How To Treat Severe Psoriasis

What Are The Symptoms Of Psoriasis

• Psoriasis may not have any associated symptoms, but it can be itchy and painful. Certain sites such as the scalp, lower legs and groin can be particularly itchy. If psoriasis affects the hands and feet, painful fissures can develop and these can affect use of the hands and walking. Severe psoriasis on the body can also develop cracks which are painful and can bleed.
• Psoriasis can affect the nails and lifting away of the nail from the finger can be painful.
• Psoriatic arthritis produces pain, swelling and stiffness in one or more joints, particularly in the morning.

Biologic Treatments For Psoriasis

Biologics are a systemic treatment option typically reserved for patients with moderate to severe psoriasis. Theyre often taken by injection or infusion. Biologics target specific proteins that are overproduced in the immune system, helping to reduce inflammation.

To learn more about how biologics work,

Talk to your dermatologist about your psoriasis symptoms to see what treatment options may be right for you.

Learn about a biologic treatment option for moderate to severe plaque psoriasis,

Dermatology Life Quality Index

Psoriasis can affect a persons mental health, and people with psoriasis often experience anxiety, depression, and social isolation.

For this reason, doctors a Dermatology Life Quality Index questionnaire to assess the impact of symptoms on a persons quality of life. Symptoms that look mild to others can have a severe impact on mental health and daily functioning.

Doctors may also factor in the results of a questionnaire on coping strategies.

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A doctor may recommend a treatment alone or alongside a drug or another topical option.

Many topical treatments can have adverse effects, such as burning or irritation. Some treatments increase susceptibility to UV light. People should check with a medical professional before using any product.

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How Is Psoriasis Diagnosed

There arent any special tests to help doctors diagnose psoriasis. Typically, a dermatologist will examine your skin and ask about your family history.

Youll likely be given a diagnosis based on this physical exam.

In some situations, doctors will remove a small sample of the skin and examine it under a microscope. This might allow them to get a better look at the affected area and make a more accurate diagnosis.

How To Treat The Toughest Psoriasis

Do you feel like youve tried every prescription, over-the-counter and alternative psoriasis remedy available but your plaques wont go away? Are you wondering whether there are any other options?

Join us as our expert guests discuss the most hard-to-treat psoriasis and what to do when stubborn psoriasis just wont go away. Youll learn about new combinations and approaches with existing treatment techniques, find out how to cope with low self-esteem and depression, which often accompany severe psoriasis, and hear why and when it might be a good idea to take a treatment break, at least for a little while.

As always, our expert guests answer questions from the audience.

Announcer:

Welcome to this HealthTalk webcast. Before we begin, we remind you that the opinions expressed on this webcast are solely the views of our guests. They are not necessarily the views of HealthTalk, our sponsors or any outside organization. And, as always, please consult your own physician for the medical advice most appropriate for you.

Now here’s your host, Heather Stark.

Heather Stark:

Dr. Miller, thank you for joining us.

Dr. Jami L. Miller:

Thank you for having me.

Heather:

Dr. Miller, a lot of people think of psoriasis as a skin disorder and don’t understand why it’s so challenging to treat. Can you tell us what psoriasis is and how it manifests into the skin problems that we see?

Dr. Miller:

Heather:

Dr. Miller:

Heather:

Heather:

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It Can Affect The Scalp Hairline Forehead Back Of The Neck And Skin Around The Ears

Did You Know?

Symptoms may include fine scaling that looks like dandruff, or appear as thick, crusted plaques that cover the entire scalp. Other skin disorders, such as seborrheic dermatitis, may resemble psoriasis. However, scalp psoriasis appears powdery with a silvery sheen, while seborrheic dermatitis looks yellowish and greasy. Scalp psoriasis is common in patients of color, but treating it can be particularly tough due to the hair type.

Scalp psoriasis may be an indicator of psoriatic arthritis , as many people have both. If you think you have scalp psoriasis, see a dermatologist to diagnose scalp psoriasis and visit a rheumatologist to screen for psoriatic arthritis.

No matter how severe your scalp psoriasis is, there are options for treating the itching and flakes â from over-the-counter shampoos and topicals to light therapy, oral treatments and biologics.

What To Discus With Your Dermatologist

Be sure to tell your dermatologist if you:

• Experience any health problem, even if it seems unrelated to taking methotrexate, such as fever, chills, body aches, bleeding, or bruising easily

• Become pregnant

• Feel uncertain about how to take methotrexate

• Think the information that came with the medicine about how to take methotrexate differs from what your dermatologist told you

Images

Cordoro KM. Management of childhood psoriasis. Adv Dermatol. 2008 24:125-69.

Feldman SR. Treatment of psoriasis. UpToDate 2015 Jul, Wolters Kluwer Health. Last accessed November 2015.

Hugh J, Van Voorhees AS, et al. From the Medical Board of the National Psoriasis Foundation: The risk of cardiovascular disease in individuals with psoriasis and the potential impact of current therapies. J Am Acad Dermatol. 2014 70:168-77.

Menter A, Korman NJ, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis Section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol2009 61:451-85.

All content solely developed by the American Academy of Dermatology

The American Academy of Dermatology gratefully acknowledges the support from Amgen and .

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Natural Alternative And Complementary Remedies

Some people use natural, alternative, or complementary therapies alongside medical treatment.

For mild symptoms, a natural treatment alone may suffice. People with severe symptoms, however, will most likely need to use it in addition to treatment from the doctor.

Options that people sometimes use include:

• various treatments from traditional Chinese medicine

A doctor may also make recommendations regarding lifestyle measures, including:

• making dietary changes
• quitting smoking, if applicable
• limiting alcohol consumption, if applicable

Smoking and drinking alcohol can act as triggers for psoriasis and increase the risk of other conditions. Experts strongly recommend people with psoriasis quit or avoid smoking and limit alcohol consumption.

Psoriasis In The Obese Patient

Obesity, especially abdominal obesity, is considered a low-grade pro-inflammatory state, which increases the risk of cardiovascular disease and metabolic syndrome. Recently, several studies have been documenting a clear association between obesity and psoriasis. Relation between body mass index and severity and extent of psoriasis lesions appears to be direct and bidirectional.5656 Carrascosa JM, Rocamora V, Fernandez-Torres RM, Jimenez-Puya R, Moreno JC, Coll-Puigserver N, et al. Obesity and psoriasis: inflammatory nature of obesity, relationship between psoriasis and obesity, and therapeutic implications. Actas Dermosifiliogr. 2014 105:31-44.-5757 Duarte GV, Oliveira Mde F, Cardoso TM, Follador I, Silva TS, Cavalheiro CM, et al. Association between obesity measured by diferente parameters and severity of psoriasis. Int J Dermatol. 2013 52:177-81.

Bariatric surgery, particularly gastric bypass, has been shown to be a promising tool in obese patients with refractory psoriasis, not only by weight loss per se but also by postprandial increase in GLP-1 levels. However, more studies are needed in this field.5959 Sako EY, Famenini S, Wu JJ. Bariatric surgery and psoriasis. J Am Acad Dermatol. 2014 70:774-9.

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How Can Psoriasis Be Treated

Treatment of psoriasis depends upon your individual circumstances. Treatment applied to the surface of your skin is sufficient alone in most patients. For people with more extensive or difficult to treat psoriasis, ultraviolet light treatment , tablet treatment or injection treatment may be required.

Steroid Creams Or Ointments

Steroid creams or ointments are commonly used to treat mild to moderate psoriasis in most areas of the body. The treatment works by reducing inflammation. This slows the production of skin cells and reduces itching.

Topical corticosteroids range in strength from mild to very strong. Only use them when recommended by your doctor.

Stronger topical corticosteroids can be prescribed by your doctor and should only be used on small areas of skin or on particularly thick patches. Overusing topical corticosteroids can lead to skin thinning.

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How To Cure Psoriasis Permanently: Top 10 Home Remedies

What is psoriasis and what does it look like? Psoriasis is a chronic skin disease that occurs due to the excessive growth of skin cells. New skin cells developed in a day instead of a week. Skin cells start piling up on the skin and cause patches. They are thick, red, scaly patches on the skin. Psoriasis can occur on elbows, knees, scalp, palms, back, face, and feet but can occur in other parts of the body too. This is a long-lasting skin problem but you can cure psoriasis with a natural home remedy.

Psoriasis occurs when your immunity is not working properly. The cell turnover process takes months normally but during psoriasis, it takes only a day to complete. People with serious health conditions, such as diabetes, heart disease, and stress are more at risk.

Psoriasis mainly occurs in people aged between 15-40 years, but it can occur at any age. Its very rare but an infant can have psoriasis. Psoriasis is not a contagious skin disease.

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Ultraviolet Treatment For Psoriasis

is the use of UV radiation to treat skin disorders, and this can be very effective in the treatment of psoriasis. It is generally reserved for cases where topical therapy has been ineffective or too much of the skin surface is involved to treat psoriasis effectively with topical agents. It is administered in cabinets at specialised centres, and a treatment course for psoriasis will usually consist of 23 treatments per week for 2030 treatments.

• Phototherapy is best avoided in patients with very fair skin, who take certain immunosuppressive medications, or who have a previous history of skin cancer.

The need for regular travel to a phototherapy centre can make this option difficult for some patients. The beneficial effects may be short-lived.

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Treatments For Psoriatic Disease

Psoriasis and psoriatic arthritis treatments arenât one-size-fits-all, and thatâs a good thing. It means that you can work with your health care provider to find the right psoriasis treatment â or combination of psoriasis treatments â for you that reduces or eliminates your symptoms. Staying up-to-date with whatâs new and what your options are when it comes to treatment can help. ÂÂÂÂÂ

PsA can affect one in three patients with psoriasis. But treatments for it are available and can help relieve pain, reduce swelling, help keep joints working properly, and possibly prevent further joint damage. Your health care provider will recommend treatments based on the type of PsA, its severity, and your reaction to treatment.

Systemic Therapy Of Psoriasis In Children

Psoriasis during infancy, childhood, or adolescence could have a significant impact on patient and family quality of life, and those young patients who cannot be managed effectively with topical treatment should be considered for systemic therapy. Most current systemic treatments for psoriasis are off-label in children, such as acitretin, cyclosporine, methotrexate, infliximab, ixekizumab, secukinumab, and apremilast. However, methotrexate, cyclosporine, and acitretin have been used in pediatric patients, and their effectiveness and safety data are available and derived mainly from by case series studies. In contrast, etanercept, adalimumab, and ustekinumab have been approved for psoriasis vulgaris in children and adolescents because randomized controlled clinical trials have been performed.

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How Does Combination Treatments For Psoriasis Work

Combination treatments are prescribed in stages. The treatment begins with the quick fix, which is the first step. This step begins by clearing the skin lesions during a psoriasis outbreak. In the case of severe psoriasis, the first stage treatment is done with the use of either oral immunosuppressants or with the use of a strong topical steroid.

The second stage is known as the transitional phase and it involves the gradual introduction of a maintenance drug. This would include a rotational therapy that would alternate between combinations of treatments. The ultimate goal of this stage of treatment is to keep the disease under control and to lower the side effects and resistance to the medications.

The last state is known as the maintenance phase. During this phase, the medication dosage is generally decreased as the symptoms slowly start to diminish.

Research And Statistics: Who Has Psoriasis

According to the National Psoriasis Foundation, about 7.5 million people in the United States have psoriasis. Most are white, but the skin disease also affects Black, Latino, and Asian Americans as well as Native Americans and Pacific Islanders.

The disease occurs about equally among men and women. According to the National Institutes of Health , it is more common in adults, and you are at a greater risk if someone in your family has it. A study published in September 2016 in the journal PLoS One concluded that interactions between particular genes as well as genetic and environmental factors play an important role in the diseases development.

People with psoriasis generally see their first symptoms between ages 15 and 30, although developing the disease between 50 and 60 years of age is also common.

The biggest factor for determining prognosis is the amount of disease someone has, says Michael P. Heffernan, MD, a dermatologist at the San Luis Dermatology and Laser Clinic in San Luis Obispo, California.

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Clinical Trials For Psoriasis

Before a new treatment can be registered in Australia it must undergo extensive testing. Clinical trials are used to determine the safety and effectiveness of new treatments for psoriasis. The regulations governing clinical trials in Australia make the process as safe as possible for clinical trial participants. People with psoriasis may consider volunteering to participate in a clinical trial. Participation provides volunteers with access to cutting edge treatments that are not otherwise available. General information about being part of a clinical trial can be found here. Internationally, ClinicalTrials.gov provides patients, their family members, and the public with easy and free access to information on clinical studies for a wide range of diseases and conditions. If you are interested in participating in a clinical trial, talk to your doctor.

Treatment: Where To Start

The most common treatments for mild cases are medications that you put directly on your scalp. If you have a more severe case or have psoriasis elsewhere on your body, you may need a medication that treats your whole body. You can take these medications by mouth or injection.

If your psoriasis doesn’t respond well after repeated use of one medication, your doctor may replace or combine it with another type of treatment.

One of the first steps is to soften and remove scales. This makes it easier for medications to do their job.

• Apply over-the-counter products to your scalp to help soften scales and make them easier to peel off. Look for products with the active ingredients salicylic acid, lactic acid, urea, zinc pyrithione, or selenium sulfide.
• Gently loosen the scales with a brush or fine-toothed comb.
• Shampoo your scalp to remove the scales, using a salicylic acid shampoo or soap.
• Apply thick creams to your scalp while it’s still damp to hold in the moisture.

To apply medication:

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What Treatments Are Available For Nail Psoriasis

There are many treatments for nail psoriasis. Your treatment plan may include one or more of the following.Treatment you apply to the nails: This can be helpful for mild or early nail psoriasis. Nails grow slowly, so youll need to apply these treatments for several months, often once or twice a day. Because nail psoriasis can be stubborn, you may need to use more than one treatment. Sometimes, two medicines are combined to give you a faster response.

Treatment that you apply to your nails includes the follow.

• A potent or very potent corticosteroid: This can be helpful for most signs and symptoms of nail psoriasis. Its safe to use this medicine once or twice a day for up to nine months.

• Calcipotriol: In one study, researchers found this to be as effective as a potent corticosteroid at treating the buildup beneath the nail.

• Tazarotene: This treatment can be especially helpful for treating pitting, a separating nail, and discoloration.

If you need stronger treatment, your dermatologist may recommend treatment given in a dermatologist office or clinic. This treatment may include one of the following.

Psoriasis medicine that can help clear the skin and nails includes:

• A biologic

Treatment Of Associated Conditions

Health conditions associated with psoriasis include psoriatic arthritis, sleep disturbance, and depression. Treatment for these may help skin disease.

Due to the association between psoriasis and metabolic syndrome, weight loss, smokingcessation, moderation of alcohol intake, and blood pressure control may also lead to improvements in skin disease .

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Patients With A History Of Neoplasm

Patients with a positive history of neoplasm demand a cautious prescription of systemic drugs that could potentially increase the risk of recurrence. Topical therapy, phototherapy acitretin, and/or methotrexate are advisable for patients with recent malignancy as a first line treatment approach. Cyclosporine is not recommended, and phototherapy is not indicated in patients with cutaneous malignancy including melanoma. In the case of inadequate response to first line treatment mentioned, the decision to initiate biologics or apremilast should be discussed with oncologist. Type and staging of cancer, the risk of recurrence and the burden of psoriasis represent the most important elements to be considered .