Psoriasis Awareness Month: Psoriasis Treatment For The 21st Century | Skin & Hair problems articles | Body & Health Conditions center

Psoriasis is a relatively common but extremely frustrating skin condition caused by patient's own immune systems turning on them.

The presentation of psoriasis can vary dramatically from one patient to another. In most cases, red and crusting patches of skin will appear and eventually turn into silver scaling. The most common site of these plaques would be on joints such as the elbows, knees or scalp, but they can appear on virtually any part of the body.

These plaques can be present for significant amounts of time but in most patients, they will gradually recede. It is believed that approximately 5 to 8 percent of the world adult population suffers from psoriasis, and roughly 2 percent of children are afflicted with the disease.

Here, we will focus on some of the daily challenges of living with psoriasis and what treatment options may be helpful in inducing remission of this disease, to mark Psoriasis Awareness Month.

Daily living with psoriasis

Psoriasis is a chronic condition that can have a dramatic effect on a patient's quality of life. Because psoriasis can invade all aspects of a person's daily life, doctors have to consider a combination of psychological and physical aspects of the disease when trying to treat it.

The psychosocial aspects of psoriasis

Like any chronic condition, patients suffering from psoriasis have a greater risk of developing depression compared to the general population. This can be explained by the fact that many patients will have a lower self-esteem when they experience an exacerbation of psoriasis symptoms. Manifestations of the rashes on your elbows and knees may be managed easily enough with long pants and shirts, but if these marks are on your face, the social impact of psoriasis becomes much more tricky to manage.

Even simple choices like the type of clothing to wear become problematic in these types of cases. A person with psoriasis will likely wear long-sleeved clothing even on hot summer days and may be too self-conscious to remove clothing to go swimming or have sex.

What makes matters worse is the course of the disease. Psoriasis is a condition that varies markedly on a case by case basis. Some patients will have annual flare-ups whereas others may go several years without any symptoms at all. This variability can be a source of great stress for someone with psoriasis because they will likely be meeting with several specialists if they have a more severe form of the condition and may even use multiple therapies with limited effectiveness.

Physicians treating psoriasis must keep the psychological and social impact of the condition in mind when we present our proposed treatments. It will undoubtedly be frustrating for physicians as well when they see that their patients have relapsed or have not improved to the desired level of satisfaction.

It must be a very significant part of therapy for physicians to allow patients suffering from psoriasis to be able to voice their frustration and insecurities in order to maximize the therapeutic outcome.

The best treatment options for psoriasis

When it comes to psoriasis treatment options, the method of choice really depends on the type of psoriasis that you are diagnosed with. A combination of creams, emulsions and shampoos are available but will be used only in certain circumstances.

It is also worth noting here that when we consider the management of psoriasis, this will be a condition that will likely require several months of therapy in order to see a resolution of symptoms. It is important to be realistic with expectations of what outcomes could occur.

To give you some perspective, according to the American Dermatological Association, a desirable outcome in a patient suffering from psoriasis is skin plaquing that takes up no more than 3 percent of the total body surface area or a reduction in plaque size by 75 percent after 6 months. As you can already see, it will be a long process no matter what happens.

Managing mild psoriasis

The most standard form of care for a patient suffering from mild psoriasis would be using a combination of topical corticosteroids and emollients to stop skin flare-ups. Vitamin D analogs like calcitriol are also potential substitutes in this stage of therapy. If there are plaques on the face, a drug called tacrolimus will also be used to help expedite the process. Tacrolimus is a retinoid derivative that is typically used in these cases but patients using this drug should avoid sunlight exposure. This can be another point of significant distress for something dealing with psoriasis.

The effects at this stage are generally good but depend dramatically on the compliance of the patient to apply these creams daily. If you are already frustrated with the delayed results, this is something that patients may not do so it is important for the doctors to routinely meet with these patients to monitor the treatment process.

Managing moderate and severe psoriasis

When more of the body begins to be covered by psoriasis plaques, patients will receive a diagnosis of moderate psoriasis compared to mild. At this stage of the disease, more extreme measures will be taken to try to suppress the immune response causing the skin flare-ups.

Some possible treatment options at this stage of psoriasis would be using Ultraviolet B (UVB) therapy and more potent doses of topical corticosteroids, or even using systemic corticosteroids. Systemic corticosteroids are tablet forms of the medication that a patient would swallow instead of applying them as a cream.

Systemic corticosteroids are a more effective way at delivering the steroid into your body to halt the immune response, but at the same time, comes with a number of undesirable side effects like weight gain, reddening of your cheeks and a predisposition to other immune infections so this is only a short-term treatment option.

Alternative Treatment Options

When medications fail, a natural course of thought is to look into alternative medicine as a potential avenue for therapy. Some of the most commonly used types of agents that fall into this category would be substances like sepia, Arsenicum album, graphite, sulfur, petroleum and mezereum. There are currently no scientific studies that support any of these alternative medications as being a viable treatment option.

Another more pressing issue is the fact that a number of these agents are actually extremely dangerous for human use. Compounds like Arsenicum album or mezereum are derived from poisonous substances to humans and should be avoided at all costs.

Psoriasis treatment: What the future may hold

I may not have painted the prettiest picture of the current landscape of psoriasis treatment, but people with psoriasis may have a whole new spectrum of treatment options in a few short years.

Medicine as a whole has changed dramatically in the last few decades with the emergence of biological therapy and many conditions are now being treated remarkably well with these types of agents. Think of a biological agent as a more customized medication for the patient. They are more specific to the DNA of the patient and will, therefore, be more effective than a generic medication.

Psoriasis is one of the diseases that has received a lot of research in the last few years and promising agents like tumor necrosis factor (TNF) derivatives, infliximab or baricitinib can lead to a dramatic improvement in only a few short weeks. At this stage of their development, these agents are still expensive but as more funding is diverted to this field, costs of manufacturing will fall and it will become more readily available for a larger number of patients.

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