Topical corticosteroids are the primary treatment strategy for most mild to moderate cases of psoriasis. Most psoriasis patients are treated with topicals. Learn more about psoriasis and why the immune system causes psoriasis to appear on the skin. They are often itchy and painful, and they can crack and bleed. Treating moderate to severe psoriasis usually involves a combination of treatment strategies.
Mild to moderate psoriasis can generally be treated at home using a combination of three key strategies: over-the-counter medications, prescription topical treatments and light therapy/phototherapy. Three primary light sources are used:. These tend to be very expensive and have many side effects, so they are generally reserved for the most severe cases. Management of psoriasis may involve topical and systemic medication, phototherapy, stress reduction, climatotherapy, and various adjuncts such as sunshine, moisturizers, salicylic acid, and other keratolytics such as urea. Expert dermatologists from across the globe released a consensus report on treatment optimization and transitioning for moderate-to-severe plaque psoriasis. The most recent addition was Section 6 (published online in November 2010; in print 2011. Many suggest that because of the comorbidities of heart disease and cardiovascular disease that if adult patients have not been recently evaluated and screened for these, they should either be tested or referred back to their primary care provider to consider what is appropriate for any particular patient. Keywords: psoriasis, adherence, outcome, drug therapy, psychotherapy. However, most patients with psoriasis have mild disease and may be treated with skin-directed therapies. We have classified the causes of nonadherence in three categories, depending on if they were linked with factors related to the therapies, factors related to the patient, and factors related to the patient physician relationship. Thus, it is easy to understand why adherence in dermatology is poor, as it is due to the relapsing nature of the most common skin diseases and the use of multiple topical treatments which, in most cases, are not applied correctly.
Special clinical situations may change mild psoriasis to moderate to severe including involvement of visible areas or severe nail involvement. In limited (mild) disease, the most commonly used therapy is topical with the addition of phototherapy in refractory cases. Patients are frequently left on treatments for too long even though they may be ineffective. In Europe, the PASI is a commonly used tool to grade psoriasis severity and is used in the majority of international clinical trials as primary or secondary endpoint. They most often appear on the knees, elbows, scalp, hands, feet, or lower back. When psoriasis is moderate or severe, the skin gets inflamed with raised red areas topped with loose, silvery, scaling skin. Most cases of psoriasis are mild, and treatment begins with skin care. Primary Medical ReviewerAdam Husney, MD – Family MedicineE. They most often appear on the knees, elbows, scalp, hands, feet, or lower back. When psoriasis is moderate or severe, the skin gets inflamed with raised red areas topped with loose, silvery, scaling skin. Most cases of psoriasis are mild, and treatment begins with skin care. Primary Medical Reviewer Adam Husney, MD – Family Medicine E.
Topical treatments – usually used for mild to moderate psoriasis treatment. Although oral medications are very effective, they have potentially serious side effects. While taking acitretin, progestin-only birth control pills should not be used as a primary form of birth control, because they may not work. Research opens new treatment strategies for specific form of psoriasis. Psoriasis is frequently encountered in the primary care setting. While tanning beds emit primarily UVA radiation and have a wide-spectrum distribution of UV output that is poorly regulated and not standardized, they still are an effective form of psoriasis treatment.15. Topical therapies for the treatment of plaque psoriasis. In clinical practice, for the management of uncomplicated cases of moderate-to-severe plaque psoriasis, CsA is generally used for induction of remission with intermittent short courses generally lasting up to 24 weeks 5, discontinuing the drug after complete remission is achieved. 5 3 mg/kg/d for 2 4 months proved to be effective in controlling psoriasis but was associated with side effects which were poorly tolerated even if they were usually mild. Treatment of moderate to severe psoriasis was assessed according to the estimated percentage of patients in active treatment, changes in treatment with biologic therapies (treatment used, type of change, and reason for change), and treatment regimen used (monotherapy or combination therapy, and continuous or intermittent treatment). ), difficulty to adhere to the treatment regimen and access to medication, previous treatment strategies, cost of treatment, opinion of the patient, protocols and guidelines used in the center/hospital, recommendations of clinical practice guidelines, and the scientific literature. Biologic agents are important new options for treating patients with the most severe forms of the disease. All physicians should be aware that severe psoriasis may increase cardiovascular morbidity and the risk of death, and preventive strategies for patients with severe disease should be considered. Phototherapy and systemic medications including methotrexate, acitretin (Soriatane), cyclosporine (Gengraf, Neoral, Sandimmune), and biologic agents are the most effective treatments for moderate-to-severe psoriasis. In view of the prevalence of these comorbid conditions and the risks they pose, primary care physicians should consider screening patients with severe psoriasis for metabolic disorders and cardiovascular risk factors and promptly begin preventive therapies.