239 Nursing Assessment, Management and Treatment of Autoimmune Diseases
Phototherapy There are various types of photothera- pies (light therapy) used in the treatment of psoriasis. The following list provides descriptions of some of the types of pho- totherapies used in the treatment of pso- riasis: ● Sunlight : Brief, daily exposures to sunlight (heliotherapy) might improve psoriasis, but precautions should be taken. Before beginning treatment with sunlight, healthcare providers should be consulted about the most effective and the safest way to expose skin to the sun (Mayo Clinic, 2020c). ● UVB phototherapy : This treatment involves exposing affected skin to an artificial UVB light source for an established length of time or a regular basis. UVB phototherapy can be administered in the healthcare provider’s office, outpatient clinic, or at home with a phototherapy unit (National Psoriasis Foundation, n.d.). ● Psoralen plus ultraviolet A (PUVA) : PUVA treatment involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. This light penetrates deeper into the skin than does UVB light. Psoralen increases the skin’s response to UVA exposure (Mayo Clinic, 2020c). ● Excimer laser : With this type of phototherapy, a strong UVB light specifically targets only the affected skin. Excimer laser therapy requires fewer treatment sessions than traditional phototherapy because a more powerful UVB light is used (Mayo Clinic, 2020c). Oral or injected medications If the patient has moderate to severe psoriasis that has not responded to other treatments, oral or injected medications
may be prescribed. Severe side effects may occur, so these medications are only used for brief periods of time and might be alternated with other forms of treat- ment (Mayo Clinic, 2020c). Oral and injected medications include the following (Comerford & Durkin, 2021; Mayo Clinic, 2020c; National Psoriasis Foundation, n.d.): ● Steroids : A few small and persistent psoriasis patches may be treated with a steroid injection directly into lesions. ● Retinoids : Retinoids are oral medications given to decrease skin cell production. These types of drugs are not recommended for females or for those who are breastfeeding. ● Methotrexate : Methotrexate is typically administered as a single oral dose. This drug works by decreasing skin cell production and suppressing inflammation. Both men and women should stop taking methotrexate at least 3 months before trying to conceive. ● Biologics : Biologics such as infliximab (Remicade) are used for patients who have moderate to severe psoriasis and have not responded to first-line therapies. They are usually given by injection. It is important that biologics be administered with caution. They may suppress the immune system to the point that increases the risk of serious infections. Patients must be screened for tuberculosis. Biologics are expensive and may or may not be
covered by health insurance. Alternative/complementary interventions
Several alternative therapies may be used to ease psoriasis signs and symp- toms. None have been proved to be ef- fective by scientific research, but they are
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