Psoriasis is a genetically determined, chronic, inflammatory disease of the skin. It may be limited to small areas, such as the elbows or scalp, or it may be extensive and generalized. The nature of disease may change over the years. It may be made worse by stress, infections, medication, or even sunburn. Many forms of treatment are available. Therapy is tailored to the patient and the severity of the disease. In any psoriasis therapy, control - but not cure - should be expected.
Topical treatments are almost always used. These may include tar compounds, Vitamin D analogs, steroids, moisturizers, salicylic acid, and retinoids.
Phototherapy with ultraviolet light in the A or B range may be useful. The light may be delivered in the form of light booths or laser systems. This form of therapy can be effective. It was slightly more popular in the past, before the development and use of systemic drugs. A number of powerful drugs may be employed in the treatment of psoriasis. These include methotrexate, cyclosporin, and the retinoids. Each drug has its toxicity but, used properly, can control the most severe cases.
Finally, a new class of drugs has been developed. Called “the biologicals,” they are drugs which target specific points in the immune cascade that leads to the inflammation of psoriasis. They are administered by injection, are very expensive, and are not without toxicity. At this time, they are used in severe cases of psoriasis which have not responded to traditional treatment or in which excess toxicity has developed. As we gain experience with the biologicals, they will no doubt become more popular in the treatment of this disease.
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