How Psoriasis And Psoriatic Arthritis Affect The Scalp
For many patients, the scalp is the only part of the body where psoriasis occurs or its the first location where the autoimmune disease develops.
Research shows that at least a quarter of people with plaque psoriasis, the most common type of psoriasis, initially present with lesions on the scalp.
Its very common for psoriasis to affect the scalp statistics show a range of 40 percent to 80 percent of people with psoriasis have scalp involvement, says Mount Kisco, New York, dermatologist David Bank, MD, who is also an assistant clinical professor of dermatology at Columbia Presbyterian Medical Center in New York City. It may occur in isolation or with psoriasis in other areas.
Scalp psoriasis can run the gamut from mild to severe .
Sometimes, in addition to the scalp, plaques also cover nearby areas such as the forehead, back of the neck, and the skin around the ears.
Treatments To Clear Scalp Psoriasis And Stop Hair Loss
The good news is that there are many effective ways to treat scalp psoriasis. Once your skin clears, your hair will usually grow back.
The bad news is that scalp psoriasis can sometimes be difficult to treat. Hair makes the scalp inaccessible for topical therapies, which are thick and gooey and hard to get in and out of your hair.
The practicality of applying a cream, ointment, or foam into the scalp makes it difficult for topical treatment of psoriasis of the scalp, says Dr. Gohara. If you dont wash your hair every day, who the heck wants to slather creams and ointments on their scalp?
This is especially problematic for Black and brown-skinned people, she says, who tend to wash their hair more infrequently.
Treatment depends on the severity of the condition.
Is Methotrexate Right For You
The reality is that methotrexate can be a very effective treatment option in helping patients reduce the joint damage associated with RA. This, in turn, can reduce pain, improve mobility and function, and increase a patients overall quality of life. Thus, many doctors prescribe the typical dose of methotrexate for RA treatment.
Despite its long history of safety, many patients still worry about the drugs negative side effects. This is likely because theyve heard about the side effects methotrexate can cause in patients with breast cancer or other types of cancer commonly treated by methotrexate.
It is important to keep in mind that these particular patients take very, very high doses of methotrexate much higher than the doses used in RA treatment. Not surprisingly then, their side effects tend to be more prevalent and more severe due to the patient being exposed to higher levels of the drug.
To find out if methotrexate is a good choice for helping you manage your RA, talk to your doctor about whether its the right treatment for you individually. If youre prescribed methotrexate, be sure to take it exactly as the doctor prescribes for maximum treatment benefits with the lowest risk of side effects. If youre unsure what that correct dose is or how to take it, your doctor or pharmacist can answer those types of questions for you.
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Psa Patients Prefer A Treatment Plan That Does Not Include Methotrexate
In this section, patients were also asked about their experience with the disease-modifying antirheumatic drug methotrexate and whether they want it as part of their treatment plan. The majority of patients said they would strongly prefer or somewhat prefer a PsA treatment that did not include methotrexate. Of the patients who have already used methotrexate, 15 percent were somewhat dissatisfied with their experience and 32 percent were very dissatisfied.
Methotrexate is an immunosuppressive drug that is commonly prescribed to people with psoriatic arthritis, as well as rheumatoid arthritis . Despite methotrexates ability to reduce symptoms and help prevent disease progression, many inflammatory arthritis patients say they ultimately stop taking MTX because of side effects . Indeed, side effects were among the reasons patients in were unhappy with methotrexate. When given the opportunity to share why they were not happy with this treatment:
- 58% said dislike of short-term side effects
- 53% said lack of efficiency
- 44% said fear of long-term side effects
Methotrexate Plus Leflunomide Proves Effective For Psa
Dr Michelle Mulder
“We believe that prescribing this combination in routine practice is viable when combined with shared decision-making and strict monitoring of side effects,” write Michelle L. M. Mulder, MD, of the Department of Rheumatology at Sint Maartenskliniek in Nijmegen, the Netherlands, and her co-authors. Their findings were in Lancet Rheumatology.
The latest treatment guidelines from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and the European Alliance of Associations for Rheumatology recommend conventional synthetic disease-modifying antirheumatic drugs for patients with active PsA, but Mulder and her colleagues note a distinct lack of information on their effectiveness, especially this particular combination.
To assess the efficacy and safety of methotrexate plus leflunomide, they launched a single-center, double-blind, randomized trial that incuded 78 Dutch patients with PsA. The majority of the participants in this trial dubbed COMPLETE-PsA were men , and the median age of the patients was 55 years. All had active disease at baseline the median swollen joint count and tender joint count were 4.0 in both groups.
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What Other Dmards Are Used For Psoriatic Arthritis
Two other DMARDs that might be used before trying a biologic DMARD are leflunomide and sulfasalazine, Ostrowski says. These are both oral drugs and may take several months to show results. “However, it is not uncommon for doctors to recommend a biologic DMARD over these drugs since they are not usually more effective than methotrexate, she says.
The most common side effect of sulfasalazine is upset stomach. This drug can also increase sensitivity to sunlight, so youll need to use a strong sunscreen while taking it. If youre allergic to any other sulfa drugs, you may not be able to take this drug.
Like methotrexate, leflunomide can cause liver injury, and the most common side effect is diarrhea.
What Do I Need To Know About Methotrexate For Psoriatic Arthritis
Methotrexate is a DMARD because it reduces pain and swelling and may prevent joint damage and disability. It works by blocking inflammation caused by your immune system. It’s often started at a weekly dose, and it may take up to six weeks to provide results, Ostrowski says.
Side effects of methotrexate can include hair loss and mouth ulcers. It can also cause inflammation of the liver, so liver function tests need to be done, according to the NPF. Also, you shouldnt drink alcohol while taking methotrexate. Taking the B vitamin folic acid may help prevent some of these side effects, Ostrowski says.
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How To Cope With Side Effects Of Methotrexate
What to do about:
- loss of appetite, feeling or being sick, stomach ache or indigestion eat simple meals and do not eat rich or spicy food. It can help to eat and drink slowly and have smaller, more frequent meals. If you’re being sick, try taking small, frequent sips of water to avoid dehydration. For stomach ache, putting a heat pad or covered hot water bottle on your stomach may help.
- diarrhoea drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
- headaches, feeling tired or drowsy rest and drink plenty of water. Do not take non-steroidal anti-inflammatories, such as ibuprofen. You can try a painkiller such as paracetamol. Do not drink too much alcohol. Do not drive, cycle or use machinery if you feel tired or drowsy. Speak to your doctor if this does not get better.
- hair loss this is unlikely to be permanent. If hair loss bothers you, talk to your doctor. They may be able to lower your dose or recommend a different medicine.
What Are The Side Effects Of Methotrexate
As with all medications, some side effects are possible when taking methotrexate. It is important to remember that not every person taking a medication will get all, or even any, of the possible side effects listed.
Because methotrexate works by reducing the activity of the immune system, it can make people taking it more prone to infections than they usually would be. If a serious infection occurs a doctor will most likely stop treatment with methotrexate. You should let your doctor know as soon as possible if you notice signs or symptoms of an infection, such as a raised temperature, fever or sore throat.
The immune system also protects against cancer, and it is thought that treatment with low doses of methotrexate may increase the risk of developing lymphomas . If this happens, treatment with methotrexate will be stopped. Sometimes, the lymphoma will resolve itself after methotrexate is stopped, whereas in other cases it will need to be treated.
The main risk of long-term methotrexate use is the potential for liver or kidney damage. In order to detect and treat this damage early, you will have regular blood tests and may be required to have occasional liver biopsies, where a thin needle is inserted through the skin to extract a small sample of liver tissue. In most people, treatment with methotrexate will be stopped, or the dose will be reduced, if signs of liver or kidney problems are found. If you develop jaundice , you should see a doctor as soon as possible.
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Side Effects Bother You
Many meds that treat psoriatic arthritis make a big difference, but they all have risks.
For instance, NSAIDs can make stomach irritation and bleeding more likely. Methotrexate, which is prescribed for many types of arthritis, can damage the liver. And because medicines called biologics work on your immune system, they can make serious infections more likely.
Let your doctor know if you have side effects from your medication.
What Are Some Alternatives To Methotrexate
The treatment plan for PsA will depend on what symptoms you have and how severe they are. Other health conditions and any previous history of treatment are important considerations too. A few other medications that might be an option include:
Non-steroidal anti-inflammatory drugs
If your arthritis symptoms are mild, an NSAID like ibuprofen can lower pain and inflammation. Your provider may also recommend prescription-strength NSAIDs like diclofenac or celecoxib . Prescription steroids can also help swollen joints when injected into the affected joint.
Biologics are a type of medication that can be used to treat many different conditions. A few that are FDA-approved to treat PsA are Enbrel , Humira , and Cosentyx . Injectable biologics can be used alone or along with methotrexate.
Some non-medication treatments that might help with PsA symptoms include:
Braces or splints to protect the joints
Your healthcare provider may recommend a combination of medications, physical therapy, and exercise. Surgery is usually reserved for people with severe disease and damage to the joints.
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Being Able To Perform Physical Activities Is Extremely Important To Psa Patients
Participants were given a list of nine ways PsA impacts their quality of life and asked to choose the one that was most important to improve through treatment as well as the one that was least important to improve. They included:
- Sleep quality
- Ability to work or do school activities
- Ability to participate in social activities
- Ability to participate in leisure activities
- Unpredictability of disease flareups
Patients said they most want to improve their ability to perform physical activities. This is not surprising, as the joint pain-related symptoms that patients deem bothersome likely affect their ability to be active. Patients also want to improve their ability to live and function independently.
Patients least wanted to improve their ability to participate in leisure activities and social activities.
How To Take Methotrexate
Methotrexate comes in many forms. You may be prescribed a pill or liquid. Some patients inject methotrexate at home. Each form has benefits. For example, injecting methotrexate can reduce side effects such as nausea and vomiting.
Before taking methotrexate for the first time, be sure to carefully read the instructions. If the instructions are confusing or differ from what your dermatologist said, call your dermatologist before taking methotrexate. Some patients stay on methotrexate for a long time. Others stop taking methotrexate once their psoriasis is under control and restart when psoriasis flares.
Follow recommended dosage
Most people take methotrexate once a week. Taking it more often than your dermatologist prescribes can cause serious health problems.
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Health Care Providers Should Consider Patient Experience And Preference When Developing A Psa Treatment Plan
Its important to understand how people living with PsA experience common symptoms, such as pain, stiffness, and fatigue, as well as their goals for treatment so that we can develop new management strategies that reflect their preferences, lead author Alexis Ogdie, MD, Associate Professor of Medicine and Epidemiology and rheumatologist at the University of Pennsylvania, said in a press release.
Dr. Nowell agrees, adding that understanding what patients are worried about and what matters to them is important, and health care providers should seek to treat the individual patient as well as the general disease.
If you feel your current treatment plan is not adequately easing symptoms or improving your quality of life, talk to your doctor.
Important Things To Remember
- While taking methotrexate you should see your rheumatologist regularly to make sure the treatment is working and to minimise possible side effects.
- You should have regular blood tests as directed by your rheumatologist.
- If you are concerned about any side effects, you should contact your rheumatologist as soon as possible.
For more information about your condition see Arthritis Australias website:
The information in this sheet has been obtained from various sources and has been reviewed by the Australian Rheumatology Association. It is intended as an educational aid and does not cover all possible uses, actions, precautions, side effects, or interactions of the medicines mentioned. This information is not intended as medical advice for individual problems nor for making an individual assessment of the risks and benefits of taking a particular medicine. It can be reproduced in its entirety but cannot be altered without permission from the ARA. The NHMRC publication: How to present the evidence for consumers: preparation of consumer publications was used as a guide in developing this publication.
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The Impact Of Scalp Psoriasis And Hair Loss
Its not really known why the scalp is so susceptible to psoriasis. One possible reason its such a prime area is that the high follicular density of the scalp reduces natural light exposure. Ultraviolet rays from light exposure can help clear or prevent psoriasis.
Although scalp psoriasis alone involves a small percentage of the body, it can have a profoundly negative affect on a persons quality of life and self-esteem. But when it leads to hair loss psoriatic alopecia in doctor-speak it can be particularly distressing.
The decrease in hair density is typically mild and difficult for the doctor to see, but of course, we take it very seriously, says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida, and medical advisor for CreakyJoints.
Rest assured, once scalp psoriasis is under control, most people with hair loss experience complete regrowth of their hair.
The key is to seek medical help promptly, since scarring that results from psoriasis common in longstanding scalp psoriasis can cause permanent hair loss.
What If I Take Too Much
Taking too much methotrexate can cause serious side effects. In some cases it can be fatal.
Store your weekly methotrexate separately, away from any other medicines that you take daily.
Urgent advice: Contact 111 or advice if:
- you have taken more than your prescribed dose of methotrexate
- you have taken your methotrexate daily instead of weekly
Go to111.nhs.ukor call
If you need advice for a child under the age of 5 years, call .
If you need to go toA& E, do not drive yourself. Get someone else to drive you or call for an ambulance.
Take the methotrexate packet, or the leaflet inside it, plus any remaining medicine with you.
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Which Medications Can Interact With Methotrexate
Your doctor may have you take one or more drugs with methotrexate, but check with them before you take any medication besides those theyâve prescribed. This includes over-the-counter medications, supplements, or herbal remedies.
If you see a health care provider besides the doctor who prescribes your methotrexate, be sure you tell them that you take this drug. Thatâs because methotrexate doesnât mix well with several types of drugs, including:
- Some diuretics
How Effective Is Methotrexate At Treating Psa
Some researchers think using methotrexate for PsA isnt as effective as newer treatments. But, treating PsA with methotrexate is a common practice. Theres evidence that its an effective treatment. A 2016 study of over 200 people with PsA found that methotrexate treatment improved joint and skin symptoms over a 12-week period.
Methotrexate is considered a first-choice treatment for PsA. Even though there might be newer, more effective treatments available, methotrexate has advantages. The side effects are usually mild, it can be taken orally, and its inexpensive.
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