Agora, India
On June 19, 2010 in Bangalore India, June 20, 2010 in Mumbai and June 21, 2010 in New Delhi, Dr. Guenther presented to groups of Indian dermatologists on what’s new in the treatment of body psoriasis. Up to 80% of patients with psoriasis can be adequately treated topically. Moisturizers are part of “basic therapy.” They decrease scaling, limit painful fissuring, and stop itching. Topical steroids are available in a wide range of formulations with varying potencies. They are safe short-term, or on an intermittent basis long-term. Once daily is usually as efficacious as twice daily. The vitamin D analogues calcitriol, tacalcitol, and calcipotriol are synergistic with UVB light therapy. Tacalcitol is not available in Canada. Calcipotriol has also been shown to be synergistic with PUVA light therapy, cyclosporine, methotrexate and retinoids (oral and topical). Daivobet® is a fixed combination of calcipotriol and betamethasone. It is a once daily first line treatment that has been shown to improve quality of life. After 4 weeks, approximately ½ of patients have clear/almost clear disease. Daivobet® has half as many adverse effects as calcipotriol and ¼ that of tacalcitol. Tazarotene, a vitamin A derivative, is rarely used on its own since irritation is a common side effect. Treatment with tar is considered obsolete since it stains clothing, is malodorous, and its efficacy has not been proven. Anthralin is no longer commercially produced in Canada. Calcineurin inhibitors (i.e. pimecrolimus, tacrolimus) may be useful in the treatment of facial, genital and inverse psoriasis, but are not very efficacious in other areas. Moderate-to-severe disease is treated with phototherapy, methotrexate, acitretin (a vitamin A analog), cyclosporine or biologics. Currently there are 5 approved biologics in Canada (adalimumab, alefacept, etanercept, infliximab, ustekinumab).