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Treatment options - CANCELLARE

Although no cure currently exists, there are many treatment options which can help control psoriasis and offer significant relief of its symptoms.

Psoriasis treatments aim to:

  • Interrupt the cycle that causes an increased production of skin cells. This reduces inflammation and plaque formation
  •  Remove scales and smooth the skin

Your physician will help you to decide which treatment is best for you. In addition, you may want to consider the following factors when selecting a treatment that is right for you:

  • First, the treatment should never be worse than the psoriasis itself!
  • When choosing the treatment your lifestyle, available time and your budget has to be taken into account to help decide among the options
  •  The treatment has to be used until the condition is under control or as directed by your doctor. Remember that some products should only be used for a limited period of time because of risks of side effects, so make sure you understand how long the product can be used safely.
  • Keep in mind: treatment compliance strongly influences treatment effectiveness (If you don’t use it, it won’t work! )

Types of Treatment

Treatments for scalp psoriasis can be divided into 3 main types:

  • Topical treatments (shampoos, foams, solutions, creams)
  • Light (photo) therapy
  • Systemic therapies (taken by pill or injection)

For mild to moderate scalp psoriasis, topical treatments, such as shampoos, foams and gels, can be used effectively on their own. But when the disease is more severe your doctor may prescribe a regimen of therapies to manage the disease over the long term.

Main Topical Therapies for Scalp Psoriasis Mayo clinic, NPsF

Topical Therapy ATC Classification

Main Characteristics

Formulation

Side Effects & Cautions

Corticosteroids, dermatological preparations
Topical corticosteroids

Reduces inflammation, scaling and itch

Foam
Shampoo
Lotion
Scalp solution

Always listen to your physician and read the patient information leaflet of the drugs when using steroids.
Typically these can be used in the short term (2-4 weeks) for acute disease. Side effects include stinging, burning and irritation where the product is applied, and caution should be used not to get these preparations in the eyes. May cause hair loss.

Antipsoriatics for topical use
Vitamin D3 analogs

Reduces scaling and inflammation.
Often combined with corticosteroids

Ointment
Cream
Scalp solution

Avoid contact with sensitive skin (face, eyes and lips); May irritate facial skin;
You may want to test on a small area of affected skin before covering entire scalp

Antipsoriatics for topical use
Coal Tar

One of the oldest treatments
Reduces scaling, itching and inflammation
Effectiveness varies from person to person

Shampoo, cream,
gel, oil, ointment

Few side effects but
Stains bedding and light coloured hair
Strong odour
Unpleasant smell

Emollients and protectives
Keratolytics

Softens scales; used as a skin preparation prior to some other therapies to allow better penetration

Shampoo
Scalp solution
ointment

May irritate the skin if left on too long;

Attention!

Pregnant or breastfeeding women should consult a pharmacist or physician before taking any medication, in order to avoid doing harm to themselves or their babies. Make certain that you speak to your doctor about safety issues or concerns you have about the therapy(s) he or she prescribes for you.

Light (photo) therapies mayo clinic, NPsF

Hair makes the scalp difficult to access for both natural and artificial ultraviolet (UV) light. Hand-held devices, such as UV combs, are available to help deliver high intensity UV light to the scalp. Practical tips: part your hair aside, cut it short if possible.

Main Systemic Medications mayoclinic

Oral medications and biologics may help to clear scalp psoriasis, but are only appropriate for moderate to severe cases. These drugs are potent and have side effects that must be considered before taking.

Practical Treatment Tips NPsF

Removing the Scales

In some areas of the world, it is recommended that the surface of a psoriasis plaque be “smoothed” to allow better penetration of the topical medication. Your doctor my suggest that you use a preparation containing salicylic acid or lactic acid before you apply other topical treatments. Make certain that you understand your doctor’s instructions before using this type of regimen, as it may result in additional irritation. Note that even if you do not use a pre-treatment preparation, the scalp and plaques should be kept clean using a gentle shampoo or scalp solution to remove dirt and debris from the area.

It is important to always use topical medications as prescribed by your doctor. The following tips may help you in applying shampoos or scalp solutions to help treat your scalp psoriasis:

Effective application of shampoos and scalp solutions

Do not wet your hair before using treatments for your scalp, and part your hair to expose the affected areas.

Apply treatments directly onto the exposed area of the scalp, following the line of the part.

Massage medication gently into the affected skin. Then repeat the process by making a new part about a half-inch away from the first part.

  • Treat all of the affected areas, being careful to avoid getting any medication in the eyes.
  • If your doctor has prescribed pre-treatment to smooth the plaque areas, make certain that you follow his or her instructions carefully.
  • For “leave-in” preparations, do not wash your hair or scalp during the required treatment time. Some preparations can be left in for 10 or 15 minutes, then rinsed out. It is important to follow the instructions that come with the product.

Stain protection

Here is a list of some easy and accessible household items you can use to protect from staining while treatments are active:

  • Towels
  • Plastic wrap
  • Plastic produce bags

To protect your bedding from stains, make a “treatment” pillowcase by sewing two towels together on three sides.

Keeping a Psoriasis Diary

KEY MESSAGES:
The goal of keeping a psoriasis diary is to help you and your doctor better manage your psoriasis symptoms and therapies.

A psoriasis diary can be useful for identifying triggers and determining the treatments that work well for you in relieving your psoriasis symptoms. The example diary here can help you to follow improvements in a psoriasis flare-up. Noting the factors that play a role in your psoriasis flare-ups is a small task, but it may go a long way in deciding on an effective treatment plan that works for you!

It is a good idea to take your psoriasis diary with you to your doctor’s visits. Make sure it is clear and legible. If you arrive prepared, many of the questions your doctor will ask can be answered quickly and more thoroughly.

Factors to Include in Your Psoriasis Diary:

1. When does your scalp psoriasis seem to worsen?

  • This will help you to identify what factors trigger your psoriasis flare ups
  • When looking back at your diary, you may see that your psoriasis often occurs after certain types of events (e.g. environmental factors, emotional stress, with certain medications, after drinking alcohol, etc.)

2. On a calendar, keep track of any treatments used for your psoriasis and the effect it had on your lesions

  • Make sure to record which symptoms, if any, improved after each treatment (e.g. itchiness, redness, scaling, etc)
  • Record changes in symptoms on a scale of 1 to 10, where 10 is the worse and 1 is better

Before beginning treatment for a flare-up, select and record your most distressing psoriasis symptom and note its severity.
Use the table to record the psoriasis medications you are using, and how this symptom improves or worsens with each application of your psoriasis therapy. This will help you to follow the effectiveness of your psoriasis therapy.

Took medication for the following symptom (e.g. redness, scaling, itchiness):

Severity at start of treatment: (Normal)   1   2   3   4   5   6   7   8   9   10   (Severe)

Medication Name
(formulation, dose)

Date used

Left on for how long?
(if applicable)

Symptom Severity
(1 – 10)

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