How Is Psoriasis Diagnosed And Treated?November 20, 2020
Psoriasis is a chronic inflammatory skin disease characterized by erythematous, limited scaly papules and plaques. In half of the cases, there may be itching, irritation, and a burning sensation. Psoriatic lesions are red, inflamed, silvery-white, scaly, and borderless papules and plaques; It often affects the elbows, knees, extensor limbs, and scalp, and less frequently the nails, ears, and navel area. Beyond the physical aspects of the disease, psoriasis has a wide range of emotional and psychosocial effects on patients. It affects their social functioning and interpersonal relationships.
The diagnosis is usually clinical, and a skin biopsy is rarely necessary. The appropriate treatment can be done depending on the severity of the disease. Mild psoriasis is treated with topical corticosteroids and vitamin D analogues. These topical treatments are effective and can be safely initiated and prescribed by a doctor. Patients with more severe symptoms may require further assessment by a dermatologist for better treatment. Moderate to extreme psoriasis may require phototherapy and systemic therapy like oral retinoids, methotrexate, cyclosporine, or apremilast.
Two tests may be needed to diagnose psoriasis.
- Physical examination: Most doctors can make a diagnosis with a simple physical exam. Psoriasis symptoms are usually clear and easy to distinguish from other conditions that can cause similar symptoms. Be sure to show your doctor any problem areas during this exam. Also, tell your doctor if anyone in your family has had this disease.
- Laboratory test: Your doctor may do a biopsy removing a small piece of skin and testing it to make sure you don’t have a skin infection. The skin is sent to a laboratory to examine under a microscope and diagnose the type of psoriasis you have. This can rule out other possible disorders or infections as well.
Treatment of psoriasis:
Fortunately, there are many treatments available. Some slow down the growth of new skin cells while others soothe dry, itchy skin. Your doctor will choose the right treatment plan for you based on the size of your rash, your body, your age, your general health, and more.
There is no cure for psoriasis, but many medications are offered that can reduce bothersome symptoms and the onset of the disease. Treatment will depend on the severity of the condition, the cost and convenience of treatment, and the person’s response to treatment. Combination therapy is often recommended. Common treatments include:
- Topical treatments
- Ultraviolet (UV) light therapy
- Other systemic treatments
Topical Treatments: Over-the-counter and prescribed medical treatments applied directly to the skin can minimize psoriasis symptoms. This therapy contains a variety of active ingredients and is available as lotions, creams, medications, shampoos, gels, sprays, or ointments. Some of them are:
- Vitamin D3 analogues
- Calcineurin inhibitors
- Salicylic acid
- Coal tar
Ultraviolet (UV) rays from the sun slow down the production of skin cells and reduce inflammation. Some people may experience fewer psoriasis symptoms, and others may use artificial light therapy. Solar lamps and tanning chambers are not suitable substitutes for medical light sources. There are two primary forms of light therapy:
- UV-B (UV-B) light therapy is usually combined with topical treatments and is effective in treating psoriasis with moderate to severe plaque. Like natural sunlight, there is a risk of skin cancer.
- PUVA therapy combines oral psoralen, which makes the skin more sensitive to light and sunlight, with UV-A (UV-A) light therapy. 85% of patients report that they relieve symptoms with 20 to 30 treatments. Therapy is usually carried out on an outpatient basis 2-3 times a week, with maintenance therapy done every 2-4 weeks until remission. Minor such as Nausea, itching, and a burning sensation are side effects.
- Oral methotrexate is an effective treatment for severe debilitating psoriasis. Especially in cases of severe psoriatic arthritis or extensive erythrodermic or pustular psoriasis that is unresponsive to topical agents or ultraviolet radiation (narrowband UVB) or PUVA therapy. Methotrexate appears to interfere with the rapid development of epidermal cells. Dosage regimens vary, so only doctors experienced in using them for psoriasis should start methotrexate therapy.
- Cyclosporine can be used in severe psoriasis. It should be restricted to courses of a while (as long as one year) and substituted with different treatments.
- Mycophenolate mofetil can be an alternative for patients who do not respond to methotrexate or cyclosporine. It is also helpful for patients who develop toxicity from the above drugs.
- Retinoids: These pills, creams, foams, lotions, and gels are a class of medicines related to vitamin A. These immune system suppressant drugs can be used in severe cases that have not responded to other treatments.
- Other immunosuppressants – Hydroxyurea, 6-thioguanine have strict safety limits and are reserved for severe and persistent psoriasis.
Other systemic treatments:
- Biological treatment: They block the immune system (which is overactive in psoriasis) to control better the inflammation caused by psoriasis. Biological drugs include adalimumab (Humira), brodalumab (Siliq), certolizumab pegol (Cimzia)
- Enzyme inhibitors: Apremilast (Otezla) is a new type of medication for long-term inflammatory conditions such as psoriasis and psoriatic arthritis. These are pills that block certain enzymes that slow down other reactions that cause inflammation.
Many psoriasis patients seek initial assessment and treatment from their primary care provider. Perceiving psoriasis and its related clinical and mental comorbidities will encourage definitive diagnosis and treatment. In more severe and refractory cases, referral to a dermatologist may be required for further evaluation and possible systemic therapy.
There is no cure, but medication dramatically reduces symptoms, even in severe cases. Recent studies have shown that better control of inflammation in psoriasis lowers the risk of heart disease, stroke, metabolic syndrome, and other inflammatory diseases. For best treatment contact Cosmosure clinic at 040 4953 0404.