Treating psoriasis

Tachyphylaxis. PUVA. What do these mean? Is methotrexate safe during pregnancy? Can vitamin D treat psoriasis? Learn more about some of the medications, issues, and side effects of treating psoriasis.

What is tachyphylaxis?
No, it's not a disease. It can be a side effect of applying corticosteroid preparations to the skin. It occurs when the medication becomes less effective over time. In a sense, the psoriasis becomes resistant to the treatment. Tachyphylaxis can be prevented by using a non-medicated ointment for 1 to 2 weeks as a rest period in between treatments with the corticosteroid.

What psoriasis medications can be taken during pregnancy?
If you have psoriasis and plan on becoming pregnant, you should talk to your doctor about the best medication for you. Many psoriasis medications are not suitable for pregnant and nursing women. Some must never be used during pregnancy. Women who are pregnant or are planning to get pregnant must not use retinoids applied to the skin (e.g., tazarotene) or taken by mouth (e.g., acitretin), hydroxyurea, 6-thioguanine, or methotrexate, as they pose a risk of birth defects. For other medications, such as topical (skin-applied) corticosteroids, the safety of use during pregnancy has not been established. Speak to your doctor to find out what options are available.

Is it true that vitamin D can treat psoriasis?
Not exactly. However, there is an effective psoriasis treatment called calcipotriol that has a structure similar to that of vitamin D3. It's available as a cream, ointment, or scalp solution. The beneficial effects of this medication may take 6 to 8 weeks to show best results, so don't stop using it until you've given it enough time to work. The fastest improvement is seen when this medication is used together with topical corticosteroids. The two medications cannot be physically mixed by a pharmacist due to instability concerns, but a new stable pre-mixed combination product is now available. Calcipotriol shouldn't be used on the face. You should limit the amount you use to 100 g per week to prevent a potential side effect called hypercalcemia - a higher-than-normal amount of calcium in the blood.

What is PUVA?
PUVA is a form of phototherapy that stands for psoralen plus ultraviolet light A. It combines a psoralen medication with UV light. Psoralens are light-sensitizing chemicals. PUVA is useful when psoriasis covers more than 10% of a person's skin. After treatment, you must protect your eyes from UV light (sunlight) for 1 to 2 days with UVA-blocking glasses and must protect your skin to prevent sunburn. Phototherapy can increase the risk of skin cancer.

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