PSORIASIS TREATMENTS

Lubricants - petrolatum

Lubricants for psoriasis are very effective in reducing fissuring of skin and preventing skin breakdown.

Salicyclic acid 1-12%

Salicyclic acid removes scales effectively.

Tar (known as LCD: Liquor carbonis detergent)

20% coal tar solution - this agent is effective in preventing the synthesis in DNA in the skin cells, thereby preventing them from replicating quickly and causing the plaques to form

Calcipotriene Dovonex TM Dovobet TM

Dovonex / Dovobet are agents that are vitamin D analgues that bind to skin vitamin D3 and inhibit skin proliferation - these agents are never to be used on the face or the skin folds, as these areas have very thin skin and may be prone to weakening and thinning, that is irreversible

- Dovobet TM is just calcipotriol combined with betamethasone, a very strong steroid - this medication is believed to be the most potent topical medication of all for psoriasis

Topical Steroid Creams

Topical steroid creams in psoriasis mainly act by preventing further skin growth and inhibiting the immune system - decrease scaling and reduce thickness of the skin

Tazarotene Tazarac TM

This is a retinoid / vitamin A derviative that acts like Accutane Roche TM - main use is on nails

UVB ultraviolet B radiation UVB 290-320 nm

This is used mainly with topicals - sunlight has a anti-scaling / anti-psoriasis property

PUVA psoralens and long wave ultraviolet radiation

PUVA this is psoralens and UVA radiation

Psoralen Phototherapy

Psoralen is a chemical agent which is a linear furocoumarin found in numerous plants, but can also be made synthetically. Psoralens are appplied topically as either solutions or baths or can be given orally. They are then followed with UVA light exposure at 350-360 nm wavelengths which act by putting the psoralen into the DNA of skin cells which subsequently prevents these cells from further replicating and thereby stopping the formation of scales, plaques and psoriatic lesions.

Systemic Psoriasis Treatments

Methotrexate

Methotrexate is an anti-folate which basically gathers up a cells folate, which is a critical component of DNA, thereby removing the cell of its ability to make DNA and replicate. Methotrexate is also used for cancer, and arthritis. It is a well-known drug, very cheap in cost, but has numerous side effects, which include bone marrow toxicity and hepatic cirrhosis.

Acetretin

Acetrin is also known as soriatane, and is a vitamin A derivative that is very effective in treating psoriasis in combination with other medications.

Cyclosporin

Cyclosporin is an agent specifically inhibits immune cells of the T cell lineage to stop replicating, thereby removing the cells and stimuli that cause psoriasis. These agents are not used much due to their toxic profile, which includes renal toxicity, high blood pressure, and suppression of the immune system

Steroids

Systemic steroids are never used in psoriais due to an enormous rebound effect when stopped

 

Biologics for Psoriasis

Amevive

Amevive inhibits T cell activation - approved for use in Psoriasis

Enbrel

Enbrel blocks cytokines, TNF alpha

Remicade

Remicade blocks cytokines, TNF alpha

Raptiva

Raptiva inhibits T cell activation and co-stimulation