PSORIASIS

Psoriasis Treatment in Jumeirah, Dubai

Psoriasis is a long-term (chronic) skin disease characterized by red patches of skin covered with white or silvery, sometimes thick scales. Elbows, knees, scalp, back, palms and feet are the most commonly affected areas of the body. Psoriasis is not contagious, so it cannot be passed from one person to another, and it usually occurs in adults. It sometimes runs in families. Psoriasis treatments include creams, oral medications, injections and light therapy.

Causes of Psoriasis

A problem with your immune system causes psoriasis. In a process called accelerated or increased cell turnover skin cells grow too quickly and produce too much horny material that sticks to the skin as scales. Precipitating factors that make it worse include:

• Infections
• Stress
• Obesity
• Certain medicines

Types if Psoriasis

There are five major types of psoriasis, each with unique signs and symptoms:

• Plaque psoriasis – common type.

Appears as patches of raised, reddish skin covered by silvery – white scale.
Patches form frequently on elbows, knees, lower back and scalp.

• Guttate psoriasis – small red spots

Usually affect children and young adults.
Often starts after sore throat
Clears up by itself in a week or few months.

• Pustular psoriasis  – white pustules surrounded by red skin,

tends to confine itself to certain areas of the body, usually the
palms and soles and is difficult to treat, mostly requiring oral medications or injections
When widespread, the condition is called “generalized pustular psoriasis”, which is are and can be
life threatening.

• Inverse psoriasis – This uncommon type occurs when smooth, red lesions form in the skin folds. Lesions can appear in the armpit, under the breasts, and around the groin, buttocks, and genitals.

• Erythrodermic psoriasis – Causes widespread redness with severe itching and pain.  Can be life threatening.

This type of psoriasis develops frequently on the scalp and nails. It is possible to be misdiagnose as dandruff or fungal nail infection, respectively and is difficult to treat.

Psoriatic arthritis

• Inflammation of the joints. A lifelong condition that causes, pain, swelling and later stiffness in and around the joints and ultimately joint destruction.
• Between 10% and 30% of patients who develop psoriasis develop psoriatic arthritis
• Medication can help prevent joint deformities and disability if used early.

Without treatment, permanent joint degeneration and destruction can occur.

Diagnosis

In most cases, diagnosis of psoriasis is done by dermatologists. Physical Exam and Medical History – Visit your dermatologist to help you diagnose psoriasis by taking into consideration your medical history and examining your skin, scalp and nails.

• Skin Biopsy – In some cases, your dermatologist might take a small sample of your skin (biopsy). He or she will first apply a local anesthetic and then take the skin sample which is cut, stained and carefully examined under a microscope to determine the exact type of psoriasis.

What You Can Do

1. Learn about Psoriasis.  It will help you to manage the disease, make informed decisions together with your dermatologist about how you treat it, and avoid trigger that can make it worse.
2. Eat a healthy diet – exercising, not smoking and drinking very little alcohol will help. People who have psoriasis may also have an increased risk for developing heart disease, diabetes and other diseases, so practicing a healthy lifestyle is important.
3. Be aware of your joints. Consult your physician if you feel your joints are stiff and sore, especially when you wake up – it can be the first sign of psoriatic arthritis.
4. Notice your nails. If your nails begin to pull away from the nail bed or are developing pitting, ridges or yellowish-orange colour, see our dermatologist.
5. Pay attention to your mood. Depression and anxiety are more common in people who have psoriasis. Getting help is not a sign of weakness.

What We Can Do

There are three types of treatment we can offer. Our dermatologist will discuss which best suits your psoriasis.

1. Tropical Treatments – Tropical treatments include combining creams with oral medications in case the disease is severe.
• Tropical corticosteroids (cortisone) – Cortisone is a medication that is used to treat mild to moderate psoriasis. It helps to reduce inflammation and relieve itching. Mild corticosteroid ointments are usually prescribed for sensitive areas such as face and skin folds whereas stronger corticosteroids ointments are recommended for smaller and less sensitive areas.
• Vitamin D analogues –Calcipotriene (Dovonex) is a prescription cream or solution that contains a vitamin D analogue which is used for treating mild to moderate psoriasis along with other treatments. It may cause skin irritation at times. Calcitriol (Vertical) is comparatively expensive but is equally effective and less irritating than calcipotriene. These synthetic forms of vitamin D which slow down the skin cell growth.
• Tropical retinoids – Tropical retinoids are vitamin A derivatives that help reduce inflammation. The most common side effect of retinoids is skin irritation. Also, while using this medication apply a sunscreen before going outdoors since it may increase sensitivity to sunlight. Even though tropical retinoids have not been shown to cause birth defects, they are not recommended in female patients in child-bearing age.
• Calcineurin inhibitors – Calcineurin inhibitors such as tacrolimus (Prograf) and pimecrolimus (Elidel) help reduce inflammation and plaque build-up. This medication is especially prescribed to be used in areas of thin skin, such as around the eyes where steroid creams or retinoids may cause irritation. However, calcineurin inhibitors are not advised for a long-term usage due to potential increased risk of skin cancer and lymphoma.
• Salicylic acid – This medication promotes sloughing of dead skin cells and reduces scaling. Salicylic acid sometimes combined with other medications such as tropical corticosteroids or coal tar to increase its overall effectiveness. Salicylic acid is contained in medicated shampoos and scalp solutions available with or without a prescription.

2. Phototherapy – Ultraviolet (UV) light, slows the rapid growth of skin cells. This treatment uses natural or artificial ultraviolet light. It is a safe and effective treatment option. The simplest form of phototherapy involves exposing your skin to a controlled amount of natural sunlight. Alternatively, ultraviolet B (UVB) light might be used. The therapy may be used alone or in combination with topical or systemic treatments.
• UVB phototherapy – Ultraviolet B (UVB) light in a controlled amount from an artificial light source is used to treat mild to moderate psoriasis conditions. UVB phototherapy, also known as broadband UVB, is used to treat single patches, widespread psoriasis and psoriasis that is difficult to improve with tropical treatments. UVB phototherapy has short-term side effect such as redness, itching and dry skin. Using a moisturizer can help decrease these side effects.
• Narrow band (NB) UVB phototherapy – This is currently the gold standard of psoriasis UV treatment and is safer and more effective than conventional UVB treatment. Your physician may administer this treatment 2 or 3 times a week until improvements are seen, followed by maintenance which may require only weekly sessions.
• Excimer laser – This is a focused form of fNB UV light therapy that treats only smaller areas of the involved skin. Excimer laser therapy is used for mild to moderate psoriasis. In excimer laser therapy, a controlled beam of UVB light is directed to the psoriasis plaques to control scaling and inflammation.
• PUVA – Psoralen +UVA – was used to treat widespread psoriasis before NB UVB phototherapy became available and is rarely used nowadays, mainly because of safety reasons.

3. Oral medications – This is also known as systematic treatment. You may be prescribed oral or injected drugs if the psoriasis condition is severe or resistant to topical or UV light treatment alone. These medications may have severe side effects when not controlled by an experienced dermatologist and by regular clinical and laboratory monitoring.
• Retinoids – These vitamin A derivatives may help improve severe psoriasis conditions which do not respond to other therapies, in particular when given in combination with UV light. Moreover, retinoids are contraindicated in women with psoriasis in child-bearing age the due to their known potential to cause severe birth defects.
• Methotrexate – Methotrexate (MTX) is an established basic medication for psoriasis. It is taken orally in small doses (5 to 10 mg)on two days weekly only or applied subcutaneously ( i.c.) in combination with folic acid to prevent bone-marrow damage. When prescribed and carefully monitored by an experienced dermatologist, can result within weeks in a significant reduction of psoriasis activity. It also slows the progression of psoriatic arthritis is some people. Chest x-ray, liver scan, blood cell count and liver enzyme lab test are mandatory before and regularly during psoriasis treatment with MTX. Short-term side effects of MTX include upset stomach, loss of appetite and fatigue. If prescribed for longer periods in higher doses and under poor medical surveillance, it can cause severe liver damage and decreased production of blood cells and platelets.
• Cyclosporine – It is similar to MTX in effectiveness, but has a much broader and safer dose-range even when taken long Cyclosporine is an oral immunosuppressant widely given in transplantation medicine or in patients with rheumaticdiseases. Cyclosporine is contraindicated in patients with high blood pressure, with kidney disease, with active infections or with preexisting cancer and should not be combined with UV light treatment. Under regular monitoring, following established guidelines, most of the potential complications can be avoided-and are reversible when the medication is stopped.
• Drugs that alter the immune system (biologics) – These medications are given as intramuscular (i.m.) injection in two or up to 6 weeks’ intervals. They contain highly purified monoclonal antibodies to several well-defined molecules involved in the pathogenesis of psoriasis such as TNF-alpha, Interleukin 12/13 or Interleukin 17.
• Best known and widely used are TNF-alpha –inhibitors such as Adalimumab (Humira) Infliximab (Remicade) and Etanercept (Enbrel ).More recently introduced into the biologic treatment of psoriasis were the Interleukin-inhibitors ustekinumab (Stelara ), secukinumab (Cosentyx) and ixekizemab (Taltz). Most of these drugs are reserved for those patients with moderate or severe psoriasis who have failed to respond to standard or basic medications such as UV light or MTX or to those with associated arthritis. Biologics have strong effects on the immune system and therefore are contraindicated in patients with cancer or severe infection such as TBC. Otherwise, these very costly medications are better tolerated by most of our patients than MTX or cyclosporine and have, in general, a better safety profile.

Alternative Medicine

Several alternate therapies that can ease the symptoms of psoriasis. Most of these are safe and are helpful to some people in reducing signs and symptoms, such as itching and scaling.

• Aloe vera – Aloe vera extract cream is taking from the leaves of the aloe vera plant and it helps reduce redness, scaling, itching and inflammation. Use this cream for several times a day for a month or more until you see improvements in your skin condition.
• Fish oil – Fish oil supplements contain omega-3 fatty acids which help ease the inflammation associated with psoriasis. You can consume about 3 grams or less of fish oil daily until your skin condition is improved.

 

Home Remedies

Home remedies may not completely cure psoriasis, but may help improve the appearance and feel of damaged skin.

• Take daily baths – Bathing daily can improve the psoriasis conditions. Add bath oil, colloidal oatmeal, Epsom salts or dead sea salts to the bathing water and soak for about 10 minutes then gently pat dry skin. This will help remove scales and calm inflamed skin. Use lukewarm water and mild soaps that have added oils and fats. Avoid using extremely hot water and harsh soaps that can worsen the symptoms.
• Use moisturizer – Apply a heavy, ointment-based moisturizer after bathing while your skin is still moist. For very dry skin, consider using oils as they are more effective than creams or lotions and they prevent water from evaporating from your skin, keeping your skin moist. During cold, dry weathers, ensure that you constantly apply a moisturizer several times a day.
• Expose your skin to small amounts of sunlight – Exposing your skin to a controlled amount of sunlight can help ease the psoriasis conditions. Consult your dermatologist about the best way to use natural sunlight to treat your skin.
• Avoid psoriasis triggers, if possible – Study what triggers or worsens your psoriasis and take measures to prevent them. Throat Infections-especially in children, skin injuries, stress, smoking and intense sun exposure are some triggers that may worsen your skin conditions.
• Avoid drinking and overweight– If you are suffering from psoriasis, avoid drinking alcohol. Alcohol consumption may also decrease the effectiveness of some psoriasis treatments. In many adult patients, psoriasis is associated with diabetes, hypertension and hypercholesterolemia; these patients should follow a strict diet and require regular monitoring by an internist.

The Future

• Talk with your dermatologist before you stop taking your prescribed medication for psoriasis. The condition can last a long time, even a lifetime, and symptoms can come and go.
• Book an appointment today with Dr. Michael Meurer or the team of dermatologists at SHAMMA Clinic in Jumeirah, Dubai. Dubai’s finest psoriasis clinic.