As any skin health expert like Skin specialist in Lahore would tell you, psoriasis has a considerable impact on the mental and physical health of the patient. Psoriasis involves the hyperproliferation of the keratinocytes or the keratin producing cells of the skin, causing an increased turnover of the epidermal layers. The exact cause, however, of this increased turnover of the keratinocytes is not understood yet. Read on to know more about psoriasis and its treatment considerations:
Treatment options for psoriasis:
In simple terms, the treatment of psoriasis is centered around sun exposure daily, topical moisturizer, relaxation and sun bathing. However, a more tailored approach is recommended only after examination of the lesions by a healthcare provider depending upon the severity.
Topical corticosteroids:
Topical corticosteroids are most frequently prescribed for mild to moderate psoriasis. During flare-ups, corticosteroids can be applied to the lesions, such as on the face, skin folds and the widespread patches. Once the lesion is in remission, application of steroid is switched to alternate days or weekends. Long term use of corticosteroids is detrimental for the skin.
Retinoids:
Retinoids are applied once or twice a day. They are not recommended for pregnant patients.
Vitamin D analogues:
Vitamin D analogues such as their synthetic analogues—calcipotriene and calcitriol can slow down the growth of skin. The vitamin D analogues are rarely used alone, preferred more commonly with topical steroid therapy. For sensitive areas, calcitriol is less irritating.
Coal tar:
Coal tar reduces scaling, inflammation and itching. Many preparations of coal tar are available—such as shampoo, oil and cream. Even though they are messy to use, they are quite effective. For pregnant and lactating mothers, coal tar is not recommended.
Salicylic acid:
Salicylic acid enhances the ability of other drugs to penetrate the skin and therefore, are used in combination with other drugs. They are used primarily on scalp psoriasis.
Anthralin:
Anthralin is another tar product that can slow down the growth of skin cells. The scales are easier to remove with anthralin and the skin becomes smoother. However, anthralin can cause mild irritation.
Light therapy:
Light therapy is recommended for moderate to severe psoriasis. Often, it is used with other drugs for better response. Controlled amounts of artificial and natural light are used for treatment, but repeat sessions are necessary for success.
Methotrexate:
Methotrexate is given orally or injected for more severe form of psoriasis. The most common form of administration is weekly single oral dose.
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Cyclosporine:
Cyclosporine is another oral drug for severe psoriasis to suppress the immune system. It is similar in action to methotrexate.
Treatment algorithm for psoriasis :
Psoriasis is classified as systemic, topical or phototherapeutic. In mild psoriasis, the treatment regimen is limited to topical therapy alone. However, patients are not compliant in topical therapy alone, especially in the long run, which makes treatment less effective.
For localized lesions: treatment is started with topical corticosteroids, with the possible addition of calcipotriene and/or coal tar. If the lesion responds to this then the corticosteroids are tapered off. If not, anthralin or tazarotene is added.
For psoriasis plaques that are resistant to treatment, intralesional injections of corticosteroid are administered, along with triamcinolone. The dose of the latter can be increased gradually until response is seen. The potential side effects of triamcinolone include pain at the injection site, and local atrophy.
Patient education
As soon as a patient is diagnosed with psoriasis, their skincare expert or Skin specialist in Karachi should guide them about their disease. Their education of disease should include information about the non-contagious nature of skin lesions along with need of long-term therapy and the possible effect of disease on their quality of life. Patient should also be educated about the exacerbating factors such as medication—ACE inhibitors, lithium and beta blockers, stress, infection and trauma.