Psoriasis: treatment options + related issues



Psoriasis Treatment

My brother has terrible psoriasis on his arms and legs. He's been to a dermatologist, who wasn't really able to help. I think he should see a rheumatologist – I have RA and our mother had gout, so I suspect he might have an autoimmune condition, not just a dermatology problem. He says I'm crazy. Can you give me anything I can use to help persuade him to get checked out? The red spots are quite alarming, although he says they don't bother him. What will happen if they're left untreated?

By Dr. Rodanthi Kitridou

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You are very astute! Your brother should definitely see a rheumatologist, for several reasons:

  1. Psoriasis is not curable but is treatable and can be controlled.
  2. Up to about 6 percent of psoriasis patients may get psoriatic arthritis, of which there are four types, including psoriatic spondylitis or inflammation of the spine joints. These are special to psoriasis and can be controlled.
  3. Although RA is not exactly hereditary, some predisposing factors are. Both psoriasis and RA are relatively common diseases, seen in 0.5–1 percent of the population, and they can coexist.
  4. Yes, psoriasis is not just a local problem. In addition to psoriatic arthritis and spondylitis, untreated psoriasis causes elevation of uric acid in the blood from the skin cell turnover. If blood uric acid is continuously high for a couple of decades, then gout can develop from urate crystals accumulating in the joints.
  5. A rare complication of psoriasis called erythroderma causes diffuse inflammation of the entire skin; this requires hospitalization and can be life-threatening.

Treatment for psoriasis includes topical ointments or creams on the rash, and systemic medications taken by mouth or by injection. Most topical creams and ointments are steroid-based (cortisone-like). Ultraviolet light either as sunlight or as phototherapy is also helpful, as are Retin-A products.

Systemic medications include nonsteroidal antiinflammatory drugs (NSAIDs), mild forms of chemotherapy (also used in RA), and biologic drugs, which are medications that are aimed at specific substances that bring on the psoriasis inflammation. NSAIDs include aspirin, ibuprofen, and naproxen. Chemotherapy includes methotrexate given as tablets or injection once a week, cyclosporine, azathioprine, leflunomide (all of them are also used in RA) and injections of biologics. Some of these are the same as we use in RA, for example, etanercept (Enbrel), Infliximab (Remicade), and adalimumab (Humira). Other biologics (alefacept, efalizumab) have been tried primarily for the skin lesions of psoriasis.

As a rule, when psoriatic arthritis responds to a treatment, so does the psoriasis. Bottom line: Best to have your brother treated by a rheumatologist and a dermatologist who communicate with each other. I hope you can convince him.






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Date: 06.12.2018, 13:18 / Views: 53563