Pharma companies have a great deal of skin in the dermatology game at the moment – perhaps more than in any other area of medicine.
Taltz, aka ixekizumab, is yet another new drug for psoriasis. Others include Cosentyx aka secukinumab, and Stelara, aka ustekinumab. Taltz is an IL-17 antagonist, as is Cosentyx. Stelara works on IL 12 and IL 23.
There has been a huge neglect of skin. Antidepressants, antipsychotics, statins, oral contraceptives, drugs for osteoporosis and others all cause significant skin and hair changes that we and our hairdressers and likely beauty therapists, masseurs and others spot and know something about but doctors, nurses or other prescribers miss completely.
There are a huge number of people who complain of a rake of odd sensations in their skin – burning or tightening feelings or itches – that are features of peripheral neuropathies linked to exposure to a range of the medicines we use – especially psychotropic drugs. When we go to doctors with these we will often point to our skin or complain about how it feels but our complaints are commonly dismissed as not something the doctor recognizes – we are labeled as neurotic. This is made easier if we are on medications that brand us as neurotic.
People with psoriasis, acne and other skin conditions could probably tell dermatologists a thing or two about what other medical drugs do simply by noting changes in their conditions.
Dermatologists are no better than other prescribers. They put people on RoAccutane or doxycycline and completely miss the person becoming agitated or suicidal in front of their noses, as they will likely miss the suicides on Siliq, Otezla, Taltz, Cosentyx and Stelara and perhaps even the homicides. No one investigating school or campus shootings is likely to check out the dermatology preparations the crazed gunman was on.
Doctors have become boxologists. Few see the whole person in front of them. You’d imagine dermatologists would be sensitive to a person’s entire physical state as this is typically reflected in their skin from blushing to dryness. Back in the last millennium, ophthalmologists claimed they could tell everything about a person’s health by looking in their eyes, but no-one seems to see the whole person any more – excepting perhaps a few Generalists.
The claims that these drugs are IL 12, 17, 23 or PDE 4 antagonists are not far off gobbledegook, if they are taken to mean we know what these drugs are doing and so know just what can happen on them. We don’t. What happens is what happens.
Thalidomide caused akathisia, peripheral neuropathy, sexual dysfunction and birth defects – which is pretty like the profile of an SSRI even if the birth defects are somewhat different. We just do not know whether thalidomide or its sibling, Otezla, act on serotonin systems. Doxycycline and RoAccutane do act on serotonin. We don’t know what else the SSRIs act on to cause the myriad of things they can cause – especially peripheral neuropathies.
It is still too early to say just what problems these new skin drugs cause. You can find data for Cosentyx and Stelara and Otezla on RxISK but not yet for Taltz or Siliq. If you or anyone you know is taking any of these drugs please consider Waltzing with RxISK – reporting what you notice.
These gaps in our knowledge are ones through which drug company marketers march. They hypnotize us with notions of IL 17 antagonism – get us to look at what they want us to look at and miss what they want us to miss. This is Fake Biology – or at least it may not be the critical biology. And while we are looking the other way they make off with the Swag aka Loot.
Matilda was not a blemish free woman, attractive enough to capture the heart of a free Australian swagman. A Matilda is a bag into which to put the Swag.