Psoriasis - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Psoriasis or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Psoriasis Treatment
Localized Psoriais (less than 10% of skin area) - Treatment Options
| scalp | face/ neck/ ears/ genital | palms/ soles | remainder | |
|---|---|---|---|---|
| Narrowband UVB - Pharos excimer laser | effective | effective | effective | effective |
| Glycerin | lotion | cream | lotion/ cream | |
| Almond oil | yes | yes | ||
| Retinoid | gel/cream | |||
| Taclonex | solution | ointment | ointment | |
| Dovonex/ Vectical | solution | (cream) | ointment | Cream/ ointment |
| Topical steroid | lotion | cream/ointment | ointment | Cream/ointment |
| Tar | shampoo | cream | cream/ solution | |
| Protopic/ Elidel | + | |||
| Salicylic acid | Solution/ oil | ointment | Gel/ cream |
Dr. Ringpfeil: " If I had psoriasis I would remove all elements in my immediate environment that contribute to inflammation. Specifically, I would avoid animal protein and fat, as well as highly refined carbohydrates. I would also avoid
- Smoking
- Caffeine (Coffee, black tea, chocolate)
- Alcohol (except an occasional glass of red wine) and
- Stress (yoga, meditation, bio feedback, exercise are good for dealing with stress)
Pharos excimer laser
" My experience shows that when you suffer from psoriasis you can enjoy long lasting relief after just a series of short treatments. The laser treatment is safe and effective in removing skin plaques that may not respond to gels or creams, which carry the risk of harmful side effects.
Here are a few benefits that I find in the Pharos excimer laser:
- Treats scaly skin plaques quickly and effectively in about 12 twice weekly treatments.
- Treats effectively the scalp, legs, arms, and other skin areas.
- Delivers a carefully focused treatment that spares the surrounding skin and therefore minimizes side effects.
- Provides long lasting relief for up to 6 months.
Please note... this laser technology might not be the best solution if you have wide spread psoriasis over the entire body or if your psoriasis gets worse with sun exposure.
The excimer laser treatment is covered by most insurance plans after precertification. Our staff will be happy to communicate with your insurance to issue the precertification for you. "
Franziska Ringpfeil, MD.
I have patches of plaque psoriasis on my scalp. I just moved to the area and at my previous dermatologist I did 10 weeks of the Xtract Laser Treatments. I found this treatment to be the most effective on my scalp. Does your office offer this treatment?
I am not surprised to read that your psoriasis was well controlled with excimer laser treatments. It works very well for many people on the scalp.
Yes, we do offer Excimer Laser treatment in our office
I’ve had plaque psoriasis on my elbows for 13 years (since age 22). The area it covers is small and has not changed considerably in the past decade. I’ve used only steroid ointments. I read about your excimer treatments. My elbows can clear up in the warmer weather but still can flare randomly, get red and it can hurt…plus I’d like to wear cute sleeveless shirts! I had one flare of guttate psoriasis right after I had my baby last year (I’d never even heard of it), and I did PUVA tx for a few months. My skin cleared completely, with no further problems. Other than that, elbows are only issue.
Does insurance cover the excimer??
Excimer laser treatments appear to be an excellent treatment choice for you.
Treatments are performed 2-3 times per week and take about 10 minutes. The total number of treatments to clearing can vary. The average is about 12-16 treatments. Insurance typically covers these treatments yet as with PUVA treatments precertification is needed and is performed by our office. Your insurance will then let us and you know, if you have a copay or coinsurance for each treatment or if there is any deductible to fulfill.
I think I’ve had psoriasis under my hair near my temples for a little while but I only realized it recently when I started noticing that my whole scalp feels achy and sore when I take my hair down after being up in a bun or ponytail. I’ve also noticed recently that I’m losing a lot more hair in the shower and when I brush my hair. I don’t have thick scales so I’m not sure why this would affect my hair. I have no other way to explain this extra loss of hair though. Can excimer treat the whole scalp, and not just the edges? I’m definitely interested. Additionally, I am planning to start an anti-inflammatory diet. I have a little psoriasis on my elbows too.
Excimer laser treatments is the only type of light treatment that can treat the whole scalp and it can also treat your elbows. It’s is advantage over other light treatments is being able to focus on the psoriasis rather than treating unaffected skin and having to compromise on treatment efficacy.
Please pursue your plans for an anti-inflammatory diet.
My son had a respiratory infection and 2 weeks later developed a rash that looked like chicken pox over his arms, legs, chest and back and was very itchy. A doctor did a biopsy and diagnosed it as either due to a bug bite or an allergic reaction and has been treating him with zyrtec. Previously, a course of prednisone helped but did not totally eliminate it. I think he has guttate psoriasis and needs to see someone who understands this condition and can treat it.
Psoriasis is not readily missed under the microscope, however, it could have been. If in fact guttate psoriasis is present now, it could have also occurred in an area of previous rash (this is called Koebner phenomenon).
Most of the time, guttate psoriasis can be diagnosed by a dermatologist visually because of characteristic color of the spots and their characteristic scale. Please make an appointment with your dermatologist.
I am seeing a dermatologist in a few days to confirm a psoriasis diagnosis. I have been noticing just recently that my right hand an right elbow at times has a discharge. It is a golden color and looks like crumbs when it dries. Should I continue to wipe it away. Or leave it be and keep it clean and covered up? How concerned should I be?
Keep the areas clean by washing with warm water and soap and keep them covered with Vaseline and a band aid until seeing your dermatologist in a few days. If you notice new areas before evaluation by your dermatologist, you may want to see your primary doctor.
How much do you charge for pharaoh laser treatments for psoriasis. I do not have insurance. How much is the cash price
Excimer laser treatments is useful when treating psoriasis involving less than 10% body surface area. For those without insurance, we currently charge $150 per treatment.
My son has scalp psoraisis treating w salicytic acid and gels . I habe Personal choice insurance and am intersted could you let us know the out of pocket cost upfront before treatment, Also where is your officwe located?
Scalp psoriasis can be treated in various ways and if salicylc acid does do not provide efficient relief, it may be time for prescription treatment. We participate with Personal Choice and submit the office visit or any in office treatments directly to your insurance plan. Depending on the contract that you have with your insurance, you may have a copay which is due at time of visit. Some benefit plans include deductibles (similar to car insurances) or copays. Your insurance customer service should be able to let you know these details.
I am currently working with my 3rd dermatologist diagnosed with a sever case of scalp psoriasis (finally with biopsy after being misdiagnosed for the first 1.25 yrs. I have tried every topical cream/gel/shampoo/mouse/oil available with no help. I am currently on treatment number 13 excimer laser with little to no benefit. 3 weeks post initiAtion of methotrexate up to 15 mg po weekly. Being followed by rheumatologist and testing for Psoriatic Arthritis. Suffering major hair loss over last 6 months. I am looking for help with hair loss. Has there been permanent damage to my hair follicles? Will my hair grown back? You came HIGHLY RECOMMENDED. Currently seeing Gottlieb in Exton. can you help in any way with my hair loss or current situation?
I am glad to read that you are in good hands. It can take excimer treatments some time to kick in and there is no harm in continuing topical treatment that reduces scale (salicylic acid) and reduces inflammation (e.G. Taclonex scalp solution or clobetasol foam) at the same time. If you are not totally grossed out by its messiness, you could have Dr Gotlieb’s office apply mineral oil just prior to the excimer treatments. Hair loss associated with severe scalp psoriasis is not unexpected but hair will almost always grow back once your psoriasis responds because psoriasis does not destroy hair follicles.
On June 11 I went to see a dermatologist regarding my scalp psoriasis, and he told me to use an over the counter product, over night with a shower cap covering head. This is a know medical/over counter product from a reputable and good company. Obviously, this is not the proper way to use this product, and my scalp is burnt and head excruciatingly painful, unable to touch pillow with head to rest or sleep. The company does use a third party medical team to assist with problems, who have been very nice on the telephone; advising me to put Vitamen E, then slather scalp and head with pure Aloe and periodically use cold compresses. Today starts my fourth day of this , and wonder if you have any suggestions…I have not heard from the dermatologist who prescribed this treatment, therefore must move on to other assistance. Thank you for any help or suggestions you might offer me…
I am sorry to hear about your problems. You probably realize that a blog is not for personal medical advice. Please make an appointment with our office (you acn book online) or us the on-line consultation route on our home page.
I have been getting a general uvb treatment for my psoriasis and it has disappeared on most of my body. However, my elbows and some spots on my legs still remain. Is excimer laser treatment an option for those spots, or should I not do more uv-treatments this year since I already have been exposed to quite a lot of uv?
Excimer laser treatments only expose the psoriatic skin, not the unaffected skin, with a narrow wavelength in the UVB spectrum. There is no danger in overexposure with this method. Considering you success with UVB treatments, a focally higher dose of narrow band UVB will likely clear the stubborn areas on the elbows and shins.