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How to treat psoriasis effectively – By Franziska Ringpfeil, Board Certified Dermatologist


Let’s say you or one of your loved ones have just been diagnosed with psoriasis. It can feel overwhelming. Perhaps you never heard about it, perhaps you have heard the word but could not imagine what it means or perhaps you know a bit about it and think of horrific scaling over the entire body. For centuries, psoriasis was believed to reach only skin deep. Recent advances in science has shed light on this condition that affects our entire body and it has also enabled many more targeted treatments. I will provide you with crucial information that allows you to take charge of your body and I will point out the state of current treatments.

Psoriasis affects the skin and joints but is actually linked to a greater scheme, the metabolic syndrome. In simple terms, the metabolic syndrome is a constellation of markers that make you more susceptible to developing heart disease and diabetes. These markers are central obesity, high blood pressure, elevated fasting sugar levels, high triglycerides, and low levels of HDL, the “good” cholesterol. It is estimated that about 25% percent of the adult population in this country has metabolic syndrome. Obesity has been shown to be an independent risk factor for developing psoriasis, and specifically more wide spread psoriasis. The most important trigger for psoriasis, however, is stress. It is currently thought that inflammatory mediators bring about the changes on the skin resulting in the characteristic rash. These same inflammatory mediators can cause havoc on the inside of our body, especially when you have risk factors for cardiovascular disease. By reducing these risk factors, you will not only influence the downward sequelae of psoriasis but you may also reduce the triggers. Sure, everyone talks about the importance of a healthy life style and many of us have become immune to this sentence.

But in this case you really should take it to heart. Start with a healthy well balanced diet that has very little animal protein and fat but lots of different fruit, vegetables, pulses and grains. This will regulate your weight, will reduce cholesterol and triglyceride levels and it will reduce inflammation that occurs in response to animal protein and the hormones the livestock was fed. Avoid added salt in your diet. This will take burden of heart by reducing blood pressure. If you struggle with being overweight, your family doctor may recommend that you work with a dietician. Meaningful weight loss is crucial and crash diets must be avoided. Next, think about daily exercise and implement it.

Twenty to thirty minutes of exercise should fit in our schedule no matter how busy we are. You may be walking vigorously during your lunch break or perform your favorite workout in the gym. Practice stress control. Stress is the most important trigger for psoriasis and while not all stressors can be avoided, we can learn how to deal with stress without letting it overwhelm us. Many times, regular exercise can provide the time to process our stress in a constructive manner. Some of us will do better by learning stress controlling techniques such as meditation or Yoga. See your family doctor regularly. Have your blood lipids, namely triglycerides and cholesterol, blood sugar levels as well blood pressure checked yearly during a physical to catch any changes early. Sometimes, it will be necessary to take medication to keep these low. Avoid smoking at all cost because nicotine tightens the blood vessels, thereby raising blood pressure and making your heart work harder. Drink alcohol in moderation. While you are optimizing your lifestyle, you can start treatment for the psoriasis spots that your skin has already formed.

Excimer laser treatment is considered one of the most effective and safest treatment when psoriasis affects only limited areas on your skin. The excimer laser is used in your dermatologist’s office to deliver narrowband UVB rays just to psoriasis spots, avoiding exposure to unaffected skin. It takes several brief treatments to start the process and once clear, remission of 6 months or longer can be achieved.

Daily application of topical steroids alone or in combination with vitamin D analogues are used to treat localized psoriasis with good response. Various formulations such as foams, solutions, creams and ointments are available to best treat different areas of the body. It is important to cleanse the skin daily with a gentle non-soap cleanser to allow the medicine to penetrate into the skin. However, excessive exfoliation or rubbing of psoriasis with a brush or comb must be avoided because this may stimulate more psoriasis. When psoriasis affects larger areas of the body, topical treatment may be impractical and a systemic approach is most appropriate. In wide spread psoriasis, narrowband UVB rays are administered inside a light box. Recent advances in medicine have also allowed the development of very effective systemic medications that are administered in your dermatologist’s office or at home by injection.

Oral medications are an option for those who are not candidates for the treatments I just mentioned. Some of these systemic medications also treat the loints when affected..