Psoriasis Treatment-

Despite the fact that psoriasis cannot be cured, there are various treatments which will slow the rate at which the cells multiply and ease the inflammation.  Suitable creams and ointments can greatly reduce the patches in most of the mild to moderate cases.

The use of preparations containing salicylic acid will cause the thick scale to peel; preparations containing cortisone will depress the inflammation; preparations containing coal tar derivatives (Alphosyl, for example) and anthralin (Dithocream, Psoralon) reduce the rate at which the skin cells divide.  In most cases, the combination of drugs appropriate for the individual patient causes a marked reduction in the symptoms and the skin appears almost normal.

During the last few years it has been shown that prolonged use of preparations containing high concentrations of steroids cause irreversible damage to the skin.  It has also been shown that the skin becomes accustomed to steroids to the point where the concentration must be increased every few weeks to achieve the same results.  In addition, psoriasis patients noted that after the completion of steroid treatment there is often a worsening of the condition; this is known as the rebound phenomenon.

When psoriasis is spread over a large area of the body, the treatment is usually a combination of preparations containing coal tar derivatives and exposure to UVB ultra-violet rays.  This treatment is called phototherapy and involves the use of a specially built apparatus.  The treatment is given during a hospital stay averaging four weeks, or at phototherapy units which the patient visits several times a week.  Phototherapy usually achieves remission after about thirty treatments.

Another possible treatment for moderate to severe cases of psoriasis is exposure to the sun at the Dead Sea in Israel.  As opposed to treatments at phototherapy units in which the patient is exposed to UVB for a few minutes at a time, the treatment at the Dead Sea requires the patient to be exposed to the sun for a few hours daily, and that demands a great deal of time.

Another disadvantage of treatment at the Dead Sea is that it depends on the weather; the treatment is not effective during the winter.  In the past fifteen years a new treatment, called PUVA, has been developed.  It is based on a drug called Psoralen, which comes in pill form, and on exposure to UVA ultra-violet rays an hour and a half after the pills have been taken.

The pills cause increased sensitivity of the skin and eyes to sunlight, and patients  taking the drug must wear special sunglasses for at least 24 hours after the drug has been ingested.  Treatments at the Dead Sea and at phototherapy units involve similar dangers to excessive exposure to the sun, including accelerated aging of the skin and the increased risk of skin growths.

WHAT  IS  NEW  IN PSORIASIS TREATMENTS

A new type of preparation, based on Vitamin D, may improve the treatment of mild to moderate cases.  This ointment, called calcifortriol (brand name: Daivonex), is more convenient to use than those containing coal tar derivatives and safer than those containing cortisone.

According to recent studies in Great Britain, hundreds of patients reported an improvement after using this product, without experiencing any significant side effects.  Since its use is limited to 100 grams a week, it is unsuitable for treating cases of widespread psoriasis.

One of the greatest achievements in dermatology in the last few years was the development of a group of medications called the retinoids.  These drugs, whose chemical composition is close to that of Vitamin A, brought about a breakthrough in the treatment of certain skin diseases, psoriasis among them.  One of these drugs, called Tigason, is suitable for the treatment of the severe cases of psoriasis which do not respond to ointments or phototherapy.

Since this drug is teratogenic (may cause abnormalities in fetuses), it may not be taken within two years before a planned pregnancy, and any women of child-bearing age who does take it is required to use some sort of contraceptive device.

An additional disadvantage of Tigason is that it produces a sticky sensation on the skin, slight peeling around the lips and fingernails and in rare instances an increase in blood lipids or an impairment of liver function.  Despite these side effects, it is a particularly effective drug and greatly improves the quality of the patients’ lives.

Within the last few years out-patient clinics have been opened for psoriasis treatment.  These clinics give the patients topical treatments during 3-4 hours, after which the patient is exposed to 10-20 minutes of ultraviolet radiation.

The advantage of this method is that the patient can continue his or her regular routine without long hospital stays or trips to the Dead Sea.  An additional advantage is that the patient comes home without any visible signs of having undergone treatment and does not have to use any unpleasant-smelling creams or ointments at home.

CAN PSORIASIS BE COMPLETELY CURED?

Unfortunately, psoriasis cannot be completely cured.  No drug has yet been developed which can prevent psoriasis attacks once and for all.  Proper treatment, however, can cause a remission for long periods of months or even years.

This is possible if the treatment is geared to the severity of the disease and if treatment is continued even when there are very few symptoms present.  Regular treatment of the disease even when it is in remission can prevent its worsening at a later stage.