Psoriasis, a chronic skin condition with an elusive cause, disrupts the natural balance of skin cell turnover, resulting in thick, flaky skin. Contrary to some misconceptions, psoriasis is not infectious and cannot be spread, but its impact on the quality of life for those affected and their loved ones is profound.
In the quest to manage psoriasis effectively, several standard approaches have proven successful:
1. Topical Solutions: The Foundation of Psoriasis Treatment
Topical treatments form the cornerstone of psoriasis management. Key topical options include:
Steroid Ointments: These ointments help alleviate inflammation and are commonly used.
Tar-Based Preparations: Group medications with tar components are effective against psoriasis.
Vitamin D Derivatives: Salves containing vitamin D derivatives aid in controlling skin cell overgrowth.
Calcineurin Inhibitors: Non-steroidal anti-inflammatory ointments, known as Calcineurin Inhibitors, can also be beneficial.
2. Oral Medications: Targeting Extensive Psoriasis or Psoriasis arthritis
Patients with moderate to severe psoriasis often benefit from oral medications that inhibit the excessive growth of skin cells. Commonly used drugs include:
Methotrexate (MTX): A longstanding treatment, MTX effectively manages psoriasis. However, it requires regular monitoring due to potential side effects.
Acitretin: This vitamin A derivative helps modify skin cell division and reduce inflammation without suppressing the immune system. Precautions are necessary, especially for women of reproductive age.
Cyclosporin (CyA): Highly effective in reducing inflammation, Cyclosporin is not without side effects, as it suppresses the immune system. Its use requires careful medical supervision.
3. Harnessing Artificial Sunlight for Relief
Artificial sunlight, specifically ultraviolet (UV) light therapy, is a valuable tool for treating psoriasis. UVB and UVA light reduce inflammation of skin cells without affecting internal bodily systems. Properly adjusting the light and therapy should always be administered under the guidance of a medical professional.
4. The Power of Biologic Injections
Biologic drugs, widely used internationally and in Thailand since 2004, are highly effective injectable treatments. In Thailand as of 2022, there are two main subgroups of biologic drugs:
Anti-TNF (TNF Alpha Inhibitor) Drugs: These drugs significantly reduce skin inflammation and include medications like Etanercept, Infliximab, and Adalimumab.
Anti-Cytokine Drugs: Targeting proteins that trigger inflammation, this group includes drugs such as Ustekinumab, Secukinumab, Ixekizumab, Brodalumab, and Guselkumab.
5. Combination Therapy: Enhancing Treatment Efficacy
Combination therapy involves integrating multiple treatment methods for improved efficiency and minimized side effects. The collaborative approach ensures more comprehensive psoriasis management.
Each treatment approach carries its own set of advantages and disadvantages, making the choice of therapy not solely dependent on efficacy. Other considerations, including potential side effects, plan of pregnancy, financial cost or even logistical factors like travel, must be taken into account.
Ultimately, selecting the right treatment approach should be a collaborative decision between patients and medical professionals, with room for adjustments as needed.
Assoc. Prof. Premjit Juntongjin, MD