Treatment of PsoriasisThe treatment should contain these steps:
Often combination therapies are necessary. If there is a triggering infection it must be treated. Patients should avoid traumas, infections and drugs known to trigger psoriasis. In topical treatment, first of all, the scales should be removed using keratolytics. This removal will improve the efficacy of the following treatment. Usually salicylic acid is used as keratolytic. Topical application of the steroids is the most frequent treatment. High-potent steroids are initially chosen and, when improvement is obtained, substituted with lower potent steroids to minimize the risk of side effects. To prevent rebounds and recurrences, therapy should not be stopped suddenly and should be tappered down slowly like in systemic steroid therapy. Tars are long-time used antipsoriatic agents which are believed to be effective. The most frequently used ones are, coal tar (goudron d'houille lave) and juniper tree tar (huile de cade). The effect of anthralin (cignoline) is stronger and more rapid than the effect of tars. It is used in low concentrations such as 0.1-5% Goeckerman Technique: In Goeckerman technique tars are used combined with UVB. PUVA (P=psoralen + UVA): UVA is used with photosensitizers. The most frequently used photosensitizer is 8-MOP (8-methoxypsoralen). UVA is given two hours after the ingestion of 0,5-0,6 mg/kg 8-MOP. Retinoic Acid: Oral retinoids are the best choice of therapy in persistant thick plaques of chronic psoriasis. Acitretin is used more frequently. A dose of 0,5-1 mg/kg/day is recommended. It is effective in abaout 50-80% patients. It has considerable side effects such as hepatotoxicity and teratogenity. Furthermore dryness of the skin and the mucosa, and hair loss can be seen. Cyclosporine: It can be used in persistant, chronic, plaque type psoriasis with a dose of 2,5-5 mg/kg/day. The kidney functions must be monitorized. Methotrexate, is a folic acid antagonist. 25 mg/week is given intramuscularly. It is hepatotoxic. |