Active Ingredient: Isotretinoin
Currently, several biological agents are being used or evaluated for treating severe psoriasis.
Except for being prohibitory expensive, these apparently have an advantage over current systemic therapies, as systemic adverse effects do not mar their efficacy. The voluminous literature on treatment of psoriasis is itself indicative of limitations of any therapy.
It is often confusing while selecting a treatment regimen as most treatment schedules are aimed to decrease disease severity and extent that it no longer interferes with occupation, personal or psychosocial well-being of the patient.
As psoriasis is a chronic life long disease, safety of a treatment during long-term use too is of major concern.
To date there is no absolutely safe, simple and inexpensive treatment for psoriasis and the selection of various strategies has to be individualized. Intermittent or rotational therapy with frequent alterations in treatment options is employed to reduce toxicity of anti-psoriatic drugs while search for safer alternatives continues.
As management of triggers for flare-ups, lifestyle modifications, and dietary supplements are recommended frequently, it will be prudent to briefly review them alongwith few first line therapies. MANAGING TRIGGERS Despite the knowledge accumulated during past few decades that psoriasis is an immune mediated, regeneration-like reaction of the skin in genetically predisposed individuals wherein various cells including keratinocytes, antigen presenting cells, and T-cells play a dominant role at different stages, the exogenous factors which trigger psoriasis or induce flare-ups are poorly understood.
Exacerbation and persistence of psoriasis has been attributed to increased hyper-reactivity to superantigens that are usually viral or bacterial proteins.
Bacterial Staphylococcus aureus, Streptococcus sp. Balci et al found a high prevalence of colonization of skin lesions and nares of psoriasis patients by toxigenic strains of Staphylococcus aureus as compared to healthy controls.
They also observed a significant relationship between PASI scores and toxin production and suggested association between psoriasis and non-classical superantigens such as mecA, etb and see.
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