Treatment of psoriasis

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It vanished quite slowly, beginning with the end of the tail, and ending with the grin, which remained some time after the rest of it had gone.

Lewis Carroll, Alice in Wonderland

To ignore the impact of the condition on the patient's life is to fail in treating psoriasis. Like the Cheshire cat that Alice met, it tends to clear slowly and the last remaining patches are often the hardest to clear. This is frustrating enough, but there is also the knowledge that it will probably recur and need further tedious courses of treatment, so encouragement and support are an essential part of treatment.

In an attempt to quantify the impact of psoriasis on the life of the individual patient the Psoriasis Disability Index (PDI) has been developed. This takes the form of a questionnaire and covers all aspects of the patient's work, personal relationships, domestic situation, and recreational activities. It can be helpful in assessing the effectiveness of treatment as perceived by the patient.

Patients understandably ask whether psoriasis can be cured and often want to know the cause. The cause is unknown and the best answer is that the tendency to develop psoriasis is part of an affected person's constitution and some factor triggers the development of the clinical lesions. Known factors include physical or emotional stress, local trauma to the skin (Koebner's phenomenon), infection (in guttate psoriasis), drugs (P blockers, lithium, and antimalarial drugs).

Treatment comprises ointments and pastes, systemic drugs, or various forms of ultraviolet light. The treatment should suit the type of psoriasis. The age and health of the patient, social and occupational factors need to be taken into consideration. The motivation of the individual patient is also important.

The preparations mentioned in the text are listed in the formulary in chapter 26. It is estimated that 80% of patients with psoriasis do not consult a doctor, as the lesions are minimal.

Treatment of psoriasis

Type of psoriasis

Treatment

Alternative treatment

Stable plaque psoriasis

Tar preparations Calcipotriol + topical steroids Tacalcitol

Ultraviolet B (TL 01)

Short contact dithranol

Extensive stable plaques

As above. If not responding:

Ultraviolet B (TL01)

psoralen with ultraviolet A + etretinate

Methotrexate Ciclosporin A Tacrolimus

Widespread small plaque

Ultraviolet B

Tar

Guttate psoriasis

Emollients then ultraviolet B

Weak tar preparations

Facial psoriasis

1% hydrocortisone ointment

Flexural psoriasis

Local mild to moderate strength steroids + antifungal

Pustular psoriasis of hands and feet

Moderate to potent strength topical steroids

Acitretin

Acute erythrodermic, unstable, or general pustular psoriasis

Inpatient treatment Short term local steroids for acutely inflamed lesions

Methotrexate Acitretin

Ciclosporin or other immunosuppressants

Preparation applied to affected area (left). Application of stockinette (right)
Bandages being applied to larger areas (left). Patient now prepared for contact treatment (right)

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Natural Treatments For Psoriasis

Natural Treatments For Psoriasis

Do You Suffer From the Itching and Scaling of Psoriasis? Or the Chronic Agony of Psoriatic Arthritis? If so you are not ALONE! A whopping three percent of the world’s populations suffer from either condition! An incredible 56 million working hours are lost every year by psoriasis sufferers according to the National Psoriasis Foundation.

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