Plaque Psoriasis (cont.)
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Medical Treatment for Plaque Psoriasis
Topical medications effective for psoriasis available by prescription include those that contain topical steroids of various potencies, tar, and vitamin D-like molecules (calcipotriol [Taclonex]/calcipotriene [Dovonex]). 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). New and very expensive targeted drugs (etanercept [Enbrel], adalimumab [Humira], infliximab [Remicade], ustekinumab [Stelara], and secukinumab [Cosentyx]) are now available. These newer products have been termed "biologics" because they 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 immune system 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. A new oral drug that does not require additional blood monitoring has received approval for the treatment of psoriatic arthritis and psoriasis. This drug is called apremilast (Otezla), and it may approach the safety and efficacy of the biologics.
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 7/16/2015
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