Patient Education: Treatments for Psoriasis

Sharjah-based dermatologist Dr Minal Patwardhan puts the spotlight on conditions and treatments every fortnight. Today: Psoriasis


Psoriasis ia a common disabling proliferative disorder of the skin. I repeat: disorder not disease. It is by and large non-life threatening, but its significance is understood only by the sufferer and the doctor.

Mild to moderate Psoriasis

• Topical applications of steroid creams, Daivonex, moisturisers, coal tar and Anthralin therapies are commonly used.

• Drugs precipitating Psoriasis are avoided.

• Single plaques can be treated by Intralesional Steroid Injections including for the nail.

• Short Wave UVB therapy is also useful.

A golden rule is that unless life-saving, systemic steroids are to be avoided.

• Why? Because the lesions vanish temporarily but recur with a vengeance.

For more widespread Psoriasis

• Coal Tar baths and topical Anthralins under supervision.

• Ultra Violet Therapy alone or in combination with Psoralens is a little more aggressive approach.

• Immunosupressive drugs like Cyclosporin are also tried.

Acute Psoriasis

• Should be treated gently with lots of emollients and topical steroids, simultaneously maintaining the body's inner environment.

Scalp Psoriasis

• Treated with topical steroid lotions, tar-based or keratolytic shampoos, Daivonex scalp lotion, plain emollients, oils or occlusive treatments.

Nail care

These show simultaneous remission along with skin lesions. Intralesional steroid injections in nail bed matrix help. So also does clearing subungual debris.

Application of steroids under occlusion, 5 FFU applications are all a variety of therapies used.

Other medicines

Systemic Etretinate is an aromatic (chemical) Vitamin A which regulates the epidermal formation and helps to normalise the skin formation. A six-month to 12-month therapy. In the case of women, pregnancy is not advised as long as the treatment is going on and for one year after stopping it, because the drug is stored in the body and is detrimental to the foetus.

Retinoids take care of most of the manifestations of Psoriasis and the recurrence is delayed and milder.

They are used alone or in conjunction with PUVA therapy.

Psoriatic Arthropathies

• Systemic Methotrexate is the treatment of choice. Some schools of thought promote Cyclosporin. Both these are cytotoxic drugs and have an effect on cell division and maturation.

• Non-steroidal anti-inflamatories, HydroxyChloroquin, Gold have all been tried in Psoriatic Arthropathies.

• New Laser therapies (Excimer lasers) are available for quick relief of visible lesions and a cosmetic appearance.

What else is new

• Lately new biologic agents like Alfacept which helps Psoriasis and Rheumatoid Arthritis have been developed. Also known as Amevive, it is a novel and selective biologic agent for Chronic Plaque Psoriasis, Psoriatic and Rheumatoid Arthritis. It is an injectable medication and is administered over 12 weeks.

• Enbrel or Etanercept used to treat Rheumatoid Arthritis and Psoriatic Arthritis is the other breakthrough biologic drug which reduces the symptoms and inhibits the progression of structural damage of active arthritis in patients with Psoriatic Arthritis.