With me, it’s personal. I love my team. They are part of my family. I hate it when they are not feeling good and I cannot do anything to help them.
One of my team members suffers from plaque psoriasis. This condition affects her in many ways. She has scaly plaques that are not only painful and irritating, but they cause a cosmetic concern for this lovely young lady. There are many treatments for psoriasis that she could use. However, she recently gave birth to a beautiful baby and is breast feeding. All of the commercially available options to treat psoriasis including steroids, vitamin D analogs (such as Dovonex), and coal tar pose a potential risk to her breast feeding infant.
So I was tasked with the question: “What can we do to help her treat her psoriasis while not adversely affecting her infant daughter”?
I came across an article entitled “Vitamin B12 cream containing avocado oil in the therapy of plaque psoriasis”. This study compared the effectiveness of Dovonex ointment with a cream containing vitamin B12 in avocado oil. The researchers concluded that, although Dovonex worked a little quicker to resolve plaque psoriasis, after 12 weeks, there was no difference in the patients’ Psoriasis Area Severity Index (PASI) score between the two treatments. The researchers further concluded that, while the efficacy of the vitamin D preparations reached a maximum in the first four weeks and then began to subside, the effects of the vitamin B12 cream containing avocado oil remained at a constant level over the whole 12 week period. They stated that vitamin B12 preparations containing avocado oil may be suitable for use in long-term therapy.
In addition, creams containing Vitamin D analogues can irritate the skin. This research demonstrated a significant superiority of the vitamin B12 cream containing avocado oil over the Dovonex preparation. Nearly 25% of patients in this study on a vitamin D analogue cream developed skin irritation that necessitated a dose reduction where as only one patient (7%) developed itching at the application site which resolved upon discontinuation of therapy.
Cream containing vitamin B12 in avocado oil may present an alternative treatment for plaque psoriasis for people who cannot tolerate conventional therapies for some reason. We are currently evaluating a compounded formula at Keystone Pharmacy that my team member is evaluating. I will keep you informed of her success if this creams provides her relief.
by David J. Miller, RPh, PhD, FIACP