Topical steroid creams along with additives like salicylic acid, tar, anthralin and calcipotriol (Vitamin D analogue) are the mainstay of external applications. Moisturisers are added to reduce scaling.
here are many oral / injectable drugs in psoriasis. Methotrexate, Cyclosporine, Acitretin, Apremilast and Biologicals are some of these drugs which can control the disease effectively. They can be used in cyclic manner, i.e. drug is changed every 3-4 months to control the side effects. Oral steroids, which are useful in many other skin diseases, are unsuitable for psoriasis treatment (except in pregnancy when many other drugs are unsuitable.)All the special drugs mentioned below are routinely used in Alok Clinic for patients of psoriasis.
Methotrexate is effective and cheap. But it is unsuitable for people with liver problems and alcoholics. Monitoring of blood and liver parameters before and during the treatment is required. It is unsuitable in pregnancy and married females who have yet to complete the family.
Acitretin is an alternative in males. It is expensive and more useful for psoriasis of palms and soles. Once suited in an individual, it requires less monitoring as compared to other oral drugs. As the drug is not suitable in pregnancy and to be stopped 3 years before pregnancy, we in Alok clinic generally give this drug to ladies only after completion of family and after family planning surgery.
Cyclosporine is fast to act but expensive. It requires more careful monitoring of blood pressure and some blood parameters and kidney function. This is a suitable drug for children and in females during pregnancy.
Apremilast is a relatively new drug. If the patient does not develop nausea, vomiting, headache which is seen in around 7% patients, then there are no serious side effects.
Biologicals like secukinumab, adalimumab are very effective but expensive. Secukinumab is safe.