Treatment of Psoriasis
Psoriasis is a chronic skin disease that speeds up the life cycle of skin cells and forces them to build up on the skin. As a result, the patient’s skin forms scales and red patches that itches in the later stage. The word ‘Psoriasis’ originated from a Greek word ‘psōrian – to have an itch’.
Not to panic is the first step towards the recovery of any disease since stress; obesity and lethargic lifestyle are the prime reasons of psoriasis. The aim of the treatment is to slow down and stop the rapid growth of skin cells with least possible side effects. The first step towards the treatment of psoriasis involves checking the type and severity of disease. The treatment is divided into 3 categories viz.
- Topical Treatment
- Oral Medication.
- Topical Treatment
The traditional method of dealing with the psoriasis patient is topical creams and phototherapy and then move towards stronger treatment, if necessary. Mild to moderate psoriasis is effectively treated using creams and ointments applied on the skin and falls under topical psoriasis. This includes:
- A) Topical corticosteroids Perhaps the most frequently prescribed medication as they reduce inflammation and relieve itching. For face or skin, folds and widespread patches of damaged skin mild corticosteroid ointments are recommended but less sensitive and rough areas are treated by strong corticosteroids. It is a short-term treatment since its regular use can lead to the thinning of skin.
- B) Vitamin D analogues These synthetic forms of vitamin D slow down the growth of skin cells. Calcipotriene (Dovonex) and Calcitriol (Vectical) containing Vitamin D analogues are used but Calcitriol, though expensive, is less irritating to the skin.
C)Anthralin Anthralin (Dritho-Scalp) not only halts skin cell growth but also removes scales and makes skin smoother. It is applied for a short time due to its irritating and staining properties.
- D) Topical retinoidsThese vitamin A derivatives decrease inflammation. The most common side effect being skin irritation. Retinoids like Tazarotene is not recommended for pregnant or lactating females.
- E) Calcineurin inhibitors Calcineurin inhibitors — tacrolimus (Prograf) and pimecrolimus (Elidel) — reduce inflammation and plaque buildup but are not recommended for long-term use as they may cause skin cancer and lymphoma. They are especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or harmful.
- F) Salicylic acid Salicylic acid promotes sloughing of dead skin cells and reduces scaling. When combined with topical corticosteroid its efficacy increases. Salicylic acid is abundantly available in medicated shampoos and scalp solutions to treat scalp psoriasis.
- G) Coal tar Recommended for pregnant and lactating women coal tar reduces scaling, itching and inflammation. Though it is irritating, messy has a strong odor and stains clothing and bedding but it is available easily in shampoos and creams.
- H) Moisturizers Moisturizing creams are not one-man army but they definitely act as supporting members during the psoriasis battle. They do so by reducing itching, scaling and dryness. They must be applied immediately after a bath or a shower.
If Psoriasis is severe then topical creams are combined with oral medications and phototherapy.
- Phototherapy or Light Therapy.
As the name suggests during this treatment natural or artificial UV rays are provided to the affected area in controlled amounts. These light rays may be used either alone or in combination with medications.
- A) Sunlight Exposure to ultraviolet (UV) rays in sunlight or artificial light slows skin cell turnover and reduces scaling and inflammation. The intense sun exposure may damage skin, so doctor’s advice should be taken beforehand.
- B) UVB phototherapy Controlled doses of UV B light from an artificial light source improves the symptoms. UVB phototherapy, also called broadband UVB, can be used to treat single patches, widespread psoriasis and psoriasis that resist topical treatments. Short-term side effects may include redness, itching and dry skin that maybe reduced by using a mosituriser.
- C) Narrow band UVB phototherapyIts a new type of psoriasis treatment, that is more efficient than broadband UVB treatment. It’s usually administered two or three times a week until the skin improves, and then maintenance may require only weekly sessions. However it may cause more-severe and longer lasting burns
- D) Goeckerman therapy Goeckerman treatment is a combination of UVB treatment and coal tar treatment. This is prescribed by doctors because coal tar makes the skin more receptive to UVB Light.
- E) Psoralen plus ultraviolet A (PUVA) This form of photochemotherapy involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.This more aggressive treatment is used for more-severe cases of psoriasis. Nausea, headache, burning and itching are short term side Long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma.
- F) Excimer laser This treats only the involved skin without harming healthy skin. A controlled beam of UVB light is directed to the psoriasis plaques to control scaling and inflammation. Excimer laser therapy requires fewer sessions than traditional phototherapy but causes redness and blistering.
- Oral or injected medications
The doctor prescribes oral or injected drugs when the psoriasis is resistant to other treatments. This is known as systemic treatment. Some of these medications are used for only brief periods and may be alternated with other forms of treatment because of severe side effects.
Retinoids Related to vitamin A, this group of drugs may help if you have severe psoriasis that doesn’t respond to other therapies. Not recommended for pregnant women.
- A) Methotrexate Taken orally, methotrexate (Rheumatrex) decreases skin cell growth and therefore inflammation. It can be tolerated in low doses but may cause upset stomach, loss of appetite and fatigue.
- B) CyclosporineCyclosporine (Gengraf, Neoral) suppresses the immune system and is similar to methotrexate in efficiency but only for short term.
- C) Other medicationsThioguanine (Tabloid) and hydroxyurea (Droxia, Hydrea) are medications that can be used when other drugs can’t be given as in case of pregnant or lactating women.
Common side effects of oral medication are lip inflammation and hair loss. It can also affect liver and production of White Blood Cells, Red Blood Cells and platelets.
Patients suffering from psoriasis must be resilient and should take one step at a time towards the treatment of this disease. They should not let the disease affect the psychology of a patient.