Research in the past decade has led to "new, highly effective targeted therapies," with phase III data or regulatory approval. They make use of research into how immune cells like T cells and dendrocytes travel, and how they use chemical signals (cytokines) to interact with each other. The drugs follow two strategies: anti-T cell strategies and anticytokine strategies. available to psoriasis patients: 1) Taclonex Scalp, a new topical ointment for treating scalp psoriasis; 2) the Xtrac Velocity excimer laser system, which emits a high-intensity beam of ultraviolet light, can treat moderate to severe psoriasis; and 3) the biologic drug adalimumab (brand name Humira) was also approved to treat moderate to severe psoriasis. Adalimumab had already been approved to treat psoriatic arthritis.
Medications with the least potential for adverse reactions are preferentially employed. If the treatment goal is not achieved then therapies with greater potential toxicity may be used. Medications with significant toxicity are reserved for severe unresponsive psoriasis. This is called the psoriasis treatment ladder. As a first step, medicated ointments or creams, called topical treatments, are applied to the skin such as Zithranol-RR, which contains anthralin microencapsulated into a formulation of polar lipids that provide rapid release for short contact therapy (5-15 min). If topical treatment fails to achieve the desired goal then the next step would be to expose the skin to ultraviolet (UV) radiation. This type of treatment is called phototherapy. The third step involves the use of medications which are taken internally by pill or injection. This approach is called systemic treatment.
Over time, psoriasis can become resistant to a specific therapy. Treatments may be periodically changed to prevent resistance developing (tachyphylaxis) and to reduce the chance of adverse reactions occurring. This is called treatment rotation.
Antibiotics are generally not indicated in routine treatment of psoriasis. However, antibiotics may be employed when an infection, such as that caused by the bacteria Streptococcus, triggers an outbreak of psoriasis, as in certain cases of guttate psoriasis.
Cognitive Behaviour Therapy
A psychological symptom management programme has been reported as being a helpful adjunct to traditional therapies in the management of psoriasis. In the UK The Psoriasis and Psoriatic Arthritis Alliance (PAPAA) a not-for-profit charity has funded research carried out by the University of Manchester, to develop a symptom management programme called Electronic Targeted Intervention for Psoriasis (eTIPs) using a modified Cognitive Behaviour Therapy model. This research follows research by Fortune D G et al. on psychological stress, distress and disability in patients with psoriasis.
Further Reading
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