Psoriasis (cont.)
How is psoriasis treated?
There are many effective treatment choices for psoriasis. The best treatment
is individually determined by the treating physician and depends, in part, on
the type of disease, the severity, and the total body area involved.
For mild disease that involves only small areas of the body (like less than
10% of the total skin surface), topical (skin applied) creams, lotions, and
sprays may be very effective and safe to use. Occasionally, a small local
injection of steroids directly into a tough or resistant isolated psoriasis
plaque may be helpful.
For moderate to severe disease that involves much larger areas of the body
(like 20% or more of the total skin surface), topical products may not be
effective or practical to apply. These cases may require systemic or total body
treatments such as pills, light treatments, or injections. Stronger medications
usually have greater associated possible risks.
For psoriatic arthritis, systemic medications that can stop the progression of the disease may be required. Topical therapies are not effective.
It is important to keep in mind that as with any medical condition, all
medications carry possible side effects. No medication is 100% effective for
everyone, and no medication is 100% safe. The decision to use any medication
requires thorough consideration and discussion with your physician. The risks
and potential benefit of medications have to be considered for each type of
psoriasis and the individual patient. Some patients are not bothered at all by
their skin symptoms and may not want any treatment. Other patients are bothered
by even small patches of psoriasis and want to keep their skin clear. Everyone
is different and, therefore, treatment choices also vary depending on the
patient's goals and expressed wishes.
A particularly effective approach to psoriasis has been commonly called
"rotational" therapy. This is a common practice among some dermatologists who
recommend changing cycles of psoriasis treatments every six to 24 months in order to
minimize the possible side effects from any one type of therapy or medication.
For example, if a patient has been using oral methotrexate for two years, then
it may be reasonable to take them off of methotrexate and try light therapy or a
biologic injectable medication for a while. By rotating to a medication that
doesn't affect the liver, the potential of cumulative liver damage may be reduced.
In another example, a patient who has been using strong topical steroids over
large areas of their body for prolonged periods may benefit from stopping the
steroids for a while and rotating onto a different therapy like calcipotriene
(Dovonex), light therapy, or an injectable biologic.
Next: What creams or lotions are available? »
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