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Plaque Psoriasis (cont.)

Are There Plaque Psoriasis Home Remedies?

The good news is that there is a lot that can be done for mild cases of psoriasis. There are many over-the-counter products available that are effective for psoriasis -- 1% hydrocortisone cream (Cortaid, CaldeCort) is very safe topical steroid that can suppress mild disease. Preparations containing tar (that gunky, smelly stuff that is a byproduct of oil extraction) can be beneficial. Tar can be found in many ointments and shampoos so it can be effective in treating scalp disease. Sunlight has well-documented beneficial effects on psoriasis. Careful sunbathing (no sunburns) can be quite effective in controlling the disease during seasons when sunlight is abundant and the weather is tolerable. When treating this disease, it must be remembered that topical medications and light will have difficulty penetrating through thick layers of scale. This scale must be removed by gentle washing techniques so as to minimize irritation. In plaques of psoriasis, the small cutaneous vessels are very close to the surface of the skin, just under the scale. If the scale is removed, bleeding may occur, producing irritation and trauma that actually tends to activate psoriasis.

What Are Medical Treatments and Medications for Plaque Psoriasis?

Topical medications effective for psoriasis available by prescription include those that contain topical steroids of various potencies. Typical steroid medications are halcinonide (Halog, Halog-E), flurandrenolide (Cordran, Cordran SP, Cordran Tape), betamethasone (Luxiq), desonide (Desonate), alclometasone (Aclovate), mometasone (Elocon), fluocinonide (Vanos), and triamcinolone acetonide (Kenalog). Tar-containing topicals and vitamin D-like molecules (calcipotriol [Taclonex]/calcipotriene [Dovonex]) also can be helpful. Ultraviolet light administered under controlled conditions in a physician's office in various wavelengths (narrow-band UVB) with or without supplemental medication (8-methoxypsoralen) (PUVA treatment) is a very effective therapy. Systemic therapies include a vitamin A-like drug, acitretin (Soriatane), short-term cyclosporine (Gengraf, Neoral, Sandimmune) therapy for severe flares, and methotrexate (Rheumatrex Dose Pack, Trexall). A new oral drug, apremilast (Otezla), has recently become available that seems to work best for mild to moderate psoriasis. New and expensive targeted drugs called biologics, which include etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), ustekinumab (Stelara), secukinumab (Cosentyx), and ixekizumab (Taltz), are now available. These newer products are produced by new technologies requiring their synthesis by living cells. They are proteins and all currently must be given by injection at various intervals into the subcutaneous tissue by the patient or by intravenous infusion in a medical facility. They are unique in that they have precise targets in the in the inflammatory pathway that they block. Since the biologics are very, very specific in their mode of action, they claim to offer increased safety and improved efficacy over older less specific immunosuppressive drugs.

All of these treatments must be continued indefinitely because when they are stopped, the psoriasis will typically return. It has recently been appreciated that the presence of psoriasis is a sign of a systemic inflammatory predisposition. Patients with psoriasis are predisposed to being obese, having diabetes, and having a destructive arthritis and premature cardiovascular disease.

Medically Reviewed by a Doctor on 3/30/2017

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