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The thick keratin of the nail blocks absorption of topical agents.

For onycholysis, a topical corticosteroid in a solution vehicle may be used under the nail. Systemic therapy may be required to improve severe disease.

The thin skin of the genitalia is highly sensitive to the adverse effects (atrophy) of topical corticosteroids.

A low-potency topical corticosteroid ointment is recommended. Topical calcipotriene, which is not associated with a risk of atrophy, may be used.

The thick stratum corneum of palms and soles is a barrier to penetration of topical agents.

A highest-potency topical corticosteroid is recommended. Methotrexate (Rheumatrex) or acitretin (Soriatane; a systemic retinoic acid analog) may be needed.

Topical corticosteroids are the most commonly prescribed treatment for psoriasis.5 They are available in ointment, cream, lotion and solution forms. Corticosteroids have well-recognized anti-inflammatory and antiproliferative effects, which are thought to be their primary mechanism of action in psoriasis.6 Topical steroids are classified as low-, medium-, high- and super-high potency agents (Table 2). In general, treatment is initiated with a medium-strength agent, and high-potency agents are reserved for the treatment of thick chronic plaques that are refractory to weaker steroids. Low-potency agents are used on the face, on areas where the skin tends to be thinner, and on the groin and axillary areas, where natural occlusion increases the potency of a low-potency agent to the equivalent of a higher potency agent. Use of high-potency agents in these areas increases the risk of side effects and therefore should be avoided.

Potential side effects from corticosteroids include cutaneous atrophy, telangiectasia and striae, acne eruption, glaucoma, hypothalamus-pituitary-adrenal axis suppression and, in children, growth retardation. The true incidence of corticosteroid-induced hypothalamus-pituitary-adrenal suppression is unknown, but it is of concern with prolonged use.7 Often, evidence of hypothalamus-pituitary-adrenal axis suppression is found on the laboratory results, even when clinical symptoms are absent. Careful long-term follow-up of patients receiving topical corticosteroid therapy is highly recommended to detect potential complications.

Although corticosteroids are rapidly effective in the treatment of psoriasis, they are associated with a rapid flare-up of disease after discontinuation, and they have many potential side effects. Consequently, topical corticosteroids are frequently used in conjunction with another agent to maintain control. Topical calcipotriene is often used in combination with topical corticosteroids to speed clearing of the lesions and maintain control after the initial phase of treatment is completed.

Calcipotriene is a vitamin D3 analog available in cream, ointment and solution formulations. It inhibits epidermal cell proliferation and enhances normal keratinization. This agent has a slow onset of action, and patients should be aware that the effects of calcipotriene may not be noticeable for up to six to eight weeks after the initiation of therapy.

Although calcipotriene monotherapy has been shown to be moderately effective in reducing the thickness, scaliness and erythema of psoriatic lesions,8 maximal benefits are achieved when calcipotriene is used in combination with potent topical corticosteroids. A simplified approach for combination therapy is to begin therapy with a “quick-fix” phase, followed by a “transitional phase” and then a “maintenance phase.”9 For example, treatment could be initiated with twice-daily applications of a topical corticosteroid and calcipotriene until the lesions are flat; the maximum duration of this phase is four weeks.

When the lesions have become flat, therapy can then be changed to twice daily use of calcipotriene only, with corticosteroid “pulse” therapy twice daily on weekends only. This second phase helps prevent rebound from abrupt withdrawal of corticosteroids. When the lesions have remained flat and the intensity of their color has declined from bright red to pink, the maintenance phase begins, with use of calcipotriene alone and discontinuation of the weekend use of topical corticosteroids.

After appropriate control of the disease is maintained, topical therapy can be discontinued until a flare-up occurs. Use of emollients should be recommended, to reduce the scaly appearance of the lesions and to potentially reduce the amount of corticosteroid needed.

The only cutaneous side effect of calcipotriene is local irritation, which occurs in approximately 15 percent of patients.10 Calcipotriene is not recommended for use on the face or with occlusion. Hypercalcemia is a potential side effect of this agent when the dosage exceeds 100 g per week. This effect does not usually occur with weekly use of 100 g or less.11, 12 Most reports of hypercalcemia have been in patients who received prolonged therapy with 200 g or more per week. For localized psoriasis, the recommended dosages do not require monitoring of serum or urinary calcium levels. However, calcipotriene should be used with caution in patients with compromised renal function or a history of renal calculi.

Coal tar is a black viscous fluid that was first described by Goeckerman in 1925, when it was combined with ultraviolet light for the treatment of psoriasis. It is thought to suppress epidermal DNA synthesis.13

Coal tar is available as an ointment, cream, lotion, shampoo, bath oil and soap. Coal tar is most effective when it is used in combination with other agents, especially ultraviolet B light. Like calcipotriene, coal tar is effective when it is combined with topical corticosteroids. Coal tar shampoo can be used in combination with a corticosteroid scalp solution for the treatment of psoriasis on the scalp.

Because coal tar is messy and malodorous and can stain clothing, nighttime application is recommended. Patients should be advised to use old bed linens and and to wear old pajamas when they are using coal tar. Tar products can cause folliculitis, but they otherwise are generally not associated with side effects.

If good control of psoriasis is not achieved with topical corticosteroids, alone or in combination with calcipotriene or coal tar, consideration should be given to the addition of anthralin or tazarotene therapy. Anthralin, also known as dithranol, is an antipsoriatic topical preparation derived from wood tar.4 It has been available since 1916, but it is a second-line agent because of its irritating and staining properties.

Anthralin is available in 0.1 percent to 1 percent ointments, creams and solutions. It is generally used on notably thick, large plaques of psoriasis, and therapy is initiated at low concentrations for short periods. The concentration and duration of contact with each treatment is gradually increased, up to a maximum of 30 minutes per application.4 Anthralin can be combined with ultraviolet phototherapy; this is known as the traditional Ingram regimen.

Patients should be warned that anthralin has a tendency to stain any surface, including the skin, clothing and bathtub. Its use should be limited to well-demarcated plaques, and it should be applied with a cotton-tipped applicator or a gloved hand. Patients should be warned that normal skin surrounding the psoriatic lesion may become irritated if it comes in contact with anthralin.

Topical tazarotene is the first topical receptor-selective retinoid approved for the treatment of psoriasis. It is available only in gel form and exerts its effects through gamma and beta retinoic acid receptors. Tazarotene helps to normalize the proliferation and differentiation of keratinocytes, as well as to decrease cutaneous inflammation.14, 15 Once-daily application of tazarotene gel, 0.05 percent or 0.1 percent concentration, has been shown to be as effective as twice-daily application of 0.05 percent fluocinonide cream.16

As monotherapy, tazarotene has been shown to significantly reduce plaque elevation in mild to moderate psoriasis.17 However, because of its modest efficacy, slow onset of action and high potential for causing irritation, tazarotene should usually be used in combination with corticosteroids. The primary side effect of topical tazarotene is minor skin irritation and increased photosensitivity. Tazarotene is classified as a pregnancy category X drug and its use should be avoided in women of childbearing age.

Sun exposure in addition to topical therapy may be beneficial when multiple areas are affected with psoriasis. Patients should be encouraged to obtain natural sunlight exposure or tanning-bed light exposure for a few minutes a day, and then to slowly increase the duration of exposure as tolerated. Unaffected areas should be covered with a sunscreen, especially the face. Ultraviolet light exposure can be used judiciously to prevent flare-ups during the maintenance phase of therapy.

Psoriatic plaques that fail to respond to topical therapy may be improved by administration of intralesional corticosteroid injections. Triamcinolone (Kenalog) is often used for this purpose. The agent is injected directly into the dermis of a small, persistent plaque. The concentration is generally 3 to 10 mg per mL, depending on the size, thickness and area of the lesion. The dose of triamcinolone is released gradually over three to four weeks; additional injections may be needed every four to six weeks to improve the response. Disadvantages of intralesional injections include pain during the injection and potential side effects of local atrophy and systemic absorption.

The patient with refractory lesions may benefit from more advanced forms of treatment, such as phototherapy (ultraviolet B alone or psoralens plus ultraviolet A), outpatient treatment at a clinic specializing in psoriasis and systemic therapy with oral retinoids, methotrexate (Rheumatrex) or cyclosporine (Sandimmune). Combination therapy has also been shown to be effective, especially phototherapy in combination with topical anthralin, coal tar or calcipotriene (Table 4).

Psoriasis er en kronisk inflammatorisk hudsygdom, karakteriseret ved et aktiveret immunsystem og hyperproliferation af keratinocytterne i epidermis. Sygdommen ses hos 2-3% af befolkningen. Den mest almindelige præsentation er nummulate plaques, som typisk er lokaliseret til knæ, albuer og skalp. De første udbrud af sygdommen kan være i form af et papuløst eksantem (guttat psoriasis). Ved invers psoriasis afficeres hudfolder.

Diagnosen psoriasis stilles sædvanligvis på de kliniske forandringer, dog kan der være behov for histologisk verificering ved atypisk præsentation.

Lokalbehandling vil ofte være tilstrækkelig ved mild til moderat psoriasis, mens fototerapi og systemisk behandling anvendes ved sværere former, herunder psoriasisartritis.

  • Calcipotriol i kombination med gruppe III-kortikosteroidet betamethason har effekt på linje med meget stærkt virkende kortikosteroider (gruppe IV), og kan ved daglig anvendelse i 4 uger inducere hurtig remission. Efter 4 uger aftrappes behandlingen gradvis. Ved relaps kan gentagen behandling med calcipotriol i kombination med betamethasondipropionat initieres efter behov.
  • Kortikosteroider kan være virksomme ved mild til moderat nummulat-plaquepsoriasis. Generelt anvendes stærkere virkende kortikosteroider til hårbund, krop og ekstremiteter, og svagerevirkende kortikosteroider til ansigt, hudfolder og ano-genitalregionen. Stærkt virkende kortikosteroider bør ikke anvendes ved svær udbredt psoriasis på grund af risiko for præcipitering af pustuløs- eller erytrodermisk psoriasis.
    I starten bør salver foretrækkes frem for cremer, idet salvegrundlaget er med til at opløse psoriasisskæl. Ved meget hyperkeratotiske forandringer kan det være en fordel dagligt at fjerne det tykke stearinagtige skællag med madolie eller salicylsalve 5% eller 10% før påsmøring af det aktive stof, dog er det ikke nødvendigt at fjerne skæl før anvendelse af calcipotriol-betamethason gel til psoriasis, herunder skalp psoriasis.
  • Tjæresalve eller -bade, ofte givet under indlæggelse, kan være et alternativ til kortikosteroid- og calcipotriolbehandling. Se endvidere Tjæreholdige midler mod psoriasis.

Systemisk behandling og fototerapi

Ved udbredt psoriasis eller svær psoriasis på hænder og fødder, eller svær ano-genital psoriasis, vil man ofte vælge at behandle med:

  • enten fototerapi UVB eller UVB-TL01 (smalspektret UVB)
  • eller systemisk behandling med fotokemoterapi (PUVA), methotrexat, acitretin, dimethylfumarat, ciclosporin, apremilast eller et biologisk middel.

Systemisk behandling kan med fordel kombineres med lokalbehandling med calcipotriol, idet der opnås additiv effekt.

Ved i øvrigt behandlingsrefraktær moderat til svær psoriasis eller ved intolerans/kontraindikationer mod anden systemisk behandling kan et biologisk middel eller apremilast anvendes. Det er alment accepteret at man før anvendelse af et af de biologiske midler eller apremilast har forsøgt behandling med mindst en anden systemisk behandling, herunder methotrexat.

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A new psoriasis breakthrough that has already helped over 17,542 psoriasis sufferers in New York and millions worldwide end their psoriasis is currently being attacked by large pharmaceutical companies.

This new breakthrough shared in this online video has helped psoriasis sufferers cure their psoriasis with no side effects and end the need for prescription dugs. Best of all this can all be accomplished with just a few items found in your local grocery store.

However many angry and greedy pharmaceutical companies have requested government organizations in United States to ban the new groundbreaking online video that reveals how to naturally eliminate psoriasis.

They claim it is against capitalistic practices and that it would destroy the psoriasis pharmaceutical industry. They are afraid it will effect their bottom line and put them out of business.

Want to learn how to eliminate your psoriasis? Simply watch this video while you still can.


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Modermærkekræft (melanom) er desværre blevet mere og mere almindeligt, men man kan helbredes, hvis man finder melanomet tidligt nok.

Kontrol af kroppens modermærker er et af de områder vi arbejder meget med og til undersøgelsen benyttes en lille kikkert – et dermatoskop. Dette sættes ned på modermærket ovenpå huden, og man ser derved tydeligere de forandringer, der kan være udtryk for hudkræft.

Der anvendes desuden et scoringssystem kaldet ABCD. A står for asymmetri, B border ( kant ), C colours og D different structures. Jo højere man scorer i dette ABCD scoringssystem des højere er risikoen for at der er noget galt. Diagnosen modermærkekræft (malignt melanom) kan imidlertid kun stilles med sikkerhed efter at kirurg eller plastikkirurg har fjernet modermærket med tilstrækkelig fri kant og hudstykket er blevet mikroskoperet af en speciallæge i patologi.

Er mistanken høj henvises du akut til en plastikkirurgisk afdeling der tager imod dig indenfor 1 uges tid. I tilfælde, hvor fundede er borderline – d.v.s. i det grå felt hvor der scores ret højt, men dog ikke ekstremt højt i ABCD – vil modermærket med fordel kunne fjernes af en praktiserende kirurg eller plastikkirurg efter en almindelig ”københavnsk” ventetid på 2-3 uger.

Jeg fjerner dem ikke,men skriver en henvisning til dig.

Udvendige midler egner sig kun til de lette udbrud, og der må skelnes mellem, om du mest har betændelser eller hudorme. Til førstnævnte kan opløsning med antibiotika anvendes ( jeg bruger aldrig noget der svier ), til sidstnævnte kan dampning med efterfølgende udpresning eller A vitaminsyre creme anvendes.

Ved manglende effekt af udvendige midler ( de fleste har prøvet dem førend de kommer hos mig ) behandles hellere med tabletter, enten antibiotika eller isotretinoin. Isotretinoin (Accutin ) gives i ca. 4 måneder, og behandlingen virker varigt hos rigtigt mange. Man må ikke blive gravid under behandlingen og lige efter, og man tørrer ind på læberne, mens man tager tabletterne. Få får mere alvorlige bivirkninger. Det altovervejende flertal bliver glade for den ofte meget overbevisende virkning, der opnås. Isotretinoin kan betegnes som verdens mest effektive akne medicin. Stoffet revolutionerede akne behandlingen tilbage i 90erne og mere end 10 millioner er blevet behandlet med det i Europa og i USA. På nettet findes mange oplysninger om stoffet skrevet af mere eller mindre pålidelige forfattere – man bør sortere klogt, hvis man orienterer sig der.

Udslæt er en betegnelse der dækker over så forskellige lidelser som infektioner, bivirkninger til medicin, eksemlidelser, psoriasis, nældefeber og meget andet.

Graden af kløe varierer meget. For eksempel klør eksem, mens det sjældent er noget problem ved psoriasis. Nældefeber og fnat ( scabies ) er eksempler på udslæt, der klør meget.

Der findes hududslæt der kan være udtryk for mere alvorlig lidelse indvendigt, men i de fleste tilfælde er udslættet det eneste man fejler. Det kan dog også være slemt nok. Ud over kløe og andre hudsymptomer er hudsygdom kendetegnet ved at have psyko-sociale følger. Det gælder ikke mindst, hvis man har udslæt i ansigtet, på hænderne eller på mere intime områder. Man kan føle sig stigmatiseret eller få skyld for at kunne smitte andre.

De allerfleste udslæt smitter ikke. Rifter og små sår huser dog gerne bakterier, og man kan nogle gange påføre andre dem, men ikke den hudsygdom der ligger til grund for rifterne. På den anden side findes der også udslæt der helt afgjort smitter. Fnat er et eksempel herpå.

I nogle tilfælde kan man forvente helbredelse af sin hudsygdom – enten takket være den medicinske videnskab eller fordi vi selv er indrettet sådan, at en plage nu engang ofte går væk igen på et tidspunkt. I andre tilfælde forsøger man at lindre patientens symptomer mest muligt mens selve hudlidelsen ligger og lurer i baggrunden og ikke er mulig at udrydde. Psoriasis er et eksempel.

Mildere former kan oftest behandles alene med virksomme medicinske cremer. Til hårbund kan det være nyttigt at have et alternativ til opløsninger med kortison i, da kroppen optager særligt meget kortison fra denne del af legemet. Jeg kan give dig recept på en salicylsyreholdig creme som man kommer i en forud fugtet hårbund og har i nogle timer før udvaskning. Man kan endvidere have gavn af tjæreholdig shampoo, som kan udskrives på recept. Til mere udbredte former for psoriasis anbefales lysbehandling eller man kan få tabletter ( Methotrexate ). Biologisk behandling med injektioner gives kun på sygehus, men hvis dette bliver nødvendigt henviser jeg dig til dette. Vi henviser også udvalgte patienter til Bispebjerg Hospital med tanke på en vurdering af, om de kan komme med på en behandlingsrejse til Israel.

Der er mange årsager til eksem, herunder mangel på enzymet filagrin i huden, men også udtørring, friktion, sved inde i handsker, kulde, eller vand og sæbe kan fremkalde eksem. Svampe kan give anledning til udslæt i ansigtet, såkaldt seboroisk dermatitis, og dette må behandles med svampemiddel. Endelig kan eksem skyldes allergi ( se afsnittet om allergiudredning ). Behandlingen vil bestå i ordination af cremer, evt. kan gives lysbehandling. Hvis eksemet er forværret eller fremkaldt af dit arbejde vil jeg orientere Arbejdsskadestyrelsen herom, og du vil muligvis være berettiget til en erstatning.

Allergitestning for eksem gøres ved hjælp af nogle plastre, der sættes på huden mellem skulderbladene. Disse indeholder de stoffer, der skal testes for, og plastrene tages af efter to døgn. På tredje døgn aflæser jeg reaktionen på huden ( Jeg ser efter om der er fremkommet en eller flere små røde eksempletter ).

Man kan ved hjælp af denne metode, der kaldes lappetestning, afklare om du har allergi for ting, du har hudkontakt med i din hverdag. Testen kan f.eks. indeholde nikkel, parfume, konserveringsmidler og farvestoffer, der findes i så almindelige ting som smykker, lynlåse, deodoranter og fugtighedscreme, gummihandsker, tøj, rengøringsmidler ect. Hvis man har et job eller en hobby, hvor man udsættes for særlige påvirkninger af sin hud benyttes særlige testserier. Vi råder f.eks. over en frisørserie der indeholder stoffer, som både frisør og kunde udsættes for ( for eksempel hårfarvestof og permanent ).

Metoden, der anvendes, bruges af alle danske hudlæger og er anerkendt verden over. Sammensætningen af testerne er foretaget af nogle af verdens dygtigste læger indenfor hudallergi og de tests jeg anvender fremstilles af det svenske firma Chemotechnique Diagnostics, Malmø.

Nogle får eksem af den kosmetik der anvendes, og det kan være fornuftigt at finde ud af, om noget bør undlades. Er der grund til testning af egen kosmetik, vil jeg bede om, at man medbringer op til 8-10 produkter, herunder nat / dagcreme, øjenskygge, mascara, læbestift, renseprodukter og evt. pudder, eller læbepomade/læbestift. Vent med at medbringe det til vi har talt sammen.

Priktest er en gammel og billig metode, der er kendt af de fleste, men den egner sig bedst til undersøgelse af allergi imod pollen, dyrehår, støvmider og skimmel. Nyere teknik (RAST tests eller histamin-release testning) muliggør screening i blot en enkel blodprøve af nøjagtigst det samme samt meget mere. Blodprøven giver således også svar på noget så almindeligt som allergi for nødder, der som bekendt findes i chokolade eller for komælk, soja, hvedemel og fisk. Jeg sender gerne rekvisition til et af byens mange laboratorier og du går derhen en dag, hvor det passer dig – men før kl. 12 og uden at have bestilt tid. De professionelle laboranter kan du have tillid til. De er meget dygtige til at stikke, og det er ikke nyt for dem at håndtere patienter der har nåleangst eller ramme plet i selv en lille åre hos et barn.

Når et håndeksem er forårsaget af eller er blevet forværret af dit arbejde kan det vurderes som en arbejdsskade og du vil kunne være berettiget til at opnå en erstatning og få refusion af udgifter til f.eks. cremer.

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Prof. Quigley, who is also of Weill Cornell College of Medicine in Houston, adds that the study raises the "exciting prospect" of using specific probiotics to influence the immune system from inside the gut.

In 2009, a study found that out of 13 different individual strains or preparations reviewed, B. infantis 35624 was the only one that signficantly improved IBS symptoms.

A.M. Marsland BSc, MRCP, R.J.G. Chalmers FRCP, and C.E.M. Griffiths MD,FRCP

Dermatology Centre, University of Manchester School of Medicine, Hope Hospital, Manchester, UK

Chronic palmoplantar pustular psoriasis (PPP) is a disabling condition characterized by recurrent crops of sterile pustules on a background of erythema, fissuring and scaling. Genetic and environmental factors have been implicated in its etiology. Topical treatments are frequently ineffective although corticosteroids under hydrocolloid occlusion have been demonstrated to be useful. There is evidence supporting the use of systemic retinoids, PUVA and a combination of both. Oral tetracycline antibiotics may be helpful, but rarely clear PPP. Cyclosporine has been shown to be of some benefit at low doses. The choice of systemic treatments for an individual patient is influenced as much by their potential side effects as by differences in efficacy.

Key Words:
evidence, palmoplantar pustular psoriasis, review, therapy

Chronic palmoplantar pustular psoriasis, or pustulosis palmaris et plantaris (PPP), is an idiopathic condition characterized by recurrent sterile pustules on the palms and soles on a background of erythema, scaling and fissuring. Once established, it may last for decades. Significant morbidity can impair dexterity or mobility, and cause pain, pruritus and embarrassment. PPP may affect people of all ages and either sex, although it is more commonly seen in middle-aged women. It may be associated with other forms of psoriasis, although it appears to be a distinct entity in terms of epidemiology and pathophysiology. The onset of PPP has been closely linked with cigarette smoking in a number of studies from different parts of the world. Another environmental factor proposed to be of etiological importance is recurrent streptococcal tonsillitis. 1

The choice of treatment is heavily influenced by its side effect profile. Treatments are often disappointing and may cause side effects. This article summarizes the existing treatments and evidence available to support their use. It should be noted that most trials have been conducted over short time periods for what is essentially a chronic, relapsing-remitting disease that frequently requires longterm therapy. Outcome measures in these trials are poorly defined and few studies report on patients’ subjective views.

Topical treatments alone tend to be ineffective for PPP, although some patients may benefit from using emollient creams or ointments, particularly when the disease is mild. These can safely be used as frequently as the patient wishes.

Superpotent topical corticosteroids may be effective in reducing the severity of PPP in the short term, and hydrocolloid gel occlusion has been shown to increase the numbers of patients who respond even when only a moderately potent steroid is used. 2,3 Reapplication of cream under gel occlusion is applied every third day for a maximum of four weeks. In order to maintain remission, some physicians prescribe a weaker topical steroid for daily use, but evidence supporting this intervention is lacking. The potential side effects of topical steroids are well known to dermatologists: in particular, the skin around the medial longitudinal arch may be prone to atrophy.

Some dermatologists advocate the use of tar and anthralin preparations for PPP. There are no published randomized controlled trials (RCTs) that demonstrate their efficacy. In addition, treatment can be messy and irritating.

Although systemic retinoid therapy is effective, there is no published evidence to support the use of topical retinoids for PPP. Tazarotene gel, which was recently introduced to treat mild to moderate plaque psoriasis, has not yet been formally evaluated in PPP.

Oral etretinate, at a dose of 0.6mg/kg/day, produces objective improvement in about 2/3 of PPP patients 4,5 and remission has been maintained in those who responded to initial treatment. 6 There is evidence to show that acitretin, which has now superseded etretinate, is as effective in the treatment of PPP at the same dose. 7

Retinoids are highly teratogenic, and female patients must be warned of the risks. Acitretin, the hydrolysis product of etretinate, was developed because of the initial belief that it was eliminated from the body much more rapidly. However, subsequent analysis has shown that it may, under certain circumstances, be esterified in vivo into etretinate. Since terminal elimination of etretinate from body fat stores is very slow, contraceptive measures must be taken during treatment and for at least two years after discontinuing acitretin.

Side effects of acitretin include xerosis, photosensitivity, epistaxis and (reversible) alopecia. Fasting lipid and liver function tests should be checked prior to commencing and at intervals during treatment. There is a small risk of hyperostosis and extraosseous calcification in patients on long-term therapy.

Liarozole is a novel drug that inhibits breakdown of all-trans retinoic acid, causing elevation of all-trans retinoic acid levels in the skin and plasma. Its effects and side effects are similar to synthetic retinoids but it is not believed to have a prolonged action following withdrawal. A small pilot study suggests that it may be effective in the treatment of PPP and may be worthy of further investigation. 8

Oral psoralen followed by irradiation with ultraviolet A (PUVA) has been shown to effect remission in PPP. 5,9 Disadvantages include the need for the patient to attend a dedicated unit on a regular basis, a small incidence of nausea, and the inconvenience of having to protect skin and eyes from sunlight on treatment days.

Topical psoralen paint or gel avoids the systemic side effects of oral psoralens. It may, however, be irritating and poorly tolerated. Unlike systemic PUVA, studies have failed to demonstrate the superiority of topical PUVA over placebo, 10,11 although a study comparing topical with systemic PUVA found no significant difference between them. 12

PUVA was reported in different trials to be either better 5 or worse 12 than systemic retinoids at effecting remission. Short-term PUVA, as a maintenance measure following remission brought about by potent topical steroid under occlusion, was not effective in a randomized control trial (RCT), which compared it with no treatment. 3 A combination of retinoid and PUVA (re-PUVA) was demonstrated to be superior to PUVA alone in clearing PPP. 13

Psoriasis är en hudsjukdom som orsakar celler för att bygga upp på hudens yta, vilket resulterar i tjocka skalor och torr, kliande plåster. Hos personer med psoriasis, som kallas en typ av vita blodkroppar en T-cell misstag friska celler i huden för en infektion och anfaller dem. Denna immunreaktion leder till psoriasis symptom. Psoriasis är en kronisk sjukdom som kan variera i svårighetsgrad från milt irriterande att helt handikappande. Lyckligtvis finns det många behandlingar som är tillgängliga för att hjälpa klara psoriasis.

Bada varje dag för att avlägsna fjäll, lugna inflammerad hud, och att klara psoriasis. Lägg kolloidalt havremjöl eller Epsom-salt till din badvattnet för att lugna inflammation. Undvik att använda hårda tvålar och mycket varmt vatten. Det finns schampo och balsam som är skonsamma för psoriasis i hårbotten.

Använd fuktkräm efter bad för att minska symtomen och lindra klåda. Oljebaserade moisturizers kan vara mer effektivt när huden är väldigt torr och vid kall väderlek

Leta efter möjliga triggers för din psoriasis. I vissa fall kan infektioner, allergier, solexponering, stress och allergier utlösa eller förvärra psoriasis. Undvika dessa triggers kommer att klara psoriasis och förhindra framtida skov.

Använd en topikal kortikosteroid kräm för att rensa mild till måttlig psoriasis. Steroider är de vanligaste läkemedel för mild psoriasis och arbete genom att dämpa immunsystemet och bromsa cellförnyelsen. Steroider är också effektiva för att minska inflammation och lindra klåda.

Applicera en syntetisk form av vitamin D för att bromsa celltillväxt och hjälpa tydliga psoriasis. Calcipotriene är en vitamin D-analog grädde tillgängliga genom recept. Dessa läkemedel används ofta i kombination med ljusterapi.

Prova andra utvärtes behandlingar för psoriasis om steroider och vitamin D-analoger inte rensa psoriasis. Athralin hjälper normalisera aktiviteten cell-DNA och ta bort huden skala, men denna medicin fläckar på hud, kläder och allt annat den möter. Aktuell retinoider hjälpa normalisera DNA aktivitet och minskar inflammation, och stenkolstjära reducerar svullnad och hjälper till med skalning och klåda. Kalcineurinhämmare och salicylsyra andra utvärtes behandlingar för att hjälpa klara psoriasis.

Genomgå ljusterapi för att behandla måttligt svåra fall av psoriasis. Ljusterapi, eller ljusbehandling, använder artificiell eller naturlig ultraviolett ljus för att döda T-celler i huden. Detta hjälper till att rensa psoriasis genom att bromsa cellförnyelsen och minskar skalning. American Academy of Dermatology säger att ljusterapi sessioner kan krävas flera gånger i veckan under fyra veckor eller mer innan symtomen förbättras.

Ta ett oralt läkemedel för att rensa mer allvarliga fall av psoriasis. Orala retinoider, metotrexat, ciklosporin, hydroxiurea och alla ordineras för psoriasis behandling hos patienter som inte svarar på lokal behandling eller ljusterapi. Injicerbara immunmodulerande läkemedel, såsom etanercept, är användbara för personer med terapiresistent psoriasis och de med psoriasisartrit. Enligt Mayo Clinic, dessa mediciner verkar genom att blockera samspelet mellan olika celler i immunsystemet.

Psoriasis er en kronisk inflammationssygdom, der er blevet en af landets store folkesygdomme

Hvad er psoriasis?
Psoriasis er en kronisk inflammationssygdom, der er blevet en af landets store folkesygdomme. Omkring 2-3 % af Danmarks befolkning har en form for psoriasis og 30-40 % af disse mennesker har også ledbesvær, psoriasisartrit. Sygdommen kendetegnes af rødt og skællende udslæt samt pletter. Der kan opstå kløe i forbindelse med psoriasis og når den indtræffer, er den oftest mild. Psoriasis er lige så almindelig blandt kvinder som mænd og forekommer sædvanligvis første gang i 15-40 års alderen.

Der er intet lægemiddel mod psoriasis, så det er en sygdom, man må lære at leve med. Trods dette er der gode behandlingsalternativer, som for mange lindrer generne betydeligt og sørger for, at hudproblemerne forsvinder i længere perioder. Psoriasis kommer i såkaldte anfald og indebærer, at det periodevis kan variere kraftigt mellem, at man har milde til alvorlige gener. Denne sygdom smitter ikke.

Hvorfor mennesker rammes af psoriasis er endnu ikke helt kendt. Psoriasis ses som en arvelig sygdom, som kræver en udløsende faktor for at kunne bryde ud. Eksempler på udløsende faktorer kan være en infektion, psykisk stress eller anvendelser af specifikke lægemidler som litium, klorokin eller betablokkere.

Uanset i hvilken alder sygdommen bryder ud eller ved at klarlægge sygdomsgraden blandt berørte familiemedlemmer, er det ikke muligt i forvejen at forudse, hvor alvorlig en psoriasis, man kan rammes af.

Hvad sker der i kroppen ved psoriasis?
Hvis kroppen bliver angrebet af bakterier eller virus er inflammation som regel en forsvarsreaktion. Ved psoriasis er der en systemfejl i immunforsvaret, som i stedet fører til en kronisk, inflammatorisk reaktion, hvor kroppens eget væv skades.

Hudceller, der opbygges i kroppen, ældes i løbet af den tid, de færdes gennem forskellige lag af huden. Epidermis/overhuden er det yderste hudlag, man ser. Det yderste lag af epidermis er hornlaget, som består af døde hudceller, som bliver forhærdede og fungerer som en barriere mod bakterieangreb, slid og farlige stoffer. Under epidermis sidder læderhuden. Læderhudens blodcirkulation hjælper med at regulere kropstemperaturen og tilfører både næringsstoffer og ilt til de andre hudlag.

Vores hud fornyes regelmæssigt gennem nydannede hudceller. Processen fra at en ny hudcelle dannes, transporteres til overhuden og stødes bort, tager omkring 5-6 uger. Det niveau af afskalning, som sker, når en hudcelle løsner sig fra huden, er minimal, når det sker i så små mængder og over en længere periode. Den immunfejl i kroppen, der indtræffer ved psoriasis indebærer, at de hvide blodlegemer, vores forsvarsceller i kroppen, bygger en kronisk inflammation mod hudcellerne. Med andre ord ser de hvide blodlegemer deres egne celler som fremmede og angriber dem. Denne tilstand kaldes for autoimmunitet og fører til sygdomme som psoriasis og psoriasisartrit, autoimmune sygdomme. I stedet for at fornyelsesprocessen af nye hudceller tager 5-6 uger omsættes hudcellerne på omkring 4 dage. Dette forløb gør, at huden ikke kan modnes fuldstændigt, og der dannes i stedet tykke pletlignende hudområder. Desuden kan der ikke opbygges et hornlag og derfor frigøres hudcellerne ikke længere en efter en, men i større bidder, hvilket gør, at man flager og skaller af. Andre symptomer som rødme og en varmeforøgelse omkring psoriasisområdet er forårsaget af den øgede blodcirkulation pga. inflammationen.

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