According to Dr. Shupack, immunosuppressive therapy emerged when transplant patients with psoriasis went into remission while taking these drugs to inhibit organ rejection. This phenomenon not only yielded a promising new treatment for psoriasis, but shed light on the role of the immune system in the disease. That discovery has given way to a new treatment era.

Overcoming Barriers to Treatment

"Of all the treatments I've ever seen, this is the most effective," says Dr. Shupack. "Yet many patients who could benefit from cyclosporin -- those with severe, uncontrolled psoriasis -- are not getting this therapy." According to Dr. Shupack, this undertreatment exists, in part, because the medical community has traditionally considered psoriasis to be a "cosmetic" disease. In addition, some physicians are reluctant to use a potentially toxic drug, such as cyclosporin, for a disorder that is not life-threatening. And, many long-term psoriasis patients have simply learned to suffer with their condition. These patients are unaware of the successful research that has been conducted and the newer advances that have resulted from it.

A Mandate for Optimal Care

"Psoriasis is not a fatal disorder," acknowledges Dr. Shupack. "But when it is severe, it's devastating to one's quality of life. If it begins in childhood, there may be stunted social development. Adults can't get good jobs because of the unsightly, exposed areas of the skin. There's bleeding, itching and pain. When such patients don't respond to more conservative topical medications or light therapy, more aggressive treatment is warranted." Irwin Freedberg, MD, Chairman of the Ronald O. Perelman Department of Dermatology at NYU, concurs. "The teachings of the old school, that nobody died of skin disease and that you couldn't do anything about it anyway, are absolutely wrong," he says. "Not treating these patients is unfair. There is a growing body of evidence indicating that moderate to severe cases be referred to a specialist for optimal care."

Learning to Sustain Results

"Current research is focusing on the development of drugs that mimic the effects of cyclosporin, with less toxic potential," says Ken Washenik, MD, PhD, Director of the NYU Dermatopharmacology Unit. But it's not necessary to wait for new treatment. "Our department has the expertise and experience to use cyclosporin effectively and safely at the same time." In fact, Dr. Shupack and his colleagues, who have treated more than 500 patients with the drug, have compiled data demonstrating its safety and efficacy for up to one year of treatment. Currently, 300 of these patients have received therapy for more than one year. Some have been successfully treated with the drug for as long as eight years. All are carefully monitored at regular intervals for hypertension and renal toxicity. "These patients are stable and happy with their results," reports Dr. Shupack.