THE PSORIATIC PATIENT AND THE USE OF TOPICAL ANTIPSORIATICS

Psoriasis is a chronic disease with profound social implications. When patients are asked about the worst aspect of having psoriasis, most o f them answer that it is the appearance and consequent embarrassment. Dermatological diseases all have a strong impact on the patient's psyc he because of their visibility. The onset of psoriasis in childhood or adolescence can magnify the psychological aspects of the disease. Att empts have been made to quantify stress and to identify its relationsh ip to skin disease. Although studies on the relationship between stres s and psoriasis are often at variance, there seems to be a subgroup of patients in whom stress is a precipitating factor. Psoriasis for most patients requires regular treatment, There are types of the disease w hich respond very well to certain treatments with long-term remission. However, psoriasis is a disease which can be koebnerized by internal and external triggers, may vary in its life cycle and may relapse freq uently. There are still disadvantages with all available therapies. Th ey may have serious side-effects during or after treatment or the trea tment protocol may be difficult to follow Treatments such as short-con tact dithranol, ultraviolet (UV) A/B radiation and psoralen/UVA (PUVA) are either difficult to use at home or require special equipment and experienced personnel. In general, severe psoriasis requires the facil ities of a hospital or a daycare clinic. However, mild psoriasis mostl y does not need these specialist facilities. The patient is able to pe rform the treatment at home. In the last 5 years psoriatic patients ha ve experienced a marked increase in their quality of life as a result of the introduction of balneophototherapy, bath PUVA and, in particula r, new topical treatments with vitamin D-3 derivatives (calcipotriol, tacalcitol) and very recently a topical retinoid. Combination of the t opical agents with other treatment modalities such as UVA/B, bath-PUVA or balneophototherapy can increase efficacy by lowering the side-effe cts and shortening the treatment time. A treatment with tacalcitol, fo r example, once daily significantly decreases the time needed for self -care at home. In a very recent nonrandomized study, 5205 patients wit h mild to moderate psoriasis were treated with tacalcitol once daily a lone or in combination with UV or other treatments. Over 90% showed a good to very good compliance and reported very good to good local tole rability. More than 80% of the patients improved markedly during a tre atment course of 8-12 weeks. Systemic adverse events such as an increa se in plasma calcium could not be detected.