Brief Answer: Psoriasis treatment Detailed Answer: Hello and welcome to healthcaremagic I am Dr. Kakkar. I have gone through your query and I have uinderstood it. Psoriasis is an inflammatory skin disease characterised by well defined erythematous scaly plaques with silvery white or candle wax type of scaling. Chronic plaque psoriasis is the most common type. It can affect sites like scalp, arms, and legs, (specifically elbows and knees), palms and soles etc Other types of psoriasis are: Erythrodermic psoriasis, Pustular psoriasis (generalised and localised), Nail psoriasis and Scalp psoriasis. Afetr having a look at the pictures, I could make out that you suffer from plaque psoriasis. Plaque psoriasis presents with scaly, well defined plaques over scalp, neck, elbows, knees, lower back, extensor legs etc The disease has a chronic course and there topical creams/ointments/gels/lotions etc as well as oral and injectable medicines which can treat psoriasis but there is no permanent cure for psoriasis. Topical treatment: Moisturizers specially those which contain hygroscopic (attract water from the atmosphere and lock it into the skin) and keratoloytic agents like Ammonium lactate(Amylac cream), Urea, Lactic acid etc are especially useful in dry scaly conditions like psoriasis. For the patches you could use a steroid+salicylic acid ointment, twice daily (clobetasol+3% OR 6% salicylic acid in an ointment base e.g propysalic) over and above the moisturizer for 4 weeks. Other treatment modalities which can be used for localized plaque psoriasis are: Vit D analogues like calcipotriol, calcipotriene alone or in combination with steroid. Oral treatment: -Once weekly oral methotrexate is another option in case of plaque psoriasis but it should always be taken under the supervision of a dermatologist since it can rarely cause serious side effects like bone marrow suppression. -Oral cyclosporine is given for extensive psoriasis involving more than 20% of the body surface area. It is rapidly effective but it requires monitoring of kidney functions and BP. Other commonly used oral treatment modalities are: -Oral Psoralens e.g 8-methoxypsoralen and UV A phototherapy (PUVA) -Narrow-Band phototharapy(NB-UVB) -Biologics response modifiers Topical treatment is an essential part of therapy along with oral treatment. Though you have been on the right kind of topical treatment(propysalic, which is a potent topical steroid). Vit D analogues like Calcipotriol, calcitriol are also effective topical agents and can be tried because they are non-steroidal and therefore devoid of the side effects of long term potent topical steroids. I would advice that you see a dermatologist for a discussion regarding the most appropriate oral and topical, treatment modality in your case. I hope you will find this information useful. I am here to answer if you have any more questions/clarifications regards

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Brief Answer: Psoriasis treatment Detailed Answer: Hi. Psoriasis is immune cell mediated (T cells are involved in its causation). Certain inflammatory mediators (cytokines) that these cells secrete causes the skin changes that you see in psoriasis. As I had mentioned before in my answer, that the disease is chronic and can recur again and there is no permanent cure for it. However, there are effective treatment modalities available which can induce complete remission/clearance of psoriasis plaques. There are various precipitating factors for psoriasis: Infections(sore throat, dental infections etc), drugs (b-blockers used for hypertension), pregnancy, winters (psoriasis becomes worse in winters), stress, alcohol intake and cigarette smoking, topical irritants like coal tar, salicylic acid and withdrawal of oral/ topical steroids etc. However these precipitating factors are not solely responsible on there own. In general, in limited psoriasis only topical agents are used, whereas if the disease involves >20% body surface area, it is better to combine both topical and oral therapies. Topical treatment that you have been using (propysalic ointment is a combination of potent topical steroid, clobetasol + salicylic acid) works good for plaques of psoriasis. However since potent steroids can cause skin atrophy therefore you cant continue with them indefinitely. Moreover sudden withdrawal of steroids can cause a rebound flare. Therefore the need to follow up with a dermatologist regularly. You dermatologist can look for the response, can pick up any side effects that may develop, at an early stage. Steroids give fast results but they are like a double edged sword, the more you use the more the patient becomes dependent on them and develops side effects. My approach to patients of psoriasis is to give them initial 2 -4 weeks of topical steroids and then change over to Vit D analogues, which are safer even for long term. However newer agents e,g Vit D analogues like calcitriol and calcipotriol are as effective as steroids but are devoid of the side effects of steroids. So, you can discuss about these with your dermatologist. One popular brand marketed by Biocon, by the name of calpsor is topical calcipotriol and is my favourite in my patients of plaque psoriasis. Since the disease needs to be assessed every 2-4 weeks to see how the medicines are working and watched for any side effects, that's why i said that you should follow it up every 2-4 weeks with your dermatologist. Of course, it sounds strange that i am asking you to see a dermatologist myself being one, because i cant write and sign a prescription for you and its ethically not right to prescribe without having a look at you. I am here to guide you and to provide clarifications for any doubts that you might have about psoriasis. I hope my reply satisfies you this time. regards

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