week if there are frequent relapses.

Xamiol® is a once daily treatment which has a rapid onset of action. After only 2 weeks of use, over half of treated patients are clear/almost clear. Control is maintained over 52 weeks with as-needed use.

Dr. Lyn Guenther

On October 22, 2010 at the 19^th Regional Conference of Dermatology 2010 and 2^nd annual meeting of the Asian Academy of Dermatology and Venereology in Koto Kinabalu Malaysia, Dr. Guenther gave a presentation on facial, flexural and nail psoriasis.

In patients with psoriasis, the face is often spared. When the face is involved, the psoriasis is often more severe. Compared to patients without psoriasis on the face, patients with facial psoriasis tend to have a longer duration of psoriasis with earlier onset, as well as nail and joint disease. Three different variants have been described: a peripherofacial form next to the scalp which may be a result of severe scalp psoriasis, a centrofacial form affecting the central part of the face, which may be a marker of severe body psoriasis, and a mixed form with features of both of the other two variants.

Intertriginous psoriasis, also referred to as ‘flexural’ or ‘inverse’ psoriasis, occurs in the skin fold and in approximately 2-6% of patients with psoriasis. The lesions are well demarcated with minimal scale. Pain, itching and irritation from sweat and rubbing are common. The 2009 US National Psoriasis Foundation treatment recommendations include low- to mid-potency topical steroids for short-term therapy, and calcipotriol (a vitamin D analogue) and calcineurin inhibitors (pimecrolimus, tacrolimus) for long-term therapy. Low- to mid-potency topical steroids in combination with antimicrobial therapy (i.e. imidazole or antibiotic) were also included as first line therapy, and emollients and tar as second line therapies based on anecdotal evidence.

The lifetime incidence of nail psoriasis is in the order of 80-90%. It is more common in males, patients with disease of longer duration, patients with psoriatic arthritis and patients with extensive psoriasis. The severity often correlates with the severity of skin and joint disease. Quality of life is significantly impacted with 93% reporting a significant cosmetic handicap, 48% indicating that their nail disease restricted professional activities, 59% noting a negative impact on normal daily activities and 52% reporting pain in one study. Nail changes include pitting, leukonychia (whitening), redness of the lunula, crumbling of the nail, ‘oil drop’ discoloration, splinter hemorrhages, separation of the nail plate from the nail bed (onycholysis) and excessive scaling and thickening of the skin under the nail plate.Treatment of nail disease is challenging since it is difficult to deliver drug to the site of inflammation, and nails are often refractory to treatment and slow to heal. Many topical agents have been tried. Intralesional corticosteroids are very painful. PUVA, pulsed dye laser, traditional systemic agents (e.g. methotrexate, acitretin, cyclosporine) and biologics may be considered for recalcitrant or more severe disease.

Dr. Guenther

At the 2010 Dermatology Update meeting held in Vancouver BC, November  4-7, 2010, Dr. Guenther presented the new Canadian guidelines for the management of hand eczema. This is the first time Canada has had guidelines for this very common, often difficult to treat condition. Dr. Guenther was a member of the expert panel who developed the guidelines and an author of the guidelines that were recently published in the Journal of Cutaneous Medicine and Surgery. Prevention through avoidance of irritants, allergens and prolonged exposure to water and wearing gloves is important. Frequent application of moisturizers can help restore the skin barrier, decrease itching and decrease the number of flares. Topical steroids are usually the first line of therapy. The strength of the steroid depends on the severity of the disease. Topical steroids are safe in the short-term or intermittently long-term. Although phototherapy may be used for hand eczema that does not improve with topical steroids, it is not widely available. A new vitamin A derivative, alitretinoin (Toctino®) recently became available to treat refractory hand eczema. Dr. Guenther participated in some of the clinical trials that led to approval of this compound.  This medication should be taken once daily with food for a 12-24 week treatment course. After a treatment course, almost half of patients are clear or almost clear and many of these patients do not relapse after treatment is discontinued.

Agora, India

On June 19, 2010 in Bangalore India, June 20, 2010 in Mumbai and June 21, 2010 in New Delhi, Dr. Guenther presented to groups of Indian dermatologists on what’s new in the treatment of body psoriasis. Up to 80% of patients with psoriasis can be adequately treated topically. Moisturizers are part of “basic therapy.”  They decrease scaling, limit painful fissuring, and stop itching. Topical steroids are available in a wide range of formulations with varying potencies. They are safe short-term, or on an intermittent basis long-term. Once daily is usually as efficacious as twice daily. The vitamin D analogues calcitriol, tacalcitol, and calcipotriol are synergistic with UVB light therapy. Tacalcitol is not available in Canada. Calcipotriol has also been shown to be synergistic with PUVA light therapy, cyclosporine, methotrexate and retinoids (oral and topical). Daivobet® is a fixed combination of calcipotriol and betamethasone. It is a once daily first line treatment that has been shown to improve quality of life. After 4 weeks, approximately ½ of patients have clear/almost clear disease. Daivobet® has half as many adverse effects as calcipotriol and ¼ that of tacalcitol. Tazarotene, a vitamin A derivative, is rarely used on its own since irritation is a common side effect. Treatment with tar is considered obsolete since it stains clothing, is malodorous, and its efficacy has not been proven. Anthralin is no longer commercially produced in Canada. Calcineurin inhibitors (i.e. pimecrolimus, tacrolimus) may be useful in the treatment of facial, genital and inverse psoriasis, but are not very efficacious in other areas. Moderate-to-severe disease is treated with phototherapy, methotrexate, acitretin (a vitamin A analog), cyclosporine or biologics. Currently there are 5 approved biologics in Canada (adalimumab, alefacept, etanercept, infliximab, ustekinumab).

Columbo, Sri Lanka

On June 18, 2010 Dr. Guenther gave a talk on a novel treatment, Xamiol® for scalp psoriasis, to a group of dermatologists in Columbo Sri Lanka. Dr. Guenther has participated in clinical trials with this compound. Up to 80% of patients with psoriasis will have psoriasis on their scalp. Lesions are often itchy and scales can fall on clothing. Treatment options include shampoos, topical lotions, solutions, gels, foams and oils. Oral medications and biologic treatment are reserved for severe unresponsive cases. Xamiol® scalp gel contains calcipotriol, a vitamin D derivative, and the potent topical steroid betamethasone dipropionate. Studies have shown that approximately ½ of patients are clear or almost clear after 2 weeks, and 2/3 after 4 weeks of once daily treatment. In addition, once-daily application was shown to be superior to twice-daily calcipotriol scalp solution. In a 52-week long-term study, the treatment was well tolerated, effective and safe, with no cases of thinning of the skin or stretch marks noted.