Psoriasis is a chronic disease of the skin. It is now well known that changes in the immune system lead to inflammation and rapid turnover of skin causing redness, scale and thickening of the skin commonly seen with psoriasis. Psoriasis affects people of all ages with about 3-4% of the population suffering from this disease. The onset of psoriasis commonly peaks in the young adult age group from the late teens to the early twenties and then again in the late middle age population. Once developed, psoriasis tends to affect people for the long term unless treated, although it can fluctuate in severity along the way. It can have a significant impact on the self-esteem of patients.
Psoriasis is typically seen as red patches with silvery scale on the elbows and knees or scalp, however it can affect people in any location on the skin. Psoriasis can be itchy or tender. Once thought of purely as a disease of the skin, it is now realised that psoriasis is a systemic disease, associated with other internal medical problems such as diabetes, arthritis, heart and cardiovascular disease and depression. In some cases, it may be related to underlying infections or medications.
Sometimes other skin conditions may look very similar to psoriasis. A dermatologist will closely examine the skin and ask many questions about the changes on the skin and the patient’s history in order to correctly diagnose psoriasis. This is essential to ensure psoriasis is managed correctly.
Psoriasis generally is not well managed in our communities. Many people suffer under the misconception that nothing can be done to improve psoriasis. While psoriasis cannot be cured, many new treatments are available. At Bulimba Dermatology we can offer both traditional and cutting edge treatments for psoriasis. We can customise treatment plans for patients depending on the severity of their psoriasis and dependant on what parts of the skin are affected. There is always something that can be done to help patients with psoriasis.
Some of the treatments Bulimba Dermatology offers patients to manage their psoriasis include:
Narrowband Ultraviolet Light (phototherapy)
This safe, simple, and often very effective treatment uses a very select part of the light spectrum to penetrate the skin and reduce the abnormal growth of skin cells and inflammation in the skin of psoriasis patients. It is particularly useful when large areas of the body are affected by psoriasis. This treatment is NOT the same as indoor tanning beds.
Treatment is usually performed 2-3 times per week under medical supervision in our clinic and continues for approximately 10 weeks. Each individual treatment takes only minutes and is painless. Most patients (around 70% or more) notice significant improvement of their psoriasis with this treatment. The benefits are often seen for many months following treatment. All phototherapy treatments are bulk-billed at Bulimba Dermatology, so apart from a small facility fee the only cost to the patient is their time.
The application of creams, gels and ointments to the skin is a very traditional way of treating psoriasis. These often include topical steroid products, vitamin A medications and calcipotriol (a synthetic vitamin D agent). Salicylic acid and tar-based preparations are often used to help reduce scale and redness in the skin. When tailored to the patient and combined with other treatments, topical treatments can be a very effective and safe way of treating psoriasis for many patients.
Dermatologists at Bulimba Dermatology use both prescription and non-prescription topical treatments for psoriasis patients, individualised for greatest benefit and often combined with other treatments.
Systemic (oral medication) treatments
While generally used for the more moderate to severe forms of psoriasis, systemic treatments are also used when psoriasis has not responded to other forms of treatment. These treatments have traditionally included drugs such as methotrexate, cyclosporine and acitretin and several others used occasionally.
Systemic treatments generally require a dermatologist’s prescription and close supervision and monitoring for side effects. However, when used appropriately and with close supervision, the risk of side effects is usually kept to a minimum. Systemic treatments are not appropriate for all patients. Your dermatologist at Bulimba Dermatology will discuss the risks and side effects of systemic treatments with you to determine whether this is the right treatment for you.
Biologic (injectible) treatments
This fascinating new group of drugs for the treatment of psoriasis are often referred to as the “biologics”. These are highly specialised, immune system medications, which selectively target special parts of the immune system such as TNF-α (tumour necrosis factor), IL-12, 23, 17A (interleukins) and PD-4 (phosphodiesterase) which play important roles in psoriasis.
These special medications are generally administered by needle with several new drugs currently under development. They are proving much safer than the systemic treatments traditionally used for treating psoriasis, however, very strict criteria are set by Medicare to determine which patients are eligible to receive these costly new drugs. Your dermatologist at Bulimba Dermatology can determine whether these specialised medications are suitable and available to you under the current PBS medication subsidy scheme.
Complementary and natural treatments
Approximately two thirds of the Australian population use complementary, traditional or alternative medicines for treating common, chronic diseases such as psoriasis. This rate is continuing to increase. In some instances, despite an absence of established medical evidence, patients can find benefit in some of these treatments. Selective diet and good nutrition, vitamins, herbs and minerals, natural sunlight, exercise and relaxation techniques can often work alongside more conventional medical treatments to benefit patients.
It is important to discuss these treatments with your dermatologist at Bulimba Dermatology as not all “natural” treatments are safe and some may interact with prescribed treatments for psoriasis.