Doctors generally treat psoriasis in steps based on the severity of the disease, the extent of the areas involved, the type of psoriasis, or the patient’s responsiveness to initial treatments. This is sometimes called the “1-2-3” approach. In step 1, medicines are applied to the skin (topical treatment). Step 2 focuses on light treatments (phototherapy). Step 3 involves taking medicines internally, usually by mouth (systemic treatment).
Potential disadvantages of conventional treatment: 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 commonly 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 resistance or adverse reactions occur.
1. Topical Treatment
Treatments applied directly to the skin are sometimes effective in clearing psoriasis. Doctors find that some patients respond well to sunlight, corticosteroid ointments, medicines derived from vitamin D3, vitamin A (retinoids), coal tar, or anthralin. Other topical measures, such as bath solutions and moisturizers, may be soothing but are seldom strong enough to clear lesions over the long term and may need to be combined with more potent remedies.
2. Phototherapy
Ultraviolet (UV) light from the sun causes the activated T cells in the skin to die, a process called apoptosis. Apoptosis reduces inflammation and slows the overproduction of skin cells that causes scaling. Daily, short, nonburning exposure to sunlight clears or improves psoriasis in many people. Therefore, sunlight may be included among initial treatments for the disease. A more controlled form of artificial light treatment may be used in mild psoriasis (UVB phototherapy) or in more severe or extensive psoriasis (psoralen and ultraviolet A [PUVA] therapy).
PUVA--. However, it is associated with more short-term side effects, including nausea, headache, fatigue, burning, and itching.
Long-term treatment is associated with an increased risk of squamous cell and melanoma skin cancers.
3. Systemic Treatment:
Systemic agents are given internally, orally or by injection, to influence the course of psoriasis. However, they also have a variety of other systemic effects and must be used under close supervision and monitoring by a dermatologist. Systemic agents are often combined with topical agents for better clearing of lesions.
a. Methotrexate-- Oral anticancer drug that work by suppressing the immune system. Potential side effects: Patients taking methotrexate must be closely monitored because it can cause liver damage and/or decrease the production of oxygen-carrying red blood cells, infection-fighting white blood cells, and clot-enhancing platelets. Methotrexate should not be used by pregnant women, by women who are planning to get pregnant, or by their male partners.
b. Cyclosporine--Acts by suppressing the immune system in a way that slows the rapid turnover of skin cells. It may provide quick relief of symptoms, but it is usually effective only during the course of treatment. Potential side effects: Cyclosporine may impair kidney function or cause high blood pressure (hypertension), so patients must be carefully monitored by a doctor. Also, cyclosporine is not recommended for patients who have a weak immune system, those who have had substantial exposure to UVB or PUVA in the past, or those who are pregnant or breast-feeding.
c. Corticosteroids--They work by suppressing body immune system. Potential side effects: Thinning of the skin, causing striae or stretch marks, skin color changes, a tendency to bruise easily, and if absorbed systemically, possibly hormonal disruption. Stopping these medications suddenly may result in a flare-up of the disease. After many months of treatment, the psoriasis may become resistant to the steroid preparations.
d. Retinoids--A retinoid, is a compound with vitamin A-like properties that may be prescribed for severe cases of psoriasis that do not respond to other therapies.
Potential side effects: Because this treatment also may cause birth defects, women must protect themselves from pregnancy beginning 1 month before through 3 years after treatment. Most patients experience a recurrence of psoriasis after medicine is discontinued.
e. Antibiotics--Although not indicated in routine treatment, antibiotics may be employed when an infection, such as Streptococcus, triggers the outbreak of psoriasis, as in certain cases of guttate psoriasis.
Summary: Psoriasis is a chronic disease that is seldom cured with conventional system of medicine. |
Arthritis 