Psoriasis Treatment: Topicals
Since psoriasis mainly affects the skin, topical treatments are
very useful because they are relatively safe, quite effective, and can
be applied directly to the disease. They take the form of lotions,
foams, creams, ointments, gels, and shampoos. They include topical
steroids, tar preparations, and calcium- modulating drugs. The
precise drug used and the form in which it is delivered depends on the
areas involved. In widespread disease in patients with more than 10%
of the body surface involved, it may not be practical to use topical
medication. treatments.
Psoriasis Treatment: Phototherapy
For more extensive disease, a useful option is ultraviolet light
exposure. Ultraviolet light (UVL) exposure can treat large areas of skin
with few side effects if performed in the physician’s office. It should
be kept in mind that all UVL causes mutational events, which can lead
to skin cancer. At this time, the most popular type of UVL for psoriasis
is called narrow-band UVB. Only a small portion of the UVL spectrum is
used, which seems to be particularly beneficial for psoriasis and may of
less carcinogenic potential. This UVB is quite different from the UVA,
the wavelength available in tanning salons.
Psoriasis Treatment: Laser Therapy
There are lasers that produce UVL in wavelengths similar to
narrow-band UVB. These can be quite effective for small plaques of
psoriasis, but because the areas of skin that can be treated at one time
are small, they are not practical for extensive disease.
Psoriasis Treatment: Oral Medications
There are a variety of drugs administered systemically that are
useful in controlling psoriasis. The choice of which drug to use depends
upon many factors which make this a very individual choice. Since these
drugs are administered either orally or through the skin, they are more
risky for the patient than topical medications. As a generalization,
most seem to act by targeting portions of the immune system. The only
exception currently is a drug called acitretin (Soriatane), which is
structurally similar to vitamin A. Since the immune system is necessary
in order to survive, systemic treatments do have a downside. Drugs like
methotrexate and cyclosporine are administered orally and can affect the
liver, kidney, and bone marrow.
Psoriasis Treatment: Biologics
A new class of drugs has recently been developed called biologics;
they're called biologics because living cells synthesize them. Since
these drugs are proteins, they cannot be administered orally and must be
given by injection through the skin or by an intravenous infusion.
These drugs are very precise in their target and block a single step in
the immune process. This seems to have increased their safety profile
when compared to older drugs. On the other hand, they are quite
expensive.
atural Remedies for Psoriasis
Since the natural solar spectrum contains ultraviolet light, there
is no question that heliotherapy (medicinal sunbathing) can be effective
in controlling psoriasis. There is mounting evidence that increased
body mass is associated with psoriasis and that heavier individuals are
more difficult to treat. So a normal body mass is desirable. There is
some dispute as to the role of diet in psoriasis, but a diet low in
saturated fats is desirable for many reasons including weight control.
So-called "natural or botanical" treatments have very little evidence to
support their use.
Climatotherapy
At the edge of Israel's Dead Sea, there are a group of resorts that
cater to psoriasis patients by offering a combination of graded solar
exposure and the application of crude coal tar along with a spa-like
experience. For those with the time and the money, this is a reasonable
alternative to standard medical treatment.
Stress Reduction
Although there is no doubt that psoriasis is a potent inducer of
stress, the evidence that stress causes psoriasis is sparse. Dealing
with stress with or without psoriasis is a challenge for most people
living in the 21st century.
Social Support
The National Psoriasis Foundation is an excellent source of
accurate information as well as emotional support for afflicted
patients.
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