Chapter 6 – Psoriasis Treatment Options Under A Physician’s Care

When Caring for Psoriasis Yourself is Just Not Working Psoriasis is a chronic skin condition, and does not get cured.  A patient may not have any symptoms of psoriasis for months or years, but the disease remains in remission.   Any approach to the treatment of this disease must be considered for the long term. Treatment options must be developed for each individual according to age, sex, occupation, personal motivation, other health conditions, and available resources.   How severe the disease is can be partly defined by the number and extent of plaques present, but part of the definition must include the patient's perception and acceptance of the disease. Treatment must be designed with the patient's specific expectations in mind, rather than focusing on the extent of body surface area involved. A doctor will select one or several treatments for a patient based on the type and severity of psoriasis and the areas of skin affected.  A standard approach in treating a patient with a psoriasis outbreak is to start with the mildest treatments — topical creams and ultraviolet light therapy (phototherapy) — and then add additional treatments, or change to stronger ones if necessary. The most effective way to treat the symptoms of psoriasis is to interrupt the cycle that causes an increased production of skin cells, and so this will reduce the inflammation and plaque formation.  The physician is always trying to find the most effective way to slow cell production and turnover without increasing the patient’s discomfort by introducing other side effects. The biggest problem that the physician faces is that psoriasis is a very unpredictable disease.  It can improve or worsen considerably without treatment, and some solutions are of dramatic benefit to some patients and have no effect on other patients.  Also, some patients have an ability to become desensitized to a particular treatment, so what worked well for them two years ago may no longer have any effect.  Some of the strongest treatments for psoriasis have very strong side effects, and should be used with caution only on patients whose quality of life is significantly affected by the disease. If a course of treatment has been used for some time and there is little or no improvement; please have the physician review the current state of the symptoms.  It is possible that the same treatment may need more time, may need to be done more often, or may need to be changed.  Always make sure the physician is contacted about any side effect of a medication, whether or not the side effect is an uncomfortable one.   It is also a good idea for a patient to keep their own diary of the treatments to understand how the treatment works and what expectations the patient should have if a similar treatment is recommended in the future.