Psoriasis

Psoriasis is a chronic skin disease that is classically characterized by thickened, red areas of skin covered with silvery scales. The extent of skin involvement can range from discrete, localized areas to generalized body involvement. The joints, nails, and mucous membranes around the afflicted areas may also be affected with the disease. Some cases of psoriasis are so mild that people don’t know they have it. Severe psoriasis may cover large areas of the body. Dermatologists can help even the most severe cases. Psoriasis is not contagious and cannot be passed from one person to another, but it is most likely to occur in members of the same family. In the United States, two out of every hundred people have psoriasis (four to five million people). There are approximately 150,000 new cases that occur each year. There are many topical and light-therapy treatments available and newer biologic agents, that are usually injected into the skin, that are making this disease much easier to treat.

Topical psoriasis treatments include:

• Topical corticosteroids are the most frequently prescribed medications for treating mild to moderate psoriasis. They reduce inflammation and relieve itching and may be used with other treatments.
  Mild corticosteroid ointments are or sensitive areas (face or skin folds) and for treating widespread patches of damaged skin.
• Vitamin D analogues are forms of vitamin D that slow skin cell growth.
• Anthralin helps slow skin cell growth and remove scales and make skin smoother.
• Topical retinoids may decrease inflammation. With increases to sunlight, apply sunscreen before going outdoors.
• Calcineurin inhibitors, such as tacrolimus (Prograf) and pimecrolimus (Elidel) reduce inflammation and plaque buildup.
  Calcineurin inhibitors may be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects. but is not recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma.
• Salicylic acid promotes sloughing of dead skin cells and reduces scaling. Sometimes it’s combined with other medications, such as topical corticosteroids or coal tar, to increase its effectiveness.
• Coal tar reduces scaling, itching and inflammation. Coal tar can irritate the skin. It’s also messy, stains clothing and bedding, and has a strong odor.
• Moisturizing creams alone won’t heal psoriasis, but they can reduce symptoms.

Light therapy (phototherapy) uses natural or artificial ultraviolet light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight.

Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with medications.

• Sunlight
• UVB phototherapy
• Narrow band UVB phototherapy
• Goeckerman therapy
• Psoralen plus ultraviolet A (PUVA)
• Excimer laser

In the case of severe psoriasis or it’s resistant to other types of treatment, your doctor may prescribe oral or injected drugs- also known as systemic treatment. Due to the severity of side effects, some of these medications are used for only brief periods and may be alternated with other forms of treatment.

• Retinoids. Related to vitamin A, this group of drugs may help if you have severe psoriasis that doesn’t respond to other therapies.
• Taken orally, methotrexate (Rheumatrex) helps psoriasis by decreasing the production of skin cells and suppressing inflammation. It may also slow the progression of psoriatic arthritis in some people. Best in small doses, excessive usage can casue liver damage and decreased production of red and white blood cells and platelets.
• Cyclosporine (Gengraf, Neoral) suppresses the immune system and is similar to methotrexate in effectiveness, but can only be taken short-term. Cyclosporine also makes you more susceptible to kidney problems and high blood pressure

Drugs that alter the immune system (biologics). Several of these drugs are approved for the treatment of moderate to severe psoriasis. They include:

• etanercept (Enbrel),
• infliximab (Remicade),
• adalimumab (Humira),
• ustekinumab (Stelara),
• golimumab (Simponi),
• apremilast (Otezla),
• secukinumab (Cosentyx)
• ixekizumab (Taltz)

Most of these drugs are given by injection (apremilast is oral) and are usually used for people who have failed to respond to traditional therapy or who have associated psoriatic arthritis.

Drugs like thioguanine (Tabloid) and hydroxyurea (Droxia, Hydrea) are used when other drugs can’t be given.