The type of treatment prescribed for psoriasis depends on several factors
the most important being the severity of the condition in the individual. Treating PS is a very hit and miss affair although there are standard procedures and medications available it is the individual that must be treated. In general the beginning of treatment will usually commence with the less harmful medications at the doctors disposal and will progress to more extreme measures if the patient does not respond. There is always a trade of effectiveness of the medication versus the side effects.The armoury at the disposal of the dermatologist is growing and there are an ever increasing array of treatments offering new hope to sufferers
Coal tar in one form or another has been used to treat psoriasis for hundreds of years it is an incredibly complex chemical compound and it is till not known today which one of these thousands of components is responisible for the modification of psoriasis lesions. In its raw state it is simply a crude black tar it is then blended with petroleum products, alcohol,and various emoluments at concentrations of up to 10%. Coal tar is used in a variety of ways it is used in bathing compounds,Lotions and shampoos and of couse creams and ointments. (Alphosyl Cream TM is an easily applied form of coal tar cream and re4latively clean to apply and use)It is one of the tried and tested remedys for psoriasis and is still extensively used today in comprehensive treatment routines. It is messy and does smell strongly it also stains clothes and bedding but it does work and wont kill you.
Sulphur Ointment
Likewise this compound is one of the age old treatments for psoriasis. It is a yellow powder which is compounded with petroleum and emoluments such as lanoline . It can be used in conjunction with coal tar treatments. Also can be compounded into shampoos and lotions. It has a strong anti bacterial action and is an efficient fungicide. It smells characteristically of rotten eggs and can burn sensitive skin. It is used extensively in hospital treatment programs but can be messy to use at home. It is interesting to note that sulphurous springs can in my experience be very beneficial to psoriasis.
Salycilic acid
Salicylic acid compounds are very useful for stripping off the scale build up that occurs in chronic psoriasis. Due to the nature of the condition scale can build up to several millimeters in thickness and it is a vital part of treatment that this build up is effectively removed. Salycilic acid is blended with petroleum jelly at concentrations between 1 and 5 % and is used to soften scales which can the easily be removed after treatment in a warm bath. It is usual to apply the ointment in the morning under bandages or cling film and remove in the afternoon or earlier if the desired effect is achieved. Urea compounds can also be used to achieve scale removal.
Dithranol
Dithranol also known as Lassars paste is a very effective remedy for psoriasis lesions it has been used for many years and is a thick off white paste which is applied directly to the lesions and left on for 24 hours. It stains anything it comes into contact with and can irritate unaffected skin.Treatment is usualy started with low concentrations and as resistance is built up the dosage can be increased to a maximum of about 5% concentration.It is not advisable to use this product in any sensitive areas of the body.
Dovonex
Dovonex is a relatively new treatment and is a synthesised vitamin D derivative(Calcipotreol). Please not that it is not the same as vitamin D which can be purchased from health shops and vitamin D has no effect on psoriasis lesions. It is an expensive but effective form of treatment with very few side effects and is one of the safest and most effective treatments for psoriasis available today. It should be used with care in sensitive areas of the body and not applied to unaffected skin and treatment should be limited to no more than 100g in one week.Symptoms of an over dose of Dovonex include weakness, fatigue, drowsiness, dizziness, headache, decreased appetite, nausea, vomiting, and high levels of calcium in the blood.
Topical Retinoids
Clinical studies have been conducted on tazarotene (Tazorac). Results suggest that tazarotene use may lead to an extended remission in psoriasis, providing a new long-term medication. The product was aproved by the US FDA for use on patients having more than 20% coverage on their body. The gel formulation is suitable for the treatment of scalp psoriasis. Unlike calcipotriene(Dovonex, tazarotene can be used to treat psoriasis of the face. Retinoids taken orally have some potential unpleasant side effects including skeletal deformation, mouth ulcers and hair loss. Local skin irritation and rashes are frequent side effects of tazarotene, and care must be used to ensure that the medicine is applied only to affected areas of skin
Corticosteroid Therapy
Topical corticosteroids in the form of creams,ointments and gels remain one of the most widely used treatments for psoriasis. Corticosteroids have anti-inflammatory, immunosuppressive and antiproliferative properties. The effiency of an individual topical Corticosteroid is related to its potency and its ability to be absorbed into the skin. Absorption can be enhanced by the use of plastic occlusion or by the type of corticosteroid chosen. The more powerful steroid preparations can have dramatic effects in clearing psoriasis but have some serious side effects and are not deemed suitable for use on certain areas of the body and for long term treatment.
Listed below are some of the vast array of steroid preparations available throughout the world today. They can be used on there own or in combination with other preparations.
In general, mid-potency corticosteroids are used for lesions on the torso and extremities, while low-potency corticosteroids are used for areas with delicate skin, such as that on the face, genitals or skin folds. These delicate areas are at increased risk for thinning of the skin, one of the side effects of topical corticosteroids. High-potency corticosteroids are usually reserved for use on stubborn plaques or lesions on the palms of the hands and soles of the feet. Even then, they should only be used for about two weeks these preparations can cause irreparable damage to the skin. Ointments are the best choice for dry, scaly, thickened plaques; however, they feel oily to the touch and are difficult to wash away from hair. Lotions and gels creams can be used on all areas including the scalp.
One of the drawbacks of corticosteroid therapy is decreased efficiency with continued use, sometimes culminating in an acute flare-up when therapy is terminated. This reaction can be minimised by tapering off treatment and applying the medication less frequently once the lesions have improved rather than suddenly withdrawing the medication. Another strategy is the use of treatment holidays to allow a recovery period for the skin. Another Potential local side effect of topical corticosteroid therapy is localised acne. As with most effective treatments for this condition there is a trade of side effects in relation to results.
