Psoriasis

Silvery white scalesPitted or dented fingernails and/or toenailsRed lesion in the folds of the buttock Joint pain suggesting arthritis DiagnosisThe doctor will ask about your symptoms and medical history, and perform a physical exam. Your skin and nails will be examined. There are no specific blood tests or diagnostic procedures for psoriasis. Sometimes a skin biopsy will be done to confirm the diagnosis. Treatment Treatment is based on: The severity of the diseaseThe extent and location of the areas involvedResponsiveness to the treatment Topical Treatment Many patients respond very well to treatments applied directly to the skin. Topical treatments include: Corticosteroid creams and ointments (most common treatment)Synthetic forms of vitamin D and retinoids (calcipotriene ointment 0.005)Retinoids (tazarotene gel 0.05 and 0.1%)Coal tar preparationsBath solutions and moisturizersTacrolimus and pimecrolimus (especially for inverse psoriasis) Photo (Light) TherapyIf psoriasis covers more than 30% of the body it is difficult to treat with topical medications alone. Daily, short, nonburning exposure to sunlight clears or improves psoriasis in many people. Sunlight is often included among initial treatments. A more controlled form of artificial light treatment (UVB phototherapy) is often used in more widespread cases. Althernatively, psoriasis can be treated with ultraviolet A (UVA light) and psoralen. Psoralen is an oral or topical medication that makes the body more sensitive to light. This treatment is known as PUVA.

Phototherapy can be very effective in controlling psoriasis but it requires frequent treatments. It may cause side effects such as nausea, headache, fatigue, burning, and itching. Both UVB and PUVA may increase the person's risk for squamous cell and, possibly, melanoma skin cancers . It is unclear whether UVB increases the risk of skin cancer. Systemic Treatment For more severe types of psoriasis, doctors may prescribe a number of other powerful medications, which can be effective, but are associated with more serious side effects. These include: Methotrexateshould not be taken by pregnant women, women planning to become pregnant, or by their male partners.Cyclosporinesuppresses the immune system to slow the turnover of skin cells.Hydroxyurealess toxic than methotrexate or cyclosporine, but may be less effectiveSystemic retinoidsCompounds with vitamin A-like properties taken internally (such as methotrexate) may be prescribed in severe cases. Retinoids can cause birth defects, and women must diligently protect themselves from pregnancy for several years after completing treatment. Systemic retinoids are often combined with phototherapy for increased effectiveness and for their property of being protective against squamous skin cancer.Newer systemic immunomodulators, or biologicalsso called because they affect some aspect of the bodys natural immune responsemay also be quite effective. These treatments are generally the most expensive, though, and some can cause serious toxicity when given systemically (intravenously or by injection). Topical preparations of immunomodulators are currently being tested and seem to have benefits. Other drugs called thiazolidinediones may show promise as future treatments for psoriasis, but are not currently recommended.

PreventionPsoriasis cannot be preventedAvoiding physical trauma to the skin, infections, and cold, dry temperatures may help reduce flare-ups in people with the condition. Your doctor may advise you to avoid certain foods if they appear to make your psoriasis worse. RESOURCES: National Institutes of Healthhttp://www.nih.gov National Psoriasis Foundationhttp://www.psoriasis.org CANADIAN RESOURCES: Canadian Dermatology Associationhttp://www.dermatology.ca/english/ Psoriasis Society of Canadahttp://www.psoriasissociety.org/ References: American Academy of Dermatology website. Available at: http://www.aad.org/default.htm . Current Medical Diagnosis and Treatment . 44th ed. 2005. de Prost Y. New topical immunological treatments for psoriasis. J Eur Acad Dermatol Venereol . 2006;20(Suppl 2):80-82. Harrison's Principles of Internal Medicine . 16th ed. McGraw-Hill; 2000. Varani J, Bhagavathula N, Ellis CN, Pershadsingh HA. Thiazolidinediones: potential as therapeutics for psoriasis and perhaps other hyperproliferative skin disease. Expert Opin Investig Drugs . 2006;15:1453-1468. Last reviewed October 2007 by Ross Zeltser, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.