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Psoriasis

Psoriasis is chronic inflammatory condition that affects 2% of the world population. It does have a hereditary or familial tendency, and may appear on any part of the body. It is characterized by scaling, red plaques that most often involve the elbows, knees, and scalp. Arthritis and nail changes may also occur.

Psoriasis is not contagious and the risk of transmission to the children of affected individuals is not completely known. It is a chronic condition that is marked with numerous period of improvement and exacerbation. The response of psoriasis to treatment differs among individuals and is somewhat unpredictable. Treatment of psoriasis can be difficult and often requires the care of an experienced dermatologist.

Examples of treatment agents include:

Topical corticosteroids

* apply a thin layer of the medicated ointment, cream, or foam to the affected area twice daily

* strong steroid compounds should not be applied to the face, groin, elbow creases, armpits; steroid application in these areas may thin out the already thin skin leaving blood vessels showing and purple stretch marks

Topical tar / anthralin

* apply a thin layer to each psoriatic area once or twice daily

Calcipotriene / Dovonex

* apply a thin layer to each psoriatic area twice daily

* may be applied along with the topical steroid ointment

Tazarotene / Tazorac®

* apply a thin layer to the psoriatic area once or twice daily as tolerated

PUVA / NB-UVB therapy

* light therapy 2-3 times per week as determined by your physician

Acitretin / Methotrexate oral therapy

* Acitretin is taken once a day and must have monthly blood draws to monitor for possible liver or triglyceride side effects; your triglycerides may increase dramatically and lead to life-threatening pancreatitis or other long term sequelae. You may be placed on an anti-triglyceride medicine by your physician. This medication is NOT for any females who may potentially become pregnant at any time in the future. Any signs of yellow skin discoloration, abdominal pain, nausea, or vomiting should prompt stopping the drug immediately and contacting your physician

* Methotrexate (MTX) is taken once weekly and must have weekly, biweekly, or monthly blood draws to monitor for liver, kidney, or blood changes; any signs of fatigue, increased infections, of yellow skin discoloration, abdominal pain, nausea, or vomiting should prompt stopping the drug immediately and contacting your physician. After a cumulative dose of 1.5g, a liver biopsy is recommended to follow the long term effects of MTX on liver.

Cyclosporine

* Cyclosporine is an immunosuppressive medication given to transplant patient to prevent host rejection of the transplant

* This medication is dosed on body weight and is often taken once or twice daily

* blood counts, liver tests, lipids, and kidney function must be followed with routine blood tests

* high blood pressure, increased hair growth, and enlarged oil glands may be seen while taking this medication

Cellcept

* Cellcept is an immunosuppressive medication given to transplant patient to prevent host rejection of the transplant

* This medication is taken twice daily

* blood counts, liver tests, and lipids, must be followed with routine blood tests

* GI upset is the major side effect; as this is a newer medication used for a variety of conditions, there has been an association with possible lymphoma development, although no proven relationship has been demonstrated

Biologics (Enbrel®, Amevive®, Raptiva®, Humira®, Remicade®)

* These are expensive new injectable alternatives that have given new hope to many psoriasis patients

* You will need a chest X-ray and a PPD test prior to starting any of these medications

* These are newer medications. Their risks of lymphoma and long term problems is UNKNOWN.

* Enbrel is given SQ in the abdomen at a dose of 50mg twice a week; for 12 weeks if there is a family history or risk of multiple sclerosis, this medication must NOT be given

* Amevive is given IM in the thigh at a dose of 15mg for 12 weeks; it is only given in the office and blood tests are done weekly

* Raptiva is given SQ for 12 weeks; your platelets may decrease and thus you will need monthly labwork

* Humira is given SQ at a dose of 40 mg every other week for 12-24 weeks; it is currently NOT approved for psoriasis without arthritis.

* Remicade is a 4 hour IV infusion given at weeks 0,2,6 and every 8 weeks after. It is the most effective. Not for those with heart failure.

This is NOT an all-inclusive list of medications with all side effects. Make sure to consult your physician very carefully and thoroughly before undertaking any of these treatments.

Don Mehrabi MD, FAAD
Dermatologist, Certified by the American Board of Dermatology
Los Angeles, California

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