To expedite
such a system, a group of psoriasis and psoriatic arthritis
experts from the United States and Canada organized a
Psoriasis Treatment education therapy conference under
the support of the American Academy of Dermatology and
the National Psoriasis Foundation in November 2002 in
Louisville, Kentucky. There, a consensus statement and
guidelines of care for the management of psoriasis were
developed. Here is a list of factors that doctors and
patients can take into account before starting a specific
treatment. Disease-related factors that could influence
the effectiveness of a particular therapy include:
type of psoriasis (e.g., chronic
plaque-type versus pustular psoriasis)
extent of disease (e.g., localized
versus widespread)
area affected (e.g., hands or
feet can be disabled and require more aggressive therapy)
location (e.g., more sensitive
areas—groin or armpits—may require different
treatments)
Patient-related factors also control
which therapy will work best. These include:
lifestyle
occupation
geographic location (if at a
distance from treatment centers, it could be difficult
for the patient to
receive certain therapies, such as
phototherapy)
other health problems that
require medication (certain psoriasis medications might
interact with
other medications)
In the past, dermatologists
have classified patients according to the severity
of their disease based on the amount or extent of
psoriasis. Classifications for psoriasis included
mild, moderate or severe, depending on how much of
the patient's body surface area was affected.
If less than 10 percent of the
body surface area was involved, the patient was classified
as having
mild to moderate disease.
If more than 10 percent of the
body surface area was involved, the patient was classified
as having
moderate to severe disease.
If more than 30 percent of body
surface area was affected, a patient was deemed to have
severe
psoriasis.
This method is now falling out
of favor for several reasons. Basing the severity
of disease on the extent of involvement alone fails
to recognize other important factors that can impact
the severity of disease. For example, factors such
as the location of lesions (face, hands or feet),
resistance to prior therapies, and the impact on social
and emotional well-being of affected people are very
important, as is the impact on their quality of life.
Some of the key aspects that determine quality of
life include:
physical factors, such as the
severity of itching, irritation, pain, insomnia or inability
to use the hands
or feet
psychological factors, such as
the degree of a patient's self-consciousness, embarrassment,
frustration, anger, helplessness,
depression, stigmatization and anticipation of rejection
social impact, such as the fear of
going to social functions, shaking hands and wearing certain
types
of clothing to hide lesions
Drag Interactions
For those taking oral or injectable
therapies, it is important to educate yourself about
drug interactions, especially those that could interact
with your Psoriasis Treatment regime. For example,
certain drugs can reduce the effectiveness of the
therapy or increase the chance of side effects.
sexual impact, including feelings
of physical unattractive-ness leading to less sexual
activity
occupational impact, such as
being eliminated from certain jobs, lost days of work
due to psoriasis,
and loss of productivity due to time-consuming
treatment schedules
Depending on the above considerations,
your doctor will discuss all possible treatments with
you. You will be monitored while on the therapy; however,
if you feel the treatment is ineffective, irritating
or very inconvenient you should discuss alternatives
with your doctor.
Goals of Therapy
Define the goal of therapy with
your doctor so that together you can determine if
it is realistic and matches the type of therapy you
are currently receiving. Although complete clearing
of psoriasis is achievable with some new therapies,
it should be understood that in many cases complete
clearance might not be possible. What is possible
is significant improvement by clearing a large portion
of the disease. However, it is important to remember
that because psoriasis is not currently curable, the
disease usually does come back after clearance or
near clearance is obtained.
The time it takes for
psoriasis to clear depends on a number of factors,
which range from the type(s) of therapy being used
to the type and degree of psoriasis that presents.
In addition, maintenance therapy (the therapy that
continues after initial improvement) might be required.
Depending on the patient and the doctor, the therapy
used can range from topicals to phototherapy to systemics
to biologics.
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