3. How do we treat Psoriasis ?

There can be substantial variation between individuals in the effectiveness of specific psoriasis treatments. Because of this,dermatologist often use a trial-and-error approach to finding the most appropriate treatment for their patient. The decision to employ a particular treatment is based on the type of psoriasis, its location, extent and severity. The patient’s age, gender, quality of life, comorbidities, and attitude toward risks associated with the treatment are also taken into consideration.Medications with the least potential for adverse reactions are preferentially employed. If the treatment goal is not achieved then therapies with greater potential toxicity may be used. Medications with significant toxicity are reserved for severe unresponsive psoriasis. This is called the psoriasis treatment ladder.
As a first step, medicated ointment or creams, called topical treatments, are applied to the skin such as topical corticosteroids, tars, anthralin, calcipotriene (a vitamin D3 analog), or tazarotene (a retinoid).
If topical treatment fails to achieve the desired goal then the next step would be to expose the skin to ultraviolet (UV) radiation. This type of treatment is called phototherapy. Treatment with oral psoralens plus ultraviolet A exposure, called PUVA, is effective in most patients, but has been associated with an increased risk of skin cancers after many treatments over several years. Recently, narrowband UVB has been introduced for the treatment of psoriasis. It uses a narrow portion of the spectrum of ultraviolet B around 311nm, the spectrum which is optimal for the treatment of psoriasis. Narrowband UVB is more effective than traditional broadband UVB, but may be somewhat less effective than PUVA. In the few years since it has been available, it has not been associated with the skin cancer risks seen in patients treated with PUVA.
The third step involves the use of medications which are taken internally by pill or injection.. This approach is called systemic treatment. Oral retinoids, cyclosporine, and methotrexate have also been used for treatment of severe generalized psoriasis, erythrodermic psoriasis, and pustular psoriasis. Most recently, biologic agents such as Alefacept, Efalizumab, Etanercept, Infliximab, and Adlimumab have been introduced for the treatment of psoriasis.
Over time, psoriasis can become resistant to a specific therapy. Treatments may be periodically changed to prevent resistance developing (tachyphylaxis) and to reduce the chance of adverse reactions occurring. This is called treatment rotation.

2. Types of Psoriasis

The symptoms of psoriasis can manifest in a variety of forms. There are four classical clinical types of psoriasisa. Plaque psoriasis (psoriasis vulgaris) is the most common form of psoriasis. It is characterized by sharply demarcated erythematous scaling plaques (as figured) It most commonly occurs on the elbows and knees, scalp and groin. Nail involvement is common, e.g., yellow discoloration, thickening, and lifting of the nail plate off of the distal nail bed (onycholysis).b. Guttate psoriasis is characterized by numerous small oval (teardrop-shaped) spots. These numerous spots of psoriasis appear over large areas of the body, such as the trunk, limbs, and scalp. It commonly occurs after streptococcal pharyngitis.c. Pustular psoriasis appears as raised bumps that are filled with non-infectious pus (pustules). The skin under and surrounding pustules is red and tender. Pustular psoriasis can be localised, commonly to the hands and feet (palmoplantar pustulosis), or generalised with widespread patches occurring randomly on any part of the body.d. Erythrodermic psoriasis involves the widespread inflammation and exfoliation of the skin over most of the body surface. It may be accompanied by severe itching, swelling and pain. It is often the result of an exacerbation of unstable plaque psoriasis, particularly following the abrupt withdrawal of systemic treatment. This form of psoriasis can be life-threatening, as the extreme inflammation and exfoliation disrupt the body's ability to regulate temperature and for the skin to perform barrier functions.

1. What is Psoriasis ?

Psoriasis is a disease which affects the skin and joints. It commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis, called psoriatic plaques, are areas of inflammation and excessive skin production. Skin rapidly accumulates at these sites and takes a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area including the scalp and genitals. Psoriasis is hypothesized to be immune-mediated and is not contagious.The disorder is a chronic recurring condition which varies in severity from minor localised patches to complete body coverage. Fingernails and toenails are frequently affected (psoriatic nail dystrophy) - and can be seen as an isolated finding. Psoriasis can also cause inflammation of the joints, which is known as psoriatic arthritis. Ten to fifteen percent of people with psoriasis have psoriatic arthritis.The cause of psoriasis is not known, but it is believed to have a genetic component. Several factors are thought to aggravate psoriasis. These include stress, excessive alcohol consumption, and smoking. Individuals with psoriasis may suffer from depression and loss of self-esteem. As such, quality of life is an important factor in evaluating the severity of the disease. There are many treatments available but because of its chronic recurrent nature psoriasis is a challenge to treat.