Nursing Assessment, Management and Treatment of Autoimmune Diseases
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mis. Joint x-rays can hasten the diagnosis of psoriatic arthritis. Bone scans are used for the early recognition of joint involve- ment (Habashy, 2021). Treatment Treatment of psoriasis is individualized to each patient. The goals of treatment are to relieve pain, remove scales, reduce swelling, maintain joint functioning, and prevent additional damage to joints (Na- tional Psoriasis Foundation, n.d.). Topicals Topical medications are typically the first treatment recommended to some - one who is newly diagnosed. Topical medications can be purchased over the counter or by prescription (National Pso- riasis Foundation, n.d.). The following is a summary of topical ther- apy medications (Comerford & Durkin, 2021; Mayo Clinic, 2020c; National Pso - riasis Foundation, n.d.): ● Corticosteroids : Topical steroids are one of the most common topical treatments for psoriasis. They come in a variety of ranges from very strong to very weak. Corticosteroids are available as ointments, creams, lotions, gels, foams, sprays, and shampoos. Topical corticosteroids are typically applied once daily during exacerbations and on alternate days or weekends to maintain remission. Mild corticosteroid ointments (e.g., hydrocortisone) may be purchased over the counter. However, prescription creams or ointments may be needed. Examples of prescription corticosteroids include triamcinolone (Trianex) and clobetasol (Clobex).
| NURSING CONSIDERATION
Patients should be advised to apply only a small amount of the steroid on affected areas only; not to use a top- ical steroid for longer than 3 weeks without the approval of healthcare providers; not to abruptly discontinue a topical steroid because it may cause a psoriasis exacerbation; avoid using steroids in or around the eyes unless the medication is specifically for the eyes; know that the more potent the steroid, the more effective it is, but the risk of side effects is greater (Na- tional Psoriasis Foundation, n.d.). ● Vitamin D analogues : Synthetic forms of vitamin D are prescribed to slow skin cell growth. ● Calcineurin inhibitors : Calcineurin inhibitors (e.g., tacrolimus [Protopic]) reduce both inflammation and plaque build-up. These medications are particularly useful in treating delicate areas of thin skin such as around the eyes. ● Coal tar : Coal tar is given to reduce scaling, itching, and inflammation. It comes in over-the-counter and prescription formats such as shampoo, cream, and oil. Unfortunately, these products can cause skin irritation, stain clothing and bedding, and have a strong odor. Coal tar is contraindicated for pregnant women and for those who are breastfeeding. ● Goeckerman therapy: This is a combination of coal tar treatment and phototherapy (light therapy). This combined treatment is more effective than either of them alone.
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