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Psoriasis (cont.)

How Do Doctors Diagnose Psoriasis?

Psoriasis is typically diagnosed on the basis of a physical examination by observing the appearance of the diseased skin. Although usually not necessary, skin biopsies can support the diagnosis of plaque psoriasis although they are not always definitive.

Are There Psoriasis Home Remedies?

  • Exposure to sunlight helps most people with psoriasis. This may explain why the face is so seldom involved.
  • Keeping the skin soft and moist is helpful. Apply moisturizers after bathing.
  • Do not use irritating cosmetics or soaps.
  • Avoid scratching that can cause bleeding or excessive irritation.
  • Soaking in bathwater with oil added and using moisturizers may help. Bath soaks with coal tar or other agents remove scales. Be careful in bathtubs with oil added to the bathwater since the tub can become very slippery.
  • Hydrocortisone cream can reduce the itching of mild psoriasis and is available without a prescription.
  • Some people use an ultraviolet B (UV-B) light unit at home under a doctor's supervision. A dermatologist may prescribe the unit and instruct the patient on home use, especially if it is difficult for the patient to get to the doctor's office for phototherapy treatment.

What Are Psoriasis Treatment Options?

Psoriasis is a chronic skin condition that may worsen and improve in cycles. Any approach to the treatment of this disease must be considered for the long term. Treatment regimens must be individualized according to age, sex, occupation, personal motivation, other health conditions, and available economic resources. Disease severity is defined by the thickness and extent of plaques present as well as the patient's perception and acceptance of the disease. Treatment must be designed with the patient's specific expectations in mind, rather than focusing only on the extent of body surface area involved.

Many treatments exist for psoriasis. However, the construction of an effective therapeutic regimen is not necessarily complicated.

There are three basic types of treatments for psoriasis: (1) topical therapy (drugs used on the skin), (2) phototherapy (light therapy), and (3) systemic therapy (drugs taken into the body). All of these treatments may be used alone or in combination.

  • Topical agents: Medications applied directly to the skin are the first course of treatment options. The main topical treatments are corticosteroids, vitaminD3 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 inactivates calcipotriene (form of vitaminD3). On the other hand, drugs such as anthralin (tree bark extract) require the addition of salicylic acid to work effectively.
  • Phototherapy (light therapy): The ultraviolet (UV) light from the sun slows the production of skin cells and reduces inflammation. Sunlight helps reduce psoriasis symptoms and signs in many people. If psoriasis is so widespread that topical therapy is impractical, then artificial light therapy may be used. Proper facilities are required for light therapy. The medical light sources in a physician's office is not the same as the light sources generally found in tanning salons, which are of limited use for psoriasis. It must be remembered that all UV radiation has a potential to cause mutations and skin cancers. Although the incubation period for these skin cancers is quite long, UV exposures should be carefully monitored.
    • UV-B: Ultraviolet B (UV-B) light is used to treat psoriasis. UV-B is light with wavelengths of 290-320 nanometers (nm). Within the last 10 years, a new form of UV therapy called narrow-band UV-B (NBUVB) that has a peak energy output at about 313 nm) that seems to be very effective with less burning potential than conventional broadband UV-B. It presumably contains the most therapeutic wavelengths and avoids the more toxic ones. (The visible light range is 400 nm-700 nm.) UV-B therapy is usually combined with one or more topical treatments. UV-B phototherapy is extremely effective for treating moderate-to-severe plaque psoriasis. The major drawbacks of this therapy are the time commitment required for treatments and the accessibility of UV-B equipment.
      • The Goeckerman regimen uses coal tar followed by UV-B exposure and has been shown to cause remission in more than 80% of patients. Patients often complain of the strong odor when coal tar is added, and it stains clothing, towels, and sheets.
      • UV-B therapy can be combined with the topical application of corticosteroids, calcipotriene (Dovonex), tazarotene (Tazorac), or creams or ointments that soothe and soften the skin.
    • Laser therapy (Excimer laser): A laser that produces UV-B light in the same wavelength as full body phototherapy units can target smaller areas of psoriasis without affecting the surrounding skin. Because the light treats only the psoriasis plaques, a strong dose of light can be used, which may be useful to treat a stubborn plaque of psoriasis, such as on the scalp, feet, or hands. This is an impractical treatment for psoriasis that covers a large area and, like other forms of phototherapy, requires regular visits over several months.
    • PUVA: PUVA is the therapy that combines a psoralen drug with ultraviolet A (UV-A) light therapy. Psoralen drugs make the skin more sensitive to light and the sun. Methoxypsoralen for example is taken by mouth an hour before UV-A exposure. UV-A contains light with wavelengths of 320 nm-400 nm that activate psoralen. The activated drug then is thought to inhibit the abnormal inflammatory response in the skin. More than 85% of patients report relief of disease symptoms with 20-30 treatments. Therapy is usually given two to three times per week on an outpatient basis, with maintenance treatments every two to four weeks until remission. Adverse effects of PUVA therapy include nausea, itching, and burning. Long-term complications include increased risks of sensitivity to the sun, sunburn, skin cancer, and cataracts. Availability of the psoralen medication in the United States has been a problem, with lack of availability of the medication periodically extending for weeks or months at a time. This has discouraged its use.
Medically Reviewed by a Doctor on 9/19/2017

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