Treating psoriasis

With no ‘magic bullet’ to cure the disease, multiple treatment plans are recommended to alleviate symptoms.

Nurse examines patiest (illustrative) (photo credit: INGIMAGE)
Nurse examines patiest (illustrative)
(photo credit: INGIMAGE)
I am a 64-year-old man who has been suffering for some years from psoriasis, especially on my elbows and knees. It is annoying and sometimes painful. I have tried going to the Dead Sea for sun and mud treatments and have received medication from my doctor, and they have helped only temporarily. Is there anything that can get rid of it or at least work for an extended time? Z.D., Ra’anana
Veteran Jerusalem dermatologist Dr. Julian Schamroth replies: Psoriasis is a disorder of the skin – often hereditary – characterized by plaques of red scales on various parts of the body. It can sometimes involve the scalp and nails and is also associated with arthritis. In most patients, it is an innocuous, although disfiguring, condition. Rarely, it can affect the entire body and can be life threatening.
There are numerous therapies available, ranging from topical emollients and cortisone creams to ultra-violet therapy, climatotherapy (at the Dead Sea), oral medications and injectable “biologic” agents. For most patients, especially if the condition is limited in area, topical calcipotriol together with a cortisone cream will probably suffice.
To increase the cream’s efficacy, your dermatologist might suggest applying these creams under occlusion. This entails putting a larger amount of cream on the lesion, covering it with a sheet of clingy plastic wrap used in the kitchen and leaving it on the entire night.
There is no “magic bullet” that will work for all patients, so a dermatologist might try a few different therapies to see what best suits the patient.
Unfortunately, we have no means of permanently curing the condition, and therapy is often a lifelong undertaking. With continual therapy, however, we can often get the condition under control so that the skin lesions are almost invisible.
I am a 43-year-old man, and I recently began to suffer from lower-back pain. I don’t recall picking up a heavy weight or doing anything else to cause it. My family doctor said I should rest, but when I went to an orthopedist, he suggested moderate exercise to alleviate the pain. Who is right? E.M., Beersheba
Dr. Noa Ben-Ami of the physiotherapy department of Ariel University, comments: Between 65 percent and 85% of the population will at some time suffer from lower-back pain, according to the World Health Organization. It really reduces the quality of life and functioning at work and at home, and is the one of most common reasons for going to a doctor. It constitutes a huge expense to the economy and the healthcare system.
The best treatment for and means for prevention of chronic low back pain is, in fact, exercise. Even if one has pain, one should exercise despite it and minimize the number of passive treatments like massage. Sufferers usually have difficulty keeping up with the exercise due to laziness or lack of time. But one should first go to an orthopedist or physiotherapist before beginning the course of exercise so he or she can rule out other problems.
A herniated disk causes severe pain in the lower back after bending suddenly and being unable to straighten up. Sometimes, the pain radiates to the thighs and even on to the lower foot. Most people with this condition complain about difficulty driving and getting out of the car, pain from sitting too long and even when sneezing or coughing.
The back pain usually comes from contraction of the muscles to prevent the sufferer from moving. When it reaches the leg, the herniated disk puts pressure on the nerve.
You can take off and rest for a day or two, but only if you quickly return to regular activity – unless your pain is very severe; in that case, consult an orthopedist. Sufferers from back pain should go to a physiotherapy institute to learn how to relax the back and prevent pains in the future. But to succeed in preventing the pains in the future, most of the work is up to the individual to do daily, moderate exercise. The recommendation today for non-severe pain is to be active as soon as possible so the pain passes more quickly. Try walking at first for five minutes and gradually extend it to half an hour a day. Swimming and riding a bicycle are also good.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting.
Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to [email protected], giving your initials, age and place of residence.