Psoriasis is a Treatable Disease
Dr Lilly Jose
Zulekha Hospital, Sharjah
Psoriasis is a common chronic recurring disease known for ages, first described by the Greek physician Hippocrates (460-377 BC).The patient develops red scaly lesions on the outer aspect of elbows, knees or on the scalp. Sometimes skin lesions are so extensive that the whole body will be dry scaly and covered with red patches. About 60% of patients suffer from joint problems from psoriasis. Rarely joint pain and swelling precede the skin lesions, or the skin manifestation is so negligible that it is overlooked by the patient. Psoriatic arthritis affects the hands, feet, knees, spines etc. Tendon pain and nail deformities are also seen along with the skin lesions.
Previously Psoriasis was considered as a disease which affects the skin, nails and joints only and the patients were given the option of different kinds of treatment and even the option of opting out from any kind of treatment. But now it is considered as an autoimmune hereditary systemic illness predominantly affecting the skin, nails and joints. Several studies have shown that patients with psoriasis are more prone for inflammation of blood vessels (vasculitis) and atherosclerosis. Depression and suicidal tendencies are more in these patients. So they need more frequent monitoring for their general health and mental health. Emotional stress and smoking may influence the development and exacerbation of psoriasis.
Moisturizers are very important in the treatment of psoriasis. They reduce dryness scaling cracking and fissuring. Local application includes creams containing coal tar, salicylic acid, vitamin D derivatives and steroids
Apart from the creams which are commonly given for psoriasis there are different kinds of treatment in modern medicine for this menace. Since it is a disease with rapid multiplication of normal cells due to an altered immune mechanism, oral tablets which will slow the multiplication of cells can be given as pulse therapy (single dose in a week). Vitamin A derivatives which will slow the multiplication of cells and promote normal maturation of skin cells are given orally on a daily basis as apart of the treatment.
Another kind of treatment is ultraviolet light therapy, relatively a very safe modality of treatment. Narrow band UVB therapy is given thrice weekly. It takes only a few minutes for the treatment. Patient has to visit the hospital thrice weekly. Depending on the area of disease whole body treatment chambers and small units for hands and feet are available. All these modalities of treatment give relief to not only the psoriatic skin lesions but also psoriatic arthritis and further internal damage to the joints and to the vessels as described earlier.
There are injectable medicines known as biologics which can be taken by patients at home (self injection, like insulin taken for diabetes mellitus). Patient may need one injection once in a week or once in 2 weeks, or only 5 injections in a year depending on the medicine selected for the treatment. Biologics are a break through in the treatment of psoriasis. Though these injections are expensive, these are very effective and convenient for the patient. Proper evaluation of the patient to rule out infections like tuberculosis is absolutely essential before starting biologics.
All these treatments can be tailored in a way to suit individual patientís needs. The treatment recommended will depend on the type, severity and location of the disease and the general health of the patient. With all these modern modalities of treatment psoriatic patients can lead a normal healthy life with out being ashamed of the appearance of their skin.
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