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Psoriasis: An Array of
Treatment Options
Psoriasis affects between 1 and
2 percent of the U.S. population, or roughly 5.5 million
people. Though the cause is unknown, psoriasis results in an
overproduction of skin cells. The surplus skin leads to
thickening and scaling. The resulting silvery plaques
generally appear on the scalp, elbows, knees, and lower back.
The severity of psoriasis ranges from mild, undetected forms
to rare cases in which the scales cover the entire body.
Psoriasis may cause pitting of the fingernail surface,
thickening and crumbling of the nail plate, and separation of
the nail from the nail bed.
Genetic factors apparently
cause a biochemical malfunction that triggers the psoriasis.
Skin cells mature in three to four days -- much faster than
the usual 28 to 30 days -- resulting in a flaky buildup.
Itching, occasional pain, and embarrassment are the chief
complaints of psoriasis sufferers.
Doctors generally use a "1-2-3"
approach to the treatment of psoriasis. Step 1 calls for
medications applied to the skin (topical therapy). Step 2
adds light treatments (phototherapy) to the regimen. Step 3
relies on medicines taken internally, usually by mouth
(systemic therapy).
Some patients respond well to
sunlight, steroid ointments, medicines derived from vitamin D
3 (Dovonex), vitamin A retinoids (Tazorac), coal
tar, or anthralin. Other topical measures, such as bath
solutions and moisturizers, may soothe the symptoms of
psoriasis, but are seldom strong enough to clear the scales
over the long term. Acitretin (Soriatane) is the only
approved retinoid for treating severe cases of psoriasis. The
immune-suppressing drug cyclosporine (Neoral) is prescribed
for severe psoriasis in those who cannot take or have not
responded to other systemic therapies.
Arthritic symptoms often
accompany psoriasis. Aspirin and local heat usually relieve
these symptoms. Severe cases may require nonsteroidal
anti-inflammatory drugs. Two foam products, Luxiq and Olux,
also are being used in treatment of scalp psoriasis.
Psoriasis of the scalp often responds to the use of tar
shampoo and steroid lotion. Psoriasis of the fingernail
cannot be treated, but usually clears up when the skin
lesions subside.
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