In psoriasis, a chronic inflammatory skin disease, treatment is tailored stepwise from mild to severe cases by evaluating plaque extent, joint involvement, and quality of life.
Indication
- Plaque-type psoriasis (thick silvery-scaled lesions on the trunk, elbows, knees, and scalp)
- Guttate, inverse, pustular, and erythrodermic forms of psoriasis
- Nail involvement (pitting, thickening, color changes)
- Psoriatic arthritis (psoriasis-related joint pain, morning stiffness, dactylitis)
- Moderate to severe plaque psoriasis unresponsive to topical therapy (PASI ≥10 or significantly impaired quality of life)
- Treatment-resistant special-site involvement such as scalp, palms-soles, and genital area
Preparation
- Appointments with active lesions are appropriate for body surface area calculation and PASI (Psoriasis Area and Severity Index) scoring
- Previous treatments, duration of use, and treatment-response details should be noted
- Tuberculosis screening, hepatitis B/C, and HIV testing are planned before systemic or biologic therapy
- Vaccination status (especially live vaccine history) and chronic infection presence should be reported
- Co-existing metabolic syndrome, cardiovascular disease, and depression symptoms are screened
How it's performed
- Severity classification (mild/moderate/severe) is performed using clinical examination and the PASI score
- Mild cases: combination of topical corticosteroids, calcipotriol (a vitamin D analog), and moisturizers
- Moderate to severe cases: narrow-band UVB or PUVA phototherapy planned 2-3 sessions per week
- When systemic therapy is needed, methotrexate, acitretin, or cyclosporine are evaluated
- Biologic agents (anti-TNF, IL-17, or IL-23 inhibitors) are planned for cases unresponsive to conventional therapy or those with arthritis involvement
- Multidisciplinary follow-up is arranged for accompanying metabolic and psychosocial issues
Post-procedure
- Topical therapy follow-up every 4-6 weeks; phototherapy response is evaluated after an average of 20-30 sessions
- Blood tests (liver, kidney, complete blood count) every 1-3 months during systemic therapy
- Infection screening and a vaccination program are continued for biologic-agent users
- Annual blood pressure, lipid, blood glucose, and weight monitoring (cardiometabolic risk)
- Joint review with rheumatology if joint pain or swelling develops
Risks
- Skin thinning and atrophy from long-term use of high-potency topical steroids
- Phototherapy: burning, dry skin, and increased long-term skin cancer risk
- Methotrexate: liver toxicity, bone marrow suppression; cyclosporine: kidney and blood pressure effects
- Increased infection risk and reactivation of latent tuberculosis with biologic agents
- Risk of disease rebound (recurrence in a more severe form) when therapy is suddenly stopped
FAQ
Is psoriasis contagious?
No. Psoriasis is not contagious; it develops as a result of the immune system reacting against the body's own skin cells. It is not transmitted to family members through contact.
What is biologic therapy, and is it lifelong?
Biologic agents target specific immune signals (TNF-alpha, IL-17, IL-23). Treatment duration is individualized based on response, joint involvement, and side effects.
Does psoriasis go away completely?
Psoriasis is a chronic disease; permanent cure is not guaranteed. Modern treatments can provide long remission periods and substantial improvements in quality of life.
I also have joint pain — could it be related to psoriasis?
About one in five psoriasis patients may develop psoriatic arthritis. Early evaluation is important if joint pain, morning stiffness, or finger swelling occurs.
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PRP Therapy
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