Suggest Treatment For Psoriasis

Brief Answer:
Give me your treatment history so far.

Detailed Answer:
Hello XXXXXXX

Welcome to HCM.

Before suggesting any treatment,first let me know what treatment or medications you have tried so far which has not worked for you.

Kindly get back to me with your treatment history.

Regards,

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Brief Answer:
You may need more potent steroids.

Detailed Answer:
Hello XXXXXXX
Thanks for the follow-up.

Psoriasis is immune cell mediated (T cells are involved in its causation).

Certain inflammatory mediators (cytokines) that these cells secrete causes the skin changes that you see in psoriasis.

Also this disease is chronic and takes time to improve with regular medications and there is chances of recurrence is more and there is no permanent cure for it.

However, there are effective treatment modalities available which can induce complete remission/clearance of psoriasis plaques.

There are various precipitating factors for psoriasis which also need to be kept in mind while this treatment:

Infections (sore throat, dental infections etc),
Some drugs (b-blockers used for hypertension),
winters (psoriasis becomes worse in winters),
stress,
alcohol intake and cigarette smoking,
salicylic acid and withdrawal of oral/ topical steroids etc.

In general, in limited psoriasis cases,only topical agents are used, whereas if the disease involves more than 20% body surface area, it is better to combine both topical and oral therapies.

You are using dovobet cream (contains betamethsone,mild potent steroid) which might not be suitable to your psoriasis,So instead of this you should be given more potent topical steroid treatment (propysalic ointment is a combination of potent topical steroid, clobetasol + salicylic acid) works good.

Immunomodulators like tacrolimus is also the main stay of treatment along with steroids in psoriasis.

Your treating doctor will know about it,you can discuss with him regarding any drug change.Also you need to do regular follow-up with a dermatologist.

My approach to patients of psoriasis is to give them initial 4 to 6 weeks of topical steroids and then change over to Vitamin D analogues, which are safer even for long term.

Newer agents of Vit D analogues like calcitriol and calcipotriol are as effective as steroids but are devoid of the side effects of steroids. So, you can also discuss about these with your dermatologist.

Also the disease needs to be assessed every 4 to 6 weeks to see how the medicines are working and watched for any side effects.

Hope this detailed information will be helpful to you.

Regards,

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