Psoriasis appears an inflammation of the skin, recognizable as well-defined red areas that are often covered with silvery flakes. The most common areas affected by Psoriasis are the scalp, nails, elbows, knees, abdomen, and lower back/buttocks. Itching may or may not be present.
Psoriasis is caused by an abnormal overgrowth of skin cells in a process driven by inflammation within the skin. Hereditary factors also contribute in about 33% of cases.
Possible Psoriasis Treatments:
- Topical agents for limited areas of skin affected by Psoriasis
- Oral medications have been used to treat Psoriasis for over 50 years
- Ultraviolet light therapy - for large areas affected by Psoriasis
- Laser treatments - for limited areas affected by Psoriasis
- Biologic injectable agents - to treat large areas of skin affected by Psoriasis
Topical Treatments for Psoriasis Topical Steroids, Coal Tar distillates and Anthralin have been used to treat Psoriasis for a long time (over 50 years). Recently, a combination of a Vitamin D derivative (Calcipotriol) and a strong topical Steroid (Betamethasone Dipropionate) named Taclonex has been found to be reliably effective in a majority of cases of Psoriasis with limited skin area involvement. More recently, a novel Vitamin D product named Vectical has also shown marked effectiveness.
We still use Topical Tar Treatments in Psoriasis in the form of 10-15% LCD (Liquor Carbonis Detergens) in Triamcinolone 0.1% Cream and also:T Gel Shampoo
Oral Treatments for Psoriasis Methotrexate has been used in the treatment of Psoriasis for almost 50 years. With close supervision, it can be very effective in treating numerous cases of Psoriasis.
Ultraviolet Lamp Treatments for Psoriasis
For patients with large areas of skin involved with Psoriasis, a series of Narrow Band Ultra-Violet treatments can be very beneficial, especially if used in combination with topical treatments. In more severe cases, for women of non child bearing age and for men, adding a Retinoid Soriatane (Acitretin) can be of great benefit. One inconvenience is that 2 or 3 treatments weekly are necessary, often for several weeks.
For severe Psoriasis of the Palms and Soles, we often try ACITRETIN (a Vitamin A Derivative) in conjunction with the UV Light before we try the Biologics with or without the Ultraviolet LampTreatments.
For Do It Yourselfers, please use caution with Vitamin A Pills. Dangerous overdoses are easy to achieve. Vitamin A is titrated in a safe dose in Multivitamin Pills
Laser Treatments for Psoriasis
For more limited areas affected by Psoriasis such as palms and soles, or both, as well as for some large patches on the trunk or limbs, the Xtrac Laser (XTRAC) - a relatively new and safe laser treatment - can be very effective. Between 5 and 10 treatments, every 7 to 14 days, can clear up resistant patches. Most insurance plans cover these treatments.
The XTRAC Excimer Laser Treatment System is a laser that emits very concentrated ultraviolet light.
Highly precise and sophisticated, the XTRAC excimer laser allows the physician to concentrate the high dose of UVs right on the problem spot (Excimer lasers are commonly used in eye surgeries).
XTRAC Laser Benefits
Is faster than other psoriasis/vitiligo treatments (single treatment takes only minutes)
Doesn't burn healthy skin with the concentrated UVs
Doesn't require additional topical creams or Psoriasis
There is no risk of skin thinning or stretch marks (as with steroids)
XTRAC is Covered by Insurance
Most insurance companies, including Medicare, BCBS, United etc. cover Psoriasis treatments with XTRAC. Our office can determine if your insurance company will approve this highly effective Psoriasis treatment.
XTRAC for Scalp Psoriasis
XTRAC treats scaly scalp skin plaques affected by Psoriasis quickly and effectively, often in a few brief treatment sessions. Probably the best Psoriasis treatment available today, XTRAC provides long-lasting relief from Psoriasis, typically several months totally free of symptoms.
At Lakeview Dermatology, Drs. Eugene and Steven Mandrea, Board Certified Dermatologists, are proud to offer this higly effective Laser Therapy for Psoriasis (in Palos Heights,Chicago, and Park Ridge), as well as other Psoriasis treatments: Narrow Band UVB Psoriasis Treatment (in Palos Heights) and Biologics Psoriasis Treatment in all 3 Offices.
Biologic Treatments for Resistant Psoriasis For resistant and widespread cases of Psoriasis, as well as for many cases involving the face, or the palms and Soles, the Biological Treatments, often in conjunction with UVB Treatments, can be very effective.
Psoriasis, being an autoimmune disease, can be markedly improved by antagonizing some segments of the immune system that are over active in Psoriasis.
FOR ANY PATIENT CONSIDERED FOR TREATMENT WITH BIOLOGICS, TB SCREENING AND PROPHYLAXIS ARE A MUST. THE NEW QUANTIFERON GOLD TEST IS MUCH MORE RELIABLE THAN THE OLD INTRADERMAL TEST.
ALSO, HEPATITIS SCREENING AND PROPHYLAXIS ARE MANDATORY.
ALSO, HIV HAS TO BE RULED OUT.
BAD NEWS: All BIOLOGICS cause a SLIGHTLY higher incidence of common and uncommon infections in patients who use them than in patients who do not.
GOOD NEWS: a study done by Rheumatologists on 1430 patients with Rheumatoid Arthritis treated with some BIOLOGICS, (TUMOR NECROSIS FACTOR ALPHA ANTAGONISTS),showed said patients had a decrease in all cause mortality of close to 35%.
There are several Biologic treatments now available for treating Psoriasis. They consist of antibodies directed against segments of the immune system
A - BIOLOGICS DIRECTED AGAINST TUMOR NECROSIS FACTORS
- ETANERCEPT (Enbrel) is a fusion protein. It combines the DNA of the human receptor 2 of Tumor Necrosis Factor alpha with the DNA of a segment of Immunoglobulin G 1. The proteins released by this combination , link to the Tumor Necrosis Factor Receptor 2, thus not allowing other stimuli to reach the Tumor Necrosis Factor.
The starting dose for Enbrel is 50 mg subcutaneously twice weekly.
ETANERCEPT is quite well tolerated. It is also effective in Psoriatic Arthritis.
It does not lose its efficacy over time.
- ADALIMUMAB. (Humira) is a human antibody to Tumor Necrosis Factor alpha and thus reduces the inflammation caused by intrinsic and extrinsic stimuli. It is also effective in Psoriatic Arthritis and CROHN'S disease.
A dose of 40mg every 2 weeks is quite effective.
Humira may sometimes lose some of its effectiveness due to appearance of anti-drug antibodies. The addition of Methotrexate to Humira, may diminish this problem.
- INFLIXIMAB (Remicade) is very effective in Psoriasis, Psoriatic Arthritis, Rheumatoid Arthritis, CROHN'S disease, Ulcerative Colitis, Ankylosing Spondylitis.
It is used in SEVERE cases of Plaque Psoriasis, in the dose of 5mg/Kg INTRAVENOUSLY (Infusion) every 8 weeks in an Infusion Center.
B - BIOLOGICS DIRECTED AGAINST OTHER SEGMENTS OF THE IMMUNE SYSTEM
- USTEKINUMAB (Stelara) is an antibody directed against Interleukins 12 and 23 (specifically a sub segment of the immune system: molecules with highly individualized structures and targets).
Interleukins are reactive chemicals secreted by cells of the immune system, that have important roles in the function and also the malfunction of the immune system.
USTEKINUMAB is also effective in Psoriatic Arthritis.
Unlike Enbrel which has to be injected twice weekly, or Humira which has to be injected twice monthly, Stelara is injected at week 0, then at week 4, then every 12 weeks.
- SECUKINUMAB ( Cosentyx) is an antibody directed against Interleukin 17. It seems to work faster than the other BIOLOGICS. Unlike ADALIMUMAB and INFLIXIMAB, it may aggravate CROHN'S disease rather than improve it.
Cosentyx has to be injected once weekly for 5 weeks, then once monthly. C- ORAL BIOLOGICS
- APREMILAST (OTEZLA) is a Phosphodiesterase Inhibitor, resulting in a higher level of intracellular Cyclic AMP (Adenosine monophosphate).
Adenosine Monophosphate, in turn, antagonizes several pro inflammatory cytokines, such as Interleukins 2, 3, 10, 12, 23. Interleukins 12 and 23 have been referred to in the paragraph about Ustekinumab.
No Lab tests need to be done preceding treatment with APREMILAST.
The starting dose of 10 mg the first day has to be rapidly increased to 30 mg BID
It is effective in Psoriasis and Psoriatic Arthritis.
At Lakeview Dermatology, Drs. Eugene and Steven Mandrea, Board Certified Dermatologists, provide all the above Psoriasis treatments: Xtrac Psoriasis Treatment (in Chicago, Palos Heights, and Park Ridge), Narrow Band UVB Psoriasis Treatment and Biologics Psoriasis Treatment in all offices.
- TOFACITINIB ((Xeljanz) is a new oral drug, not yet approved for treatment of Psoriasis, even though a recent study found it to be equivalent to ETANERCEPT.
To discuss your Psoriasis (UVB light and XTRAC laser treatments) Chicago treatment with a Board Certified Dermatologist or a Licensed Healthcare Professional please make an online appointment or call 773-281-9200 today.Book Online
Prices on website subject to change and may not reflect actual prices after consultation.
Related Dermatologic Conditions:
Actinic Keratoses (precancers)
Basal Cell Carcinoma (AKA: Non melanoma skin cancer, Rodent ulcer)
Fungal Infections (ringworm, athlete's foot)
Hair Loss/Hair Problems
Herpes Simplex (cold sores)
Herpes Zoster (shingles)
Hyperhidrosis (Excessive Sweating)
Rosacea and Acne Rosacea
Squamous Cell Carcinoma
Psoriasis (UVB light and XTRAC laser treatments) Treatments - Chicago Dermatology Treatments by Board Certified Dermatologists
Psoriasis (UVB light and XTRAC laser treatments) Treatments - Chicago Dermatology - Board Certified Dermatologists