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Dr Jennifer Crawley on how to treat psoriasis

Psoriasis is a very troublesome skin condition with patches of red itchy scaling skin, sometimes with arthritis, and can be socially very embarrassing. However, it can be treated (but not cured) with a combination of creams, light therapy and drugs. Dr Crawley is a medical Dermatologist and specialises in drugs called biologics, used for severe psoriasis.
Miss Jane Olver: Tell us a little bit about the treatments that you offer to patients with psoriasis Jennifer.
Dr Jennifer Crawley: Yes, so lots of different treatments Jane. The first would be topical therapy. So by that I mean gels and creams that patients can actively put on their areas of psoriasis. There are many different types. It is important that I see patients before I can advise which topical treatment will work in each patient depending on the amount of redness, scaling, the amount of inflammation, symptoms on the skin. Sometimes light treatment in the form of UVB phototherapy can be helpful. The next step on from phototherapy in management Jane would be systemic agents or drug treatment for psoriasis.
Miss Jane Olver: Is that by tablets or injections?
Dr Jennifer Crawley: So the first step would be oral tablets. A drug called Methotrexate would be our first line agent for psoriasis. Another two, in addition, would be acitretin and ciclosporin. These drugs Jane do have numerous side effects and obviously lots of blood monitoring is very important in anyone taking these therapies. When you have psoriasis you produce too many skin cells and cell turnover is high. The medicines described above are immunosuppressant agents, in order to reduce this. If one gives drugs that cause immunosuppression, the side effects of that can be infection or perhaps long-term risk of other types of cancers. Some of the drugs can affect your liver or kidney function so it is important to monitor these tests very closely.
Then after the oral medicines Jane, if that is not improving things or people cannot tolerate it or the psoriasis is too aggressive and getting worse, then we use quite new and specialist injectable treatments.
Miss Jane Olver: So they have to go to the local hospital I imagine?
Dr Jennifer Crawley: Yes, they do and these are called biologic drugs. Once again they are targeted to block very specific molecules and cascades that we know are involved in the psoriasis pathway. But there are some side effects of those drug treatments Jane including immune-suppression and infection, to name a few. It is a very quickly advancing field and very exciting in dermatology.


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