Brief Answer:
Could be due to flare of psoriasis

Detailed Answer:
Hello,

Welcome to healthcare magic.

I understand from your query that you are having severe psoriasis associated with burning sensation and redness after using topical medications.

In some cases where the psoriasis is severe, applying creams may cause peeling of skin which may worsen burning.

Severe psoriasis involving more than 20% of body surface area requires oral / systemic treatment.

Please discuss with your dermatologist about these options as they are all associated with side effects which needs to be monitored and cannot be used over the counter by the patient himself.

1. Phototherapy- This involves use of light to clear psoriasis.

2. Methotrexate - This is a tablet given orally and gives very good clearance of psoriasis. But has to be monitored regularly for side effects.

3. Cyclosporine- This is given orally as a crisis buster in severe cases of psoriasis, especially a type called as pustular psoriasis. This has to be given only under supervision of a dermatologist.

4. Retinoids- This is a good medicine for maintaining remission.

Please discuss with your dermatologist about these options as they are all good medications provided you take them under proper supervision.

Hope this helps you.

If you have any more queries, I would be glad to answer.

Regards,
Dr. Johny Chacko

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Brief Answer:
Biologicals are very expensive

Detailed Answer:
Hello,

I would not say that the creams are "harmful". But applying only creams over such a wide area of involvement will cause peeling ( which is the expected action of salicylic acid component in the cream) and peeling over such widespread areas can cause burning.

Immunosuppressants like methotrexate when taken under supervision work very well. Do not hesitate to try them as they will make your life much more comfortable and you can start living a near normal lifestyle soon.

There are no special precautions to be taken while on these drugs. They are not like steroids which cause profound immunosuppression. The dosage used for psoriasis is quite minimal compared to say, its use in renal transplant patients,etc. You could just follow a healthy and hygienic lifestyle to avoid infections.
But monitoring liver function and renal function by regular blood check up is important initially.

Biologicals are a new set of medicines which is latest in the treatment of psoriasis. They also cause immune modulation and have to be monitored for side effects. Moreover, they are extremely expensive. 1 injections can cost Rs.8000 and you need 16 weekly injections during the clearing phase. It is generally reserved if the less expensive treatments like methotrexate do not work well.

There are several good dermatologists in XXXXXXX I do not anyone personally. I am sorry I may not be able to assist you on that aspect.

Hope I have cleared your doubts.

Wishing you good health,
Dr. Johny Chacko

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Brief Answer:
Cyclosporine is not 1 st line of treatment

Detailed Answer:
Hello,

I am sorry about your loss and I understand your cause of anxiety.

Cyclosporine, as I mentioned earlier is used as a "Crisis buster" and is not the 1 st choice of treatment.

Based on your history and description, I would consider methotrexate as the 1 st choice if all your blood work up is normal.

Do consult a good dermatologist and discuss about the options about methotrexate and phototherapy.

I am glad I could put your mind at ease.

Warm regards,
Dr. Johny Chacko

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