Treatment options a simple guide

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1 Guide Treatment options a simple guide To decide which treatment is right for you, a good starting point is to know what options you have and to understand the pros and cons of each one. People respond differently to treatments, so it s important to find the most suitable one for you and your lifestyle. Your doctor will talk you through the options and together you ll agree upon a treatment plan. Topical (creams and ointments) Prescribed by a doctor or dermatologist for people with mild, or moderate psoriasis. Some can also be bought in a pharmacy without prescription. Topical treatments are creams and ointments applied to the skin according to your doctor s prescription or to the package leaflet. Treatment is started as soon as your doctor confirms you have psoriasis. Can be used on their own, in combination, or together with other treatments (i.e. light therapy, systemic treatments and biologics). If you are not already treated by a dermatologist, you might need to see one if your psoriasis does not respond to initial topical treatments, or if your doctor wants a second opinion on your diagnosis. Choice of treatment depends on the severity and pattern of psoriasis, and individual preference. If you are buying products over the counter, always discuss how to use them with your pharmacist and read the label to make sure you are following guidance correctly.

2 Emollients can soften scale, soothe irritation and moisturise dry skin Unless otherwise directed by your doctor or pharmacist, emollients can be applied frequently, with continued use even after your skin condition has started to improve. Emollients include: aqueous cream, emulsifying ointment, hydrous ointment, liquid and soft paraffin ointment. Emollients are made up of water, fats, waxes and oils and help to soothe, soften and moisturise the skin. Dry skin is mainly due to loss of moisture. Emollients quickly moisturise the outer layers of the skin and the oils contained in emollients form a layer over the skin, preventing further evaporation of water. Some emollients can also be used to wash with instead of soap, which can help prevent the skin becoming too dry. If you are using an emollient as a wash cream (soap substitute) or shower gel, gently rub onto the skin and rinse off thoroughly after washing. Keratolytics Vitamin D derivatives Keratolytics are preparations or creams designed to dissolve skin flakes and scales. Removing these scales can help improve the appearance of the skin and minimise further flaking. Most keratolytics are available from your pharmacist. The ingredients most commonly found in keratolytics include salicylic acid, urea, lactic acid and phenol. Your doctor or pharmacist will be able to recommend these products if this type of treatment is considered appropriate. Act by promoting normal skin cell growth and preventing excessive growth of the cells that cause psoriasis. For example calcipotriol, talcalcitol and calcitriol. If applied as directed, you may see flattening and partial clearance of psoriasis plaques.

3 Tar preparations Available as a cream, lotion, gel, bath oil and shampoo, they can be applied twice daily at home. Newer tar preparations are less smelly and messy than older products. Works by slowing down the skin cell overgrowth that is a symptom of psoriasis. Dithranol preparations Ointment used for skin areas other than the face, backs of joints and genital area. Ointment is applied to the plaques for to 0 minutes a day and then washed off. Up to six weeks of treatment is required for an improvement to be seen. Topical steroids Topical steroids are one of the first treatment options used for people with mild or moderate psoriasis (e.g. clobetasone butyrate/betamethasone). Steroid based creams should always be used as instructed by your doctor. Using more than the recommended amount can have negative effects. Short-term use of steroid creams can be very helpful when psoriasis is inflamed or when it is found in delicate areas of the body. Vitamin A derivatives Designed for treating mild to moderate psoriasis. Work by controlling cell growth and reducing inflammation (redness and irritation).

4 Light therapy 8 May be prescribed by a dermatologist. Used to treat moderate to severe psoriasis that has not responded to topical treatments. Exposure to ultraviolet (UV) light either Ultraviolet B (UVB), or psoralen (a medication applied to the skin or taken in tablet form to increase the effectiveness of light therapy) combined with Ultraviolet A treatment using specially adapted light machines under medical supervision (PUVA). UV light helps to slow down skin production, so your skin behaves more like normal skin. Your dermatologist will calculate precisely how much UVB light your skin should be subjected to. UVB Treatment is usually given two, or three times a week, for four to six weeks. PUVA combines exposure to UVA light with use of medications that are applied to the skin or taken in tablet form to increase the effectiveness of light therapy. a) Can be more successful on thicker plaques of psoriasis than UVB, as the UVA is absorbed much deeper in the skin. b) Treatment is usually given twice a week, for a period of five to eight weeks. Sunburn can worsen psoriasis, so use a sunscreen with an SPF of at least with UVA and UVB filters and re-apply it regularly. Try to cover up, or avoid being out when the sun is at its strongest between am and pm.

5 Conventional systemic therapies May be prescribed by a dermatologist. Systemic medications are prescription medications most often taken in tablet form that work on the entire body. Mostly used to treat people with moderate to severe psoriasis. There are four main options: Methotrexate, Ciclosporin, Acitretin and Hydroxycarbamide. Biologics May be prescribed by a dermatologist. Biologics have been in use for over 00 years - vaccines and insulin are biologics. They are called biologics because they are made from human or animal materials called proteins. Biologics are specifically designed to act in the body to block diseases from developing in the immune system. Biologic treatments are prescribed for patients with moderate to severe psoriasis who have not responded to other treatments, or who cannot take other treatments. 8 Methotrexate, Ciclosporin and Hydroxycarbamide all work by suppressing the immune system. Acitretin also helps regulate the skin shedding process. If your dermatologist recommends one of these treatments, they will discuss the pros and cons, so that together, you can make the best decision for you. If you are taking a systemic treatment, you will be monitored via regular blood tests and blood pressure checks to ensure treatment is progressing well. There are currently four biologics available for the treatment of psoriasis etanercept, infliximab, adalimumab and ustekinumab. These treatments work by targeting and blocking the cells which are thought to cause psoriasis, or the chemicals produced by them so that the symptoms of psoriasis are lessened. If your doctor feels this is the best course of treatment for you, they will discuss the pros and cons of each treatment with you and explain the tests you will need before starting and during treatment. Taken by injection or infusion (either in a clinic or at home depending on the specific medication). References Date of preparation: March 0 STE pso WEB FEB0 EMEA 0

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