Psoriasis

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Treatment

Therapy for psoriasis ranges from conservative to aggressive treatment. Due to the chronic nature of the disease, many patients try several therapies over time. Guttate psoriasis usually is managed more easily and complete remission typically occurs. In addition to standard treatment, patients with guttate psoriasis are given a course of oral antibiotics to eradicate the strep infection. Once resolved, the psoriasis remains in remission until another episode of strep infection occurs.

Most patients experience improvement with sensible exposure to sunlight and psoriasis often improves during the summer months. Sometimes artificial ultraviolet light is administered in the physician's office. In these cases, the patient is exposed to an increasing amount of ultraviolet B (UVB) or ultraviolet A (UVA) rays. UVA rays are used with an oral or topical substance called psoralen, which makes the skin more sensitive to treatment and improves its effectiveness. This treatment is called Psoralen plus UVA (PUVA).

Corticosteroids, which are available in creams, ointments, gels, lotions, and foams, are the mainstay of topical therapy. They are often used for short-term management and are often used in combination with other topical therapies. Corticosteroids may cause thinning of the skin and progressive resistance and are usually discontinued gradually.

Prescription and over-the-counter tar medications also may be effective. These preparations are available in shampoos, as additives for the bath, and as anthralin (tar-like) creams.

A vitamin D-related ointment called calcipotriene (Dovonex®) is also available. Many patients respond to this treatment, which often is used in combination with a topical corticosteroid. The two treatments work somewhat synergistically, enabling a more rapid resolution of lesions.

A topical retinoid (vitamin A-related) gel, called tazarotene (Tazorac®), also may be used with a corticosteroid. When used alone, this treatment can cause local irritation.

Oral (systemic) treatment of psoriasis may be used in severe cases. Several therapies are available, including acitretin (Soriatane®), an oral retinoid. This drug can be used alone or in combination with ultraviolet light therapy. Blood tests are performed regularly during treatment to monitor for side effects, which can include elevated levels of cholesterol and blood lipids (fats), and liver irritation. This drug is contraindicated in women who are pregnant and in those who intend to become pregnant within 3 years of discontinuing treatment.

Methotrexate, which inhibits cell proliferation, may be administered weekly to treat severe psoriasis and psoriatic arthritis. During treatment, daily supplementation with vitamins and 1 to 5mg of folic acid is recommended to reduce the risk for anemia and nausea caused by the medication. Regular blood tests are also performed during treatment to detect liver inflammation. After 1-1.5 grams of the drug has been administered, a liver biopsy may be performed to detect abnormalities not apparent in blood tests.

Cyclosporine (Neoral®) also may be used to treat psoriasis. During this treatment, kidney function and cholesterol levels are monitored using blood tests.

Mycophenolate mofetil is an imunosuppressant that may be used. This medication is typically less effective than other drugs, but it is safe for long-term use. Maintaining a daily dosage under 3 grams minimizes side effects such as low white blood cell count (neutropenia). Routine blood tests are performed during treatment.

Alefacept (Amevive®) is an immunosuppressant used to treat moderate to severe psoriasis. This medication is given by injection or administered intravenously (through an IV) once a week, for 12 weeks. In some cases, the course is repeated.

Alefacept inhibits the production of overactive T cells, which can cause psoriasis, without impeding normal immune system function. T cell are a critical component of the immune system, and T cell counts are routinely monitored during the course of treatment.

Patients with compromised immune systems due to disease or medication and those undergoing phototherapy should not take alefacept. This medication should be used with caution in patients with a history of metastatic cancer or chronic infections.

Side effects include the following:

• Chills
• Cough
• Dizziness
• Headache
• Increased risk for infection and cancer
• Muscle pain
• Nausea
• Pain, itching, and inflammation (redness) at the injection site
• Sore throat

There are several ongoing investigations for biologic treatment of severe psoriasis. Initial trials with anti-CD 11a are promising. This medication, given by injection, modulates the immune system's activity, thus resolving psoriasis plaques.

Prevention

At this time, not enough is known about psoriasis to prevent its occurrence. Patients who have experienced a psoriasis flare-up with strep throat should be treated using antibiotics at the first sign of infection.

Psoriasis, Treatment, Prevention reprinted with permission from dermatologychannel.net
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