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.
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.
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