Psoriasis issues

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talkhealth
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by talkhealth on Mon Feb 13, 2017 2:12 pm

Psoriasis issues

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I've been diagnosed with p.s for over 2 years and have only just been referred to a specialist..
i'm finding that they are still giving me the same things that the doctors used to give me.

I have the psoriasis all over my body.. and I mean all over..
its really uncomfortable.. it feels like sunburn when I lie down on my bed..
i'm really embarrassed about it too because people notice it and I no they stop and stare..
so my confidence level really has fell below 0..
I bleed all the time also.. even one little knock will make me bleed somewhere

Can you help me with my problem?
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Dr Anton Alexandroff
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by Dr Anton Alexandroff on Mon Feb 13, 2017 10:16 pm

Re: Psoriasis issues

I m so sorry to hear about your problem.
In general psoriasis management approach uses what doctors call a treatment ladder - it starts from less effective but safer treatments and progresses to more effective but also more powerful and/or new treatments which may potentially have rare serious adverse effects or very rare potentially unknown side effects.
I also would like to make another point - if body psoriasis is inflamed - feels and looks very raw (usually evaluated by your GP or dermatologist) (inflammation of hands and/or feet only is a slightly different situation because skin in these areas is very thick and tends to behave differently) then potent topical treatment or /and phototherapy can make it even more inflamed, in a paradoxical manner, and in such cases for a short period of time very mild topical steroids and bland greasy moisturisers are used to make psoriasis more stable or systemic (oral or injection) treatments may be used.

otherwise, psoriasis treatment ladder is usually:
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 tra 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 (used off licence in the UK in some 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) more are coming but some are yet not licensed, some are yet not 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)
2) more medications are in development or/and clinical studies or/and at different stages of approval.

In the light of the above it is impossible to advise you I am afraid without seeing you in person but it sound like you may benefit from phototherapy or systemic treatments depending on a number of factors including your age, sex, other medical conditions and/or medications you may have. I wonder if you would like to make another appointment with your dermatologist to discuss treatments suitable for you.

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
www.alexandroff.org.uk
Dr Anton Alexandroff
Consultant Dermatologist, Honorary Senior Lecturer & BSF spokesperson - FRCP, CCT (Derm), PhD, FRSM, FAAD

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Dr Nisith Sheth
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by Dr Nisith Sheth on Wed Feb 15, 2017 9:35 pm

Re: Psoriasis issues

A very comprehensive answer from Dr Alexandroff which I agree with.

I think if the Psoriasis is as extensive as you describe you need specialist help and please ask your gp to refer to a consultant. When you go make a list of all the things that you have tried and the dates. These will be in your medical records but it will help make the consultation more focussed and make more efficient use of the limited time you have.
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 12:37 am

Re: Psoriasis issues

Many thanks for your question and both Drs Sheth and Alexandroff have left fantastic replies. I would also just add that you need to make sure that your lifestyle factors are also addressed and you have an open discussion with your treating dermatologist about this. Stress can often be a contributory factor and ways to manage this may help in some people in treating disease. If your psoriasis is affecting your self-esteem and stopping you living your life the way you want then help from a clinical psychologist can often be invaluable.

Best of luck,

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

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