15 August 2008

Psoriasis Treatment

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There is no cure for psoriasis. However, treatment is usually effective and will control the condition by clearing or reducing the patches of psoriasis. Most people with psoriasis can be treated by their GP. Your GP may refer you to a dermatologist (skin specialist) and their team based in a hospital if symptoms are particularly severe or have not responded well to previous treatments.

Treatments are based on the type and severity of your psoriasis and the area of the skin affected. Your GP will probably start with a mild treatment - such as topical creams - and then move on to stronger treatments if necessary.

There is a wide range of treatment options for psoriasis but identifying what treatment is most effective can be difficult. You should talk to your GP if you feel a treatment is not working, or you are experiencing uncomfortable side effects.

Treatments fall into three categories:

* topical - creams and ointments are applied to your skin,
* phototherapy - your skin is exposed to certain types of light, and
* oral and injected medication - medicine is used to reduce the production of your skin cells.

Different types of treatment are often used in combination.
Topical treatments

Topical treatments are creams and ointments you apply to the affected areas of your skin. They are used to treat mild to moderate psoriasis. Topical psoriasis treatments include:

* Topical corticosteroids - these are the most commonly used medicines for treating mild to moderate psoriasis. The treatment works by slowing the production of skin cells; this reduces the inflammation and relieves the symptoms of itching. Topical corticosteroids range in strength from mild to very strong. Stronger topical corticosteroids are normally only used on small areas of your skin or on particularly thick patches. You should only use topical corticosteroids when instructed by your GP. Over-use can lead to you developing a tolerance to the cream and it could damage your skin.

* Vitamin D analogues - the Vitamin D in the cream has a suppressing effect on your immune system, slowing the production of skin cells. The most widely used Vitamin D analogue is calcipotriol, which is used to treat mild to moderate psoriasis. Calcipotriol has no side effects, provided you do not use more than the amount recommended by your GP.

* Dithranol - this has been used for over 50 years in the treatment of plaque psoriasis. It is effective in suppressing the production of skin cells and has no side effects. However, it is typically only used as a short-term treatment under hospital supervision, as it stains everything it comes into contact with including your skin. It is normally only applied to your skin for five minutes before being washed off to reduce the risk of staining your skin. Dithranol is often used in combination with phototherapy.

* Tazarotene - this cream contains a chemical similar to Vitamin A - a retnoid - this slows the production of skin cells. It is used in the treatment of moderate plaque psoriasis. The most common side effect is skin irritation. Tazarotene can cause birth defects so it should be strictly avoided during pregnancy or if breastfeeding. It is not recommended for children or teenagers.

* Coal tar - this is a thick heavy oil and is probably the oldest treatment for psoriasis. How it works is not exactly known, but it reduces scales, inflammation and itchiness. Coal tar does cause staining of clothes and bedding but it has a very strong smell. It is often used in combination with phototherapy.


Phototherapy

Phototherapy uses natural and artificial light to treat psoriasis.

* Sunlight - brief, daily exposure to small amounts of sunlight can improve symptoms, but too much sun can cause a worsening of your condition and cause skin damage. Consult with your GP about the safest way to make use of the sun.

* UVB phototherapy - this uses a wavelength of light that is invisible to human eyes - ultraviolet B light. The light slows down the production of skin cells and is an effective treatment against guttate or plaque psoriasis that has not responded to a topical procedure. Treatment takes place at a hospital under the supervision of a dermatologist. You will normally need between 10 and 30 sessions.

* Psoralean plus ultraviolet A (PUVA) - for this treatment, you will first be given a tablet called psoralean. This makes your skin more sensitive to light. Your skin is then exposed to a wavelength of light called ultraviolet A. This light penetrates your skin more deeply than ultraviolet B light. This treatment may be used if you have severe psoriasis that have not responded to other treatment. Common side effects of the treatment include nausea, headaches, burning and itchiness. Long-term use of this treatment is not encouraged as it can increase your risk of developing skin cancer.

* Combination light therapy - combining phototherapy with other treatments often increases the effectiveness of phototherapy. Some doctors use UVB phototherapy in combination with coal tar, as the coal tar makes the skin more receptive to light. Combining UVB phototherapy with Dithranol cream has also proved effective.


Oral and injected medication

You will normally only be prescribed tablets or injections if your psoriasis is severe and is resistant to other treatments. Oral medications can be very effective in treating psoriasis but they all have potentially seriously side effects - so they are only used for short periods of time.

* Methotrexate - methotrexate is a medicine that decreases the production of skin cells and suppresses inflammation. It is useful in treating pustular psoriasis, psoriatic erythoderma and extensive plaque psoriasis. It has no short-term side effects, but long-term use can cause serious liver damage. People who have previous liver disease should not take methotrexate. You should not drink any alcohol when taking methotrexate. Methotrexate can cause serious birth defects. Women should take adequate contraceptive precautions to avoid falling pregnant during therapy and for three months afterwards. Methotrexate can affect how sperm cells develop, so men should avoid fathering a child during therapy and for three weeks afterwards.

* Aciterin - aciterin is an oral retnoid that reduces the production of skin cells. It is used to treat severe psoriasis that has not responded to other treatments. It has a wide range of side effects including dryness and cracking of the lips, dryness of the nasal passages, loss of hair, and in rarer cases, hepatitis. Acitretin causes serious birth defects, and women should avoid pregnancy during treatment, and for two years after.

* Ciclosporin - ciclosporin is an immunosuppressant - a medicine that suppresses your immune system. It has proved effective in the treatment of all types of psoriasis, but as it stops your immune system from working normally, it can make you more at risk from infection. Ciclosporin also increases your chances of kidney disease and high blood pressure.

All of the oral and injected medicines for psoriasis come with both benefits and risks. Before starting a treatment of oral medication, your GP or dermatologist should clearly explain the benefits and risks of the treatment, both verbally and in writing.

Source: http://www.nhsdirect.nhs.uk


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