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Suggest treatment for severe psoriasis - Online Doctor Chats

Date : 20-Apr-2014
User rating for this question
Very Good Posted in: Skin Hair and Nails
Answered by

General & Family Physician
Practicing since : 2003
Answered : 1504 Questions
User:My wife has severe psoriasis and creams don't work. They take away the itching but it gets worse. She was taking a prescribed pill and it all but cleared it up but the doctor quit prescribing it said it woes damage her liver. She has to contantly cover up to go anywhere and really embarrasses about it.Can you help?
User:Did you get my message
Doctor:I am sorry to learn about your wife's condition
User:Can you hep.
Doctor:I can
Doctor:but I will only be able to give you some guidelines
Doctor:I will not be able to give you any prescriptions
User:Tell me
User:I understand
Doctor:Can you tell me the name of the medicine that was prescribed
Doctor:with which your wife was getting better?
User:Can't remember but it was a pill. Will look to see if that info is avail
User:It all but cleared it up. I think it is the one you see advertised on TV for plaque
Doctor:It is hard to identify the drugs based on advertisements
Doctor:it would help me greatly if you could remember the generic name of the medicine
User:Will try but in the meantime is there any other wonder things she can try?
Doctor:There are multiple drugs that are currently being used
Doctor:to treat psoriasis
Doctor:They are broadly divided into topical coticosteroids
Doctor:probably what your wife is using currently
User:Went to the pharmist and tried a cream he recommended but it didn't help. When it first started any tar based solution helped a lot. But can't find them anymore
Doctor:if the one she is using currently is not working, then it is better to switch to a stronger one
Doctor:Yes, tar based solutions help quite well
Doctor:and it is quite difficult to get them these days
Doctor:The other class of drugs used are called immunomodulators
Doctor:in this group are
Doctor:1. Tacrolimus this causes liver damage
Doctor:2. Cyclosporin -- causes liver damage
Doctor:3. Alefacept (Amevive) this is a new drug
Doctor:this is administered intramuscularly
Doctor:and is quite effective in moderate to severe psoriasis
Doctor:it diminishes the immunity
Doctor:but has no liver damaging effects
User:She is currently using clobetasol 0.05, desoximetasome 0.25 and blue star ointment
Doctor:4. Ustekinumab (Stelara)This is again a new medicine
Doctor:indicated for moderate to severe psoriasis
Doctor:is quite effective
Doctor:and does not cause liver damage
Doctor:Instead of clobetasol she can use Triamcinolone, which is stronger and longer acting
Doctor:it is available as Kenalog or Aristocort in 0.025 to 0.1% strengths
User:What about sensitive sarna.
Doctor:she can start at 0.05 and increase the strength based on the response
User:Is this avai over OTC?
Doctor:Kenalog maybe available over the counter
Doctor:rest of the medicines I have mentioned all are prescription only medicines
Doctor:and should be taken under the guidance of a physician only
Doctor:sensitive sarna will not be effective
Doctor:it is only for minor itching and allergic kind of reactions
Doctor:In my opinion, opting for Ustekinumab or Alefacept will be most beneficial
User:Any other suggestions before my time is up
Doctor:if you have insurance then you should request your dermatologist to prescribe them for your
Doctor:It will never be available as OTC
User:Yes I have ins
Doctor:And trust me, OTC will not help in psoriasis
Doctor:Then please ask your dermatologist to prescribe these new drugs I have mentioned
Doctor:they are quite effective
Doctor:and well tolerated
Doctor:Is there anything else you would like to ask me>
User:Yea I know I'm just fishing..
Doctor:Anything else?
User:Is there any dermatologist you know in Harrisonburg va?
Doctor:I am sorry, i live in India
Doctor:You can try this
Doctor:Anything else?
User:Is oatmeal any good or just soothing
Doctor:it is good to some extent
Doctor:I hope I was able to help you with your issue
User:Ok im done thank you
Doctor:Thanks for using the service
Doctor:It was my pleasure to help you
User:Better than going to the doctor
Doctor:I wish your wife a speedy recovery
Doctor:take care
Doctor:bye bye
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