Psoriasis
Psoriasis is a very common skin disease. An estimated six and eight million people in this country have some form of psoriasis. Psoriasis is not contagious and can be controlled with a variety of treatments. Each case is treated on an individual basis.
In psoriasis, skin cells in certain areas of the body grow at a much faster rate than normal, resulting in patches of tough, dry, scaly skin. It most often affects the elbows, knees, shins, nails and scalp. Psoriasis of the scalp may be mistaken for dandruff as the patches get thicker and tougher and begin to flake off.
Psoriasis can affect people of any age. Although it usually begins in young adults, it can also start in childhood or first appear in old age.
Psoriasis may or may not be a chronic condition. Some patients suffer from it intermittently for their entire lives. Many things can trigger the symptoms of psoriasis, including physical trauma (burns, cuts, or surgery), infections (such as strep throat), drugs, severe sunburn, and periods of emotional stress.
For more information, see the website of the National Psoriasis Foundation at www.psoriasis.org.
Therapeutic treatment options for psoriasis
Three types of therapies are available for treating psoriasis:
- Topical therapies. Topical steroids (creams, lotions, foams, ointments, gels, solutions and sprays) are used to treat mild to moderate psoriasis. For severe psoriasis, these therapies may be used in combination with other forms of therapy, such as systemic (oral or injected medication) or phototherapy. Anthralin (sold under several brand names), Dovonex® , and Tazorac® are other topical therapies that can be used.
- Phototherapies. PUVA, Broadband UVB, Goeckerman (UVB + Coal Tar), and Narrowband UVB.
- PUVA consists of the use of Methoxsalen (Oxsoralen®) prior to UVA radiation (320 to 400 nm) for moderate to severe psoriasis. A danger of this therapy is its increased risk of skin cancers.
- Broadband UVB is the most commonly used phototherapy for moderate to severe psoriasis. It can be used alone or combined with topical or systemic therapies.
- Goeckerman treatment is for moderate to severe psoriasis and consists of applying coal tar followed by UVB. The coal tar prepares the skin to respond to the UVB light more positively.
- Narrowband UVB utilizes UV radiation in a narrow range at 311nm. This treatment is superior to UVB and safer than PUVA. It is believed to be less carcinogenic (cancer-producing) than the other forms of therapies. It is particularly useful in treating psoriasis that is refractory and unresponsive to broadband UVB.
- Systemic therapies. These therapies include Soriatane® (Acitretin), Neoral® (Cyclosporine), Methotrexate (sold under several brand names), and tumor necrosis factor inhibitors, a new class of drugs, that includes Enbrel® (Etanercept), Remicade® (Infliximab), and Amevive® (Alefacept).
