Dr ILYAS discusses Bryhali Lotion with Allure!

Dr ILYAS discusses Bryhali Lotion with Allure!

January 02, 2021

Dr ILYAS discusses Bryhali Lotion with Allure!


1) What is psoriasis?

Psoriasis is thought to be a chronic immune mediated or autoimmune skin condition. 

How many people are affected/how common is it?
 Psoriasis is common! It is estimated to affect about 2-3 % of the population and can start at any point in life- childhood or adulthood. 
What are the signs/symptoms and what are typical triggers for flare ups?
Psoriasis most often appears as pink scaling patches or plaques. Usually these are found on knees, elbows and the scalp. However, it can occur anywhere from head to toe. When it occurs under the breasts or in the fold between the hip and groin or under the belly it is often red, raw and shiny. When it affects the nails it can appear as little pits in the nails or oil spots. 
I find the most common trigger by far and away is stress. I’ve had two year olds with new onset of psoriasis when they start with a new babysitter or are potty training and I’ve had 85 year old patients with new onset of psoriasis when a spouse passes. I tend to tell patients to think of it as a ‘check engine light’- at times the flares will tell you that you are taking on more than you can handle! Take a step back and take care of yourself. For many, however, there is no rhyme or reason to the flares. Other common triggers are injuries to the skin (psoriasis can often show up in surgical scars), medications can trigger it, infections (strep throat is linked to a particular type of psoriasis called gut rate), weather changes, smoking and alcohol use. 

Does it come and go or is it chronic?
Flares from psoriasis can come and go but it is overall a chronic condition. Those with psoriasis will often always have a tendency towards developing. 
2) What are typical treatments for psoriasis and how effective are they? 
I break this down for patients as ranging from topicals, to light therapy to medications by mouth or injectables. This starts us at minimal side effects to more. The choice is for me a personal decision from the patients. I can’t  judge a patient’s day to day experience living with this type of skin condition. Although most people that choose light therapy or injectables/ oral medications tend to have more extensive disease, anyone can consider these based on their quality of life.
Topical medications tend to be steroids, nonsteroidals, vitamin D analogs, and retinoids. They work well with topical steroids as more effective. The issue tends to be the need to reapply, or extensively apply which can be difficult. 
Phototherapy is a great option for people not ready to do something more with systemic medications but need to treat larger parts of their bodies. Treatments are quick, 2-3 times per week. Many, if they do well, can get a lightbox for home use of it is established  that it could benefit them.
Oral medications and injectables have become very popular and are extremely effective. I find they have changed the face of psoriasis because we finally have options that can clear patients effectively.  These can work by either suppressing or altering the immune system that is overactive in psoriasis. 

3) What areas of the body does psoriasis pop up on and what marks a severe case?
Psoriasis can be anywhere from head to toe but most commonly elbows, knees, scalp. 
Severity is dictated by location and extent of the disease . if psoriasis shows up in sensitive areas like the folds (under the breasts or belly) or hands and feet that can make it difficult to get through work or the day.  how extensive the body surface area covered by psoriasis can also dictate how severe it is. 
When/why would someone want new drugs for treatment? 
Usually people seek out new drugs because their other treatments have been ineffective, not tolerated well, or developing side effects. Steroids can cause thinning of the skin over time, for example. 

4) what is halobetasol and why is this a good form a treatment?
Halobetasol is a superpotent topical steroid. It is considered a class 1 steroid (there are 7 classes).  It works very well as a topical treatment option for psoriasis as they are anti inflammatory. They  reduce the  redness and inflammation in the skin associated with psoriasis. 

what about it makes it work and what exactly does it do to fight psoriasis? 
Halobetasol is very effective for psoriasis, as are it’s other partners in the Class 1 category of topical steroids.  They would be the strongest topical options to consider, either alone or in combination with other topical agents. They exert a local effect where applied to reduce the inflammation associated with psoriasis.

4) For this new treatment, Bryhali lotion, what are your thoughts on its potential effectiveness? 
How does it work and why is it supposedly helpful based on conclusions? Does this seem promising to you? 
The active ingredient in Bryhali is established to be effective in treating psoriasis. The key that differentiates it is the ability to use it once daily and for a longer duration of time than most topicals. The issue that arises with topical steroids is that they are effective but have side effects with long term treatment. The most common issue is thinning of the skin called cutaneous atrophy. Usually, we cycle topical steroids- 2 weeks on/ one week off or other patterns. This is meant to reduce the chances of building up the potential for side effects or tolerance of the medication. The issue practically speaking is that sometimes patients are just starting to clear when they need to take a break and have to wait a week to restart- so frustrating! Bryhali will have two benefits- one is that patients can use it for 8 weeks in a row.  Their studies have shown no signs of thinning of the skin after 8 weeks of use. The second important benefit is that it’s once daily. This is a big deal. I have patients that tell me the amount of time they have to set aside morning and night to apply their topicals when they have extensive disease. A once daily topical will definitely make life a little easier. 


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