Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
People with the generalized form of pustular psoriasis are occasionally admitted to the hospital to make sure they have adequate fluid intake and bed rest and don't lose too much heat or have too much strain on the heart. Bland compresses are applied to the skin, and saline (saltwater) solutions and oatmeal baths help to soothe and heal affected areas. In children with pustular psoriasis, this treatment is often all that's needed.
There are two basic types of treatments for psoriasis: (1) topical therapy
(drugs used on the skin); and (2) systemic therapy (drugs taken into the body). All of these treatments may be used alone or in combination.
Topical therapy: Medications applied directly to the skin are the first course of treatment options. The main topical treatments are corticosteroids, vitamin D-3 derivatives, coal tar, anthralin, or retinoids. There isn't one topical drug that is best for all people with psoriasis. Because each drug has specific adverse effects, it is common to rotate them. Sometimes drugs are combined with other drugs to make a preparation that is more helpful than an individual topical medication. For example, keratolytics (substances used to break down scales or excess skin cells) are often added to these preparations. Some drugs are incompatible with the active ingredients of these preparations. For example, salicylic acid (a component of aspirin) inactivates calcipotriene (form of vitamin D-3). On the other hand, drugs such as anthralin (tree bark extract) may require addition of salicylic acid to work effectively.
Ultraviolet-B (UV-B) and narrow-band UV-B light: UV-B light is also used to treat psoriasis. UV-B is light with wavelengths of 290-320 nanometers (nm). (The visible light range is 400-700 nm.) UV-B therapy is usually combined with one or more topical treatments. The major drawbacks of this therapy are the time commitment required for treatments and the accessibility of UV-B equipment.
Systemic agents: For generalized pustular psoriasis, systemic agents such as retinoids may be required from the beginning of treatment. This may be followed by PUVA treatment. For milder and chronic forms of pustular psoriasis, topical treatment or light treatment may be tried first. People whose disease is disabling for physical, psychological, social, or economic reasons may also be considered for systemic treatment.