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Psoriasis and Treatment Failure: What to Do When Nothing Works? © triocean / iStockPhoto
There are many treatments for psoriasis, depending on the severity of the condition. Not all treatments are available at your local dermatologist. What should you do when treatment fails?
Sometimes, topical treatment is enough to treat psoriasis. For some, more intensive therapies are necessary. But sometimes these approaches are not enough, and the patient’s quality of life continues to be greatly diminished by this genetic skin disease, with a significant impact on their psychological state. What should be done if treatment fails to combat psoriasis? Dr. Marc Perrussel, dermatologist, discusses last-resort options.
Marc Perrussel begins by reminding us that psoriasis cannot be cured. But some treatments allow for remission, which can be very long-lasting, to the point of significantly improving the patient’s quality of life. This is the goal that doctors are aiming for. Depending on the severity of the condition, we adapt the treatment of this condition, which causes the skin to renew itself too quickly, causing red patches topped with white scales of varying thickness and well-defined areas.
Local or systemic treatment for psoriasis
First, there are two types of psoriasis: mild and severe. The first is treated with a combination of vitamin D and dermocorticoids, in an appropriate dosage form: “when the plaques are thick, we choose an ointment, when it is oozing, we opt for a cream, for the scalp we prefer a lotion or a foaming gel,” he explains. We speak of a severe form when the plaques cover more than 10 times the surface of the palm of the hand, or 10% of the body, or when the locations are bothersome, in the folds, the face or even the nails, with a risk of seeing the disease evolve into psoriatic arthritis.
In this second case, we opt for a general treatment. “According to the regimen currently recommended by the HAS, at your local dermatologist’s, you can be prescribed classic systemic treatments, such as methotrexate, retinoids, cyclosporine, which is an immunosuppressant, or even PUVA therapy sessions (in UV ray cabins). But these treatments, which are the most common, are not always enough to provide long-term relief for patients.”
In case of treatment failure, go to the hospital
There is another option, the last resort, biotherapy treatments. In case of treatment failure, you must go to the hospital, explains the dermatologist: “These treatments cannot be prescribed outside of the hospital environment.” These are treatments discovered 20 years ago, anti TNF alpha, anti interleukins 12, 17 and 23. “Their principle is to be immunoregulators. An antibody blocks the interleukin, which prevents communication and self-excitation of the immune cells that cause psoriasis.”
As a reminder, this disease is linked to excessively rapid renewal of the skin, “keranocytes, cells making up the epidermis which produce keratin, renew themselves every 7 days, instead of 21 days,” explains the French Eczema Association.
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