Menter A, Korman N, Elmets C, et al; American Academy of Dermatology. Guidelines of care for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol 2009; 60: 643–59. DOI: 10.1016/j.jaad.2008.12.032. PubMed
People with chronic plaque psoriasis often have lesions on the scalp. Hair makes the scalp difficult to treat and the adjacent facial skin is particularly sensitive to topical treatments.
Newer drugs are in development and no doubt will be available in the near future. As this class of drugs is fairly new, ongoing monitoring and adverse effect reporting continues and long-term safety continues to be monitored. Biologics are all comparatively expensive especially in view of the fact they none of them are curative. Recently, the FDA has attempted to address this problem by permitting the use of "biosimilar" drugs. These drugs are structurally identical to a specific biologic drug and are presumed to produce identical therapeutic responses in human beings to the original, but are produced using different methodology. Biosimilars ought to be available at some fraction of the cost of the original. If this will be an effective approach remains to be seen. The only biosimilar available currently is infliximab (Inflectra). Two other biosimilar drugs have been accepted by the FDA, an etanercept equivalent (Erelzi) and an adalimumab equivalent (Amjevita) -- but currently, neither are available.
Psoriasis: the Facts Here are 10 more psoriasis triggers you can avoid. See the DermNet NZ bookstore. A dermatologist may be able to diagnose scalp psoriasis by examining the rash. Sometimes, they may recommend a skin biopsy to rule out other conditions.
There are several different types of treatment for psoriasis. Your doctor may recommend that you try one of these or a combination of them: More Information
Tropical Dermatology in Tanzania 1The Mount Sinai School of Medicine, New York, NY, USA Psoralen and ultraviolet A phototherapy (PUVA) combines the oral or topical administration of psoralen with exposure to ultraviolet A (UVA) light. The mechanism of action of PUVA is unknown, but probably involves activation of psoralen by UVA light, which inhibits the abnormally rapid production of the cells in psoriatic skin. There are multiple mechanisms of action associated with PUVA, including effects on the skin's immune system. PUVA is associated with nausea, headache, fatigue, burning, and itching. Long-term treatment is associated with squamous cell carcinoma (but not with melanoma). A combination therapy for moderate to severe psoriasis using PUVA plus acitretin resulted in benefit, but acitretin use has been associated with birth defects and liver damage.
Chronic administration of methotrexate has been associated with the development of hepatic fibrosis. For a number of reasons documented in the literature, the frequency of hepatic fibrosis appears to be increased in patients with psoriasis compared to patients with rheumatoid arthritis. Consequently, guidelines call for periodic liver biopsies to monitor patients with psoriasis treated long term with methotrexate. Liver biopsies are recommended after 1.5 g cumulative methotrexate dose and approximately every 1.5 g thereafter if liver function tests are normal.29
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Give your child emotional support. Many kids who have emotional problems due to their psoriasis can benefit from talking with a therapist or joining a support group of people who understand the challenges of dealing with psoriasis.