private treatment options

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by Guest Posts on Mon Feb 13, 2017 12:36 pm

private treatment options

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Are there any treatment option available privately to get rid of psoriasis?
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Dr Anton Alexandroff
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by Dr Anton Alexandroff on Mon Feb 13, 2017 10:31 pm

Re: private treatment options

Thank you.

I am afraid it is currently impossible to cure psoriasis and management aim is to keep psoriasis under a good control and provide a good quality of life. Most treatments are currently available on both NHS and privately with rare exceptions e.g. Apremilast (brand name Otezla) is currently available mostly privately and not available on NHS in the majority of hospitals because it has not been yet approved by NICE.
The main advantages of private treatment are absence of waiting time and the convenience of seeing a specialist at a suitable for you time.
Please see current treatment options for psoriasis:

A) topical preparations
1) moisturisers and/or
2) dovobet or a new version of dovobet (enstilar foam) (this is too strong for face and skin fold areas where mild topical steroids [hydrocortisone, daktacort, eumovate, betnovate diluted 1:4] or TCI [tacrolimus, pimecrolimus - both are used off licence/off label in psoriasis] are used)
3) or/and coal tar preparations (e.g. exorex)
B) phototherapy
UVB or PUVA (this may be combined with topical preparations as above but it is not recommended to combine phototherapy with TCI)
C) classical systemic treatments (oral or injections, these treatments have to be initiated by a dermatologist and administered under a close monitoring because they are very powerful and potentially very rarely may cause life threatening side effects or e.g. may cause serious birth defects if pregnancy happens within a certain period after stopping the medication and so on. Screening and close monitoring tests are required to minimise risk of serious side effects. Adverse effects profile is different between different medicines - please consult your dermatologist and read appropriate patient information leaflets to make an informed decision on what medications you would like to try)
1) ciclosporin
2) methotrexate
3) acitretin
4) fumaderm (unlicensed in the UK but can be used privately and is also used by some NHS hospitals)

D) biologics (new drugs, injections, approved to be used in the UK by NICE in patients with severe psoriasis who failed or can not have 2 classical systemic treatments including phototherapy. Efficacy, convenience, recapture of the response rate and potential side effects are different in different biologics -please consult your dermatologist and read appropriate patient information leaflets to make an informed decision on what medication you would like to try)
1) etanercept
2) adalimumab
3) ustekinumab
4) consentyx -currently my favourite biologic
5) Taltz® (generic name - ixekizumab) is mostly available privately because it has not yet been approved by NICE

C) 'small molecules' oral treatments (a new generation of medications)
1) Apremilast (Otezla) - currently my favourite because it does not require any screening or monitoring tests. Unfortunately I understand it has not yet been approved by NICE (although it is licensed in the UK)

I hope this is helpful.
With best wishes,

Dr Anton Alexandroff CCT(Dermatol) PhD FRCP(UK) FAAD FRSM
Consultant Dermatologist and Honorary Senior Lecturer
The British Skin Foundation Spokesperson
Member of The British Association of Dermatologists
Leicester Spire Hospital, Nuffield Health Cambridge and Leicester Hospitals, Bedford BMI Manor Hospital
http://www.alexandroff.org.uk
twitter: your_skin_dr
Dr Anton Alexandroff
Consultant Dermatologist, Honorary Senior Lecturer & BSF spokesperson - FRCP, CCT (Derm), PhD, FRSM, FAAD

http://www.talkhealthpartnership.com/on ... ndroff.php

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Dr Nisith Sheth
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by Dr Nisith Sheth on Wed Feb 15, 2017 9:41 pm

Re: private treatment options

Excellent reply from Dr Alexandroff. In addition to this excimer laser can be used for limited areas of psoriasis but it is not widely available even in the private sector. Pulsed dye laser can have some benefit as well. It is more widely available but less effective than excimer laser.
Dr Nisith Sheth
Consultant Dermatologist and British Skin Foundation spokesperson

http://www.talkhealthpartnership.com/on ... _sheth.php

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Dr Anjali Mahto
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by Dr Anjali Mahto on Thu Feb 16, 2017 12:18 am

Re: private treatment options

Some absolutely fantastic and detailed responses from both of my dermatology colleagues. There is little to add to this thread!

I very much hope that the above answers help and my very best wishes,

Anjali Mahto
Dr Anjali Mahto
Consultant Dermatologist and British Skin Foundation spokesperson
http://www.talkhealthpartnership.com/on ... _mahto.php

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