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What causes persistent psoriasis on the body and scalp despite taking medication?

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Posted on Wed, 16 May 2018
Question: Good evening doctor, am 39 yr old female, I hv scalp psoriasis and in body...I was prescribed CSAC6 ointment + dipnate...the lessions however don't show any improvement though...it seems reddish elevated and sometimes painful.... Request you to kindly suggest ....
doctor
Answered by Dr. Kakkar S. (39 minutes later)
Brief Answer:
Kindly upload images for reference

Detailed Answer:
Hello. Thank you.
I am Dr Kakkar (Dermatologist and Venereologist). I have noted your concern.

The ointments which you have been using are topical potent steroid preparations.

Though topical steroid preparations are the first line treatment options in plaque psoriasis, of scalp and body, sometimes they may not be very effective in clearing the plaques, especially if there is widespread body involvement or thick plaques of psoriasis or because the plaques have become less responsive to the topical steroid preparation i.e tachyphylaxis.

I'd request you to kindly upload a few images so that I am able to have a better understanding of your skin involvement with psoriasis and guide you better.

There are other topical preparations like Calcipotriol ointment or Calcipotriene ointment which are also effective in psoriasis plaques apart from systemic treatment options like Methotrexate or Cyclosporin or phototherapy.

I would be able to guide you better once I have a look at the images and have a better idea about the severity and extent of body involvement.

Awaiting...

Regards
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Kakkar S. (10 hours later)
Dear doctor,
Thank you for your kind reply...I hv attached some photos for your reference....also I hv been given Allegra.....to add, nowadays am extremely depressed, there is hair loss and pain in muscles like cramps .... Request you to kindly help....

Thanks

Last year I had only scalp psoriasis, I'd been to homeopathy treatment, and after that I started getting lessions on my body....one on hand (pic enclosed), 5 on the back and bum, 2 backside of thighs, one on hip....then I developed reddish rashes in between my breasts, armpits and groin area.... initially was treated for fungal with candid b.....but later diagnosed as inverse psoriasis...I applied clobet lotion...by God's grace its healed ....I hv omega3 and vit d supplements....so much about my plight .... :(

doctor
Answered by Dr. Kakkar S. (5 hours later)
Brief Answer:
Regarding treatment for your psoriasis

Detailed Answer:
Thank you.
I have viewed the Images. You seem to have a moderate grade of psoriatic skin involvement.
I suggest you to use a Coal Tar and Salicylic acid based shampoo for scalp e.g protar lotion or salytar lotion. Lather it well on to wet scalp and allow it to act for 10 minutes before rinsing it off.
In addition I suggest you to use a topical potent steroid and salicylic acid based lotion for overnight scalp application e.g Clobetasol Propioate 0.05%and Salicylic acid 3-6% combination lotion or Mometasone furoate and Salicylic acid based combination lotion.
For the skin plaques you may use a Calcipotriol and Clobetasol propionate combination ointment e.g Sorvate C ointment or Pasitrex C ointment, twice daily.
In addition to that you may also take a tablet of cetrizine 10mg once daily for symptomatic relief from itching.
If the plaques don't improve as expected in 2-4 weeks then I would suggest adding a systemic drug/ oral medication e.g either Methotrexate or Apremilast along with the topical medications.
These topical and oral medications that I mentioned are prescription medications and must be taken under supervision and guidance of a local Dermatologist.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 9373 Questions

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What causes persistent psoriasis on the body and scalp despite taking medication?

Brief Answer: Kindly upload images for reference Detailed Answer: Hello. Thank you. I am Dr Kakkar (Dermatologist and Venereologist). I have noted your concern. The ointments which you have been using are topical potent steroid preparations. Though topical steroid preparations are the first line treatment options in plaque psoriasis, of scalp and body, sometimes they may not be very effective in clearing the plaques, especially if there is widespread body involvement or thick plaques of psoriasis or because the plaques have become less responsive to the topical steroid preparation i.e tachyphylaxis. I'd request you to kindly upload a few images so that I am able to have a better understanding of your skin involvement with psoriasis and guide you better. There are other topical preparations like Calcipotriol ointment or Calcipotriene ointment which are also effective in psoriasis plaques apart from systemic treatment options like Methotrexate or Cyclosporin or phototherapy. I would be able to guide you better once I have a look at the images and have a better idea about the severity and extent of body involvement. Awaiting... Regards