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From acne to psoriasis, from warts to wrinkles,
Dr. Lofgren treats a wide variety of medical and cosmetic problems. In
addition, he has a special interest in some of the more common but often
difficult-to-treat conditions like psoriasis and contact dermatitis. |
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Psoriasis—Effective Treatment for a Stubborn Disease |
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Psoriasis is a fairly common disease affecting three to four percent of the population. For most people, it manifests as a scaly patch on the scalp, elbows or knees that can be effectively treated with cortisone creams supplemented by retinoids (derived from Vitamin A) and calcipotriene (derived from Vitamin D). However, in the past severe forms of this disease necessitated hospitalization. Dr. Lofgren developed an interest in psoriasis during his training at the prestigious Mayo Clinic. At any one time, 60 patients were being treated in the hospital with a messy salve of coal tar and Vaseline. The 24 hour a day salve was removed once a day to expose the affected areas with ultraviolet light from a hot quartz lamp. At the end of three weeks, patients could expect to emerge tanned, clear and comfortable for about a year. Dr. Lofgren benefited from his experience with clinical trials utilizing other treatments with light, such as PUVA (psoralen and UVA). The efforts of medicine in creating more effective and longer lasting treatments have been rewarded. Today, hospitalization for psoriasis is rarely used. While psoriasis remains a frustrating disease, no patient
need be at the mercy of it. More severe cases will, of course, require
customized treatments that can be expensive and time consuming. There
isn't a cure, yet today's treatments are effective, tolerable, practical
and offer hope to sufferers of this disease. |
PUVA
and Narrow Band UVB
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New Biologic Psoriasis Treatments |
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Three new injectable biologic treatments for psoriasis have become available
the last few years. All of the injectable treatments are based on new information about the immunologic cause of psoriasis. Dr. Lofgren views them as real breakthrough treatments. Although they are new and only a few thousand patients have had them, they seem to be much safer than alternative systemic psoriasis treatments such as methotrexate or Soriatane. In addition they are not messy like the creams or inconvenient and carcinogenic like light treatments. After about a year's experience with these treatments Dr. Lofgren is
now beginning to combine them with older treatments to get a more rapid
or
complete
response. It is clear that these injectable treatments are not going
to replace traditional treatments, but they are great additions to the
options available for patients with severe psoriasis. |
Enbrel has been used in arthritis treatment for some years but
was in short supply until recently. Dr. Lofgren is now using it in psoriasis
patients that also have psoriatic arthritis with good results. It requires
two
subcutaneous
injections per week. These are easily given at home by a family member
with some training. |
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Contact Dermatitis—An Itchy Subject |
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Contact dermatitis is an itchy rash that is caused by something that contacts the skin surface. The only way to permanently cure contact dermatitis is to avoid contact with the causative substance. Identifying the causative substance sometimes requires some detective work. A detailed history of the rash can give very important hints. Examination of the rash also gives important hints. Usually an identification of the cause can be made quickly, combining the evidence from the history and physical examination with the dermatologist's knowledge of common causes of contact dermatitis. If the cause of a rash is not identified immediately,
allergy patch tests can be done. This testing involves application of
a battery of allergens (chemicals known to cause allergic contact dermatitis)
to the back, waiting 48 hours, and examining the back for reactions. |
A delayed reading is done at 96 hours to identify delayed reactions. With this additional evidence, it is usually possible to identify the cause of the dermatitis. Once the cause of the dermatitis is known, a plan is
then formulated for the patient to help him avoid contact with it. Sometimes
simple things like wearing gloves or learning what poison oak looks like
is all that is necessary. Often, however, an allergen that is causing
trouble is widely present in the patient's environment and more extensive
recommendations are needed. There are lists of items containing a specific
allergen for those allergens that are most problematic, so a patient can
know what to avoid. |
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Which of these three
items do YOU think causes allergic contact dermatitis? |
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Contact dermatitis can also be caused by irritation, which is not an allergic mechanism. Such things as harsh cleaners and acids are examples. After allergies are ruled out one is left with irritation and there are various techniques available to avoid contact with irritants. Some people just have sensitive skin, perhaps associated with dryness. Products that are safe for the majority of people may be irritants just for those with sensitive skin. Sometimes it is necessary to treat the underlying cause of the skin sensitivity to allow these people to tolerate commonly contacted items such as soap or cosmetics. |
Topical or systemic corticosteroids are used to rapidly clear up contact dermatitis and give the patient relief from itching, which can be severe in contact dermatitis. Because of side effects, however, steroids should not be used for extended periods of time so it is important to identify the cause of the contact dermatitis so the corticosteroids can be stopped. If contact dermatitis recurs after stopping the steroid treatment, further investigation should be done to determine what allergen or irritant the patient is still contacting. |
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