Psoriasis Guide: Your Prescription for Psoriasis Treatment Information

Psoriasis is a condition that can cause discomfort, pain and emotional stress. We have put together this Guide to address this condition and answer some of the questions you may have about psoriasis, and how you can find relief. We have provided information on the basics of psoriasis, what should be avoided and help on general skin care, and diet information. You will also find research on some of the new and latest treatments, various therapies, and creams available for treating psoriasis.
Psoriasis treatment options range from topical and oral treatments, to light therapy. A person’s psoriasis can be mild and localized or be very extensive and have numerous symptoms. There are many types of psoriasis conditions including psoriatic arthritis, plaque psoriasis (psoriasis vulgaris), scalp psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, erythrodermic psoriasis, and nail psoriasis. This guide has information that addresses all of these conditions.

Treatment Of Scalp Psoriasis Topical Therapy : Topical therapy includes corticosteroids, calcipotriol/calcipotriene, tazarotene, tars, and anthralin. Tars and anthralin are discussed above. If the psoriasis is thick, measures must be taken to thin down the plaques. Since creams and ointments are hard to apply to the scalp and wash out of the hair, they are rarely used to treat scalp psoriasis. Lotions, solutions, and gels are generally used since they are easier to apply, and do not give a greasy appearance to the hair, and are easier to wash out.
Topical Corticosteroids : Topical corticosteroid gels, lotions, solutions, oils, and shampoos may be used to treat scalp psoriasis. They work quite quickly, often within 1-2 weeks however, with long-term use, steroids often lose their effectiveness.
The scalp solution may be easily applied to the scalp, the onset of action is usually slower (could take up to 2 months) than with topical steroids, but it is usually effective and safe for long term use. Since it may cause irritation, you should take care to limit application to your scalp and avoid use on your face.
Example of topical calcipotriol/calcipotriene scalp solution:
Calcipitriol scalp solution (Dovonex®) Topical Tazarotene : Tazarotene is a selective retinoid with properties that are similar to vitamin A. The gel formulation is generally applied once daily overnight to the scalp patches, it can be easily worked into your scalp. Scalp irritation may occur with this product, but less commonly than elsewhere. To minimize irritation, apply a thin layer of the medication only to the patches and avoid the uninvolved surrounding skin. You should not use this medication if you are pregnant.
Systemic Therapy : Most of the time, oral medications are not required for scalp psoraisis, but if you have a very resistant case or if your itch is uncontrollable, they may be used.
Methotrexate : Methotrexate is usually given once a week orally (pills) or occasionally by injection (with a needle). It helps control psoriasis affecting your skin, nails, and joints. Side effects include upset stomach, mouth ulcers, suppression of the bone marrow with low blood counts, and liver damage. Careful monitoring by your physician is essential on this medication. Liver biopsies may be required.
Acitretin : Acitretin is a retinoid with properties similar to vitamin A. For most patients, it does not appear to be as effective as methotrexate or cyclosporine in the treatment of plaque psoriasis. However, it works quite well for pustular psoriasis. Side effects include dryness of your skin, lips, eyes, and nose, elevation of your cholesterol and triglyceride levels, liver toxicity, and bone changes. Since it may cause birth defects, it is used mainly in men, and women who are post-menopausal or have had a hysterectomy. Monitoring by your doctor, and regular blood tests are required while taking this medication.
Cyclosporine : Cyclosporine is an immunosuppressant medication that is used in organ transplantation. It is very effective, but because of its cost and side effects (kidney toxicity, high blood pressure, numbness and tingling, hair growth, skin cancer, and lymphomas), it is usually reserved for people with severe, disabling, resistant disease. Careful monitoring by your doctor is required while taking this medication.
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Herpes Guide: How do I know if I have herpes?

Welcome to Herpes Guide, a member of the SkinCareGuide network of websites, written by international dermatologists. Did you know that herpes virus infections are common in both men and women? We hope you find answers to your questions about herpes in this Guide, which explores the various types of herpes, including Herpes Simplex Virus and herpes in pregnancy.
We have developed this site to help you understand the basics of herpes, how it is diagnosed, the role of cold sores and which drugs are effective in treating herpes. Take the time now to browse through our links and learn more about herpes.
There are now several drugs available in Canada to treat herpes, such as acyclovir (Zovirax®), valacyclovir (Valtrex®), famciclovir (Famvir®), penciclovir (Denavir®), ganciclovir (Cytovene®, Vitrasert®), vidarabine (Vira-A®), cidofovir (Vistide®), and foscarnet (Foscavir®). These prescription drugs come in different formulations such as topical, oral and intravenous formulations. There is also a drug for cold sores that you can buy without a prescription called docanosol cream (Abreva®). Your physician will help in recommending an appropriate regimen for your specific circumstance.
Acyclovir Acyclovir and its related compounds, valacyclovir, famciclovir, and penciclovir, remain the first line drugs of choice for the treatment of herpes simplex infections. Acyclovir is available in an oral, an intravenous, and a topical formulation. Valacyclovir and famciclovir are only available in oral form and not approved in Canada for use in children. Unfortunately only 10-20% of acyclovir is absorbed when taken orally. In contrast, valacyclovir is 80% absorbed and then converted to acyclovir in the liver.
Acyclovir is a “nucleoside analogue” (it can insert itself into virus DNA during virus replication) and specifically targets virus infected cells. It prevents the production of new virus by stopping viral DNA from properly forming. Famciclovir and valacyclovir work in a similar manner to acyclovir. Because of the way they act, these 3 drugs require the virus to reactivate in order to be effective. Therefore, they are only effective against virus that has escaped from the nerve-cell and is replicating in other parts of the body. Thus, they do not cure a ‘dormant’ (latent) HSV infection, since the latent virus is not replicating. There is no antiviral treatment available that can eradicate latent HSV infection.
Read about advantages and disadvantages of Acyclovir treatment.
Vidarabine
Vidarabine, one of the first HSV antiviral drugs available, is less safe than acyclovir and is only used in a 3% ointment form in North America, as treatment against herpes infections of the eye.
Foscarnet Foscarnet, another of the early anti-herpes drugs, was only used in life threatening HSV infection due to toxicity. It is now used in serious HSV infection if acyclovir does not work.

Eczema Guide: Your Prescription for Eczema Treatment Information

Eczema is a chronic, recurring, intensely itchy, inflammation of the skin, which usually starts in early childhood. It is also known as atopic eczema or atopic dermatitis.
Taking a sensible approach to treating eczema is very important, so we have designed this site to help you understand your eczema more clearly. It discusses what eczema is, what causes eczema and what eczema treatment options are available. You will find out about cosmetic and skin care for your eczema, including how important moisturizing is. Different types of eczema are discussed including hand eczema, contact dermatitis, allergic dermatitis and others, and a selection of eczema pictures are available. There are also a number of topical and oral eczema treatments available that will help your eczema, including new classes of drugs and medical procedures like light therapy. If you have adult eczema, or your child has baby eczema or infant eczema, we encourage you to read this site and discuss your options with your physician.

Acne Guide: Your Source for Acne Care and Treatment

Acne, oftens thought to be only a teenager’s skin problem, is actually a condition that can affect adults both male or female, although it generally begins during puberty. Taking a proactive approach to treating acne is very important. Your daily skin care regime, along with the acne treatment or product you and your dermatologist select, are key steps in your fight to eliminate pimples and curing acne.
This site was designed to help you understand your skin condition more clearly, define the different types of acne, to provide information about preventing acne scarring and maintaining acne control, and to help cure it with acne medication. You will find out about the medical acne treatments that are available, as well as cosmetic and skin care for your acne prone skin. We also list various acne remedies and acne medicines that are available including over-the-counter acne products, prescription drugs including creams, oral treatments and hormone therapies.
If you have pimples, we encourage you to find a solution by seeking acne treatment early. You will be happier with your skin, and you may be able to prevent scars from developing in the future. If you already have acne scars, this site will also examine the treatment options currently available to reduce or remove scarring, such as microdermabrasion or laser skin resurfacing

Treatments for Unwanted Facial Hair

Unwanted facial hair (UFH) in women is a common problem, and is most often a result of ethnic background or heredity. In a small percentage of women, it may be caused by androgen overproduction, increased sensitivity to circulating androgens, or other metabolic and endocrine disorders. Approximately 22% of women are affected by the presence of UFH growth on the mustache and chin area, and this can be a source of distress, leading to anxiety, depression and a reduced quality of life.1
It is very important to determine the underlying causes. Most are ethnic or hereditary; however, one must rule out any signs of androgen excess, e.g., an increase in body hair, irregular menstrual cycles, acne, alopecia, and seborrhea.
Polycystic Ovary Syndrome (PCOS) is the most common cause of androgen excess, and 70%-80% of patients with androgen excess demonstrate hirsutism, though this sign may be less prevalent among women of Asian extraction. There is a strong familial predilection for hirsutism, primarily because the underlying endocrine disorders in this population and the factors regulating the development of hair growth have a strong genetic component.2
Patients should be adequately advised of the available treatment modalities for hair removal. No single method of hair removal is appropriate for all body locations or patients, and the one adopted will depend on the character, area and amount of hair growth, as well as on the patient's age and their personal preference.3
Treatment options for removing excess facial hair are limited and can vary in effectiveness, the degree of discomfort, and cost. Current methods for removing this unwanted hair include such over-the-counter methods as plucking, waxing (including the sugar forms), depilatories, shaving, and home electrolysis. Hair removal methods that could take place in a doctor's office include laser, and intense pulsed light (IPL). An additional modality is a topical cream that inhibits hair growth: eflornithine 13.9% cream (Vaniqa®, Barrier Therapeutics in Canada and Shire Pharmaceuticals elsewhere).1
These methods are temporary with the time of regrowth ranging from a few days to a few months. For hirsutism associated with PCOS, treatments include oral contraceptives and/or antiandrogens, such as spironolactone, cyproterone acetate, flutamide and finasteride.4
Eflornithine HCl 13.9% cream is an irreversible inhibitor of ornithine decarboxylase, an enzyme that has been associated with the prolongation of the anagen or growth phase of the hair.6 Consequently, it reduces the rate of hair growth for all hairs. It appears to be effective regardless of whether the unwanted facial hair is hereditary or is due to medical conditions such as an androgen excess disorder, e.g., PCOS. After 24 weeks of treatment in clinical trials, it was shown to be effective on the chin and upper lip.7
Eflornithine, also known as difluoromethylornithine or DFMO, was synthesized in the 1970s as a potential anticancer drug. In 1980, Bacchi, et al. reported that this drug was effective in the treatment of African trypanosomiasis in a mouse model,8 and this finding later led to clinical studies in humans. In 1990, the US FDA granted marketing approval and orphan drug status for eflornithine to treat this disease. Clinical observations identified hair loss as a side-effect of eflornithine therapy and led to the development of Vaniqa®, which gained US regulatory approval in July 2001, as the first and only prescription cream clinically proven to slow the growth of unwanted facial hair in women.9

New and Effective Treatments for Warts

Warts are caused by viral infections of the skin. These viruses are explained on www.skincareguide.ca/glossary/w/warts.html. In some cases warts are just a nuisance, but warts can be unsightly and can interfere with work when they affect the hands or feet. Certain occupations - notably butchers - tend to develop warts on the hands which are thought to be related to their work. Warts on the hands can be a problem for those who work closely with the public, for example servers, nurses, doctors and dentists. Warts on the feet can hobble letter carriers, and interfere with sports like golf and hockey.
Until recently, the only treatment for warts was to burn the warts off, either with caustic chemicals or with high frequency electric current. Neither treatment was very reliable, and both treatments were quite unpleasant.
Treatments by type of wart is explained on
www.skincareguide.ca/conditions/warts/wart_treatment_by_type.html.

Sometimes warts go away without any treatment. When this happens, it is thought to result from activation of the immune system, causing recognition and destruction of the warts. Over the past couple of years, researchers in the United States have shown that injections of Candida antigen (derived from a yeast) can often stimulate the immune system to recognize and attack warts which have been injected, and sometimes even other warts which were not injected. Because the injections are done using very fine needles, and there is no destruction of tissue, there is essentially no discomfort or cosmetic disability. In some cases, the warts need to be injected several times, two to four weeks apart. A cream called imiquimod (Aldara®) which is used mainly for genital warts, can occasionally be effective when applied to other kinds of warts. It works by boosting the skin's immune system which attacks the virus.
Within the past year, a highly effective vaccine against the wart virus which is associated with carcinoma of the cervix has been developed, and it is hoped that this will be commercially available soon. Perhaps some day we will have protective vaccines (and perhaps even therapeutic vaccines) against the viruses which cause warts on the hands and feet.