Clinical Evidence: Psoriasis Management - Essay Example

Clinical Evidence: Psoriasis Management Daivonex To many psoriasis sufferers, the disease is a very inconvenient disease to live with. And even if it is a non-contagious disease, it still causes patients embarrassment and job stress because of the appearance of their skin. It currently affects about 2-3 percent of the world population affecting all races, both sexes and all age groups, from babies to the elderly population (National Psoriasis Foundation, 2008). Its cause has yet to be fully established, and many scientists credit both genetics and the environment as possible contributors to this disease. Psoriasis is a long-term condition, often re-surfacing after years of remission. It is often treated depending on the severity of the disease and body surface covered. Topical solutions like creams, ointments, and lotions are usually preferred treatment methods for mild forms of the disease. For the more moderate to severe manifestations of the disease, pills, injections and light treatments are used, as topical solutions are insufficient to manage the disease. This paper will critically analyze the current clinical evidence to support the management of the disease, reviewing one mainstream over the counter therapy and one complementary/alternative therapy for the disease. This paper will review the drugs Daivonex, Exorex, and alternative medicine treatment options, and assess their effectiveness in treating psoriasis. Daivonex, a non-steroidal medication containing calcipotriol is currently one of the main drugs being used for the treatment of psoriasis. Some practitioners have reviewed this drug and found it ineffective and inapplicable for some types of psoriasis. Daivonex is not applicable for widespread (all over the body) psoriasis. For those who suffer from some types of psoriasis like guttate, generalized pustular psoriasis, or erythrodermis psoriasis, Daivonex is also not applicable (Medical-Look, 2008). In applying the medication, the patient has also to be cautioned about getting any of the medicine on unaffected skin, as it can cause skin irritation. Clinicians do admit that Daivonex is recommended safe for most psoriasis sufferers, but they caution that there are some potential users of the drug that need to consult with their doctors before using it. Allergy to calcipotriol and any drug containing such ingredient can trigger allergic reactions. Allergic reactions tend to include difficulty in breathing, wheezing, swelling of the throat, face, lips, or tongue, rashes or hives. There are various precautions which are required for the drug and which may not exactly be noticed or considered by the patient. The fact that high levels of calcium in the blood, intake of Calcium and Vitamin D supplements are some important points to remember in taking this medication will more likely be not taken into consideration by the patient if proper medical consultation is not sought prior to application of the medication. Cream and scalp solutions for the medication cannot be used with other topical medications in order to prevent possible undesired drug interactions. It cannot also be used on the face because rashes may develop from such an application. It is recommended by many clinicians because it produces side effects rarely and these are manifested as burning sensations, stinging sensations, skin irritation, dry skin, darkening of skin or increased sensitivity to light. Studies on the effects of the medication on pregnancy have yet to be fully established. It cannot therefore be clearly predicted if this medication is safe during pregnancy. Breastfeeding mothers though are cautioned against breastfeeding their baby while they are using Daivonex. As to pediatric use, the Daivonex cream is not recommended for pediatrics. This drug is favored by various patients because improvements in their conditions are seen in as early as 2-3 weeks after use. This drug is also safe for long-term use. Combination therapies with other drugs have also been seen to be effective in the treatment of psoriasis. Dosage reduction may also be done in instances of combination therapies. Studies have revealed that Daivonex usually takes longer to work than topical corticosteroids. As a result, some patients are often dissatisfied with the lack of improvement during the first few weeks of treatment. Some of them discontinue their medication even before the full benefits of the medicine are realized. Optimal results sometimes take up to 8-12 weeks to manifest and this prolonged period can sometimes be considered a long wait for patients. Due to local irritation, some patients also have difficulty adhering to the therapy. Exorex Exorex has been reviewed by many users and most of them are pleased with its effectiveness. Exorex is a coal-tar based preparation and is able to keep psoriasis under control and, more importantly, make some patches disappear. However, some users have complained that after prolonged use of the product, their psoriasis flared up again. They also take issue with the way it can stain clothes if it is not immediately absorbed by the skin. They also complain about the strong odor of the medicine. Thirty eight psoriasis patients were included in a study comparing the effectiveness and reactions to coal tar preparations and calcipotriol creams. Their results revealed that the coal-tar preparation was “found to be comparably as effective as calcipotriol in treating psoriasis” (Tzaneva, et.al., 2003, p. 350). Since the coal-tar preparation is considerably cheaper than the calcipotriol cream, the coal-tar based product appears to be the better product to be used for treating psoriasis. In a study covering thirty six patients, results revealed that calcipotriol ointment was able to produce a “faster initial response and had better cosmetic acceptability in patients, although after a long period of treatment, i.e. 12 weeks, 5% coal tar treatment had comparable efficacy” (Sharma, et.al., 2003, p. 834). As regards relapse, the study revealed that there was no significant difference in the rates between these two types of medications. Complementary and Alternative Methods in Psoriasis Treatment The complementary and alternative therapies in the treatment of psoriasis include mind-body therapies (yoga), dietary supplements and other topical remedies which include aloe vera, apple cider vinegar, and dead sea salts, among others. Fluid squeezed from the aloe vera plant is a common relief treatment used for burns and cuts. Its effectiveness in treating psoriasis however has yielded mixed results during clinical trials. The use of apple cider vinegar has also been seen in some psoriasis cases. Some patients have attested that this vinegar helps soothe psoriasis flare-ups when added to bathwater or moisturizer or applied directly to the skin. However, there is yet no firm clinical evidence to support or refute the applicability and effectiveness of the drug in easing the discomforts of the disease. However, it still remains as a popular remedy for many psoriasis sufferers. Capsaicin, a substance which is extracted from cayenne peppers is also an alternative therapy for psoriasis. Capsaicin helps to block “pain and itch sensations from reaching the brain” (Tremblay, 2009). Some studies have revealed that it is able to decrease redness and scaling; however, it must be kept away from eyes, nose and mouth. Dead Sea Salts have also been advocated by some alternative medicine practitioners. The salts are said to have high curative properties for psoriasis. However, some studies have revealed that the benefit of the Dead Sea salts is actually in the exposure to the area’s sun and warm climate, not the water or the salts. Evening primrose oil has been found to be successful in treating eczema, however, its effectiveness in psoriasis has yet to be fully determined, and previous studies have not shown any benefit for psoriasis so far. Oats have also been advocated by alternative medicine practitioners as a means to soothe irritated and itchy skin. And while there is yet to be an actual clinical research to specifically indicate the effect of oats on psoriasis, good evidence indicates that they temporarily relieve dryness and itching in psoriasis sufferers. Tea tree oil has also been hailed for its antiseptic qualities, making it highly recommended in dentistry and dermatology circles. It is also particularly helpful in scalp psoriasis patients. However, tea tree oil is known to cause allergic reactions in some individuals, therefore should be used with care. No clinical studies have also studied the effectiveness of this substance in the treatment of psoriasis. These alternative therapies for psoriasis suffer from lack of sufficient evidence to support their effectiveness. These therapies have to be checked first with the physician before they can be tried by the patient because they can cause all sorts of reactions and adverse interactions with conventional drug treatments. It also has to be emphasized that “herbal supplements do not undergo the same rigorous testing as conventional medications, which must be approved by the Food and Drug Administration before hitting the market” (Tremblay, 2009). Some clinicians also emphasize that one product that may work for one patient, may not work as well with another patient; side-effects may even be severe and manifest in some other patients. Some adjustments in conventional medicine have been made to accommodate some of the alternative approaches to psoriasis treatment. And to date, a good marriage between these two extreme methods of treatment has yet to be established. The same problem with alternative therapies is still the current issue that prevents conventional medicine from accepting these modes of treatment into their practice. And the National Psoriasis Foundation is still very much cautious about endorsing or supporting any of these alternative methods of treatment. It still does not endorse or recommend any treatments for psoriasis of psoriasis arthritis. However, they also do not dismiss or discount any treatments that actually work for some patients – whether these are conventional or not. The studies and materials presented above indicate an analysis of the effectiveness of Daivonex, Exorex, and some of the complementary and alternative methods in psoriasis treatment. Based on medical reviews, Daivonex presents with various side-effects that cause many practitioners to caution users about opting for this medication without their advice and consult. Some users are impatient about the prolonged effect of the medicine, which makes some patients discontinue treatment with the medicine. Daivonex has limited applicability and cannot be used for widespread psoriasis. On the other hand, Exorex is reviewed by users and do not favor its strong odor and staining qualities. Comparing both medications, studies have revealed that coal tar creams are just as effective as calcipotriol based creams; coal-tar based creams are lightly cheaper than the Daivonex creams, hence are more efficient for customers. Both treatments both take a long time to take effect, although Exorex takes slightly faster effect as compared to Daivonex. As to long-term effectiveness, studies reveal no significant difference between these two medications. Complementary and alternative medicine options for psoriasis treatment are not widely endorsed by conventional medicine because of lack of proof and lack of clinical evidence to support their effectiveness. Studies need to be conducted in order to strongly support these options before they can be recommended for the treatment of psoriasis. Works Cited About Psoriasis: Statistics (2008) Psoriasis.org., viewed 22 March 2009 from http://www.psoriasis.org/about/stats/ Alai, N. (2009) Psoriasis, Medicine.net., viewed 22 March 2009 from http://www.medicinenet.com/psoriasis/article.htm Alternative approaches to psoriasis treatment (November 2006), Psoriasis.org, viewed 22 March 2009 from http://www.psoriasis.org/treatment/psoriasis/alternative/about.php Calcipotriol/Calcipotriene (Dovonex®, Daivonex®) (2008) Psoriasis Guide, viewed 22 March 2009 from http://www.psoriasisguide.ca/medical_treatment/topical/dovonex_daivonex.html Daivonex Review (28 January 2008) Medical-Look, viewed 22 March 2009 from http://www.medical-look.com/reviews/Daivonex.html Exorex Treatment for Psoriasis (n.d) Dooyoo, viewed 22 March 2009 from http://www.dooyoo.co.uk/archive-lifestyle/my-experience-of-psoriasis/438210/ Sharma, V., et.al, (2 October 2003) Calcipotriol versus coal tar: a prospective randomized study in stable plaque psoriasis, International Journal of Dermatalogy: Volume 42, Issue 10: pp. 834-838. Tremblay, L. (n.d) Complementary and Alternative Psoriasis Treatments, About.com, viewed 22 March 2009 from http://psoriasis.about.com/lw/Health-Medicine/Conditions-and-diseases/Complementary-and-Alternative-Psoriasis-Treatments.htm Tzaneva, S., et.al., (2003) Observer-Blind, Randomized, Intrapatient Comparison of a Novel 1% Coal Tar Preparation (Exorex) and Calcipotriol Cream in the Treatment of Plaque Type Psoriasis, Medscape, viewed 22 March 2009 from http://medgenmed.medscape.com/viewarticle/460991_print Read More