How Psoriasis Treatment Costs Us Billions
January 26, 2015 | 384,599 views
By Dr. Mercola
Psoriasis is a chronic disease of your immune system that causes cells to build up on the surface of your skin, leading to thick, red, scaly patches that are very itchy and sometimes painful. Up to 7.5 million Americans suffer from the disease, which has a surprisingly significant economic impact as well.
A new study in JAMA Dermatology reported that direct US healthcare costs related to psoriasis treatment may be up to $63 billion a year.1 There were also indirect costs (such as loss of work hours) of up to $35 billion and another $35 billion in costs related to associated health problems, like heart disease and depression.
Taken together, the researchers found the annual US cost of psoriasis amounted to approximately $112 billion in 2013.
Psoriasis Is More Than a Superficial Skin Condition
Although psoriasis appears as a skin condition, it is actually an autoimmune disease. Part of the reaction occurs when a type of white blood cell called a T cell mistakenly attacks healthy skin cells.
These overactive T cells then trigger other immune responses that collectively speed up the growth cycle of skin cells, causing them to move to the outermost layer of your skin in a matter of days rather than weeks.
Because the dead skin cannot be removed quickly enough, it builds up into the thick patches characteristic of psoriasis. For up to 60 percent of people with psoriasis, the condition seriously impacts their daily life.
Your skin may become so inflamed that it cracks and bleeds. Up to 30 percent of sufferers also develop psoriatic arthritis, which can cause debilitating joint damage.
People with psoriasis are also at an increased risk of numerous other chronic diseases, including eye conditions, type 2 diabetes, high blood pressure and heart disease. And then there are the psychological repercussions.2
Those who aren’t familiar with psoriasis may view it as a contagious rash, and as a result people with psoriasis may be shunned or excluded socially. People with psoriasis often suffer from depression, low self-esteem, social isolation and problems at work, which may lead to a lower income.3
Vitamin D Is Crucial for Autoimmune Diseases, Including Psoriasis
If you have psoriasis, it is imperative that you have your vitamin D levels tested and maintain levels in the therapeutic range of 50-70 ng/ml year-round. Vitamin D is a potent immune modulator, making it very important for the prevention of autoimmune diseases.
According to one study, “vitamin D could have important immunomodulatory effects in psoriasis,” but unfortunately 80 percent of patients in winter, and 50 percent in the summer, were vitamin-D deficient.4
Vitamin D is thought to effect psoriasis on multiple levels, including helping to regulate keratinocyte (skin cell) growth and differentiation as well as influence the immune functions of T lymphocytes and other cells. Vitamin D also inhibits cytotoxic T cells and natural killer cell activity, potentially helping to regulate skin cell growth.5
In fact, not only are vitamin D derivatives commonly used as a topical treatment for psoriasis, but phototherapy is also a preferred type of treatment.
There is also at least one published report of a specific type of drug-induced psoriasis resolving after high doses of vitamin D3 were given to treat vitamin-D deficiency.6
Existing psoriasis drug treatments are risky and expensive. NPR followed one man with psoriasis who has taken multiple prescription drugs for psoriasis, including experimental drugs, and is still suffering.
One of the drugs, Raptiva, was pulled from the market for increasing the risk of deadly brain infections. Another, Stelara, worked, but only for five years when his symptoms returned. In those five years alone, he reported the drug costs added up to $250,000.7
One of the most common psoriasis treatments is the drug psoralen combined with UV light exposure (known as PUVA). Psoralen makes your skin more sensitive to UV light, but it is often combined with UVA exposure. UVA rays are the type associated with skin damage, while UVB light causes your skin to produce vitamin D.
Optimize Your Vitamin D Levels If You Have Psoriasis
Typically, the best psoriasis treatment is exposure to sunlight to optimize your vitamin D levels. You don’t need to visit a dermatologist; you can do it yourself.
Speaking out in a professional capacity against this idea can cost you. In 2004, Dr. Michael Holick published the book, The UV Advantage, in which he encouraged readers to get some sensible sun exposure.
At the time, he was a professor of dermatology because of the work he'd been doing with active vitamin D for the treatment of psoriasis. In fact, he'd received the American Skin Association's Psoriasis Research Achievement Award—a rather prestigious award.
“As a result, I was in the department of dermatology, continuing to do psoriasis research. But once I began recommending sensible sun exposure for vitamin D, which is counter to what the American Academy of Dermatology's message was, I was asked to step down as professor of dermatology back in 2004...
The American Academy of Dermatology still recommends: you should never be exposed to one direct ray of sunlight for your entire life.”
This is highly counterintuitive, given the research showing how beneficial vitamin D is for psoriasis. Sunlight exposure works, in part, because UV rays in sunlight and certain types of artificial light kill off the activated T cells in your skin.
This slows down cell turnover and reduces the scaling and inflammation of your skin.
Proper sunlight exposure will help you get your vitamin D levels into the therapeutic range, which has additional health benefits as well. It’s probably no coincidence that people with psoriasis, who are often vitamin D deficient, have an increased risk of chronic diseases like heart disease and metabolic syndrome – which are also associated with low vitamin D.8
Low Vitamin D Linked to Parkinson’s Disease and Cancer
People with psoriasis are at an increased risk of Parkinson’s disease as well, and this, too, is associated with vitamin D deficiency. According to one study:9
“Plasma levels of both dietary and sunlight-derived vitamin D are inversely correlated with the risk of Parkinson disease (PD) … The finding suggests that low vitamin D levels in PD are not simply a result of reduced mobility.”
Research scheduled to be presented at the 2015 Gastrointestinal Cancers Symposium in San Francisco also revealed that higher vitamin D levels are associated with markedly improved survival in people with advanced colorectal cancer.10
For this study, those with the highest vitamin D levels only had an average of 27.5 ng/mL, which is still far below the optimal range of 50-70 ng/mL. Theories linking vitamin D deficiency to cancer have been tested and confirmed in more than 200 epidemiological studies, and understanding of its physiological basis stems from more than 2,500 laboratory studies.
One particularly noteworthy study was completed by Joan Lappe and Robert Heaney in 2007. A group of menopausal women were given enough vitamin D to raise their serum levels to 40 ng/ml. These women experienced a 77 percent reduction in the incidence of all cancers, across the board, after just four years11 (and again, 40 ng/ml is a relatively modest level).
So far, scientists have identified nearly 3,000 genes that are influenced by vitamin D status, and a robust and growing body of research clearly shows that vitamin D is critical for optimal health and disease prevention.
Have You Checked Your Vitamin D Level Lately?
While the optimal level for general health lies between 50-70 ng/ml, when treating chronic diseases such as cancer, heart disease, and autoimmune (i.e. psoriasis) and/or neurological diseases, your level should ideally be somewhere between 70-100 ng/ml, which is about double what is typically considered “normal.”
It’s important to realize that vitamin D deficiency is common around the world, even in areas where you’d suspect most people would get plenty of sun exposure. One recent study done in India found that 69 percent of 37,000 people tested across the country were vitamin D deficient (at or below 20 ng/ml), and another 15 percent had insufficient levels (20-30 ng/ml).12 Men between the ages of 31-60, and women aged 16-30, were at highest risk of vitamin D deficiency, although in the US the elderly are also seriously at risk.
The ideal method to optimize your vitamin D levels is through sensible UVB exposure. You can also use an oral supplement of vitamin D3. GrassrootsHealth has a helpful chart showing the average adult dose required to reach healthy vitamin D levels based upon your measured starting point. Many experts agree that 35 IUs of vitamin D per pound of body weight could be used as an estimate for your ideal dose, but you’ll need to test and monitor your levels to be sure.
If Taking a Vitamin D Supplement, Remember K2 and Magnesium, Too
If you opt for a supplement, be sure to take vitamin D3—not synthetic D2—and take vitamin K2 and magnesium in conjunction with it. Vitamin D is fat-soluble, so taking some form of healthy fat with it will also help optimize absorption. The biological role of vitamin K2 is to help move calcium into the proper areas in your body, and without sufficient amounts, calcium may build up in areas such as your arteries and soft tissues. This can cause calcification that can lead to hardening of your arteries—a side effect previously thought to be caused by vitamin D toxicity. We now know that inappropriate calcification is actually due more to lack of K2 than simply too much vitamin D.
Magnesium is also important, both for the proper function of calcium, and for the activity of vitamin D as it converts vitamin D into its active form. Magnesium also activates enzyme activity that helps your body use the vitamin D. In fact, all enzymes that metabolize vitamin D require magnesium to work. As with vitamin D and K2, magnesium deficiency is also common, and if you’re lacking in magnesium and take supplemental calcium, you may exacerbate the situation.
Vitamin A, zinc, and boron are other important cofactors that interact with vitamin D. When taking supplements, it can be easy to create lopsided ratios, so getting these nutrients from an organic whole food diet and sensible sun exposure is generally your best bet. Dietary sources of magnesium include sea vegetables, such as kelp, dulse, and nori. Vegetables can also be a good source. As for supplements, magnesium citrate and magnesium threonate are among the best.
How Vitamin D Performance Testing Can Help Optimize Your Health
A robust and growing body of research clearly shows that vitamin D is absolutely critical for good health and disease prevention. Vitamin D affects your DNA through vitamin D receptors (VDRs), which bind to specific locations of the human genome. Is it any wonder then that no matter what disease or condition is investigated, vitamin D appears to play a crucial role? This is why I am so excited about the D*Action Project by GrassrootsHealth. It is showing how you can take action today on known science with a consensus of experts without waiting for institutional lethargy.
It has shown how by combining the science of measurement (of vitamin D levels) with the personal choice of taking action and, the value of education about individual measures that one can truly be in charge of their own health. In order to spread this health movement to more communities, the project needs your involvement. To participate, simply purchase the D*Action Measurement Kit and follow the registration instructions included. (Please note that 100 percent of the proceeds from the kits go to fund the research project. I do not charge a single dime as a distributor of the test kits.)
As a participant, you agree to test your vitamin D levels twice a year during a five-year study, and share your health status to demonstrate the public health impact of this nutrient. There is a $65 fee every six months for your sponsorship of this research project, which includes a test kit to be used at home, and electronic reports on your ongoing progress. You will get a follow up email every six months reminding you “it's time for your next test and health survey.”