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Is there any place for light therapy in facial psoriasis?

The face and intertriginous sites are highly responsive to topical medications, but are particularly sensitive to the side effects of many topical agents. Topical corticosteroids cause cutaneous atrophy, telangiectasia, and striae. Therefore, only milder, safer corticosteroids should be used on the face and intertriginous sites, and alternating with non-corticosteroids may be optimal if psoriasis recurs. The topical immunomodulatorstacrolimus 0.1% ointment and pimecrolimus 1% cream are effective and safe for facial and intertriginous psoriasis, but not as effective on thick plaques on the rest of the body.<br>
PUVA is one of the most effective treatments for psoriasis and offers long remissions for many patients. Because of its increased risk of cutaneous malignancy, PUVA is usually reserved for those who do not achieve adequate remissions with UVB.

Do you recommend laser therapy for scalp psoriasis?

Involvement of the scalp is common and requires gels, solutions, sprays or foams that are not as messy as ointments and creams. Shampoos containing tars, salicylic acid, or corticosteroids are useful adjunctive therapies for the scalp. A new home device that delivers narrowband UVB to the scalp through fibre-optic filaments has recently been introduced.

What is the cosmetic role of emollient in treating facial psoriasis ?

What is the cosmetic role of emollient in treating facial psoriasis ?

Emollient use in psoriasis is sometimes seen as an optional extra. Fluhr et al (2008) summarise the evidence that highlights the therapeutic benefits of using emollients in psoriasis. As well as reducing scaling and dryness through an occlusive effect (thus increasing levels of stratum corneum hydration) emollients normalise cell proliferation and cell differentiation in psoriatic plaques (Fluhr, 2008). It is important to consider, when choosing suitable emollients for those with psoriasis, the other added ingredients. Urea has an accepted moisturising effect due to its humectant properties, however it is also thought to have keratolytic and epidermal thinning properties which are helpful in psoriasis.
Is there any chemical peel for psoriasis disorder?

Salicylic acid is the most effective keratolytic substance and
is extremely helpful in thinning psoriatic plaques. Proposed useful properties of salicylic acid include corneocyte intercellular bonding, corneocyte swelling, corneocyte desquamation and stratum corneum softening (Fluhr, 2008). The higher the concentration, the more effective the product is likely to be, however salicylic acid has local and systemic side-effects which must be monitored.

What are the differences between creams and lotions?

Lotions are similar to creams but more watery. As a consequence they are not really suitable for people who have dry skin, but are generally used for maintaining skin health for someone who has normal skin. Most cosmetic emollients that come in bottles are lotions eg Vaseline, Dove, Nivea etc.

Can we use cream after cosmetic procedures like chemical peel, microneedling or ablative laser treatment?

All these modalities create the inflamatory response in the derm and epiderm of skin. This is based on the level and depth of the injuries(thermal or non-thermal). Therefore, the skin after these procedures is sensitinve. Creams are not a suitable mode of moisturising after cosmetic procedures.<br>
They are made of Water and oil mixed together and in doing so an emulsifier has to be added to hold the two substances together otherwise they separate. Because water is added the contents can become contaminated by bacteria therefore a preservative has to be added. These extra added ingredients can sometimes cause skin reactions if a person is sensitive to one of the ingredients. Creams are generally avoided when moisturising lower limbs that have venous or arterial disease esp in patients with leg ulcers. People with eczema may sometimes complain that a cream makes their skin feel worse, if this is more than just transient stinging then an ointment may be more suitable. Trial and error is the only way to find out unless someone knows that they have an allergy/sensitivity to a substance. (Ref: Ersser et al 2007)

can we use ointments after chemical peel?

 ointments are true emollients. They work by occluding the skin and trapping the moisture into the stratum corneum.
Generally they don't have preservatives or emulsifiers although there are some exceptions. They don't have perfumes. Because they are very basic substances with minimal extra ingredients they have a low potential for sensitising, i.e. people rarely have reactions to these products. They don't need the preservatives because bacteria do not like to live in this kind of lipid intense environment and emulsifiers are not needed because no water is added.<br>
These are the option of choice if the skin is very dry (Ref: Ersser et al 2007)

How we can maintain the texture of facial skin after any cosmetic procedure like laser, micro-needling or chemical peel?

 There are some after care instruction for each cosmetic procedures. Your aesthetic practitioner will provide you with details after care instruction. These instructions are for post-procedures. If you want to keep your skin(especially facial skin) healthy and well hydrated you can used different moisturising products from a simple moisturiser to emollient with growth factor.

what is the best approach to slow down the process of aging skin?

Reducing the speed of aging is related to tackling the external and internal factors of aging skin. Protecting against UV by applying high SPF(Sun Protection Factor) and reducing or giving up smoking are among the steps to reduce the speed of aging skin. The internal factors like genes and texture of skin must also be taken into consideration in a holistic approach. Emollients are very effective substances in providing hydration to the skin and alternatively reduce trans epidermal water loss (TEWL).<br>
They work by reducing the amount of water lost across the skin barrier, thus improving its function. There is some evidence to suggest that emollients are also mildly anti-inflammatory so in conditions such as eczema may help to reduce the inflammation. By improving skin quality they do also help to reduce the amount of itch that people experience (when itch is related to dry skin) and therefore the amount of scratching that they do) (Ref: Marks 2001)

How does Superficial Fractional Radiofrequency work?

The SFR (Superficial Fractional Radiofrequency) handpiece provides minimally invasive delivery of RF energy to the epidermis and dermis with its'unique dual channel delivery system. The first channel delivers a deeper zone of controlled thermal effect, while the second channel provides micro ablation of the upper layers of the epidermis and mild coagulation. Working in combination, the two distinctive channels result in luminous skin, controlled tightening and scar revision.


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