Psoriasis

Psoriasis is a common, chronic, and recurrent skin disease that affects 1-2% of the US population with equal frequency in both sexes.

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.

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.

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 Extrac 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.

Biologics Treatments for Resistant Psoriasis

For resistant Psoriasis cases with extensive involvement Biologics have become very popular. There are 2 classes of Biologic treatments for Psoriasis:

• Anti Tumor Necrosis Factor treatments: The most common in use are: Etanercept (Enbrel) and Adalimumab (Humira). Both can be self-injected subcutaneously by the patient. A 3rd one, Infliximab, has to be injected intravenously in a doctor's office or in a special infusion center. At least 2 new Anti TNF factors are soon to be approved. Before considering biologics, a patient must get a number of tests, especially regarding Tuberculosis, inasmuch as the above mentioned treatments may cause it to flare. Insurance coverage, while not automatically peovided, is relatively easy to obtain.


• T Cell antagonists: Since the withdrawal of Efalizumab (Raptiva), there is mainly one biologic left: Alefacept (Amevive). It is less commonly prescribed than the anti TNF drugs. Same insurance coverage as for the latter.

At Lakeview Dermatology, Drs. Eugene and Steven Mandrea, Board Certified Dermatologists, provide all the above Psoriasis treatments: Extrac Psoriasis Treatment (in Palos Heights and Park Ridge), Narrow Band UVB Psoriasis Treatment and Biologics Psoriasis Treatment in all 3 Offices.

Call (773)281.9200 now to make an appointment with a Board Certified Dermatologist.

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Psoriasis

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