PSORIASIS Treatment

Dry Itchy Scalp & Dandruff Causes & Remedies.!

The fundamental lesion in psoriasis is probably biochemical since the disease is often present in forebears, siblings or collaterals, but its exact pathogenesis is not understood. It is a reversible change; and, if the lesions disappear, the skin is unblemished. People who are subject to the disease often develop it for no obvious reason but at other times attacks clearly follow infections (tonsillitis provokes guttate psoriasis), physical trauma to the skin (operation scars, etc.), climatic changes, endocrine disturbances (pregnancy and the menopause) and emotional upsets. It is associated with an arthritis more commonly than can be accounted for by chance ; the disorder affecting the joints is often rheumatoid in type, but some patients develop a specific psoriatic arthropathy which can be distinguished by clinical and serological methods.

Corticosteroid drugs taken systemically suppress psoriasis as a rule but the dose required to maintain the improvement is too great to make this a practicable form of treatment; and there is an impression that systemic corticosteroids may precipitate the serious pustular form of the disease. The newer corticosteroid local applications, betamethasone valerate and fluocinolone acetonide, are effective particularly when their penetration is assisted by occlusion of the area with polythene film. This method, however, carries the risk of significant systemic absorption and it is advisable to limit the periods of occlusion to not more than 12 out of the 24 hours applied to no more than one-third of the total body surface at one time. Corticosteroid applications seldom produce a permanent effect on their own and the best results are obtained by alternating them with tar or dithranol.

Psoriasis which is extensive and waxing should always be treated with respect —for fear of aggravating it or even converting it into an exfoliative dermatitis. In such cases the patient should be put to bed and given salicylates as though he had rheumatic fever, and soft yellow paraffin should be used locally.

The usual problem is to deal with localized scaly patches involving the scalp, limbs and trunk. It is unfortunate that the most effective remedies are the most messy, for example crude coal tar and dithranol. These active agents should be applied after the worst of the scales have been removed with an ointment con­taining from 2 to 4 per cent. salicylic acid in emulsifying ointment, combined with soaking in a bath and washing off the scales gently where this is tolerated. Tar is started as 2 per cent. crude coal tar in zinc paste and worked up to 10 per cent. Its effect is improved by giving ultra-violet light treatment con­currently. Dithranol is a more powerful substance and should be started at a strength of o-i per cent. in zinc paste and worked up to 2 per cent., although some patients need—and wall tolerate—greater strengths. Dithranol is unsuitable for application to the face and scalp because it irritates the eyes. For the. scalp 12 per cent. oil of cade is useful, combined with 4 per cent. of camphor and 4 per cent. of yellow oxide of mercury in emulsifying ointment. The oil of cade has a strong smell which many patients dislike ; but purified tars—which are cosmetically more acceptable—are less effective. The hair needs washing twice a week during this regimen, and soap spirit B.P.C. or any ordinary shampoo can be used. The obsessive patient will overtreat his psoriasis, and for him sedatives are indicated : externally Lassar's paste should be applied; and phenobar-bitone, 30 mg. twice daily, is often useful. The efficacy of inorganic arsenic taken bv mouth is bevond doubt. Arsenic, however, is a cumulative poison with unpleasant delayed effects, and it is doubtful whether its use is ever justified even in short courses. Recently antimitotic drugs have been used with some success but the treatment needs very careful supervision and it is too early to define its indications and limitations. It is regrettable that in many cases the psoriatic spots remain obstinately present. The physician must train himself and his patient to the view that perfectionism is not without its dangers, and that the virtues of the immaculate state can be exaggerated.

Dry Itchy Scalp & Dandruff Causes & Remedies.!