Treatment for Pustular Psoriasis
The distress of psoriasis is a reality for many people, but no more so than those with the condition of pustular psoriasis. Fortunately, this condition is one of the rarest forms of psoriasis and there are various treatment options available to the health-care provider and patient.
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Basics
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Pustular psoriasis is seen most often in adults, with the average age of those with the condition being 50 years old. The condition is characterized by the presence of white pustules (raised, filled eruptions on the skin), surrounded by reddened skin areas.
Treatment
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Three basic types of treatment are available for pustular psoriasis: systemic therapy, photo therapy and topical therapy.
Systemic or whole body therapy will depend in part on the type of pustular psoriasis you have: some types are generalized in nature while other types are localized in areas such as the palms of the hands and soles of the feet.
For generalized pustular psoriasis, treatment with oral retinoids (such as acitretin) may be utilized, alone or in combination with another oral agent, psoralen, a medication that allows the skin to be more sensitive to ultraviolet-A (UVA). This treatment is known as PUVA.
Due to the potential for dehydration from the draining pustules and to avoid too much strain on the heart, patients with generalized pustular psoriasis are often admitted to the hospital.
Other types of pustular psoriasis that are milder or of a chronic nature may first be treated with photo and/or topical therapy. If these treatments are unsuccessful, or if the condition is debilitating physically, socially or psychologically, systemic treatment may be used.
Photo therapy described above (PUVA) may be the treatment of choice when topical therapy has failed or when there are too many patches of pustular psoriasis to count. Ultraviolet-B (UVB) is also used to treat pustular psoriasis and may be used in combination with topical treatment(s).
Topical agents are those that are applied directly to the skin. Treatment is usually begun with topical therapy, then depending on the success of this treatment, systemic and/or photo therapy may be initiated. Sometimes two or more basic topical drugs may be combined to work most effectively for the individual condition. It is not uncommon for the basic battery of topical medications to be used on a rotating basis to avoid the side effects of the various medications. -
Medications
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Systemic medications include Psoralen, Cyclosporin, Methotrexate, Alefacept and Etanercept.
The main medications used for the topical treatment of pustular psoriasis are coal tar, Vitamin D in an ointment, cream or solution, tree bark extract, corticosteroids and topical retinoids.
Options
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Other treatments used by some psoriasis sufferers include looking to alternative medicine such as changes in diet regimen, use of supplements and reduction of stress. Although none of these alternative methods have been tested in clinical trials, you may wish to discuss interests you have in this area with your health-care provider.
Considerations
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Oral corticosteroid therapy, a systemic therapy, may bring some relief of symptoms, but when the medication is completed, the pustular psoriasis often returns.
Women who have psoriasis and are considering becoming pregnant should know that most physicians advise against treatment other that topical and photo therapy during conception, pregnancy and nursing.
Elderly persons with an outbreak of pustular psoriasis should seek immediate medical attention as these outbreaks can be life-threatening in the older population.
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