Wednesday, June 20, 2018
Health

Mayo Clinic Q&A: a look at treatment plans for psoriasis, scoliosis

SEVERAL OPTIONS EASE PSORIASIS

I have quite a few patches of skin that are much drier than others, including on my lower legs, knees and elbows. These areas get red and scaly sometimes, and itch on and off. Could this be psoriasis? Should I see my doctor?

From your description, it sounds like you could have psoriasis. Make an appointment to have your condition evaluated by a dermatologist. If it is psoriasis, your doctor can recommend treatment and give you advice on how to take care of your skin.

Psoriasis is a common skin condition that changes the life cycle of skin cells. It causes cells to build up rapidly on the surface of your skin. The extra skin cells can form thick, silvery scales and itchy, dry, red patches that can be painful. Psoriasis often goes through cycles, with symptoms flaring for a few weeks or months, then going away for a time.

A dermatologist usually can diagnose psoriasis by reviewing your medical history and examining your skin, scalp and nails. Your doctor also may recommend a biopsy to rule out other skin disorders. Conditions that can look like psoriasis include seborrheic dermatitis, lichen planus, pityriasis rosea and ringworm of the body.

If you have psoriasis, your dermatologist will talk with you about treatment options. Psoriasis is a chronic condition, and there's no cure. But, treatment can reduce symptoms by stopping the skin cells from growing so quickly. Therapies also can be used to remove scaly patches and smooth your skin.

If your condition is mild, you may only need to put a cream or ointment on your skin to relieve your symptoms. Topical corticosteroids are a common psoriasis treatment. These anti-inflammatory drugs slow cell turnover by suppressing the immune system. That eases inflammation and relieves itching. Other topical medications also can be useful in treating psoriasis, including retinoids, salicylic acid and coal tar. Regardless of what medication you use, keeping your skin well-moisturized will help control the dryness and discomfort.

When topical treatments alone aren't enough to keep your symptoms in check, your dermatologist may suggest you also use light treatment, or phototherapy, to control psoriasis. The easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light. Although this treatment may be time consuming, it can be very effective.

If you have severe psoriasis or if it doesn't respond to other kinds of treatment, your doctor may recommend oral or injected drugs, along with other therapies. In general, these drugs help lower the production of skin cells or reduce inflammation. They also may suppress your immune system.

Psoriasis sometimes can be challenging to manage. It may be unpredictable, going through cycles of improving and worsening symptoms without warning. In addition, treatment is not uniformly effective. What works well for some people might not work for others. Your skin may become resistant to some treatments over time, and the most potent psoriasis treatments can have serious side effects.

If your symptoms are due to psoriasis, you and your dermatologist can work together to develop a treatment plan. As you move forward with treatment, stay in contact with your doctor, especially if your condition doesn't improve after starting treatment or if you're having uncomfortable side effects. He or she can help you adjust your treatment to ensure the best possible symptom control.

Rokea el-Azhary, M.D., Ph.D., Dermatology, Mayo Clinic, Rochester, Minn.

BRACES NOT ONLY SCOLIOSIS HELP

Is wearing a brace full time the only treatment option for a child with scoliosis? What are the risks of not getting treatment?

Although braces commonly are used to treat scoliosis, they aren't the only option. The right treatment choice depends mainly on a person's age and the size of the curve. Mild cases of scoliosis may not need treatment. But, moderate to severe scoliosis that is left untreated can lead to pain and increasing deformity, as well as potentially heart and lung damage.

Scoliosis is a sideways curve of the spine with rotation. It most often develops during the growth spurt just before puberty. If the spinal curve is small — less than about 15 degrees — then having it checked periodically may be all that's needed. Most of the time, these small curves don't worsen.

When the curve is in the 20- to 40-degree range, however, and a child has at least two years of growth remaining, a brace typically is a good choice. Wearing a brace doesn't cure scoliosis or reverse the curve, but it usually prevents the curve from getting worse.

The most common type of brace is made of plastic and is contoured to a child's body. It fits under the arms and around the rib cage, lower back and hips. To be most effective, the brace must be worn day and night. Children who wear a brace for scoliosis usually can participate in most activities and have few restrictions. If necessary, kids can take off the brace to participate in sports or other physical activities. A child stops wearing the brace once his or her bones stop growing. A brace won't help older teens and young adults who are diagnosed with scoliosis after they have stopped growing or for patients with severe curves. In those situations, most doctors recommend surgery.

In general, surgery is also the first step in treatment for curves that are large — usually greater than 50 degrees. The standard surgery for scoliosis is spinal fusion. This procedure corrects the curve of the spine by connecting two or more of the spinal vertebrae. Metal screws and rods are used to hold the vertebrae together, so they can heal into one solid unit.

A newer surgical option is anterior vertebral body tethering. It involves inserting screws into the vertebrae affected by scoliosis. The surgeon attaches a cord to each of the screws and then pulls and secures the cord. The vertebrae are cinched together on one side and splayed open on the other, correcting the curve. This aligns the spine and gives the vertebrae space to grow in properly. This surgery is used mainly for cases of significant scoliosis in children with growth remaining. Mayo Clinic is one of only a handful of centers where this surgery is being performed.

If moderate to severe scoliosis is not treated, it usually continues to progress at an average of 1 degree per year. Significant spinal deformity leads to noticeable changes in appearance, such as shoulders that are not level, ribs on one side of the body that stick out farther than on the other side, uneven hips and a shift of the waist and trunk to the side. It also can cause increased back pain, and, in rare occasions, the rib cage may press against the lungs and heart, making it more difficult to breathe and harder for the heart to pump.

If you notice that your child's spine seems to be curved, or if you spot other signs and symptoms of scoliosis, such as uneven shoulders or an uneven waist, one hip higher than the other or one shoulder blade that seems more prominent than the other, make an appointment to have it evaluated as soon as possible.

Todd Milbrandt, M.D., Pediatric Orthopedic Surgery, Mayo Clinic, Rochester, Minn.

Mayo Clinic Q & A is an educational resource and doesn't replace regular medical care. Email a question to MayoClinicQ[email protected] For more information, visit mayoclinic.org. © 2016 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency, LLC. All rights reserved.

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