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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Need to speak to dr kakkar

Answered by
Dr.
Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 8800 Questions

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Posted on Sun, 24 Feb 2019 in Skin Hair and Nails
Question: Need to speak to dr kakkar
doctor
Answered by Dr. Kakkar S. 8 hours later
Brief Answer:
Regarding psoriasis

Detailed Answer:
Hello and welcome to ask a doctor service. I have reviewed your query and here is my advice.

Topicals alone are effective for mild to moderate plaque psoriasis. Psoriasis involving more than 20% of BSA (Body Surface Area) i.e moderate to severe psoriasis should be treated with systemic treatment in combination with topical treatment as systemic treatment would not only arrest further progression but also induce faster remission. So, if the patient is developing new patches or if the disease is very itchy and becoming unstable i.e tending to progress, it is better to combine systemic with topical treatment. However, stable disease even with moderate involvement i.e 10-20% BSA can be managed with topicals alone.

Approximately 30% of patients with psoriasis will eventually develop psoriasis. Widespread psoriasis is not necessarily associated with joint disease and many patients with psoriatic joint disease may have only mild psoriasis of the skin or not at all.

I won't advice any herbals or traditional treatment as they may make the existing disease more severe/ unstable. Amongst topical treatment bland emollients like vaseline or paraffin are a must and not only help in reducing scaling/ shedding but also provide symptomatic improvement.

Hope I have answered your query. Let me know if you need any more assistance.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Kakkar S. 14 hours later
Thank you but how would any patient decides how much of a BSA is involved
Is there any calculating parameter ?
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Follow up: Dr. Kakkar S. 1 minute later
And what systemic treatments would u advise in order of preference?
Pl include approximate dosages and duration of treatment to get an approximate idea
doctor
Answered by Dr. Kakkar S. 15 hours later
Brief Answer:
Regarding Psoriasis

Detailed Answer:
Hi.

Body Surface Area is calculated by the 'Rule of 9' as in burn patients. Commonly used systemic treatment options for psoriasis are Methotrexate, Cyclosporin, Phototherapy and Acitretin. Methotrexate is usually effective in a dose of 7.5 to 15mg / week. Response takes 6-8 weeks and usually 8-12 weeks of Methotrexate are necessary. Cyclosporin is effective in a dose of 3-5mg/kg/day. It is fast acting. Once the disease enters into remission, usually within 4-8 weeks, it can then be maintained with a low dose of 2-3 mg/kg/day or with weekend only dose of 4-5mg/kg/day for up to a year. Phototherapy too takes around 20-25 sessions for a response at a frequency of 3 sessions / week. Acitretin is usually combined with Phototherapy in a dose of 25-35mg / day.

Take care
Let me know if you need any more assistance
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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