How to cure psoriasis?

The aim of therapy is to minimize the extent and severity of psoriasis to the point at which it is no longer detrimental to a patient’s quality of life. Treatment choice should be guided by the expectations and needs of each individual patient. Patient should understand that psoriasis is a chronic disease and the treatment will only CONTROL the disease but NOT CURE it. Psoriasis is quite a common disease in daily dermatology practice and a non-communicable disease.

What is the role of lifestyle in management of Psoriasis?

Healthy lifestyle in form of regular exercise, yoga, meditation, mind relaxation techniques helps to relieve stress which is one of the major triggers of this disease. Also reduction in alcohol consumption, cessation of smoking and maintenance of ideal body weight (BMI of 18.5-24.9) helps in therapy. Besides above, medications like Beta blockers, Lithium, Anti-malarials etc. and Bacterial/ Viral infections can also trigger the flare-up of disease. Thus, timely cure of infections and substituting the causative medication is very important.<

What are different options for treatment of psoriasis?

Choice of therapy should be individualised. A patient may be prescribed simultaneous multiple therapies depending on the severity of the disease and expertise of treating dermatologist. I am briefly listing the various treatment options in this article:

• Topical therapy (creams and emollients): First line therapy for patients with mild disease. Emollients like petrolatum, mineral oils, glycerine etc softens and smoothens the stratum corneum (uppermost layer of epidermis) and helps in retaining the moisture in the skin. Steroid creams (from low to highest potent) are prescribed for application for limited period on the affected areas due to their anti-inflammatory, vasoconstrictive, immunosuppresive and anti-proliferative effects. Other creams like keratolytics, Anthralin, Calcineurin Inhibitors, Tars, Retinoids, Vitamin D analogues will be prescribed depending on various factors like thickness of plaques, response to previous therapy etc.
• Phototherapy: Phototherapy is generally used in patients with moderate degree of affection or in patients with psoriasis in vulnerable areasthat are not responsive to topical therapy or if certain mitigating symptoms are present. History of  skin cancer in patient or first degree family members, photosensitive disorders, medications that increase the photosensitivity of skin are known contraindications to phototherapy. Patient should be instructed to apply emollients during the phototherapy sessions to increase its efficacy. An effective sun-block should be applied to unaffected skin (if possible). Areas like breasts, eyes and genitalia should be adequately covered during the sessions. There are various types of phototherapy modalities available like broad band and narrow band UVB, Psoralen UVA (PUVA), 308nm Excimer LASER etc.
• Systemic therapy (Non-Biological): Various agents include Cyclosporin, Methotrexate, Mycophenolic Acid, Acitretin etc.These agents are indicated in following circumstances:
  • Disease cannot be controlled by topical therapy
  • Total well being (physical, social, psychological) of the patient is affected by the disease.
  • Diagnosed severe disease and/or localized affected part significantly impaired or distressed and/or failure of phototherapy.
• Systemic therapy (Biologics): Various agents in this category include adalimumab, alefacept, itolizumab, efalizumab, etanercept, infliximab etc. and these may be considered for patients with:
  • Severe disease which should be quantified with psoriasis area severity index (PASI) and dermatology life quality index (DQLI) and documented.
  • At high risk or has developed clinically significant drug related toxicity and alternative standard therapy cannot be utilised.
  • Intolerance and failure to respond to standard systemic therapy.
  • Severe, unstable, life-thretening disease.
  • Psoriatic arthritis making the patient eligible for anti-tumour necrosis factor agent therapy.

Patients should not self medicate, as all these medications have side effects. These medications should be taken only ON PRESCRIPTION of a QUALIFIED DERMATOLOGIST. Regular follow up is a must for better results.

What is the average duration of treatment?

Duration varies depending on the modality of treatment utilized by the treating dermatologist and the severity of disease. Average duration is between 6 months to 1 year.

What are the common side-effects of treatment?

Side effects are many to be enumerated however not all patients will develop these side effects, also if these medications are administered under care and supervision of a qualified dermatologist then the side effects or adverse events related to these medicines can be avoided.

THIS ARTICLE IS AUTHORED BY Dr. Chirag Desai

Dr. Chirag Desai is a consultant dermatologist, aesthetic physician and dermatopathologist practicing in Mumbai since 5 years. After his dermatology training he had been awarded a fellowship in pediatric dermatology by the Indian association of dermatologists(IADVL). He is also a university certified dermatopathologist, trained at KEM Hospital, Mumbai. He has also been certified by Kaya skin clinic, in performing various aesthetic procedures.

Clinic address: Kasturmahal Polyclinic, Flat no. 3, C-wing, Kasturmahal Bldg, Above Kamal Photo studio, Opp. Canara bank, Sion, Mumbai-22 Mon-Sat 6 to 8pm. and at Parakh Hospital, Ghatkopar (East) (By prior appointment)