ROLE OF TRAUMA IN ISOMORPHIC RESPONSE IN PSORIASIS.
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Biomedical subjects
Publications and source records attributed to E M FARBER.
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Latent psoriasis is a state which exists before the development of clinical psoriasis and wherein probably some as yet undiscovered defect exists. Investigation concerning a group of persons with latent psoriasis might disclose basic aberrations. The natural course of psoriasis may be altered by therapy. Folic acid antagonists and intradermal corticosteroids may at times eclipse psoriatic lesions. Oral adrenal corticosteroids may prove morbidistatic but on discontinuance a rebound flare may occur which is both protracted and recalcitrant. Antimalarial agents when employed as therapy for coexistent arthridites may cause psoriasis to become more severe. The Goeckerman regimen which employs topical tar and ultraviolet light therapy produces in some 75 per cent of patients a prolonged remission. As it is safe and repeatable it is favored for the usual severe case of psoriasis. Psoriasis therapy is better assessed by considering its effect on the natural evolution of the disease.
The use of corticosteroids systemically in dermatology has benefited patients with pemphigus and systemic lupus erythematosus in that they now have a better chance to carry on a productive life. These hormones, used cautiously, can alleviate some of the tremendous suffering during the explosive exacerbations and acute crises of atopic and neurodermatitis. Corticosteroids are useful in the widespread and acute contact dermatitis and drug eruptions; they are contraindicated in the treatment of ordinary psoriasis. Every attempt should be made by history-taking, clinical examination and necessary laboratory studies to reach an accurate diagnosis before corticosteroids are used. If use of them is indicated, then total patient care is required to avoid complications, and a very careful follow-up is mandatory.
Ionizing radiation in the form of x-ray therapy is the best modality of treatment available at the present time for single, isolated lesions of mycosis fungoides. However, for generalized mycosis fungoides, generalized x-ray therapy is technically difficult and dangerous. It is now possible to employ electron beam therapy for generalized mycosis fungoides, using energies which confine the dose to the superficial layers of the skin and thus avoid hematopoietic injury. A technique for wide field electron beam therapy has been developed for this purpose which has been effective and well tolerated in limited trials to date.
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