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When it comes to psoriasis treatment, there are many options, opinions, and variations. Also, treatments will depend on the severity of the skin rash and the area of the body most affected. Psoriasis is an "autoimmune disease". This means that your immune system mistakes your own healthy skin cells for invaders and sets up an immune response to them.
Whether or not you need to consult a dermatologist for your psoriasis treatment is a matter of opinion. To some extent this may depend on (a) the severity of your rash (b) how financially well off you are or what health insurance plan you carry and (c) how long you will need to wait to see a dermatologist for psoriasis treatment. Usually a competent General Practitioner should be well able to manage your psoratic treatment other than in an acute flareup situation.
Here is a list of psoriasis treatment in order of popularity:
- Topical treatments: In the main, these will consist of corticosteroid creams and ointments. Coal tar preparations have been used since the eighteenth century and are still useful particularly as a shampoo for scalp psoriasis. This is called Polytar and can actually be used directly on the rash.
- Other topical treatments are Vitamin D and Vitamin A derivatives and salicylates. Usually it is a question of trial and error to find the topical treatment that works best for you.
- Light therapy: Sunlight, taken sensibly, usually improves psoriasis. So too does ultraviolet light or UVL, given under medical supervision, improve psoriasis.
- Systemic treatments: Medicines and injections of the immuno-suppressant type of drugs are now being developed and are showing a lot of promise in controlling flare-ups of this very unpleasant skin disease.
- Methotrexate: Taken orally, methotrexate helps psoriasis by decreasing the production of skin cells and suppressing inflammation. It may also slow the progression of psoriatic arthritis in some people. Methotrexate is generally well-tolerated in low doses but may cause upset stomach, loss of appetite and fatigue. When used for long periods, it can cause a number of serious side effects, including severe liver damage and decreased production of red and white blood cells and platelets. Methotrexate is probably best given as a single long-acting injection and left at that.
- Cyclosporine: Cyclosporine suppresses the immune system and is similar to methotrexate in effectiveness. Like other immuno-suppressant drugs, cyclosporine increases your risk of infection and other health problems, including cancer. Cyclosporine also makes you more susceptible to kidney problems and high blood pressure — the risk increases with higher dosages and long-term therapy.
- Drugs that alter the immune system (biologics): Several immunomodulator drugs are approved for the treatment of moderate to severe psoriasis. None are without risk. They include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira) and ustekinumab (Stelara). These drugs are given by intravenous infusion, intramuscular injection, or subcutaneous injection and are usually used for people who have failed to respond to traditional therapy or who have associated psoriatic arthritis.
- Other medications: Thioguanine and hydroxyurea (Droxia, Hydrea) are medications that can be used when other drugs can't be given.
If you suffer from this bothersome and unsightly skin condition, or have been recently diagnosed with it and are wondering about your options for management, then we are here to help you.
Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments — topical creams and ultraviolet light therapy (phototherapy) — and then progress to stronger ones only if necessary. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.
In spite of a range of options, effective treatment of psoriasis can be challenging. The disease is unpredictable, going through cycles of improvement and worsening, seemingly at random. Effects of psoriasis treatments also can be unpredictable; what works well for one person might be ineffective for someone else. Your skin also can become resistant to various treatments over time, and the most potent psoriasis treatments can have serious side effects.
People who suffer from psoriasis will tell you that periods of stress or anxiety can cause flareups. Obviously then treatments like meditation or mindfulness may be worth considering in certain circumstances.
Talk to your doctor about your options, especially if you're not improving after using a particular treatment or if you're having uncomfortable side effects. He or she can adjust your treatment plan or modify your approach to ensure the best possible control of your symptoms.