Spring and fall are peak allergy seasons in many areas, with spring trees still pumping out millions of grains of pollen each day and the summer grasses already starting to contribute their share. Sneezing, running nose, and itching – itchy eyes, itchy nose, itchy throat – wouldn't it be great to be able to prevent allergies before they even got started.

Preventing asthma and allergies is possible, according to a study in the June 2003 issue of Thorax. Children at high risk for asthma and allergies were recruited in 1990 to be part of this study. Half of them went about life as normal, and the other half had a low-allergy diet as infants – starting with breast milk (with moms on a low-allergy diet) or Nutramigen formula (no milk or soy-based formula). This group of families also undertook significant measures to avoid exposure to house dust during infancy.

Avoiding inhaled allergens, though, may be another story. Other studies have shown that babies who are exposed to dogs and cats before the first birthday, for example, are far less likely to develop allergies later. It seems to me that the nose is designed to detect changes (which is why you often no longer notice even very strong odors if you are around them long enough). It seems to me that a baby’s nose learns what is "normal" to have around them in the air during the first year or so, and then begins to consider some later arrivals as dangerous invaders – the body develops an allergic response to them.

Allergies happen when the body is tricked into thinking that harmless particles are dangerous invaders. The immune system tries to get rid of these allergens by sneezing them out, flushing them out with tears or mucus, or dislodging them with nose rubbing. It tries to prevent them from getting into the lungs by constricting the airways. These are all normal responses to toxins and viruses. They are allergies if the trigger is not really a problem.

There may have been other differences between the two groups in the study. One half certainly worked harder and paid more attention to allergy issues. We still have a lot to learn. What’s exciting about this breakthrough study is that it demonstrates that preventing allergies, asthma, and eczema is truly possible. Now we just have to learn how best to do it.

There are five types of psoriasis: Plaque, Guttate ,Inverse ,Pustular ,Erythrodermic

Plaque : Most common form of the disease.

Guttate: Appears as small red spots on the skin.

Inverse: Occurs in armpits, groin and skin folds.

Pustular: White blisters surrounded by red skin.

Erythrodemic: Intense redness over large areas.

Psoriasis triggers

Psoriasis is not contagious¡Xno one can "catch" it from another person. Because of their genes, certain people are more likely to develop it, but a "trigger" is usually necessary to make psoriasis appear. These triggers may include emotional stress, injury to the skin, some types of infection and reaction to certain drugs.

Stress Stress is a proven trigger in some people. It can cause psoriasis to flare for the first time or aggravate existing psoriasis. Relaxation and stress reduction may help people with psoriasis. For example, not only does relaxation help lower stress levels, but also it gives people a feeling of control. These techniques, however, seem to work best with traditional medical treatments, instead of using the techniques alone.

How can people cope with stress? Cope with the stigma: A stigma¡Xa characteristic that other people think of as negative¡Xcan erode a person's self-esteem. Low self-esteem can lead to stress, and possibly a worsening of psoriasis. One way to overcome the stigma, however, is to understand how and why it occurs. Hypnosis: This relaxation technique may help people who are using other treatments. For example, one study found that people who listen to meditation-based relaxation tapes while they are using light therapy may clear faster than those who don't listen to the tapes. Injury to skin Sometimes psoriasis appears in areas of the skin that have been injured or traumatized. This is called the "Koebner phenomenon." Vaccinations, sunburns and scratches can all trigger a Koebner (KEB-ner) response. The Koebner response can be treated if it is caught early enough. For example, people receiving a vaccination may be at risk for the Koebner response, but the physician can bring it under control if the psoriasis occurs at the injection site. Medicine Certain medications are associated with triggering psoriasis. Lithium: Used to treat manic depression and other psychiatric disorders. Lithium aggravates psoriasis in about half of those with psoriasis who take it. However, people can ask their physicians about alternatives to lithium. Antimalarials: Quinacrine, chloroquine and hydroxychloroquine may cause a flare of psoriasis, usually two to three weeks after the drug is taken. Hydroxychloroquine has the lowest incidence of side effects. Inderal: This high blood pressure medication worsens psoriasis in about 25 percent to 30 percent of patients with psoriasis who take it. It is not known if all high blood pressure (beta blocker) medications worsen psoriasis, but they may have that potential. Sometimes other medications can be substituted. Quinidine: This heart medication has been reported to worsen some cases of psoriasis. Indomethacin: This drug is used to treat arthritis. It is a nonsteroidal anti-inflammatory drug. It has worsened some cases of psoriasis. Other anti-inflammatories usually can be substituted. Indomethacin's negative effects are usually minimal when it is taken properly. Its side effects are usually outweighed by its benefits in psoriatic arthritis.

What are some other triggers? Allergies: Although unproven, some people suspect that allergies trigger their psoriasis. Diet: Although unproven, changing the diet has helped some people improve their psoriasis or avoid flares. Strep infection: May trigger guttate psoriasis. Weather: May make skin drier and more susceptible to a psoriasis outbreak.

Topical treatments¡Xagents applied to the skin¡Xare usually the first line of defense in treating psoriasis. Researchers believe psoriasis occurs when faulty signals in the immune system cause skin cells to grow too rapidly, creating dry, red, scaly patches called lesions. Topicals slow down or normalize that excessive cell reproduction and reduce inflammation (redness) associated with psoriasis.

Doctors tend to first prescribe topicals and/or phototherapy for mild to moderate psoriasis because they may be more appropriate than other treatments, such as systemic medications, which affect the entire body. There are many effective topical treatments. While many can be purchased over the counter (OTC), others are available by prescription only. Anthralin This prescription topical can be very effective in treating plaque psoriasis. It does not work as quickly or as thoroughly as superpotent topical steroids, but unlike steroids, it has no known long-term side effects. Dovonex A form of synthetic vitamin D3 approved for treating psoriasis, available by prescription. It slows down the rate of skin cell growth, flattens psoriasis lesions and removes scale. Dovonex also can be used on the scalp and for nail psoriasis. Salicylic acid Also known as "sal acid," salicylic acid helps remove scales and is often combined with topical steroids, anthralin or tar to enhance effectiveness. Available in both OTC and prescription forms. Tar Coal tar is available over the counter in crude and refined forms to treat mild, moderate and severe psoriasis. For decades, tar was viewed as the "traditional" treatment for psoriasis, and it remains a safe, effective and readily available treatment option for many people. Tazorac Tazorac topical gel and cream (also known by its generic name tazarotene) are FDA-approved for treating plaque psoriasis. Tazorac is a vitamin A derivative and is also known as a topical retinoid. It is available by prescription. Topical steroids Corticosteroids, ordinarily called "steroids" by doctors and patients, are routinely used to treat psoriasis. Topical steroid medications can be very effective in controlling mild to moderate psoriasis lesions. They are easy to use and work relatively quickly. Most are available by prescription. Other OTC topicals Information about bath solutions, moisturizers and nonprescription medications that can be used to moisturize, soothe, remove scale or relieve itching. Dovonex

what (as in defining something, WHAT is) is Dovonex and how does it work? Dovonex (also known by its generic name calcipotriene) is a form of synthetic vitamin D3 approved for treating psoriasis. It is available by prescription. It slows down the rate of skin cell growth, flattens psoriasis lesions and removes scale. Dovonex also can be used on the scalp and for nail psoriasis. It is not as effective at decreasing inflammation, though for most patients redness will improve over time. The U.S. Food and Drug Administration (FDA) approved Dovonex topical ointment in 1993 for the treatment of mild to moderate psoriasis. It is one of the most commonly used topicals. In addition to the ointment, Dovonex is sold in a cream form and scalp solution. All Dovonex products come in 0.005% strength by prescription, and they are odorless and nonstaining. Dovonex is not related to vitamin D found in vitamin supplements taken by mouth. These supplements should not be used to treat psoriasis. Ingesting large doses of vitamin D¡Veven though it is sold without a prescription¡Vcan cause serious side effects. How well does Dovonex work? Patients using Dovonex often see results after two weeks of treatment, but clearance or full effect usually takes at least eight weeks. Doctors typically prescribe Dovonex for an initial treatment period of six to eight weeks. People who do not clear at eight weeks may improve if they continue using the medication. In general, Dovonex does not work as quickly as superpotent topical steroids (also called corticosteroids), but unlike steroids, Dovonex has no known serious side effects when used according to directions. Dovonex is FDA-approved for long-term use. For psoriasis plaques on the body, studies have shown that Dovonex ointment is slightly more effective than the cream. How is Dovonex used? Dovonex should be applied directly to psoriasis lesions in a thin layer. Dovonex can irritate unaffected skin. It is important to follow your doctor's directions in applying Dovonex. Patients should always wash their hands thoroughly after applying the medication to avoid spreading it to unaffected areas of skin. Dovonex ointment is a greasy formulation and some find it less appealing to use than Dovonex cream. The cream is generally easier to apply and less messy for work and social situations than the ointment. Some dermatologists recommend using the ointment at night and the cream in the morning. Covering or wrapping (occlusion) of Dovonex-treated skin can result in rapid clearance but should only be done under a doctor's guidance. Doctors usually recommend applying Dovonex twice per day, which studies have shown to be more effective than using it once per day. A peripheral ring of scaling around Dovonex-treated psoriasis plaques leads some people to worry that their psoriasis is spreading. In fact, it may be a sign that the psoriasis is about to clear. Using Dovonex on the scalp Dovonex scalp solution is a water- and alcohol-based formulation specifically designed for treating scalp psoriasis. Rub the solution gently into scalp lesions at night, and then cover (occlude) the scalp with a shower cap or plastic bag overnight. The Dovonex may be washed out in the morning, if necessary. Avoid getting the mixture on the face or around the eyes, where it can cause irritation. Sweat can carry the medication onto the face and neck as well, so it is important to protect unaffected areas of skin. Also, Dovonex scalp solution should not be used during a flare of scalp lesions; the alcohol in the solution may irritate the skin. Using Dovonex for nail psoriasis Dovonex has proven successful in treating nail psoriasis for some patients. In one study, Dovonex ointment proved about as effective for nail psoriasis as a combination ointment of salicylic acid and a topical steroid. Side effects of using Dovonex Dovonex has no known serious side effects when used according to guidelines. The most common minor side effect is skin irritation, usually in the form of stinging or burning. This adverse reaction to Dovonex is generally mild and temporary, and the irritation should decrease as the skin becomes accustomed to the medication. Some dermatologists recommend mixing Dovonex with petroleum jelly, first at a ratio of 1-to-1 and then in increasing amounts of Dovonex to help the skin adjust. Topical steroids may reduce the redness, and alternating Dovonex with a topical steroid may reduce the likelihood of developing this irritation. Less common side effects for Dovonex include dry skin, peeling, rash, dermatitis and worsening of psoriasis. The face, the genitals and skin folds can be extremely sensitive to Dovonex irritation. Wash hands thoroughly after applying Dovonex to prevent transferring the medication to sensitive areas. Do not overuse Dovonex, as the medication can be absorbed into the body, increasing the risk of side effects. Guidelines recommend using no more than 100 grams of Dovonex cream or ointment or 60 milliliters of the scalp solution in one week. Dovonex is not recommended for use during pregnancy unless the benefits outweigh the possible risks to the fetus. It should not be used during breast-feeding, as the medication may be passed through breast milk. Using Dovonex with other treatments Because Dovonex is relatively safe and free of serious side effects, it is used in combination with many other treatments. In that way, it is considered to be one of the most effective and safest long-term treatment regimens for psoriasis. Combining Dovonex with topical steroids¡Vfor example, applying one at night and the other in the morning¡Vcan be more effective and less irritating than using Dovonex alone. Also, according to one study, a combined maintenance treatment of daily Dovonex plus weekend use of a superpotent topical steroid (called pulse therapy) may prolong remissions. Note: Always remember to taper off topical steroids gradually, whether they are being used alone or in combination. Abruptly stopping steroid treatment may cause a rebound (a temporary worsening of psoriasis). Dovonex has also been combined with nonsteroidal topical treatments, such as Tazorac, anthralin and tar. One small study found that Dovonex and Tazorac together may be as effective as some superpotent corticosteroids. If Dovonex is prescribed along with other topicals, apply the medications at different times of day and never mix them. The active ingredient in Dovonex is easily inactivated, particularly by acidic compounds like salicylic acid. Dovonex enhances the efficacy of UVB treatments and PUVA treatments. Dovonex should be applied only after UV treatment because it may partially block the light during treatment, and UV rays can inactivate the medication. In moderate to severe cases of psoriasis, Dovonex and several systemic treatments have been combined. With Neoral (also known by its generic name cyclosporine) or Soriatane (also known by its generic name acitretin), Dovonex improves overall results and reduces the amount of systemic drugs needed, thereby reducing their risks and side effects. There are no known problems using Dovonex with methotrexate or biologics. but studies are limited. Anthralin What is anthralin? Anthralin is a synthetic substitute for chrysarobin, found in Goa powder from the bark of the araroba tree of South America. This substance has been used to treat psoriasis for more than 100 years. It is available by prescription. How well does anthralin work? Anthralin can be very effective in treating plaque psoriasis. It does not work as quickly or as thoroughly as superpotent topical steroids. but unlike steroids, it has no known long-term side effects. Anthralin can produce extended, treatment-free remissions in some patients. Studies indicate that anthralin can produce a remission of four to six months, and there are reports of longer remissions when anthralin is used in a hospital or day treatment program. Results will vary depending on the individual. How is anthralin used? Anthralin is available by prescription as a cream and a scalp formulation. A pharmacist can prepare higher-strength preparations of anthralin in a thick paste (often referred to as Lassar's paste). Anthralin has a long history as a safe treatment for psoriasis, but it can also be messy to use, as it tends to stain anything it touches¡Vskin, clothing, bedding and bathroom fixtures, for example. Different regimens and formulations of anthralin may make the medication easier for patients to use at home. Some practical guidelines for home use of anthralin include: „h Apply anthralin only to psoriasis; do not apply to unaffected skin. You may prefer to use plastic disposable gloves to apply anthralin. „h Anthralin cream should be rubbed in well, and any excess should be wiped off. „h Expect to see a brown stain on the surrounding skin if the anthralin comes into contact with the unaffected skin. This is a good sign and indicates that the anthralin is working. When the stain occurs in the center of a lesion, the psoriasis is clearing. Stains on skin and hair will eventually fade and disappear. „h Use old clothing and sheets when anthralin is on skin. Protective dressings (occlusion) can be used, unless otherwise instructed by your doctor. If staining occurs, rinse with water and do not use soap (see tips for stain removal on page 9). „h Wash hands after applying anthralin. „h Do not apply anthralin near eyes, on the face or in the groin area. Do not rub eyes with anthralin-contaminated fingers. Should eye irritation occur, rinse eyes with water and consult your doctor. „h Anthralin must be fresh to work effectively. Fresh anthralin paste or cream is bright yellow. The shelf life of paste anthralin is about six months. „h Follow your health care provider's instructions when using anthralin. There are many ways in which it can be used. Always check with your doctor about precautions to take while using this medication. Short-Contact Anthralin Therapy (SCAT) SCAT (also called "Minutes Therapy") is designed for patients with localized areas of psoriasis. Anthralin is left on the involved skin for a short period of time. The contact time varies, ranging from 10 minutes to an hour. Patients may be instructed to gradually increase the amount of contact time as their skin becomes accustomed to the medication. Anthralin on the scalp Short-contact use of anthralin may effectively treat scalp psoriasis. Anthralin can be left on the scalp for a short period of time, such as 10 minutes, and then washed off. In many people, daily applications may clear psoriasis on the scalp in several weeks. Sometimes, a more potent application of anthralin is required to clear thick scales on the scalp that do not respond to steroid lotions or tar-based shampoos. In this case, the doctor can prescribe anthralin mixed with other agents, such as salicylic acid, mineral oil or propylene glycol. This mixture is massaged into the scalp and left on overnight, then removed in the morning by shampooing. This regimen can be followed daily or intermittently, depending on how the psoriasis responds. Applying petroleum jelly to ear folds and the neck will minimize contact with unaffected skin and reduce irritation. Anthralin stains are a particular problem for people who have very light hair. A neutral henna powder can be diluted with warm water and left on the scalp for a half hour. Neutral henna powder coats the hairs for three to four weeks, providing some protection against staining. Neutral henna is colorless, but it will interfere with a permanent or hair coloring. Neutral henna is available from beauty supply or health food stores. Psoriatec Psoriatec is an anthralin formulation designed to reduce the risk of staining and irritation. It is a 1% anthralin cream in which the active ingredient is surrounded by a protective layer of lipids. These layers melt at body temperature, releasing the anthralin only on the skin where it is applied, not on clothes, bedding or bathroom fixtures. Psoriatec and the scalp When used properly, Psoriatec can improve scalp psoriasis and greatly reduce the hair staining often associated with anthralin on the scalp. The regimen for treating scalp psoriasis with Psoriatec is similar to its use for psoriasis on other parts of the body. Side effects of using anthralin Anthralin is known to be a skin irritant, and the irritation a patient experiences is directly related to the strength of the product being used and the individual's tolerance of the medication. Normally, anthralin is not used on the face or on extremely inflamed psoriasis lesions. It is not known if anthralin is safe during pregnancy. Women who become pregnant and are using anthralin should consult with their health care provider. Staining from anthralin Much of the irritation and staining from anthralin use can be prevented with the application of triethanolamine, a nonsteroidal chemical used for many years as a stabilizer in soaps and cosmetics. Triethanolamine, known by the brand name CuraStain, neutralizes any anthralin residue remaining on the skin. CuraStain is first applied to the unaffected skin one or two minutes before anthralin is washed off, to form a protective film over the skin. This prevents smearing during removal, which would cause irritation of uninvolved skin. It is applied again after the skin is towel-dried to neutralize any remaining residue. CuraStain is manufactured by Young Pharmaceuticals, 800.874.9686, and is sold over the counter in drugstores. Anthralin stain removal Detergent can "set" the anthralin stains in fabric, so wash only after rinsing thoroughly. „h White fabric: In general, the longer a stain remains on a fabric, the more difficult it is to remove. In one study, stains of up to a duration of 24 hours were removed from test fabrics (65% polyester/35% cotton, 100% polyester and 100% cotton) using a 10-minute soak in full-strength chlorine bleach (such as Clorox), followed by a water (tap water should be fine unless the recipe calls for bottled water) rinse and air drying. „h Colored fabric: Chlorine bleach diluted by a ratio of 1-to-10 is sufficient to remove stains, but a bleach-safe test is recommended before applying the diluted bleach to assure color fastness. „h White plastic shower curtain: The best approach is immediate treatment (within five minutes) with 95% ethyl alcohol or Lestoil, a cleaning product found in some grocery stores, followed by a water rinse. If the exposure is longer than five minutes, anthralin stains may not be removed entirely with any solvent or tested household chemical. „h White floor tile with crevices: Scrub cleansers such as Comet or Soft Scrub remove stains on floor tiles, but occasional dark brown spots may remain. Acetone-based cleansers are also effective at removing stains. „h Tub or shower: Acetone-based cleansers can help remove stains, as can dishwashing detergent. To help prevent staining of the tub or shower during the removal stage, use CuraStain or alcohol. Using anthralin with other treatments Combining anthralin with other treatments, including ultraviolet light B (UVB) treatments, PUVA (the use of the light-sensitizing drug psoralen plus ultraviolet light A), Tazorac or topical steroids, may improve the response. Ask your doctor before initiating such a regimen. The Ingram regimen The Ingram regimen combines anthralin paste, a coal tar bath and UV exposure. Anthralin is applied to lesions as a thick paste (also called Lassar's paste). Anthralin in strengths of 0.1% to 5% or higher is used. Once the anthralin is removed, the patient is then exposed to UV and may also take coal tar baths. Usually, low concentrations of anthralin are used first, gradually increasing the potency until clearance occurs. Generally, a patient using the Ingram regimen in the hospital or day treatment program will require three weeks of therapy, clearing in an average of 20 days.

Systemics

Systemic medications are prescription medications that affect the entire body, and are usually reserved for patients with moderate to severe psoriasis who are not responsive to or eligible for conventional topical medications or ultraviolet (UV) light treatments.

Biologics Biologic medications are developed from living sources, such as cells, rather than combinations of chemicals like traditional drugs. The U.S. Food and Drug Administration (FDA) has approved Amevive and Raptiva and for the treatment of psoriasis. Enbrel is approved for the treatment of both psoriasis and psoriatic arthritis, while Humira and Remicade are both approved for the treatment psoriatic arthritis. Cyclosporine Cyclosporine is a prescription systemic medication used to treat psoriasis. In 1995, Neoral (one brand name for cyclosporine) was FDA-approved to help prevent organ rejection in transplant patients. In 1997, the FDA approved Neoral as a treatment for psoriasis. Methotrexate

Methotrexate is a systemic medication usually sold as a generic. Initially used to treat cancer, methotrexate was discovered to be effective in clearing psoriasis in the 1950s and was eventually approved for this use by the FDA in the 1970s. Soriatane Soriatane is a prescription medication called an oral retinoid, which is a synthetic form of vitamin A. Synthetic retinoids were introduced as experimental drugs in the mid-1970s and were approved in the United States in the 1980s. Soriatane is currently the only oral retinoid approved by the FDA specifically for treating psoriasis. Other systemics Accutane, Hydrea, mycophenolate mofetil, sulfasalazine, 6-Thioguanine Psoriasis in skin folds

Inverse psoriasis can occur in the armpits, groin, under the breasts and in other skin folds around the genitals and buttocks. This type of psoriasis first shows up as smooth, dry lesions that are very red. Inverse psoriasis is frequently irritated by rubbing and sweating due to its location in skin folds and tender areas. Steroid creams and ointments are considered very effective in treating inverse psoriasis. Because these areas are prone to yeast or fungal infections, doctors sometimes use diluted topical steroids in combination with other medications, such as 1% to 2% hydrocortisone with anti-yeast or antifungal agents. Elidel and Protopic are also very effective for treating psoriasis in skin folds. They do not support the growth of yeast or fungus. For a severe episode of inverse psoriasis, try alternating a moderate-strength steroid, such as betamethasone, for a brief period with an antifungal agent, such as Nizoral, in combination with soothing baths. Topical steroids should be used with caution because skin folds are more susceptible to thinning of the skin. Skin folds also should not be occluded (covered with an airtight plastic or cloth wrap). Dovonex and Tazorac may also be used in these areas, but be aware that these medications may cause irritation to sensitive skin folds.

Genital psoriasis

Psoriasis can occur in the genital area at the same time it occurs elsewhere on the body, or it can appear in the genital area only. People with genital psoriasis may have affected areas that range from small, red spots to large patches. The most common type of psoriasis in the genital region is inverse psoriasis.

Genital psoriasis generally responds well to treatment. However, due to the sensitivity of genital skin, treatment requires some special considerations (see treatment tips for more information). Use the links below to learn more about genital psoriasis. Treatment tips

Genital psoriasis can be difficult and frustrating to treat because of the nature of the affected skin. However, by keeping up with the treatment regimen recommended by your doctor, you may find relief and clear your psoriasis. Genital psoriasis usually responds well to various topical treatments; however, caution should be taken due to the sensitive nature of the skin in this area. It is important to remember that response times to treatments vary among individuals. You may want to make a follow-up appointment with your doctor so he or she can evaluate your response to the treatment and make necessary changes or modifications. Protopic and Elidel Protopic and Elidel are two topical immunosuppressant prescription drugs that are approved for treating eczema. These drugs can be effective for treating genital psoriasis. Both of these drugs reduce skin inflammation much as topical steroids do, but they do not cause thinning of the skin. They may, however, cause some irritation when they are first used. These products also do not promote yeast or bacterial growth, which may further help with inflammation and itching. Ultraviolet (UV) light UV light can be used to treat some genital psoriasis, but only in special circumstances and in doses much lower than are normally used to treat psoriasis on other areas of the body. Overexposure to UV light can burn the skin. There is an increased risk of burning genital skin because it is thin. UV exposure and burning may also increase the risk of developing skin cancer. Psoriasis in the pubic area may respond well to UV light treatment if the pubic hair is cut short or shaved. For psoriasis in the crease between the thigh and the groin, a doctor may prescribe UV light treatment. Individuals must position themselves carefully to adequately expose the skin in the creases to the light. The American Academy of Dermatology (AAD), the nation's largest professional organization of dermatologists, recommends that male patients undergoing any kind of ultraviolet light therapy protect the penis and the scrotum. Studies indicate that skin on the male genitals should not be exposed to UV radiation, particularly PUVA (the light-sensitizing drug psoralen plus UVA light), because of the possibility of an increased risk of skin cancer. Men should wear briefs or athletic supporters to protect their genitals while sunbathing or receiving UV light treatment on other parts of the body. Dovonex Dovonex, a prescription topical and synthetic form of vitamin D3, is not generally recommended for use on the genitals because of the potential for irritation. However, some doctors recommend cautious use of Dovonex on genital skin, because it does not have any of the drawbacks of topical steroids. Mixing Dovonex with petroleum jelly may minimize irritation. Other doctors have recommended rotating the use of Dovonex with a low-strength steroid on alternating nights. Using the cream version of Dovonex may be less irritating than its ointment formulation.

Tazorac Tazorac, a prescription topical vitamin A derivative, is not recommended by its manufacturer for use on the genitals because of the potential for irritation. And it should be used carefully and sparingly in skin-fold areas. However, on occasion it is used cautiously for genital psoriasis, under a doctor's supervision. An alternating regimen of Tazorac (usually 0.05% strength) and a low-strength topical steroid has been suggested by some doctors. Using the cream formulation of Tazorac may be less irritating than Tazorac gel. Patients should wash their hands carefully after applying Tazorac to avoid transferring it inadvertently to other areas of sensitive skin.

Steroids Only low-strength topical steroid preparations should be used in the genital area. Skin in the genital area tends to be more sensitive and thin, and steroids should be used only with careful direction from your doctor. Prolonged use of topical steroids can permanently thin the skin and cause stretch marks. Furthermore, psoriasis may become resistant to clearing with continuous long-term use of steroids. They should be used with caution due to their potential to cause irreversible damage to the skin. Since the genital area can be warm and moist, this can lead to increased steroid absorption, which can increase the likelihood of the steroid's negative side effects.

Over-the-counter (OTC) moisturizers It is also important when treating genital psoriasis to keep the skin in the affected areas continuously moisturized. Caution should be taken, as ingredients in some topicals may be irritating to the genital area's sensitive skin. Moisturizers with fragrance and perfumes may be especially irritating. If you read the labels of various moisturizers, you will find most moisturizers contain a combination of the same general ingredients. They may, however, differ in consistency. Facial moisturizers tend to be thin, while hand moisturizers tend to be thick, and body moisturizers fall somewhere in between. The most important thing is to find a moisturizer that provides the skin with the moisture it needs.

Plaque psoriasis is the most prevalent form of the disease. About 80 percent of all those who have psoriasis have this form. Its scientific name is psoriasis vulgaris (vulgaris means common). It is characterized by raised, inflamed, red lesions covered by a silvery white scale. It is typically found on the elbows, knees, scalp and lower back.

Guttate psoriasis

Guttate [GUH-tate] psoriasis is a form of psoriasis that often starts in childhood or young adulthood. The word guttate is from the Latin word meaning "drop." This form of psoriasis resembles small, red, individual spots on the skin. Guttate lesions usually appear on the trunk and limbs. These spots are not usually as thick as plaque lesions. Guttate psoriasis often comes on quite suddenly. A variety of conditions have been known to bring on an attack of guttate psoriasis, including upper respiratory infections, streptoccocal infections, tonsillitis, stress, injury to the skin and the administration of certain drugs (including antimalarials and beta-blockers). A streptococcal infection of the throat (strep throat) is a common guttate psoriasis trigger. Strep throat can be present without symptoms and can still cause a flare of guttate psoriasis. Talk with your doctor about getting a strep test to determine if you have an underlying strep infection. Guttate psoriasis may persist despite clearance of the strep infection. Some doctors prescribe antibiotics to help prevent an occurrence of an infection that can cause the outbreak of guttate psoriasis. Moisturizers are considered the preferred treatment for guttate psoriasis. However, people often find it tedious to apply topical preparations to the multiple small "drops" on their skin.Phototherapy treatment with ultraviolet light B(UVB) or PUVA (the light-sensitizing drug psoralen plus ultraviolet light A) is also very effective for guttate psoriasis. Only in severe cases will doctors prescribe systemic medications (drugs given orally or by injection) for this type of psoriasis, although sometimes a short course of one of these drugs results in rapid and prolonged clearing.

Inverse psoriasis

Inverse psoriasis is found in the armpits, groin, under the breasts, and in other skin folds around the genitals and the buttocks. This type of psoriasis first shows up as lesions that are very red and usually lack the scale associated with plaque psorasis. It may appear smooth and shiny. Inverse psoriasis is particularly subject to irritation from rubbing and sweating because of its location in skin folds and tender areas. It is more common and troublesome in overweight people and people with deep skin folds. Treatment can be difficult due to the sensitivity of skin in these areas. Steroid creams and ointmens are considered very effective, but they should not be occluded (covered) with plastic dressings. Overuse or misuse of steroids, particularly in skin folds, can result in side effects, especially thinning of the skin and stretch marks. Because these areas are prone to yeast and fungal infections, doctors may test for infection and then may use diluted topical steroids in combination with other medications, for example, 1% or 2% hydrocortisone with anti-yeast or antifungal agents. Other topical agents, such as Dovonex, coal tar or anthralin can be somewhat effective in treating psoriasis in skin folds, but they may also be irritating. They should be used with caution and under the direction of a doctor. People with severe inverse psoriasis may occasionally require systemic medications to control the condition. Protopic (also known by its generic name tacrolimus) and Elidel (also known by its generic name pimecrolimus) are two topical medications approved by the U.S. Food and Drug Administration for the treatment of eczema. Many dermatologists have found they work well for psoriasis lesions in the skin folds. Sometimes a product called Castellani's Paint (prescribed by a doctor and compounded by a pharmacist, or bought over the counter as brand name Castederm) is used to treat inverse psoriasis. It is a liquid that can be painted on the affected skin and can help to dry moist lesions of psoriasis in folds. The use of powders may also help to dry the moist lesions associated with inverse psoriasis. Some people will use creams at night and powders in the morning. Pustular psoriasis

Primarily seen in adults, pustular [PUHS-choo-ler] psoriasis is characterized by white pustules (blisters of noninfectious pus) surrounded by red skin. The pus consists of white blood cells. It is not an infection, nor is it contagious. It may be localized to certain areas of the body¡Vfor example, the hands and feet. Pustular psoriasis also can be generalized, covering most of the body. It tends to go in a cycle¡Vreddening of the skin followed by formation of pustules and scaling. Pustular psoriasis reportedly may be triggered by internal medications, irritating topical agents, overexposure to UV light, pregnancy, systemic steroids, infections, emotional stress and sudden withdrawal of systemic medications or potent topical steroids. It is not unusual for doctors to combine or rotate treatments for pustular psoriasis due to the potential side effects of systemic medications and phototherapy. More than one study has shown that Soriatane (also known by its generic name acitretin) and methotrexate in combination produced a rapid remission in the acute state of pustular psoriasis and an eventual clearing of the skin. Types of pustular psoriasis Von Zumbusch The onset of von Zumbusch pustular psoriasis can be abrupt. Widespread areas of reddened skin develop, and the skin becomes painful and tender. Within a few hours, the pustules appear. The pustules then dry and peel over the next 24 to 48 hours, leaving the skin with a glazed, smooth appearance. A fresh crop of pustules may then appear. Eruptions often come in repeated waves that last days or weeks. Von Zumbusch pustular psoriasis rarely appears in children, although when it does, the prospect of improvement may be much better than for adults. Von Zumbusch pustular psoriasis can be triggered by an infection; sudden withdrawal of topical or systemic steroids; pregnancy; and drugs such as lithium, propranolol (brand name Inderal) and other high blood pressure drugs, iodides and indomethacin (brand name Indocin). Von Zumbusch pustular psoriasis is associated with fever, chills, severe itching, dehydration, a rapid pulse rate, exhaustion, anemia, weight loss and muscle weakness. The goal of treatment is to restore the skin's barrier function, prevent further loss of fluid, stabilize the body's temperature and restore the skin's chemical balance. Chemical imbalances can put excessive stress on the heart and kidneys, especially in older people. Because this form can be life-threatening, medical care must begin immediately. If you can't get in to see your doctor (medical) , you should go to the emergency room to get treatment. People with von Zumbusch pustular psoriasis often require hospitalization for rehydration and initiation of topical and systemic treatments, which typically include antibiotics. Soriatane, cyclosporine or methotrexate are often prescribed. Some doctors may prescribe oral steroids for those who do not respond to other treatments or who have become very ill, but their use is controversial because von Zumbusch pustular psoriasis can be triggered by the sudden withdrawal of steroids. PUVA may be used once the severe stage of pustule development and redness has passed. Palmo-plantar pustulosis Palmo-plantar pustulosis (PPP) is a type of pustular psoriasis that causes pustules on the palms of the hands and soles of the feet. PPP is characterized by multiple pencil eraser-sized pustules in fleshy areas of the hands and feet, such as the base of the thumb and the sides of the heels. The pustules appear in a studded pattern throughout reddened plaques of skin, then turn brown, peel and become crusted. The course of PPP is usually cyclical, with new crops of pustules followed by periods of low activity. Those who are at risk for PPP should seriously consider not smoking, as some studies suggest that these patients may have an abnormal response to nicotine which can trigger flares of PPP. Topical treatments are usually prescribed first, but PPP often proves stubborn to treat.PUVA, UVB, Soriatane, methotrexate or cyclosporine may be used to clear this form. Acropustulosis (acrodermatitis continua of Hallopeau) This rare type of psoriasis is characterized by skin lesions on the ends of the fingers and sometimes on the toes. The eruption occasionally starts after an injury to the skin or infection. Often the lesions are painful and disabling, producing deformity of the nails. Occasionally bone changes occur in severe cases. This form has traditionally been hard to treat. Topical preparations that are occluded may help some patients. Systemic medications have been used with some success in clearing the lesions and restoring the nails. Erythrodermic psoriasis

Erythrodermic [eh-REETH-ro-der-mik] psoriasis is a particularly inflammatory form of psoriasis that often affects most of the body surface. It may occur in association with von Zumbusch pustular psoriasis. It is characterized by periodic, widespread, fiery redness of the skin. The erythema (reddening) and exfoliation (shedding) of the skin are often accompanied by severe itching and pain. Patients having an erythrodermic psoriasis flare should make an appointment to see a doctor immediately. Erythrodermic psoriasis causes protein and fluid loss that can lead to severe illness. Edema (swelling from fluid retention), especially around the ankles, may also develop along with infection. The body's temperature regulation is often disrupted, producing shivering episodes. Infection, pneumonia and congestive heart failure brought on by erythrodermic psoriasis can be life threatening. People with severe cases of this condition often require hospitalization. Known triggers of erythodermic psoriasis include abrupt withdrawal of systemic treatment; the use of systemic steroids (cortisone); an allergic, drug-induced rash that brings on the Koebner response (a tendency for psoriasis to appear on the site of skin injuries); and severe sunburns. Initial treatment usually includes medium-potency topical steroids and moisturizers, combined with wet dressings, oatmeal baths and bed rest. Antibiotics may also be used. Careful attention is paid to restoring and maintaining fluids in the body. In addition, methotrexate, Soriatane or cyclosporine are frequently required to bring severe cases under control. Use of systemic steroids for erythrodermic psoriasis is controversial, and if used, they should be tapered off slowly. Stopping them suddenly can trigger a flare of psoriasis. UVB or PUVA treatment is usually held in reserve until the degree of redness has improved.

Corticosteroids, which are ordinarily called "steroids" by doctors and patients, are the most frequently used treatment for psoriasis. Topical steroid medications are easy to use, often work quickly and can be very effective in controlling mild to moderate psoriasis lesions. Topical steroids are not considered adequate when used as the only treatment for moderate to severe psoriasis. However, they may complement other psoriasis treatments that are used to treat severe psoriasis. The exact mechanism of action of steroid medications is not completely understood. Steroids are referred to as anti-inflammatory agents, because they reduce the swelling and redness of lesions. It is essential that patients use topical steroids properly to avoid unnecessary side effects. There are many brands of steroid medications on the market. They may look very similar, but they differ tremendously in their potency (strength of the medication) and in the way in which they are to be used. Some steroids are to be used only for short periods of time or applied only to certain areas of the skin. It is important that patients know which steroid medication they are using and how to use it correctly. This will reduce the risk of side effects and help ensure a positive treatment outcome Methods of using topical steroids

Applying steroids to lesions A small amount of topical steroid medication is applied directly onto the psoriasis lesions to form a thin layer. The medication should be used sparingly. The medication should be confined to the lesion only and not applied to uninvolved skin. Apply the steroid medication to the skin sites for which it was prescribed, and as often as prescribed (usually once or twice per day). Using the steroid more than once or twice per day is not helpful and can actually be harmful. Occlusion Some people apply steroid medications to psoriasis lesions and cover the area with an airtight plastic wrap, cellophane dressing, waterproof dressing or a nylon suit. This is called occlusion. Occlusion can increase the effect of the steroid and the amount of medication absorbed into the skin. An emollient may be applied on top of the steroid to moisturize the lesions and enhance the effectiveness of occlusion. Always check with your doctor before occluding a steroid medication. Although occlusion is an old and often reliable treatment option, many steroids are too strong to cover. Just as occlusion can intensify the effectiveness of a steroid medication, it can also intensify the side effects, and increase the possibility of skin atrophy (thinning of the skin), skin sensitivity and systemic absorption (see side effects). Your doctor can decide if a steroid is appropriate for occlusion and will also help you establish an appropriate treatment schedule. Pulse-dosing Pulse-dosing refers to a particular treatment schedule for applying steroid medications that can maximize improvement while minimizing the risk of side effects. In a typical regimen a patient might clear lesions with daily applications of a potent steroid. Once the psoriasis lesions clear, the application of the steroid is reduced to a few times per week. For instance, after clearing with daily use, the steroid might be applied twice daily on weekends only, at 12-hour intervals, e.g., Saturday morning, Saturday night, Sunday morning and Sunday night. Using topical steroids to treat scalp psoriasis Topical steroid medications are frequently used to treat the scalp. Normally, potent steroids can be used safely to treat scalp psoriasis, though generally they should not be used for long periods of time unless absolutely necessary. Several topical steroid medications are designed specifically for use on the scalp. A few of these products include: Cormax Scalp Application, Derma-Smoothe/FS Topical Oil, Kenalog Spray, Luxiq Foam, Olux Foam and Temovate Scalp Application. Children and topical steroids In most cases, experts feel that weak- to moderate-strength topical steroids are safe for children if used on limited parts of the body. Potent steroids are used sparingly with careful monitoring, usually for very brief periods. Steroids used over the whole body or in potent strengths can affect a child's growth and cause side effects if overused, so the guidance of a doctor is important. Topical steroids, pregnancy and nursing If you plan to become pregnant, tell your doctor. Usually, women are advised to stop some psoriasis treatments before conceiving and during pregnancy. Your doctor will be able to give you direction about the localized use of steroids during pregnancy. If you are nursing an infant, you should also discuss the use of topical steroids with your doctor. Topical steroids are easily absorbed into the nipple, for example, and this could result in problems for the infant. For more information about psoriasis and conception or pregnancy, see concPotencies of topical steroids

Topical steroid medications come in various strengths, ranging from very strong, or superpotent (Class 1), to very weak, or least potent (Class 7). Once a person has stopped responding to a steroid of a particular strength or potency, it is unlikely he or she will respond to any brand of steroid at an equal or lower strength, unless an extended period of time has elapsed. The potency chart below provides the potencies of a variety of steroid medications used to treat psoriasis. Generally, the stronger the steroid, the more effective it is in clearing psoriasis, but the risk of side effects is also greater. The base, or formulation, of a steroid medication can also influence how much medication penetrates the tissue. Steroids come in a variety of bases, such as creams, ointments, gels, sprays, solutions, lotions, foam and tape. Potency chart The following potency chart categorizes brand-name topical steroid medications along with the name of the corresponding generic drug. The list positions these medications according to their potency. The list may not be comprehensive. BRAND NAME GENERIC NAME CLASS 1 - Superpotent Clobex Lotion, 0.05% Clobetasol propionate Cormax Cream/Solution, 0.05% Clobetasol propionate Diprolene Gel/Ointment, 0.05% Betamethasone dipropionate Olux Foam, 0.05% Clobetasol propionate Psorcon Ointment, 0.05% Diflorasone diacetate Temovate Cream/Ointment/Solution, 0.05% Clobetasol propionate Ultravate Cream/Ointment, 0.05% Halobetasol propionate CLASS 2 - Potent Cyclocort Ointment, 0.1% Amcinonide Diprolene Cream AF, 0.05% Betamethasone dipropionate Diprosone Ointment, 0.05% Betamethasone dipropionate Elocon Ointment, 0.1% Mometasone furoate Florone Ointment, 0.05% Diflorasone diacetate Halog Ointment/Cream, 0.1% Halcinonide Lidex Cream/Gel/Ointment, 0.05% Fluocinonide Maxiflor Ointment, 0.05% Diflorasone diacetate Maxivate Ointment, 0.05% Betamethasone dipropionate Psorcon Cream 0.05% Diflorasone diacetate Topicort Cream/Ointment, 0.25% Desoximetasone Topicort Gel, 0.05% Desoximetasone CLASS 3 - Upper Mid-Strength Aristocort A Ointment, 0.1% Triamcinolone acetonide Cutivate Ointment, 0.005% Fluticasone propionate Cyclocort Cream/Lotion, 0.1% Amcinonide Diprosone Cream, 0.05% Betamethasone dipropionate Florone Cream, 0.05% Diflorasone diacetate Lidex-E Cream, 0.05% Fluocinonide Luxiq Foam, 0.12% Betamethasone valerate Maxiflor Cream, 0.05% Diflorasone diacetate Maxivate Cream/Lotion, 0.05% Betamethasone dipropionate Topicort Cream, 0.05% Desoximetasone Valisone Ointment, 0.1% Betamethasone valerate CLASS 4 - Mid-Strength Aristocort Cream, 0.1% Triamcinolone acetonide Cordran Ointment, 0.05% Flurandrenolide Derma-Smoothe/FS Oil, 0.01% Fluocinolone acetonide Elocon Cream, 0.1% Mometasone furoate Kenalog Cream/Ointment/Spray, 0.1% Triamcinolone acetonide Synalar Ointment, 0.025% Fluocinolone acetonide Uticort Gel, 0.025% Betamethasone benzoate Westcort Ointment, 0.2% Hydrocortisone valerate CLASS 5 - Lower Mid-Strength Cordran Cream/Lotion/Tape, 0.05% Flurandrenolide Cutivate Cream, 0.05% Fluticasone propionate DermAtop Cream, 0.1% Prednicarbate DesOwen Ointment, 0.05% Desonide Diprosone Lotion, 0.05% Betamethasone dipropionate Kenalog Lotion, 0.1% Triamcinolone acetonide Locoid Cream, 0.1% Hydrocortisone butyrate Pandel Cream 0.1% Hydrocortisone probutate Synalar Cream, 0.025% Fluocinolone acetonide Uticort Cream/Lotion, 0.025% Betamethasone benzoate Valisone Cream/Ointment, 0.1% Betamethasone valerate Westcort Cream, 0.2% Hydrocortisone valerate CLASS 6 - Mild Aclovate Cream/Ointment, 0.05% Alclometasone dipropionate DesOwen Cream, 0.05% Desonide Synalar Cream/Solution, 0.01% Fluocinolone acetonide Tridesilon Cream, 0.05% Desonide Valisone Lotion, 0.1% Betamethasone valerate CLASS 7 - Least Potent Topicals with hydrocortisone, dexamethasone, methylprednisolone and prednisolone

Side effects of topical steroids

Topical steroid medications are capable of clearing psoriasis lesions from the skin, but steroids don't usually produce remissions, and the clearance often doesn't last very long. The early return of psoriasis can contribute to patients using steroids for a longer period of time than is recommended or using a steroid that is too potent for a particular type of skin. (For example, the skin on the face is very different and much more sensitive to steroids than the skin on the bottom of the foot.) This may contribute to the appearance of common side effects associated with topical steroid medications. Weak, less potent steroids are ordinarily used to treat thin, sensitive skin, such as the face, groin and breasts. These areas are most prone to steroid side effects; therefore, even weak steroids must be applied with caution. Treating lesions on the face, skin folds or genitals should only be carried out under the direction of a doctor. Stronger steroid medications are more appropriately used on thicker skin, such as the knees and elbows. Superpotent topical steroids can be very effective in clearing lesions, but they must be used cautiously. They can cause serious skin damage if used too often, over a long period of time or under occlusion. Some of the side effects of topical steroids may go away after the medication is stopped. In other cases, the damage is permanent. It is difficult to recognize the subtle changes in the skin that mark steroid damage¡Vthis is why a doctor should be consulted periodically. The following is a list of potential side effects from using topical steroids. „h Skin damage: Skin thinning, changes in skin pigmentation, easy bruising, stretch marks, steroid redness and dilated surface blood vessels may occur. „h Rebounds: Psoriasis may get worse if topical steroids are discontinued suddenly. This is called a psoriasis "rebound" or "flare." Some doctors attempt to stall a rebound by slowly reducing, or tapering, the use of steroids after the psoriasis starts to go away. Others prefer to gradually lower the strength of steroid medications to avoid a rebound. While it is quite rare, abruptly stopping the use of superpotent topical steroids can potentially cause a common form of plaque psoriasis to convert to pustular psoriasis. Pustular psoriasis can be serious and require hospitalization. „h Facial psoriasis: Steroids can be helpful in the treatment of psoriasis on the face; however, using steroids on the face can cause redness, acne or visible blood vessels that appear swollen. Topical steroids should not be used around the eyes or on the face unless specifically directed by a doctor. Avoid getting steroids in the eyes, for instance, when treating the scalp. Internal absorption: Steroids can be absorbed through the skin and affect a person's whole body, including internal organs. This happens if a topical steroid is grossly misused, i.e., applied to widespread areas of skin, used over long periods of time, or with improper occlusion of potent steroids. For this reason, a doctor should monitor the use of topical steroids Tips for using topical steroids

Use topical steroids exactly as your doctor prescribes them. Overuse can cause psoriasis to become resistant to steroid treatment. It is also important to check with your doctor first before using topical steroids on the face, genitals or other sensitive areas. Most experts think that the lower-strength (weaker) steroids can be used for longer periods of time. Practical tips when using topical steroids „h Use topical steroid medications sparingly. More is not better. „h Remember that the amount of time it takes to clear lesions and the length of remission from psoriasis achieved by using topical steroid medications will vary for each individual. „h Have your dermatologist check your skin at regular intervals (at least two to three times per year). „h In general, apply the steroid once or twice per day. More frequent use is unnecessary, can be expensive, and most importantly, can increase the risk of side effects. „h Some doctors will use topical steroids in combination with ultraviolet B (UVB) treatments to help clear stubborn areas of psoriasis. However, it is controversial as to whether or not the combination provides a significant advantage. Some studies actually report that topical steroids can shorten the remission experienced with UVB. „h There may be a slight advantage to using topical steroids in combination with PUVA, a type of ultraviolet light treatment. „h Topical steroid medications can be compounded with other topical psoriasis medications, such as salicyclic acid (a scale lifter). „h Topical steroids can be used in combination with other topical psoriasis medications, such as anthralin, coal, Dovonex and Tazorac. They work particularly well with the last two, because they help calm the irritation these medications can cause. „h Topical steroid medications can become ineffective as a treatment over time. If one topical steroid stops working, switching to a higher potency may be beneficial. It also may help to change to a non-steroidal treatment option. „h Topical steroid medications used for nail psoriasis may improve the surrounding skin, but they generally will not improve the nail. „h Usually, stronger (more potent) topical steroids are more effective, but they carry a greater risk of side effects. „h Avoid stronger steroids on sensitive skin such as the face, groin and breasts. „h Stronger steroids are more effective on thicker skin areas, such as the knees, scalp and elbows. When you wish to discontinue treating your psoriasis with a topical steroid medication, gradually taper off unless your doctor directs you to do otherwise. Stopping abruptly may cause a flare of your psoriasis. Internal use of steroids

At times, a steroid medication is administered internally for the treatment of psoriasis and psoriatic arthritis. There are three methods of doing this: injections directly into the psoriasis lesion (intralesional injections); pills taken by mouth (oral steroids); and injections into the muscle (intramuscular injections). The internal use of steroids, especially over a prolonged period of time, can cause many potential side effects, including decreased calcium absorption, which can increase the risk of osteoporosis. Blood sugar levels can also become elevated after using internal steroids, creating an increased risk of diabetes. It is important to discuss the use of internal steroids with your doctor and to be continually monitored to prevent potential long-term side effects. Intralesional injections Injecting a steroid medication directly into a psoriasis lesion is used for one or a few lesions that are very visible or for lesions that resist clearing with other treatments. This includes the scalp. Intralesional injections can help to clear isolated psoriasis lesions. It would not be a safe or practical approach for treating numerous lesions on the body or scalp. Nail psoriasis is sometimes treated by injections of steroid medication into the nail bed or skin folds around the nail. The results vary and are unpredictable, and the injections, which can be painful, usually have to be repeated on a regular basis to maintain improvement. Intralesional injections have few side effects unless they are repeated too often, used for too many lesions or the concentration of steroid medication is too high. If overused, intralesional injections might result in potentially dangerous levels of steroid absorption into the bloodstream. Also, localized thinning of the skin may occur at the site of the injection. Thinning of the skin may be reversible. Talk with your doctor about possible prescription medications that can help reduce this side effect. Oral steroids and intramuscular injections When steroid medications are taken in pill form or injected into the muscle, they are called systemic steroids because they affect the entire body. Administering steroid medications in this manner for the treatment of psoriasis is very controversial, even though it can temporarily clear psoriasis. Most dermatologists, but not all, believe that steroids given in this way have the potential to result in disease flares, including flares of pustular psoriasis in people who never before had pustular psoriasis. Pustular psoriasis is a severe form of the disease which can require hospitalization and, in rare cases, be life-threatening. Many doctors believe this can occur even after a single dose of a systemic steroid. People with arthritis may require occasional injections into an inflamed joint or have to take low doses of the oral steroids. This type of steroid use has generally not been associated with psoriasis flares. Specific skin sites

Psoriasis can occur on any part of the body. Learn more about psoriasis on specific skin sites:

Scalp psoriasis

Scalp psoriasis is very common. In fact, at least half of all people who have psoriasis have it on their scalp. As with psoriasis elsewhere on the body, skin cells grow too quickly on the scalp and cause red lesions covered with scale to appear.

Scalp psoriasis can be very mild, with slight, fine scaling. It can also be very severe with thick, crusted plaques covering the entire scalp, which commonly can cause hair loss. Psoriasis can extend beyond the hairline onto the forehead, the back of the neck and around the ears (a common area). Most of the time, people with scalp psoriasis have psoriasis on other parts of their body as well. But for some, the scalp is the only affected area

Other scalp conditions

Other skin disorders, such as seborrheic dermatitis, may look similar to psoriasis, but there are differences. Scalp psoriasis scales appear powdery with a silvery sheen, while seborrheic dermatitis scales often appear yellowish and greasy. Despite these differences, the two conditions can be easily confused. Treating scalp psoriasis

How is it treated?

Many treatment options can help control scalp psoriasis and its symptoms. Sometimes scalp psoriasis will clear on its own (a spontaneous remission), or it can remain on the scalp for long periods of time. It is important to select scalp treatments that are agreeable to you. Treatments should never be worse than the psoriasis itself. Consider your lifestyle, available time and the cost to help you decide among the options. Tar products and salicylic acid are generally sufficient for treating very mild scalp psoriasis. More severe scalp psoriasis may require persistence and experimentation to find an effective treatment plan. Treatments include topical medications (applied to the skin) and occasionally ultraviolet (UV) light. Treatments are often combined and rotated because a person's psoriasis can become resistant to medications after repeated use. Systemic (oral or injected) psoriasis treatments are not commonly used just for scalp psoriasis, but they may be tried if psoriasis is present elsewhere on the body and/or the psoriasis is severe. Treatment schedules Scalp treatments must be repeated until you get adequate control of your lesions. This can take up to eight weeks or longer. Once you achieve clearing, or a level of acceptable clearing, you may be able to keep psoriasis from coming back by using a tar shampoo or other medicated shampoo daily or twice a week. Moisturizing the scalp may also help. Tar products Tar products, usually available without a prescription, are widely used to treat scalp psoriasis. You will be able to find over-the-counter (OTC) tar shampoos, creams, gels, oils, ointments and soaps. Tar also can be prescribed by your doctor in a variety of strengths. It may be used as a single treatment or in combination with other treatments. While tar is an effective medication, it can stain bedding and gray or white hair, and has a strong odor. There are two kinds of tars: coal tar and wood tar. Coal tar is the most common form for treating psoriasis, but some wood tar products, especially soaps (such as Grandpa's Pine Tar soap), can treat scalp psoriasis. Soaps are less expensive and typically last longer than shampoos. Coal tar is available in OTC products in concentrations from 1% to 5%, although higher concentrations are sometimes prescribed. Refined coal tars, such as liquor carbonis detergens, commonly referred to as LCD, have less of an odor and may cause less staining. Unfortunately, refined tars are not as strong, and may be harder to find. How do you use tar on the scalp? Massage tar shampoo into the scalp and leave it on for about five minutes before rinsing it off to allow for maximum absorption of the tar. Shampoo or conditioner can reduce the smell of the tar shampoo and make the hair more manageable. Tar gels, creams, solutions and lotions can be massaged into the scalp and left on overnight. These tar products are used for psoriasis on other parts of the body as well. Effectiveness will vary for each person. Tests have shown tar shampoos to be superior to shampoos without tar in treating scaling. Topical steroids Topical corticosteroid medications (steroids) can be effective against scalp psoriasis. These prescription medications come in solutions, gels, creams, lotions, sprays, ointments and foam. Topical steroids range from very mild to very strong (potent). Normally, strong steroids can be used safely for scalp psoriasis, but they should not be used continuously for long periods of time. A two-week cycle of treatment is commonly recommended for strong steroids. In addition, they should not be used under a dressing or covering (occlusion). Follow your doctor's instructions carefully. Abruptly stopping steroid treatments can cause a rebound (worsening, if stopped too quickly) flare of psoriasis. Slowly reducing the use of steroids can help avoid a rebound flare. Do not use steroid preparations on your face and other sensitive skin areas, such as under the breasts and genitals, unless directed by your doctor. Avoid getting steroids in your eyes. Several topical steroid prescription medications are designed specifically for treating scalp psoriasis. These formulas are water- and alcohol-based, which makes it easier to wash them out after treatment. Cormax Scalp Application, Clobex Shampoo, Temovate Scalp Application and Olux are four scalp products that contain clobetasol propionate, one of the strongest topical steroids. Clobetasol propionate can be very effective in clearing psoriasis. Olux and Luxiq are foam-based prescription scalp medications that contain steroids. Foam-based applicators resemble styling mousse cans. The foam turns into liquid when applied to the skin and is absorbed quickly, leaving little residue. Some scalp psoriasis cases become resistant to topical steroids. If this happens, you can switch to other scalp treatments, such as anthralin, Dovonex, Tazorac or tar. It can take several months before topical steroid medications will work again for skin that has become resistant. Intralesional steroid scalp injections Sometimes doctors inject scalp lesions with steroid medications. This is done only when the scalp psoriasis is mild and involves a few areas. It would not be appropriate to inject many plaques. Steroid injections are given sparingly because the medication can be absorbed into the system. Anthralin Anthralin is an older, prescription medication that may work for some people with scalp psoriasis. The typical use of anthralin for scalp treatment is 30 minutes with either 0.25% or 0.5% anthralin. Anthralin can be left on the scalp for as little as 10 minutes and then washed off. Higher concentrations are applied for shorter periods of time. This is called Short Contact Anthralin Therapy, or SCAT. Anthralin can stain the skin and can cause irritation in some people. Remove anthralin from the scalp by rubbing the shampoo toward the back of the head to avoid getting anthralin on your forehead or in your eyes. Psoriatec is the brand name of a 1% anthralin cream that may limit staining because the medication is released from tiny capsules only at skin temperature. Rinse Psoriatec from the scalp, clothing, towels or bathroom fixtures with cool or lukewarm water to prevent these capsules from breaking down; this may prevent the staining and irritation usually associated with anthralin. CuraStain (available through a pharmacist as triethanolamine) is a product that may help control the staining associated with anthralin. Dovonex Dovonex (also known by its generic name calcipotriene) is a prescription topical vitamin D3 derivative that comes in a water- and oil-based scalp solution. After applying Dovonex at night, cover the scalp with a shower cap or plastic bag before going to bed. Confine Dovonex to the scalp because it irritates unaffected skin, particularly the face. You may wish to test a small area before applying it to the entire scalp. Avoid contact with your eyes. Tazorac Tazorac (also known by its generic name tazarotene) is a topical vitamin A derivative that comes in a cream or gel form for the treatment of psoriasis. The gel absorbs more rapidly than the cream, while the cream may be less irritating for people with dry or sensitive skin. Apply Tazorac in a thin film to lesions on the scalp or hairline. The medication may dry out the skin; to reduce irritation, apply moisturizers 30 minutes before Tazorac is used. However, the skin should be dry when treated. Tazorac is safe to use on your face, but it should not be applied around the eyes. Do not cover treated skin. Overnight application of Tazorac is recommended. Let the medication air dry on the scalp before going to bed, so you don't spread it on your pillow and face as you sleep. Antimicrobial therapy Scalp psoriasis can get worse if the scalp becomes infected with bacteria or yeast. If crusting of the scalp along with scaling occurs and/or the lymph nodes in your neck are enlarged, your doctor may prescribe antimicrobial treatment. Mild scalp psoriasis also may respond to treatment with antifungal shampoos such as Nizoral, a prescription shampoo that helps reduce yeast organisms. It may require the use of an antifungal shampoo once or twice a week to maintain results. Ultraviolet light Hair blocks UV light treatments from reaching the scalp. However, better results can be achieved with conventional UV units if you part your hair in many rows, if you have very thin hair or if you shave your head. Hand-held devices called UV combs are available to deliver a higher intensity of UV light. Natural sunlight may also help if the hair is very thin or the head is shaved. See phototherapy and sun and water therapy for more information. Medicated shampoos Many coal tar and non-coal tar medicated shampoos for treating scalp lesions are on the market. Leave shampoos on the scalp as directed and rinse them out thoroughly. Remember, medicated shampoos are designed for the scalp, not the hair. You may want to use a regular cosmetic shampoo or conditioner after your scalp treatment to reduce the smell of the medicated shampoo and make your hair more manageable. Systemic treatments for psoriasis If moderate to severe psoriasis is present on other skin sites in addition to the scalp, your doctor may prescribe systemic psoriasis medications (medications that are taken by mouth or injection). The most common include methotrexate, oral retinoids, cyclosporine and biologic medications. They may help clear scalp psoriasis, and are only appropriate for very severe cases. Systemic psoriasis medications have side effects that must be weighed in relationship to their benefits. Hair loss can be a side effect of certain systemic psoriasis treatments. Ordinarily, the hair will grow back when the medication is stopped. Practical treatment tips for the scalp

The forehead, neck and ears Scalp psoriasis may creep down onto the forehead and the neck and around the ears. These areas can be treated with the same products used for the scalp. However, there are some specific considerations. For example, anthralin can stain facial skin. Strong steroid medications should never be used on the face because they can irritate and thin facial skin. Dovonex is not recommended for the face, although some people use it there successfully. Tazorac is considered safe for facial use, although it can irritate the skin. The face, neck and ears require special care. Scale softening and removal The first step in treating scalp psoriasis is to remove (lift) any scale on psoriasis plaques. Scale lifting is necessary to make it easier for topical medications to penetrate the plaques and clear them. Keratolytics contain active ingredients such as salicylic acid, urea, lactic acid or phenol. A keratolytic is usually applied to the scalp, left on for a prescribed length of time (sometimes overnight) and shampooed off. The loosened psoriasis scales are washed away. You may avoid some of the messiness by applying them at night and covering your head with a shower cap. Salicylic acid is the most common keratolytic, and can be used in combination with tar or selenium sulfide. Its popular nickname is "sal acid," and you will find it both in OTC and prescription products, mostly shampoos and soaps. Treatments with high concentrations of salicylic acid can cause irritation. The body may absorb salicylic acid if used over large areas of the skin. Salicylic acid may also weaken hair shafts and make them more likely to break, causing temporary hair loss. This is not permanent; hair should return to normal after stopping treatment. Soaking the scalp in warm (not hot) water can help loosen scales. Soaking with water "plumps up" scales and makes them easier to remove. Another way to soften and loosen scales is to apply oils, lotions, creams or ointments to a damp scalp. Some people report that lubricants work better with a hot towel wrapped around the head. You can also apply heated olive oil to the scalp and wrap your head in a towel for several hours, or apply olive oil and sit under a hair dryer. Once the psoriasis scale has been softened, it needs to be removed. People generally use round or fine-tooth combs, or brushes. One of the best methods is to comb the scalp gently with a light circular motion, holding the comb almost flat against the scalp. Once the scale is loosened, you may shampoo to flush the scale from the scalp and out of the hair. Some people use a hair dryer to blow additional scale from the scalp and hair. Removing scales too vigorously can break the skin and lead to an infection. It can also break hair off at the scalp, causing temporary hair loss. The Koebner [keb-ner] response, a tendency for psoriasis to appear on damaged skin, can occur at the site of rough scratching or scraping. If treatments worsen your psoriasis or irritate your scalp, use plain oils and water until the irritations subsides. Great care should be taken when removing scales and applying topical medications to avoid triggering this response. Occlusion and stain protection Shower caps, towels, plastic wrap and plastic produce bags are good examples of the types of head covers used to occlude (cover) the scalp while also protecting pillows, clothes and furniture from medications and oils. Plastic produce bags are inexpensive, if not free, and do not make the annoying "crinkle" sound of a regular shower cap. To protect your bedding from stains you can make a "treatment" pillowcase by sewing two towels together on three sides. Some people wear wigs during the day to hide psoriasis medications or to hide hair that is compromised by psoriasis treatments. Never use a shower cap or other covering with prescription scalp medications, unless specifically directed by your doctor. Scalp itch Itching is often a problem for those with scalp psoriasis. OTC tar shampoos can help reduce itching. Topical steroids are often effective, and oral antihistamines are occasionally prescribed. Sometimes doctors add menthol to scalp medications; many over-the-counter medicated shampoos contain menthol. Combining medications A doctor can prescribe special combinations of medications, a process known as compounding. Specialized preparations prescribed by a doctor can be mixed by a pharmacist for individual cases. Be aware that some medications may inactivate others, so it is best to consult your doctor before combining medications on your own. Effective application of medications „h Part your hair and hold it in place while you drip or pat oils or lotions directly on your scalp. Make a new part about a half-inch away and repeat. If you use a cream or ointment, rub it right into the psoriasis. Preparations should be used sparingly. Getting the medication on the hair is wasteful. „h Treat all of the affected areas, including those around the ears and hairline. Products such as anthralin and Tazorac may irritate the folds behind the ears. Protect those areas by covering them with a thin layer of petroleum jelly before applying medications. Avoid getting any medication in the eyes. „h Pre-treat the scalp lesions with keratolytic agents or oils to soften and remove the heavy scales and make scalp medications more effective. Shampoo before applying a scalp medication. Apply petroleum jelly to cotton balls and insert them gently into the ears before applying the medications or shampoos to keep shampoos and medications out of ears. Psoriasis on the face

In diagnosing facial psoriasis, your doctor will examine your lesions and take a personal and family history. Facial psoriasis most often affects the eyebrows, the skin between the nose and upper lip, the upper forehead and the hairline. A biopsy may be needed to distinguish psoriasis from other skin diseases. Facial psoriasis may respond initially to non-irritating moisturizers and petroleum jelly. Occasional use of mild topical steroids, also called corticosteroids, may be effective. Other treatments include Dovonex (a vitamin D3 derivative, also known by its generic name calcipotriene), Tazorac (a topical vitamin A derivative, also known by its generic name tazarotene), keratolytic products (scale removers) and ultraviolet light. Dovonex and Tazorac can be irritating, so you should work with your doctor to find a way to address this concern. In December 2000, the U.S. Food and Drug Administration (FDA) approved a drug called Protopic (also known by its generic name tacrolimus) for eczema. In December 2001, Elidel (also known by its generic name pimecrolimus) was also approved by the FDA for the treatment of eczema. Many dermatologists have also found that both drugs work well for treating psoriasis on the face or other sensitive areas. Medication used to treat facial psoriasis should be applied carefully and sparingly; creams and ointments can irritate the eyes, and large amounts offer no additional benefits. Because facial skin is delicate, prolonged use of steroids may cause it to become thin, shiny and/or prone to enlarged capillaries (spider veins). Treatment with steroids may be safe if a careful treatment schedule is followed.

Psoriasis around the eyes, ears, mouth and nose

Psoriasis around the eyes When psoriasis affects the eyelids, lashes may become covered with scales, and the edges of the eyelids may be red and crusty. If inflamed for long periods, the rims of the lids may turn up or down. If the rim turns down, lashes can rub against the eyeball and cause irritation. Treating eyelid inflammation may involve washing the edges of the eyelids and eyelashes with a solution of water and baby shampoo. Cotton tip applicators or washcloths are useful for carefully scrubbing the lids. An over-the-counter product, called Ocusoft, can help with removing scales on the lids and eye margins. After removal of scales, moisturizers without corticosteroids may then be applied. In some cases, a special steroid medication made for use around the eyes may be used to treat scaling. Your doctor must carefully supervise the treatment because eyelid skin can be easily damaged. If topical steroids are overused in and around your eyes, glaucoma and/or cataracts may develop, which is the reason doctors suggest having your intraocular pressure checked regularly by an ophthalmologist (a doctor who specializes in treatment of eye diseases). Protopic ointment or Elidel cream won't cause glaucoma and is effective on eyelids, but can sting the first few days of use. Using Protopic or Elidel for eyelid psoriasis may help you avoid the potential side effects of topical steroids. Psoriasis of the eye is extremely rare. When it does occur, however, it can cause inflammation, dryness and discomfort, and may impair vision. Topical antibiotics may be used to treat infection. Psoriasis in the ears Psoriasis in the ears can cause scale buildup that blocks the ear canal. This buildup may lead to temporary hearing loss, and should be removed by a doctor. However, over-the-counter ear-cleaning kits that involve squirting small amounts of fluid into the ear and letting it drain may be used. Plain warm water, followed by a thin layer of mineral oil applied with a cotton swab, is also effective for some people. Psoriasis generally occurs in the external ear canal, not inside the ear or behind the eardrum. Prescription steroid solutions can be dripped into the ear canal or applied to the outside portion of the ear canal. Dovonex or Tazorac may cause irritation when used alone and may be best used in combination with a topical steroid. The eardrum is easily damaged. Care should be taken when inserting anything rigid into the ear. Also, impaction of scale already present from psoriasis can occur if medication prescribed for the skin on the ear is not appropriately applied inside the ear canal. Psoriasis in and around the mouth and nose For a very small number of people, psoriasis lesions appear on the gums, the tongue, inside the cheek, inside the nose or on the lips. The lesions are usually white or gray. Psoriasis in these areas can be relatively uncomfortable, and can cause difficulty in chewing and swallowing food. For the most part, psoriasis treatments for the mouth and nose involve the use of topical steroids that have been designed to treat moist areas. Improving hygiene and rinsing frequently with a saline solution can help relieve oral discomfort. Low-potency steroids, such as hydrocortisone 1% ointment, may be useful in treating psoriasis on the lips. Protopic and Elidel may also be effective treatment options for psoriasis in and around the mouth. Psoriasis on the hands and feet

Acute flares of psoriasis on the hands and feet need to be treated promptly and carefully. In some cases, flares are accompanied by cracking, blisters and swelling. General treatments include the use of moisturizers, mild soaps and soap substitutes. Some patients have helped heal non-bleeding, superficial skin fissures by closing them up with "super glue," Elmer's Wonder Bond Glue or Dermaflex, a product by Zila Pharmaceuticals. Use glues sparingly to avoid contact with unaffected skin. Traditional topical treatment of palm and sole psoriasis includes tar, salicylic acid and steroids. Combinations of these three agents may be superior to each one used individually. When directed by a doctor, some topical medications may be used with occlusion. This intensifies the effect of the cream or ointment. Cotton or plastic gloves can be worn over creams or moisturizers on the hands. Socks, or special occlusive foot covers, can be used on the feet. An easy way to occlude the feet is by putting each foot in a plastic bag and then putting a sock on over the bag. Try occlusion while you sleep or for an hour or two before going to bed. Soaking the hands or feet in warm water can reduce swelling, and should be followed by an application of medications or moisturizers. It may be necessary to find additional ways to reduce built-up layers of skin in order for medications and phototherapy to be effective. You might try soaking in warm water with oilated oatmeal powder or bath oil for 20 to 30 minutes, then gently rub the affected skin with a sponge to remove scales. Dovonex can also be effective with psoriasis on the hands and feet, however, cotton gloves should be worn to prevent transfer of the medication to sensitive skin sites, such as the face or skin folds. A regimen alternating Dovonex and potent topical steroids may be beneficial. Occlusion with Tazorac is not usually recommended but could be useful for palm/sole lesions. You may also want to alternate Tazorac with a topical steroid. If topical medications do not work, your doctor may recommend PUVA, methotrexate, cyclosporine or Soriatane (also known by its generic name acitretin). PUVA involves the use of a light-sensitizing drug called psoralen, which can be taken orally or applied topically, combined with exposure to ultraviolet light A (UVA). Special palm/sole units are available to treat psoriasis on the hands and feet. Systemic treatments taken by mouth or injection for severe palm and sole psoriasis may be beneficial. In this case, the benefits of treatment may outweigh the risk of side effects. Methotrexate can clear most cases of palm and sole psoriasis within four to six weeks. However, methotrexate has the potential for side effects to the liver, which require regular monitoring by a doctor. Cyclosporine is similarly effective for palm and sole psoriasis but has the potential for kidney side effects. Biologics may be effective for treating psoriasis on the palms and soles. As a class of drugs, biologics were studied for chronic plaque psoriasis; however, after approval, success in treating all forms of psoriasis has been reported. For people with scaling plaques of the palms and soles, oral retinoids such as Soriatane will result in thinning of plaques over a period of days or weeks. Thinning the scale buildup on the palms or soles may increase the effectiveness of topical treatments. Oral retinoids in lower dosages are generally well-tolerated. However, oral retinoids do cause birth defects and should not be taken by women planning a pregnancy within three years. The risk of side effects from phototherapy are reduced by combining low doses of retinoids with ultraviolet light B (UVB) or PUVA. The combination of retinoids with PUVA is one of the most effective treatments available for palm and sole psoriasis. Pustular psoriasis of the palms and soles This form of psoriasis is characterized by white pustules (blisters of noninfectious pus) surrounded by red skin. The pus is not contagious. The lesions are most prominent on the palm toward the base of the thumb, the fleshy part of the palm toward the ring and little finger, and on the soles and sides of the heels. Often, the lesions are painful and disabling. Plaque psoriasis can appear elsewhere on the body at the same time. Doctors usually prescribe topical treatments such as steroids and coal tar first. However, PUVA, retinoids and methotrexate may have to be used in order to clear this form. Antibiotics are occasionally prescribed with varying results. Oral retinoids, such as Soriatane, can be helpful for pustular psoriasis.

Psoriasis of the nails

Nail changes occur in up to 50 percent of people with psoriasis and at least 80 percent of people with psoriatic arthritis. The nail problems most commonly experienced by psoriasis patients are: „h Pitting¡Xshallow or deep holes in the nail „h Deformation¡Xalterations in the normal shape of the nail „h Thickening of the nail „h Onycholysis¡Xseparation of the nail from the nail bed „h Discoloration¡Xunusual nail coloration, such as yellow-brown Nail treatments Because psoriasis affects the nail when the nail is being formed, it is difficult to treat. The matrix, where the nail is formed, is difficult to penetrate with topical medications. Injections of steroids into the nail bed or matrix area have been used with varying results. The pain of the injections must be weighed along with the possibility of the relief being only temporary. The major treatments specifically for nail psoriasis are: „h Topical treatments¡XDovonex, Tazorac, corticosteroids, steroid impregnated tape (Cordran), 5-fluorouracil; „h Intralesional¡Xinjection of steroids into each affected nail; „h Phototherapy¡XPUVA (psoralen applied as "paint" or taken by mouth to increase sensitivity to ultraviolet light A); „h Cosmetic repair¡Xnails deformed by psoriasis may be removed surgically or with a strong urea compound. Long, thick nails can be scraped and filed down. Color changes can be covered with nail polish, and pitted nails can be buffed and polished. In some instances, artificial nails may be warranted. When people have severe, generalized psoriasis, the nail treatment is determined by the treatments they are already receiving for other parts of the body. If a person's condition requires methotrexate, for example, nails are likely to improve. Similar results may be expected from other systemic psoriasis treatments that are dramatically effective. Oral retinoids, such as Soriatane, can be beneficial for skin lesions of psoriasis, but usually result in the formation of very thin nails that are not normal in appearance. The nail changes caused by retinoids resolve several months after retinoids are discontinued. In people whose psoriasis is sufficiently severe that treatment with PUVA is warranted, nails may improve. As with systemic treatments, the nail improvement may lag behind clearance of plaques on the body by several months. Onychomycosis, a fungal infection that causes thickening of the nails, may be present with nail psoriasis. It can be treated with systemic antifungal agents. About one-third of people who have nail psoriasis also have a fungal infection that could actually be triggering their psoriasis or making the psoriasis worse. It is important to note that treating the fungus may not cause the nail psoriasis to clear. A double-blind, randomized study of Tazorac gel in the treatment of nail psoriasis found that once-daily applications of the medication can significantly reduce separation of the nail from the nail bed (in occluded and non-occluded nails) and pitting (in occluded nails). In the study, some patients' nails were wrapped (occluded) with a plastic film after the medication was applied. Another study published in the July 2003 issue of the British Journal of Dermatology found that of 25 patients treated with Tazorac, 19 showed a good clinical response. The study lasted for 12 weeks and people were treated once a day at bedtime. Nail care In most cases, the nails should be trimmed back to the point of firm attachment with manicure scissors. Nails should be kept as short as possible. Loose nails continue to be subjected to strain as they rub against surfaces. It is important to protect your nails from damage because trauma will often trigger or worsen nail psoriasis. One way to do this is to wear gloves while you are working with your hands. Vigorous cleaning and scraping under the nails may break the skin where the nail is attached. Be gentle when using instruments for cleaning under the nails. Soaking your nails can help. Try three capfuls of tar bath oil in a bowl of warm water. Soak your fingers for 20 minutes and then rub moisturizer into each nail. A variety of tar bath oils and moisturizers are available at local pharmacies. If your nails are mostly intact, application of a nail hardener or artificial nails can improve their appearance. However, sensitivity reactions to glues and chemicals may be a problem. Rule out any sensitivity reactions before using artificial nails. Be aware that a manicurist may be reluctant to apply the nails to badly eroded fingernails. Toenails can be improved by soaking the feet for 10 minutes in a tub of warm water, gently filing the thickened part of the toenail with an emery board, and using good clippers to cut off a small piece at a time. The aim is to cut straight across the toenail to help keep it from becoming ingrown. Wearing roomy shoes leaves room for the toes and helps avoid the friction that can cause toenails to thicken.