Strategy

Treatment of psoriasis

Treatment of psoriasis is an art. To treat the following guide-lines may be useful

1. Assess the extent of skin lesions. This can be done with the help of rule of nine. Up to 20% of body surface area involvement the disease may be treated with topical agents. If the extent is >20%, it is better to use systemic therapy.

2. Note whether the disease is stable or not. This can be done by noting the varied morphology of the lesions ( plaques, papules, pustules), erythema of majority of lesions, history of appearance of newer and newer lesions, increased scaling and presence of recent Koebner phenomenon.

3. If the disease is unstable: Never use irritant preparations such as coal tar, salicylates, dithranol, etc. At this phase it is better to avoid calcipotriol, calcitriol and topical retinoid. Use emollients till the disease is stable. Once the disease is stable use the extent of lesion to formulate treatment.

4.  Look for any drugs which precipitate or perpetuate the disease. Lithium, beta-blockers, NSAIDS are the common ones. It is better to review all the drugs the patient had taken in the recent past and the drugs which he is now on.

5. Evaluate the psychological status of the patient. The patient should be adequately assessed and remedial measures suggested.

6. Educate the patient. All relevant information regarding the disease, its course, prognosis and the treatment options must be given to the patient.

7. Once a treatment decision is made adhere to it. You may review the treatment regularly and make appropriate changes. Don’t change the treatment without any reason.