Ideally all patients with suspected psoriasis should be seen by a dermatologist to establish the diagnosis before any treatment is instituted and guidelines issued.
Psoriasis is a chronic disease which has genetic and life style triggers; the treatment guidelines involve continuous monitoring and life long care for the patients.
Psoriasis Treatment Basics
- As of now, there is no cure for psoriasis. It can only be controlled.
- Patients should be aware of the psoriasis triggers and their role in precipitating the disease. Care should be taken to avoid these psoriasis triggers.
- Different treatment options are available to reduce or temporarily eliminate the symptoms of psoriasis.
- No one treatment works for everyone.
- There is no way of predicting which one will work or which will not. Trial is the only sure method to assess the effectiveness of a therapeutic option.
- Life style management is as important, if not more, as pharmaceutical intervention in psoriasis.
- Many psoriasis treatments come with side-effects. The dermatologist will balance the pros and cons of side effects versus the disease impact on the quality of life of the patient before deciding on the most appropriate treatment schedule.
- Never change or stop a treatment suddenly after a short period, as most will take some time to show results and sudden stoppage may actually worsen the disease activity.
- In recent years, new biological therapies have been introduced and several existing treatments have been improved giving new hope to people with psoriasis.
Factors Influencing Choice of Treatment in Psoriasis
Psoriasis treatment involves mainly 3 areas:
- Topical therapy: Treatments applied to the skin.
- Phototherapy or a combination of phototherapy and medications: Using artificial or natural light sources.
- Systemic treatment : Medications taken by tablet or injection.
A number of factors will determine which treatment will best suit a person with psoriasis. These include:
- The type of psoriasis: Plaque, guttate, flexural, pustular, erythrodermic, arthritis all have different treatment options.
- Psoriasis location on the body: Scalp, face, nail, body, flexures, genitals etc.
- Psoriasis severity: Mild to moderate: usually topical and or phototherapy will suffice. Severe: systemic therapy required.
- The stage of the disease: Progressive (active therapy), stationary (do not irritate!) or regressing (help along).
- The person’s health, age and medical history .
- The person’s response to previous therapy.
- Financial constraints in those who are not properly insured.
The Goals of Psoriasis Therapy
- The goal of psoriasis therapy is to reduce inflammation and to control shedding of the scales.
- Moisturizing creams and lotions loosen scales and help control itching.
- Patients should also take care to avoid the psoriasis triggers.
- Depending upon the factors mentioned above, different types of treatments and several visits to the dermatologist may be needed.
Who Should Treat Psoriasis?
- Ideally all patients with suspected psoriasis should be seen by a dermatologist to establish the diagnosis before any treatment is instituted.
- Once the dermatologist has started the treatment, localized forms of psoriasis can be followed up and managed by primary care physician
- All other types of psoriasis, especially the generalized psoriasis should be managed by a dermatologist only, who is knowledgeable about all types of therapies available for psoriasis.
- Give up the habit of flitting from one dermatologist to the other and one type of treatment to the other. Stick to one dermatologist for at least one year and do not change or stop treatment without his/her advice.
Psoriasis Treatment Guidelines
- Moderate amounts of sunlight will be beneficial, but avoid sunburns, as these may exacerbate psoriasis through the Koebner phenomenon.
- Avoid using high strength topical steroids for localised forms.
- Steroids are double edged swords. Use the other topicals first and, if they are not working, then only go for the steroid applications, especially the super potent ones.
- Bland emollients like vaseline along with a judicious sun exposure can keep most psoriasis under control.
- If you are using steroids, never ever stop them suddenly. You can precipitate a severe attack of generalized psoriasis, pustular eruptions, or erythroderma. Always reduce the strength moving from super potent-potent-moderate potent- mild-emollients.
- The sequential therapies are an excellent way to avoid the side effects of steroids.
- Always keep the psoriasis lesions moist with copious application of emollients. Drying will increase the itch-scratch cycle and precipitate new lesions. Emollients also cool down the “angry skin” of psoriasis.
- Newer biological therapies are excellent for psoriatic arthritis and severe psoriasis. If you can afford it, or you have insurance coverage, discuss these options with your dermatologist.
Next: Topical Therapies for Psoriasis
Further Reading
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
The copyright of the article Psoriasis Treatment Guidelines in Psoriasis is owned by Hanish Babu. Permission to republish Psoriasis Treatment Guidelines in print or online must be granted by the author in writing.
