Treatment for Psoriasis, Psoriasis Treatment in Overweight Patients

Treatment for Psoriasis

Therapy for psoriasis ranges from conservative to aggressive treatment. Due to the chronic nature of the disease, many patients try several therapies over time. Guttate psoriasis usually is managed more easily and complete remission typically occurs. In addition to standard treatment, patients with guttate psoriasis are given a course of oral antibiotics to eradicate the strep infection. Once resolved, the psoriasis remains in remission until another episode of strep infection occurs.

Most patients experience improvement with sensible exposure to sunlight and psoriasis often improves during the summer months. Sometimes artificial ultraviolet light is administered in the physician's office. In these cases, the patient is exposed to an increasing amount of ultraviolet B (UVB) or ultraviolet A (UVA) rays. UVA rays are used with an oral or topical substance called psoralen, which makes the skin more sensitive to treatment and improves its effectiveness. This treatment is called Psoralen plus UVA (PUVA).

Corticosteroids, which are available in creams, ointments, gels, lotions, and foams, are the mainstay of topical therapy. They are often used for short-term management and are often used in combination with other topical therapies. Corticosteroids may cause thinning of the skin and progressive resistance and are usually discontinued gradually.

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Prescription and over-the-counter tar medications also may be effective. These preparations are available in shampoos, as additives for the bath, and as anthralin (tar-like) creams.

Vitamin D-related ointments (e.g., calcipotriene [Dovonex®], calcitriol [Vectical™]) are also available. Many patients respond to these treatments, which often are used in combination with a topical corticosteroid. The two treatments work somewhat synergistically, enabling a more rapid resolution of lesions.

A topical retinoid (vitamin A-related) gel, called tazarotene (Tazorac®), also may be used with a corticosteroid. When used alone, this treatment can cause local irritation.

Raptiva Effective for Overweight Patients

There's good news for overweight psoriasis patients, who are typically harder to treat than people of average weight for several reasons: they are prone to larger lesions, they often have skin folds that make it difficult to use phototherapy and topical creams, and they are more likely to have other diseases that restrict their use of certain oral medications.

Researchers at Mount Sinai School of Medicine found that the injectable drug Raptiva (efalizumab) is as safe for use in heavy patients (over 200 lbs) as in non-heavy patients.

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