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MALE VOICE: I have a special interest in psoriasis and have had for perhaps 30 years now. Psoriasis affects approximately 2% of the United States population, about 6 million people in this country. And it typically manifests as red, scaly plaques. They can be limited to a tiny area or they can be quite extensive, involving even 100% of the body's surface area. A number of years ago, we had very few therapies for psoriasis. They were limited largely to moisturizers, to topical steroids, to tars, to broadband ultraviolet-B light, and to largely a single oral medication, methotrexate. In the last three decades, we've made remarkable strides. There are some marvelous new therapies out there. For example, when it comes to topical therapies, to rub-on therapies, we have now moisturizers that can not only re-up the skin and reduce scale, but they can change the way the skin forms scale and restore normal barrier function to the skin. We have new topical steroids in new formulations, so-called super-potent topical steroids that can make thin psoriasis, elbows and knees, largely disappear. We have new forms of light therapy for the more advanced psoriasis, more widespread psoriasis. Years ago, we had broadband ultraviolet B. It was succeeded in part by PUVA therapy, psoralens and UVA. And that in turn has given way largely to narrowband ultraviolet B phototherapy, a remarkable advance for patients who've got moderately severe psoriasis. And I'm glad to say that we have narrowband UVB phototherapy at Torrey Pines Dermatology.

In addition to that, for patients who have severe psoriasis and need systemic or now biologic therapies, a new class of agents, we have more and newer agents in both of those classes as well. In the systemic category of oral medications, we have not only methotrexate, but now we have Soriatane, a vitamin D derivative that along with phototherapy can be remarkably useful. And we have cyclosporine, a drug originally developed to prevent transplant rejection in patients that has dramatic effects on psoriasis in the most severe of cases. And then in the last 10 or 12 years, there's a whole new class of drugs that were not available previously, so-called biologics. Biologics are a group of proteins that are made in a unique way. They're not synthesized, but rather they're made in biologic factories. We've engineered, genetically engineered a living cell to produce a focused molecule. That cell is—they're grown, fermented in large vats, and the molecule is extracted, refined, purified, and can be used. We have several of these new. And they have a marvelous effect on some of even the most severe cases of psoriasis. Not only do they treat psoriasis, but many of them, the so-called TNF or tumor necrosis factor alpha blockers, can treat the arthritis that accompanies psoriasis in 10% to 30%...