PSORIASIS
Scratching the surface
IT Is esTIMATeD THAT ABOuT TWO PeR CeNT OF PeOPLe ARe AFFeCTeD BY PsORIAsIs TO DIFFeReNT DeGRees. FORTuNATeLY, THeRe Is AN INCReAsINGLY eXPANDING RANGe OF THeRAPIes AND TReATMeNTs ReADILY AVAILABLe…
A
ccording to the Psoriasis Association, between two and three per cent of people
in the uK suffer from psoriasis and, unfortunately, there isn’t a cure.
What is psoriasis? Psoriasis is a chronic condition that causes patches of itchy, scaly and often inflamed skin.
The word ‘psora’ comes from the Greek verb for itching. It first came into use in c.133AD and is in fact considered to have been what was referred to in the Bible as ‘leprosy’. The most common form of the condition – psoriasis vulgaris or plaque psoriasis – constitutes around 80 per cent of cases, with most affecting the scalp, elbows, knees and lower back.
In addition to plaque psoriasis, the other main types of the condition include:
Guttate psoriasis: this type of psoriasis usually affects children, teenagers, and young adults and can often appear following a bacterial infection, such as tonsillitis.
Pustular psoriasis: this form of the condition can cause pus-filled blisters on the skin, when then dry up, become scaly and peel off. Primarily seen in adults, this condition can cause the person to feel generally unwell.
Erythrodermic psoriasis: the rarest form of psoriasis, which causes fiercely red and scaly skin to appear over large areas of the body. This condition can evolve from other forms of psoriasis or be triggered by treatment for psoriasis, but can also be triggered by withdrawal from drugs such as corticosteroids.
34 - PHARMACY IN FOCus
Inverse psoriasis: this form of psoriasis, causes scaly, bright red patches to appear in folds of skin, such as those under the breasts or in the armpits, and is exacerbated by obesity.
Treatment since there is no cure for psoriasis, it has to be treated and managed by the patient in conjunction with their GP or pharmacist.
There are currently three major categories of treatment: topical, ultraviolet light (phototherapy) and systemic.
Topical therapies Treatment usually begins with emollients and topical corticosteroids in the form of creams, ointments or gels. These are generally prescribed for mild to moderate cases of psoriasis, or are used in combination with other treatments.
Topical agents used to treat psoriasis include vitamin D analogues, such as calcipotriol, corticosteroids, retinoids and coal-tar products. These drugs work by slowing down skin-cell production and reducing inflammation.
Dithranol is also commonly prescribed, but it works by generating free radicals.
Phototherapy In the event that these treatments are unsuccessful, many patients are referred to secondary care for a course of phototherapy, where the patient’s skin is exposed to certain types of ultraviolet light.
Light therapy usually involves exposure to a short wavelength of ultraviolet light, called ultraviolet B
(uVB). In the case of resistant moderate to severe psoriasis, a combination of oral or topical psoralen and a longer wavelength ultraviolet A (uVA) light is used.
In phototherapy, uVB, which is present in sunlight, penetrates the skin and slows the growth of affected skin cells.
Treatment involves exposing the skin to an artificial uVB light source for a set length of time on a regular basis.
There are two types of uVB treatment: broad band and narrow band. several studies have indicated that narrow-band uVB clears psoriasis faster and produces longer remissions than broad-band uVB.
During uVB treatment, the patient’s psoriasis may worsen temporarily before improving, and the skin may also redden and itch from exposure to the uVB light.
Occasionally, temporary flare-ups can occur with low-level doses of uVB, but these reactions tend to resolve with continued treatment.
uVB can be combined with other topical and/or systemic therapy (below) to enhance efficacy, but some of these may increase photosensitivity and burning, or shorten remission. systemic medications
systemic medications are oral and injected medications that work throughout the entire body and are generally used for patients with moderate to severe psoriasis.
They’re also useful for those who are not responsive, or are unable to take topical medications or phototherapy.
systemic drugs that may be prescribed for psoriasis include methotrexate, ciclosporin and the biologics.
Biologics are medicines that are made from living cells and have proven very successful in the treatment of psoriasis. unlike drugs that work on the whole immune system, biologics block only the parts that are responsible for the overgrowth of skin cells.
Biologics are taken as injections or infusions through an IV. That ensures that they bypass the patient’s stomach, where acids would eat up the protein in the drugs and stop them from working.
Patients are generally switched to biologic drugs if they: • Have tried other systemic treatments like methotrexate or retinoids but did not experience positive outcomes
• Were unable to withstand the side effects of particular medications
• Had an existing condition that made other psoriasis drugs unsafe to take
Summary Because psoriasis is unique to each patient, a treatment that works for one person doesn’t necessarily work for another, so one of the main problems with the treatment of psoriasis is finding the treatment that is best suited to the individual.
As such, treating psoriasis can be a process of trial and error, and many patients find this frustrating to the point where they can find themselves emotionally low. Patients who find themselves demotivated or ‘down’ should be signposted to their GP for extra assistance.
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