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Psoriasis: Diagnosis and Treatment
Diagnosis
- A medical history and physical examination are the first steps.
Psoriasis is usually diagnosed by the appearance and location of
skin plaques.
- Blood tests are not available to confirm or exclude the diagnosis.
- In some cases, a skin biopsy may be helpful to identify the diagnosis.
- Psoriatic arthritis, which primarily affects the joints of the
hand, is diagnosed by history, physical examination, and exclusion
of other arthritic disorders, such as rheumatoid arthritis and
gout.
Treatment
Despite a wide range of therapeutic options, psoriasis can be a challenge
to treat. Treatments are based on the type of psoriasis, severity,
and areas of skin affected.
- Topical creams and ointments are the initial therapy for mild
to moderate disease. Topical corticosteroids are especially useful
for advanced disease.
Coal tar is probably the oldest known treatment and is used to
reduce inflammation, itching, and scaling. Moisturizing creams
and ointments can also reduce itching and scaling. However, lotions
have the reverse effect. Medicated shampoos are used for scalp
lesions.
- Phototherapy is known to be beneficial and is used especially
for widespread disease. Options include natural sunlight (lesions
usually improve during the summer) or ultraviolet radiation. Phototherapy
may be combined with topical treatments to increase efficacy.
- In severe disease, oral medications may be necessary. Options
include oral retinoids (e.g., acitretin), methotrexate with folic
acid, azathioprine, cyclosporine, sulfasalazine, and hydroxyurea.
These can have significant side effects and cannot be used in pregnant
women.
- Psychological approaches may be valuable in individuals with
psoriasis. Stress plays an important role in the onset, exacerbation,
and prolongation of the disease, and may decrease the effectiveness
of treatment. Some evidence indicates that hypnosis and cognitive-behavioral
therapy reduce symptom severity.
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