Question

I am 62 years male, have psoriasis only on both hands mainly on sides n undersides of fingers for past 1 year. Small cracks form n heal in a day or two. Hv bn applying skin creams n sorifix cream.
Need help.

Dr.Surbhi Agrawal · Accepted Answer

Psoriasis is an inflammatory skin disease characterised by well defined erythematous scaly plaques with silvery white or candle wax type of scaling. Chronic plaque psoriasis is the most common type. It can affect sites like scalp, arms, and legs, (specifically elbows and knees), palms and soles etc.
Other types of psoriasis are: Erythrodermic psoriasis, Pustular psoriasis (generalised and localised), Nail psoriasis and Scalp psoriasis.
There are various precipitating factors for psoriasis: Infections (sore throat, dental infections etc), drugs (b-blockers used for hypertension), pregnancy, winters (psoriasis becomes worse in winters), stress, alcohol intake and cigarette smoking, topical irritants like coal tar, salicylic acid and withdrawal of oral/ topical steroids etc. The disease has a chronic course and there topical creams/ointments/gels/lotions etc as well as oral and injectable medicines which can treat psoriasis but there is no permanent cure for psoriasis.
For limited disease involving < 20% of BSA, Topical treatment alone suffices:
-Moisturisers specially those which contain hygroscopic (attract water from the atmosphere and lock it into the skin) and keratoloytic agents like Ammonium lactate (Amylac cream), Urea, Lactic acid etc are especially useful in dry scaly conditions like psoriasis.
-For the patches you could use a steroid+salicylic acid ointment, twice daily (clobetasol+3% OR 6% salicylic acid in an ointment base e.g propysalic NF Ointment) over and above the moisturiser for 4 weeks.
-Other treatment modalities which can be used for localized plaque psoriasis are: Vitamin D analogues like calcipotriol, calcipotriene alone or in combination with steroid.
For extensive psoriasis (involving more than 20% of BSA) oral as well as topical treatment is combined together:
-Once weekly oral methotrexate is another option in case of plaque psoriasis but it should always be taken under the supervision of a dermatologist since it can rarely cause serious side effects like bone marrow suppression.
-Oral cyclosporine is given for extensive psoriasis involving more than 20% of the body surface area. It is rapidly effective but it requires monitoring of kidney functions and BP.
Other commonly used oral treatment modalities are:
-Oral Psoralens e.g 8-methoxypsoralen and UV A phototherapy (PUVA)
-Narrow-Band phototharapy (NB-UVB)
-Biologics response modifiers (Etanercept, Infliximab, Adalimumab etc)
To summarize, in limited psoriasis only topical agents are used, whereas if the disease involves >20% body surface area, it is better to combine both topical and oral therapies.
I would suggest that you see a dermatologist and have a fair discussion regarding the most appropriate treatment modalities for you.

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