Options for Psoriasis Treatment?

My husband has been diagnosed with Psoriasis for the last one and half years. His skin on ankles, palms, and feet used to get broken, and bleed as minute drops. But now it has stopped and the whole body itches for 5 minutes at certain times. He is overweight, has high blood pressure, and had treatment for arthritis two years back ayurvedically. What are some options for Psoriasis treatment? Will laser treatments help?

Doctor Answers 1

Many Options

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It is hard to condense a subject for which books have been writen into a few paragraphs.

My best and succinct advice would be to encourage your husband to go under the care of someone with a good knowledge of skin care, i.e. a dermatologist. It is difficult to give any but the most general advice not enjoying the opportunity to evaluate the psoraisis: location, type, severity, patient's attitude about their disease, financial considerations, and convenience to treatment centers.

With these handicaps in mind, let me procede in a pyramid of treatment options. Topical treatment would be at the base of this pyramid. Topical steroids the mainstay with the addition of tar products, Vitamin D analogues, Tazaratene, and Salicylic acid. Clobex Spray is the strongest steroid and I personally use it quite a bit for a three week period. This can be combined with other products. Rather than list all the topical steroids let me say they are in various Classes according to their strength.

Scytera is a new toical foam which I like quite a bit. It is derived from coal tar. Drithrocreme is also effective. I feel it is underutilized due its somewhat cumbersome routine and messy nature.

A new Vitamin D product called Vectical has been working well for me. I use it on the face, groin and armpits, places I am reluctant to use steroids. It is much more effective than Dovonex cream.

A combination product which includes a pretty strong steroid and Vitamin D is called Taclonex. I find it especially good on the hands and feet for some reason. Its onece a day application increases patient compliance. Plus I can combine it with another product.

Sometimes, Tazarac works well. In some people it can really shrink down the plaques of psoriasis. However, it is a category X so I am reluctant to use it in women in the child-bearing years. It can be a bit irritating. Ironically, when used as an anti-aging cream and for acne it is less irritating/

I like Salicylic acid and urea products to thin down the plaques, especially on the scalp.

Diet has been largely disappointing through the years. Two weeks ago, I took my staff to lunch at an Appplebee's. I noticed our waitress had psoriasis. After waiting for my staff to clear, I asked her about it. She lifted her sleeves and she had terrible psoriais. Then she starts proclaiming how wonderful her diet was from Dr. Pagano (??) from the Edgar Cayce Institute. It had red cloves etc. Now as someone who has had severe psoriais themselves, and cleared it conventionally, I wonder how effective this young lady's treatment is compared to my own. I guess if she thinks it is good, who knows. However, as someone who has seen diets for psoriasis come and go, I become a bit skeptical. Still, diets with plenty of Omega 3 fatty acids such as salmon ( do not give this to a dog with psoriasis they may die) and flax seed oil are beneficial.

Some physicians feel psoriaisis may be caused or aggrevated by Candida so I see nothing wrong with an Diflucan and protiotics ( although these were shown to be worthless for ezcema in a very recent article.). Similarly, some dermatologists feel that psoriasis is exacerbated by strep and place patients on a broad spectrum antibiotic.

Light therapy has been very useful for psoriasis. Many of us are switching to Narrow Band UVB. While probably not quite as effective as PUVA ( psoralen plus Ultraviolet A light) one does not have the inconvenience of taking a pill and wearing rather funky sunglasses. UVB with tar is a mainstay of treatment ( modified Gockerman) regimen.

You asked about lasers helping. One particular trend I have noticed is the non-dermatolgogist purchasing a laser and jumping to this expensive treatment. I think such physicians are driven by the Almighty Dollar rather than the practice of good medicine and what is best for their patient. Shame on them! I find this disturbing to say the least.

While the Eximer laser has been shown to be effective. I have not been blown away by the machine in comparison to the IPL UVB light source. In my hands, they seem to be about equal and the UVB IPL is about a tenth of the cost. The concept is good, especially if you view psoriasis as a local disease rather than a systemic disease. I think the laser is a fine treatment for a patient with hand and foot psoriasis ( psoriasis of Barber) or limitied stubborn plaques which are not resonding to topical treatment.

Finally, there is the broadening area of the so-called biologicals. Your husband should have an evaluation to rule out psoriatic arthritis. Biologics in this instance can prevent the crippling outcome that psoriasis can wreak. Enbrel is very effective and perhaps, safer than Humira. Humira, is the more effective of the two in my opinion. Remicade perhaps, superior to either but requires IV infusion. Recently, in fact in March 2009 Journal of the American Academy of Dermaotogy by Meese et al, Alafecept ( Amevive, the first of the biologics), this was shown to be a great combo for psoriatic arthritis. There are two more biologics which should be out before the end of next year, one by Abbott and the other Centocor that, in studies, seem to be even more effective than those already available.

In sum, I would consult a dermatolgist who enjoys treating psoriasis, if you have not already done so.

Virginia Beach Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.