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Psoriasis
See Also
Psoriasis:
Overview
Psoriasis:
Causes
Psoriasis:
Exacerbating Factors & Triggers
Psoriasis:
Symptoms & Types
Psoriasis:
Psoriatic Arthritis
Psoriasis:
Treatment Options
Psoriasis Treatment Options
Like many skin diseases, there is no cure for
psoriasis. An array of treatment options do exist and
patients will have to consider them under a long-term
treatment plan. Treatment plans will vary according to
age, sex, type of psoriasis, location of the plaques and
severity of the plaques. According to Dr. Hon Pak
reporting for EmedicineHealth.com, treatment may also
depend on the patient's perception and acceptance of
their psoriasis. "Treatment must be designed
with the patient's specific expectations in mind, rather
than focusing on the extent of body surface area
involved." (5)
Treatment of Psoriasis generally follows a 3-step
approach involving:
- Topical Therapy (applied
directly to the skin)
- Light Therapy (treatments where
skin is exposed to ultraviolet light)
- Systemic Therapy (drugs or
medications taken orally or by injection).
For patients with a minimal amount of psoriasis,
topical therapy may be enough. Other patients may need a
combination of the three. There is no one way to treat
psoriasis as patients may respond differently to
different medications. Treatment plans may also have to
be periodically changed and mixed up to counter against
your body developing a resistance to certain medications.
"Over time, affected skin can become
resistant to treatment, especially when topical
corticosteroids are used. Also, a treatment that works
very well in one person may have little effect in
another. Thus, doctors often use a trial-and-error
approach to find a treatment that works, and they may
switch treatments periodically (for example, every 12 to
24 months) if a treatment does not work or if adverse
reactions occur." (2)
1. Topical Therapy
The first line of defense in treating psoriasis begins
with topical therapy. Topical treatments can soothe the
itching and irritation, reduce inflammation as well as
slow down the excessive cell growth the causes plaques to
grow. Some topical treatments, such as bath and lotion
moisturizers are only meant to soothe the associated
symptoms (itching and dryness) and do little to treat the
disease. The most common medicated creams and ointments
are listed below.
Topical Steroids
(Corticosteroids): Corticosteroids, or
just "steroids," are the most
frequently used topical treatment options for
psoriasis since they work fast, are easy to use,
and are effective at reducing inflammation and
swelling. In mild cases of psoriasis, topical
steroids can be quite effective, but in cases of
moderate to severe psoriasis, topical steroids
will have to be used in combination with other
therapies. There are many different brands and
potency levels of corticosteroids, each of which
have side-effects including thinning of the skin.
Follow your doctor's guidelines when using
corticosteroids.
Clobetasol Propionate: Is
a high potency corticosteroid which is topically
applied as an ointment for eczema and psoriasis.
When sold under the brand name, Olux, it is
dispensed as a foam, which penetrates the skin
and can make it less messy. It is effective in
treating psoriasis of the scalp and body.
Calcipotriene (Vitamin D3
derivative, brand name Dovonex, Taclonex):
Calcipotriene is a synthetic form of a Vitamin D3
and is often prescribed under the brand name
Dovonex which has been approved by the FDA for
treating psoriasis. Dovonex "...slows
down the rate of skin cell growth, flattens
psoriasis lesions and removes scale. It is not
effective at decreasing inflammation, though for
most patients redness will improve over
time."(1) Dovenex has proved effective
in treating nail psoriasis and a special version
exists for treatment of scalp psoriasis. Dovonex
has been an attractive option for the treatment
of psoriasis due it's lack of severe
side-effects. The NPF also reports that using
Dovonex in combination with topical steroids may
be more effective then using Dovonex alone. This
combination includes applying topical steroids in
the morning, and dovonex at night. Dovonex works
well with phototherapy treatments, but should not
be used in conjunction with salicylic acid which
can render Dovonex ingredients inactive. Since
many doctors prescribe Dovonex in conjunction
with a steroid, a new medication, called
Taclonex, was created which combines the active
ingredient in Dovonexd (calcipotriene) with a
potent steroid called betamethasone dipropionate.
Taclonex is FDA approved for psoriasis. Follow
your doctor's guidelines and the instructions
which accompany the prescription.(1)
Topical Retinoids (brand
name Tazorac): Retinoids are a synthetic
form of vitamin A and are often prescribed under
the brand name Tazorac, for which retinoid is the
main ingredient. Tazorac can be used on the face,
scalp and nails. Results with Tazorec may be seen
in 2 to 12 weeks. Retinoids should not be used by
pregnant women. Follow your doctor's guidelines
and the instructions which accompany the
prescription.
Anthralin (also called
Dithranol): Anthralin is a synthetic
substitute of chrysarobin, a substance found in
the bark of a South American tree and used a
treatment for psoriasis for over 100 years.
Anthralin works by reducing the rapid growth of
skin cells which cause plaques to develop.
Doctors usually prescribe anthralin to be applied
for short periods of 10 to 30 minutes and then
removed or washed off completely. Anthralin may
take several weeks of application before positive
results can be seen and can also be messy.
Although it is not as strong as topical steroids,
anthralin has no long-term side-effects.
Coal Tar: Coal
tar is derived from the coal carbonization
process and is a popular and frequently used
topical treatment for many types of skin
conditions. In patients with psoriasis, coal tar
can reduce inflammation, reduce rapid skin cell
growth which causes plaques to form, relieve
itching and irritation, and improve the skin's
appearance. Coal tar is available over the
counter (OTC) in shampoo, gel and cream form.
Coal tar can be messy. Follow your doctor's
guidelines and/or the instructions that accompany
the product when you purchase it.
- Salicylic Acid: Salicylic acid
helps remove and reduce the scales that accompany
plaque psoriasis. It is often used in combination
with other topical treatments such as steroids,
tar, and anthralin, or can be mixed together by
the pharmacist (with a doctor's prescription)
with other ingredients. Salicylic acid comes in
many OTC topical forms: cream, gel, lotion,
ointment, pads, plaster, shampoo, soap and
solution. The 3 percent and under solution is
available OTC and solutions over 3 percent
require a doctor's prescription.
Light Therapy (also called
Phototherapy):
Ultraviolet light from the Sun has been proven to slow
the production of skin cell growth and reduce
inflammation. "When absorbed into the skin, UV
light suppresses the process leading to disease, causing
activated T cells in the skin to die." (2)
Although too much Sun can be harmful for
some psoriasis patients, light treatments administered
with special phototherapy equipment, either in a doctor's
office or using a home-based unit, have proven very
effective in treating psoriasis patients. When used in
combination with topical and systemic treatment, light
therapy can be highly successful. Light therapy is
especially useful when patients start to develop a
resistance to topical steroids. The key to successful
treatment of psoriasis with light therapy is consistent,
long term, disciplined treatment sessions.
There are two main forms of light therapy administered
by doctors.
1. UV-B or Ultraviolet B: Ultraviolet
light B is present in natural sunlight and can help
psoriasis patients by decreasing the rapid cell growth. "UVB
penetrates the skin and slows the abnormally rapid growth
of skin cells associated with psoriasis. UVB treatment
involves exposing the skin to an artificial UVB light
source for a set length of time on a regular schedule,
either under a doctor's direction in a medical setting or
with a home unit purchased with a doctor's
prescription."(1) Treatment times and frequency
vary according to patient.
There are two types of UVB light, broad band and
narrow band. Broad is most widely used in the United
States, however, narrow band is starting to gain
popularity as a treatment among doctors as it seems to be
more effective.
2. PUVA: PUVA is a different type of
light therapy then UV-B used for the treatment of
psoriasis. PUVA is an acronym that stands for Psoralen
UltraViolet-A light, or Psoralen UVA. Similar to UV-B,
UVA light by itself is not effective for the treatment of
psoriasis. Under PUVA light therapy, a medication called
psoralen is orally or topically applied to make the skin
more receptive to UV-A light. Ultraviolet-A has a long
wave-length that penetrates deeper into the skin.(2)
According to NIAMS, PUVA is used when more than 10
percent of the body is covered or affected by psoriasis
plaques, or when the affected areas interfere with the
patient's profession such as the hands of a teacher or
salesperson.
"Compared with broadband UVB treatment, PUVA
treatment taken two to three times a week clears
psoriasis more consistently and in fewer treatments.
However, it is associated with more shortterm side
effects, including nausea, headache, fatigue, burning,
and itching. Care must be taken to avoid sunlight after
ingesting psoralen to avoid severe sunburns, and the eyes
must be protected for one to two days with UVA-absorbing
glasses. Long-term treatment is associated with an
increased risk of squamous-cell and, possibly, melanoma
skin cancers. Simultaneous use of drugs that suppress the
immune system, such as cyclosporine, have little
beneficial effect and increase the risk of cancer." (2)
Light therapy is usually more effective when used in
combination with topical or systemic treatment options,
then as a stand alone treatment. As mentioned above, it
is worth restating that for light therapy to be
effective, long-term, consistent treatment sessions are
needed. Home units can be purchased with a doctor's
prescription and are usually worth the investment for the
35 percent of patients who have moderate to severe
psoriasis. Talk to your doctor for more information.
Systemic Therapy
In moderate to sever cases of psoriasis, or when
psoriasis won't go into remission with topical and light
therapy, doctor's may prescribe internal medicines that
are taken orally or by injection. These medications carry
side-effects your doctor or pharmacist or prescription
fact sheet should inform you about. The most common
systemic medications include:
Methotrexate: Slows cell production
by suppressing the immune system.
Cyclosporine: Like methotrexate,
cyclosporine works by suppressing the immune system and
reducing the skin cell turnover rate. Cyclosporine should
not be used with Light Therapy.
Retinoids (Soriatane): Soriatane is a
prescription medication called an oral retinoid, which is
a synthetic form of vitamin A and is approved by the FDA
for the treatment of psoriasis. According to the National
Psoriasis Foundation, it is not exactly clear how oral
retinoids benefit those with psoriasis, but is believed
to assist cells in how they regulate their behavior. "Retinoids
help control how cells multiply, including how fast skin
cells will grow and shed from the skin's surface." (1)
Biologic Response Modifiers (Biologics): Unlike
other medicines which are made from chemical compounds,
biologics are made from human or animal proteins. They
have been in use for 100s of years but have only recently
been steered towards and applied to patients with
psoriasis. A new class of medicines from biologics have
emerged recently and are proving effective in treating
psoriasis. The most frequently prescribed of these
biologic medicines include:
Alefacept (brand name
Amevive): Amevive was approved by the
FDA in January of 2003 for the treatment of
psoriasis. It is an immune suppressing drug that
reduces the T cells that can cause psoriasis
plaques. Amevive is prescribed to patients with
moderate to severe psoriasis and can be used in
conjunction with phototherapy.
Etanercept (brand name
Enbrel): Enbrel was approved by the FDA
in January 2002 for the treatment of both
psoriatic arthritis and psoriasis. Enbrel works
by controlling the cytokines which lead to
inflammation.
Adalimumab (brand name
Humira): Humira was approved by the FDA
in October 2005 for the treatment of rheumatoid
arthritis and psoriatic arthritis. It is
currently being studied as a treatment for
psoriasis. According to the NPF, "...some
doctors are already prescribing it
"off-label" for this diseasea
common and accepted medical practice." (1)
Efalizumab (brand name
Raptiva): Raptiva was approved by the
FDA in October 2003 for treatment of moderate to
severe plaque psoriasis. Raptiva works on the T
cells which lead to plaque build ups and
inflammation.
See Also
Psoriasis:
Overview
Psoriasis:
Causes
Psoriasis:
Exacerbating Factors & Triggers
Psoriasis:
Symptoms & Types
Psoriasis:
Psoriatic Arthritis
Psoriasis:
Treatment Options

Article by Jason Morrow,
OmniMedicalSearch.com
SOURCES:
(1) National Psoriasis Foundation
(2) National Institute of Arthritis and Musculoskeletal
and Skin Diseases, Questions and Answers
about Psoriasis, May 2003
(3) American Academy of
Dermatology, Psoriasis Pamphlet, August 2005
(4) American Academy of Family Physicians, Psoriasis,
2006
(5) EmedicineHealth.com, Psosriasis, by Hon Pak, MD, January 2006
(6) University of British Columbia, DermWeb, Psoriasis: What is it
and How is it Treated?
(7) American Journal of Human Genetics, Sequence
and haplotype analysis supports HLA-C as the psoriasis
susceptibility 1 gene, 2006
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