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KULIT – Living with Psoriasis PDM Campaign 2007 (Article 6 – ‘T’ – Treatment)

Yes, psoriasis can be treated This six-part KULIT article series by the Persatuan Dermatologi Malaysia aims to raise awareness of psoriasis. In this final article, PDM President Dr Allan K C Yee highlights an important message for people with psoriasis – there is no cure yet for psoriasis, but its symptoms can be effectively treated and managed. Be open-minded and willing to work with your doctor to find a treatment that will work for you. The object of treatment is to reduce the extent and severity of psoriasis – the red scaly stigmata, the tell-tale scaling on one’s clothes, the rough cracked palms that make handshakes awkward, painful joints that limit one’s activities. In short, the goal is to improve the quality of life which has been shown in studies to be as affected as much as other major diseases such as cancer, heart disease and depression. The good news is that with today’s medical armamentarium, much can be done to allow the sufferer a greatly improved quality of life.

Treatments must be individualized Fortunately, only 20% of psoriatics suffer from severe psoriasis, and the site involved is so variable that the treatments must be individualized. Limited disease can be treated with topical agents but more extensive skin involvement will require oral systemic treatments, phototherapy with artificial UV light, or even injectable agents (biologics). Furthermore psoriasis can affect any part of the body, each meriting special measures.

Site-specific treatments For instance, thick scalp psoriasis is often mistakenly treated with endless anti-dandruff shampoos with little results. Scalp psoriasis invariably responds dramatically to tar pomades under occlusion for one to two weeks, a tip that an experienced dermatologist would gladly share with sufferers. Similarly, thick and cracked scaly palms and soles that prevent working with the hands or sometimes even walking, can be significantly improved with special steroid-salicylic acid ointments used under occlusion. These soften and shed the thickened dead skin making the skin pliable and usable once more. Psoriasis affecting the face, body creases – groins, armpits and private areas can be improved with the judicious use of weaker topical steroids and the newer and safer nonsteroidal calcineurin-inhibitors. The problem is that these thinned skinned areas are often treated with strong steroid creams that are not meant to be used in these sensitive areas. The end-result is irreversible side-effects such as ugly pink stretch marks, easy bruising and skin

infections. We see a lot of these unfortunate cases who are sold these strong steroids from errant pharmacies without a prescription, or are introduced to them by well-meaning friends and relatives. The Dermatological Society of Malaysia is working with the Ministry of Health to ensure that potent steroids are only available with a prescription. The treatment should not be worse than the disease! Hopefully with warnings such as in this article, the lay public will be better informed about the dangers of self-medicating with potent topical steroids.

Topical Treatments Generally, when the extent of psoriasis is limited to less than 5 – 10% of the body surface area (BSA), it is best to use topical treatments in the form of creams, ointments, lotions. As a guide, 1% of the BSA is the area covered by one’s palm. The red, thickened skin in psoriasis is due to the increased multiplication of the skin, allowing the collection of the dead skin layer to be manifested as thick scales. Most effective treatments whether topical or systemic work by reducing the cell multiplication, and by removing the dead skin layers. Time tested agents are coal tar, and anthranols which are messy and brown-staining thus adding further to the stigmatization sufferers feel. More cosmetically acceptable topical agents are steroid creams, vitamin D analogues and...
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