advanced dermatology dermatological treatments


Psoriasis is a non-contagious chronic skin disorder that is seen as scaly plaques on the skin. The Psoriasis appears as an elevated red plaque that is covered by a silvery dry scale. It affects 1-2% of the world population.

A normal skin cell matures in 28 – 30 days. In Psoriasis, cells move to the top of the skin in three days. The excessive skin cells that are produced “heap up” and form the elevated red, scaly plaques that characterize Psoriasis. The white scale that covers the red plaque is composed of dead cells that are continually being cast off. The redness of the plaques is caused by the increased blood supply necessary to feed this area of dividing skin cells.

Do not let Psoriasis affect your confidence. Make peace and ensure you have a strong mind and body to deal with the everyday challenges. Empower yourself with knowledge of your condition to enable you to be in control of your condition.

Different Types of Psoriasis

Discoid or Plaque Psoriasis
This is the most common type of Psoriasis. Well defined, coin-shaped patches of skin that are usually red and covered in white, waxy scales that appears on the knees and elbows but plaques can appear anywhere on your body. They can be itchy and may bleed if scratched.

Guttate Psoriasis (Latin gutta, meaning drop)
Guttate Psoriasis usually develops 7-14 days after a severe throat infection or bout of tonsillitis caused by streptococcal infection. The “drop-like” patches are mostly found on the trunk and limbs. It generally occurs in children or young adults and often disappears by itself after several weeks/months.

Flexural (inverse) Psoriasis
Flexural Psoriasis is found in “skin folds” of sites such as the armpits, groin, buttocks or beneath the breast. The skin is red and covered with thin plaque but not scaly.

Napkin Psoriasis
Well defined glazed areas in nappy area of babies

Scalp Psoriasis
Scalp Psoriasis is common in Psoriatic patients. About 50% of all Psoriasis patients suffer from scalp Psoriasis. It is clearly defined, infiltrated, very thick, white and scaly plaques over the scalp, especially in occiput and above the ears. Masses of sticky grey-ish white asbestos-like scales on scalp. It can look similar to dandruff and can be embarrassing.

Sebopsoriasis is usually seen on the scalp and also the face (glabella, eyebrows and nasolabial folds), postauricular and pre-auricular areas and sometimes on the central chest. It overlaps with seborrhoeic dermatitis but is distinguished by having more well-demarcated plaques. The face is usually not affected when it comes to psoriasis. Psoriasis of the scalp can extend down over the forehead, temples and sometimes over the eyebrows and ears.

Palmoplantar Psoriasis
May only effect palms and or soles. Well-demarcated plaques on palms of hands or soles of feet. More hyperkeratotic types (thickening of skin) tend to form painful fissures. It can be difficult to distinguish palmoplantar Psoriasis from:

  • Tinea (scrapings for fungal culture should be routinely ordered)
  • Dermatitis eg. Allergic contact dermatitis

Pustular Psoriasis
Pustular Psoriasis usually exists as a large red area covered with green, tender pustules (blisters), despite their colour the pustules are not infected (the green colour is caused by masses of white blood cells-these cells flood into any part of the skin that is inflamed). After 7-10 days pustules become dispersed and brown scales appear and later fall off. Pustular Psoriasis on the palms and soles tend to be sore rather than itchy. It is uncomfortable, unsightly and can make writing and walking difficult.

The most rare and most severe form is Generalised Pustular Psoriasis. A patient becomes ill, feverish and a sudden onset of tiny pustules all over the skin, within a few hours or days. The pustular change is induced by the overuse of strong cortisteroid application.

Palmoplantar Pustulosis-PPP
This is an independent disorder. Around the pustules the skin becomes red, thickened and painful fissures will form with a distressing itch. It is most common in middle aged females. People with this condition can benefit from UVB treatment.

Nail Psoriasis
In 50% of patients with Psoriasis, the nails are affected. Pitting, discolouration and thickening of the nail may occur

Psoriatic Arthritis
It is an inflammatory form of Arthritis which may affect only a few or multiple joints.

90% Or more of skin is inflamed. It may be a slow worsening of chronic plaque Psoriasis or an explosive form of unstable psoriasis. The skin becomes red, hot and continually scales. They lose the ability to control their body temperature and experience the loss of fluids and proteins. Psoriatic Erythroderma may be provoked by too intense topical treatment, by infections, the sudden withdrawal of topical corticosteroid therapy as well as anti-malarial therapy

There are no blood tests diagnostic for Psoriasis; the diagnosis is made by the dermatologist’ observation of the skin lesions and if necessary a skin biopsy specimen removed from the plaques can confirm the diagnosis. It is unusual to have nail Psoriasis without Psoriasis elsewhere on the skin.

ANYONE! We detected a family pattern in one out of three cases. Chromosomes 6 and 8 are usually suspect and are linked to Psoriasis. One gene is modified by other genes and when combined with certain environmental factors, can produce Psoriasis. This complex method of inheritance explains why several generations may be skipped before Psoriasis appears.

Men and Women are equally affected. In 75% of sufferers the onset is before age of 46 but there are two peaks of onset at ages 16 – 22 and 57 – 60. It is less common in children though usually Guttate type is diagnosed. Babies usually are diagnosed with napkin psoriasis and/or cradle cap.

Certain races seem to be more prone and Psoriasis is more common in Northern Europeans, less common in African blacks and Asians and rare in American Indians and Aboriginal Australians.

Our skin is the means by which we initially define ourselves to others. This coupled with the fact that we live in a society that places a high value on physical appearance, causes people with Psoriasis to feel uncertainty as to their acceptance socially and/or in the workplace.

A holistic approach is crucial.

The severity of the disease is measured in terms of both its physical and emotional impacts. If 10% of the body surface is involved the case is mild, 10% to 30% percent is moderate and more than 30% is considered severe. However, Psoriasis confined to the feet and hands only can be severe enough to be disabling. When the disease affects major body surfaces, various physical problems can occur such as intense itching, pain and cracking skin with swelling. Body movement and flexibility can be affected.

The course of the disease is highly variable and unpredictable. Psoriases will go through cycles of improvement and flare-ups. For no reason there can be spontaneous remission. The disease can gradually improve on its own over time. In some cases it can worsen.

There are treatments which significantly improve a skins appearance. Treatment-induced remissions can last anywhere from a few weeks up to several years. The treatment of Psoriasis varies from being simple to a major challenge and a patient’s response to therapy is unpredictable. Treatments are tailored to the patient depending on the extent of the disease, patient preference and practical issues, response to previous treatment and relative or absolute contra-indications.

Yes, Greek word Psora means itch. Keep skin moisturized to help control the itching.

To date no specific dietary regime has been identified through scientific investigation that will clear or improve Psoriasis. Culprits are NICOTINE AND ALCOHOL!!

Scaling decreases once the Psoriasis clears, often there are white spots left which will gradually disappear.

No evidence that allergies can directly cause Psoriasis.

Sometimes remission occurs during pregnancy while other women experience a flare during pregnancy. Nursing generally has no effect on Psoriasis.

Psoriasis generally worsens during winter months and improves during summer as a result of exposure to sunlight. Sunlight obtained in regular doses can clear Psoriasis.


Physical and or emotional trauma. Lithium can also worsen Psoriasis.

There is no evidence that stress is a direct cause of Psoriasis but studies have shown that Psoriasis can be aggravated by emotional stress. Psoriatic patients may be divided into stress reactors and non-stress reactors

Keep your skin well lubricated. Take advantage of the sun shine if possible. Minimize contact with soap and chemicals. Minimize stress with a regular exercise programme. The relaxing effect of exercises enhances improvement. Protect your skin against injuries, eg. Shaving with dull razor, wearing too tight shoes, getting soap under your ring or watchband.

No not at all.

NB UVB phototherapy is time tested. There is no convincing evidence that therapeutic UVB increases the risk of skin cancers, regardless of skin type.

Treatment Options

Treatments are tailored to the patient depending on:

  • Extent of disease
  • preference
  • practical issues
  • response to previous treatments
  • relative or absolute contraindications

Broadly, treatments can be thought of as a ladder of options:


Topical Agents

Psoriatic skin tends to be very dry and this dryness can lead to a worsening of the psoriasis if it is not treated. Excessively dry skin can also cause itching. Regular lubrication of the psoriatic skin with CrémeClassique Ointment and CrémeClassique Anti-bacterial Cream is recommended to restore the moisture and flexibility of the skin. Emollients smoothens, soothes and hydrates the skin by sealing in moisture. Loose, silvery scales are the most embarrassing aspect of Psoriasis. Long term use of emollients are safe and have no side effects

Coal Tar
Tar ointments are highly effective in treatment of Psoriasis and help reduce scaling and inflammation. Coal tar is a complex mixture of many substances produced from coal. It has been used as a treatment of Psoriasis for over 100 years. It can be used on the whole body and the scalp. Therapeutic tars are derived from either coal or tar or wood tar. It may be crude or refined and are available as paste, ointments or creams as well as a shampoo. We strongly recommend over the counter CrémeClassique Coal tar cream and CrémeClassique Coal tar shampoo. A useful inexpensive mixture is coal tar solution 5% and salicylic acid 3% in white soft paraffin. Be careful not to use tar products on pustular psoriasis as it will cause severe irritation.

Topical Therapy

  • Mild topical corticosteroids
    These mixtures are available as creams or ointments and contain up to 1% hydrocortisone. Weak steroid creams may not have much effect on Psoriasis
  • Prescription-only topical corticosteroids
    For thick plaques of Psoriasis fairly potent corticosteroids are needed. These, however, suppress the plaques rather than clearing them. Lower strength steroids are used for more sensitive areas like the face, groin, armpits and breasts


  • If potent corticosteroids are used over a widespread area of the body for prolonged periods, it can cause severe systemic side-effects for example: thinning of the skin or Telangiectasia
  • Steroids are short-term solution- you can’t use them forever. The product will stop working and the Psoriasis will get worse
  • Steroids are like a rubber ball; if you drop them, they will bounce back. If you suddenly discontinue the use of steroids you can suffer “rebound” Psoriasis-the Psoriasis is suddenly worse
  • Taper off-don‘t just quit
  • Don’t mix and match steroids
  • Don’t trade or borrow other people’s mixtures


Salicylic acid
Salicylic acid acts as a scale lifter, helping to soften and remove psoriasis scalesand enhances the effectiveness of other emollients, eg corticosteroids as well as UVB rays which will be discussed later.

Dithranol (Anthralin)
Dithranol is a highly effective synthetic compound. Dithranol is very effective in the treatment of chronic plaque Psoriasis. It works by inhibiting the synthesis of DNA, preventing rapid cell turnover. Side effects include skin irritation of normal skin, staining or discoloration of skin (not permanent) and staining of clothes (permanent). This treatment is done only under the supervision of specialists. Dithranol treatment is highly specialised and sophisticated and not readily available in South Africa. Advanced Dermatology offers this unique service. Dithranol has a potent antipsoriatic effect which can be enhanced by combination with NB-UVB treatments.


UV Therapies
UVB Narrowband (311 nm) Sun exposure and dead sea treatment was noticed to improve Psoriasis. UVB light slows the abnormal growth of normal skin cells which is associated with Psoriasis. Ultra violet light is defined as short wave light energy (311nm)(ultra violet B light). Phototherapy works by a combination of anti-proliferative effects and local immune suppression. It is generally the treatment most physicians will begin with as it is most effective and less risky. The combination of Phototherapy and abovementioned topical treatments is highly effective and can put the Psoriasis in remission for a long period. UVB Narrowband treatment is available at Advanced Dermatology, Tel 012 492 7871, Tijger Valley Office Park, block 5, office 5, Silverlakes.

Narrowband UVB (NB UVB) phototherapy matches the action spectrum for the treatment of Psoriasis while minimizing exposure to non-therapeutic light.

DEKA Excilite-µ: A complete system for targeted and selective phototherapy MEL@308nm source.


  • Compared to UVB Narrowband, it requires fewer sessions
  • Compared to Laser, sessions are shorter with Excilite-µ
  • Compared to PUVA, Excilite-µ does not require the use of drugs
  • Treatment is targeted and selective towards lesions, without involving the healthy perilesional skin
  • Wavelength (308nm) selectivity enables intervention on more delicate areas
  • Minimizing side effects such as erythema, burns and unwanted darkening of normal skin
  • Repetitive treatments with Excilite-µ cause stabilization of results with prolonged times of relapses
  • All the above benefits enhances the patients quality of life without compromising social and work activities
  • Excilite-µ can also treat Vitiligo, Psoriasis, Atopic dermatitis, Alopecia Areata and Mycosis Fungoides
  • Targeted Phototherapy with MEL@308nm is revolutionary. Excilite-µ combines the advantages of laser phototherapy and broad-spectrum lasers while eliminating their disadvantages.


Natural sunlight
Multiple short exposures to natural sunlight can temporary clear Psoriasis. A slow and gradual tan is recommended for best results. Up to 95% of people will improve with regular exposure to sunlight. Sunburns should be avoided at all costs as it can trigger the Psoriasis. Be sure to apply a sunscreen before sun exposure on your normal skin. After 15-30 minutes exposure of Psoriasis lesions, put sunblock on lesions as well. Try CrémeClassique Safari Sun block for ultimate protection.

Systemic Treatments
These treatments should not be used systematically except under exceptional circumstances (most severe Psoriasis) and under strict Specialist Dermatologist supervision.

Is a highly potent, anti-mitotic (anti-cancer) drug. That is given in small doses to clear severe and or disabling Psoriasis. It has a role in psoriatic erythroderma, generalised pustular psoriasis, psoriatic arthritis and pustular psoriasis of the palms and soles. BEWARE!! Methotraxate can c

Women must avoid this treatment due to the fact that they must avoid pregnancies for two years after the last capsule has been taken. It is a very expensive treatment. Dryness of lips and mucus membrane, hair loss may occur as well as thinning of the skin. Liver functions must be monitored during treatment.

IMPORTANT! Long term systemic steroids for psoriasis are contra-indicated because of development of tachyphylacsis (development of tolerance) and severe exacerbation following discontinuation (rebound)

General Hints during Psoriasis therapy

In treating Psoriasis there are different approaches. Rotate therapies over the long term to minimize side effects from any one therapy. It also reduces the possibility of the individual developing a resistance to the therapy. It can happen that the therapy ceases to be effective after prolonged use. Frequently people give up too soon! Results can take a long time to achieve. Persevere with treatments. It can only take 12 treatments to clear for one person while another may require 60 – 80 treatments. Be sure to discuss the variation of your treatments with your therapist at Advanced Dermatology. A commitment to a lengthy treatment may be necessary to achieve clearance. On some occasions, one’s Psoriasis can get worse during treatment before suddenly getting better.

Trigger factors
Apart from streptococcal infection, the following are often implicated as a trigger factor in Psoriasis

  • Ear, nose, throat infections, teeth and gums, bladder infections
  • Drugs – lithium (a drug used to treat manic depression)
  • Hydroxychloroquine or choloroquine – Malaria medicine
  • Betablockers
  • Aspirin, voltaren, brufen, Coxflam, Myprodol
  • Stress – precipitating and exacerbating factor
  • Smoking – nicotine
  • High Alcohol Intake
  • HIV Infection
  • Excessive Sun Exposure
  • Diet
  • Gluten-free diet


Melanin, the pigment that determines colour of skin, hair and eyes, is produced in cells called melanocytes. If these cells die or cannot form melanin, the skin becomes lighter or completely white. Vitiligo is a chronic pigmentation disorder or a skin condition of white patches resulting from loss of pigment. Pigment cells (melanocytes) are killed in areas due to an auto-immune reaction (white blood cells and anti-bodies against own pigment cells).

Different types of Vitiligo
Vitiligo may cover the whole body or only a few spots. It can appear on both sides of the body, symmetrical or asymmetrical (one side) which is usually more stubborn to treat. Most common sites of pigment loss are body folds (groin and armpits) and around body openings (eyes, mouth, ears and genitals)


  • Hereditary effect- runs in the family
  • Autoimmune problem
  • Thyroid malfunction may be involved
  • After physical trauma to the skin (Koebner effect)

Treatment of Vitiligo
Most advanced treatment with DEKA Excilite-µ. Vitiligo is among the most psychologically devastating diseases with dramatic effects on the patient’s social life.

The advantages of using DEKA Excilite-µ:

  • Targeted treatment; treats only the lesions
  • Less effects of erythema, burns and hyperpigmentation
  • Fewer sessions needed
  • Targeted Phototherapy with MEL@308nm is revolutionary. Excilite-µ combines the advantages of of laser phototherapy and broad-spectrum lasers while eliminating their disadvantages.

UVB Narrowband therapy
UVB Narrowband (311 nm). Ultra violet light is defined as short wave light energy (311nm)(ultra violet B light). Phototherapy works by a combination of anti-proliferative effects and local immune suppression. UVB Narrowband treatment is available at Advanced Dermatology, Tel 012 492 7871, Tijger Valley Office Park, block 5, office 5, Silverlakes.

For mild forms of Vitiligo, topical corticosteroids may be used to restore small patches of non-pigmented skin. This can only be prescribed for a short period of time as it has some side effects.

  • Expose patches of affected skin to the sun. This may promote repigmentation, but don’t overdo it. Protect the normal skin with a good sun protector ex. Creme Classique Safari Sunblock
  • If you feel good about yourself and seek relationships with people who value more than superficial appearances, there is no reason for Vitiligo to interfere with your interactions with other people. Vitiligo does not erasehumour, personality, intelligence, kindness and affection-only pigmentation.
  • Over the counter cosmetic camouflage

Vitiligo is not contagious. It is not something you can catch or pass on.

Vitiligo is a chronic pigmentation disorder or a skin condition of white patches resulting from loss of pigment.

Diagnosis is usually made by observation. Progressive, white areas on typical sites point to a diagnosis of vitiligo. If the diagnosis is not certain, the doctor will test for other conditions which can mimic vitiligo, such as chemical leukoderma, fungus infections or systemic lupus erythematosus. If the tests rule out other conditions, vitiligo is confirmed.

An auto immune condition, the immune system rejects the patient’s own pigment cells.

Any area may be affected but mostly areas of sunburn, minimal friction, pressure, trauma, around eyes, nose, mouth, armpits, groins, legs, around moles. Small or large, single or multiple areas mostly progressive. Spontaneous improvement may occur.

Yes. Frequently an association may be noted.

Social and emotional affects may occur.

There is no cure BUT phototherapy can improve your condition up to 70-80% and even more.


The term Eczema is derived from the Greek word “Ekzein” meaning “to boil over”, referring to the spongiostic vesicles characteristic of the early stages of the disease.

Eczema is an endogenic chronic, recurring itching skin condition with genetic predisposition. This means that the disease is always present, even though flares may come and go. The symptoms of eczema include dry, inflamed skin and intense itching.

Chromosome 11 and 5 predicts the tendency and is part of the atopic syndrome eczema, hay fever, sinusitis, asthma, keratosis pilarus and allergies of ear, nose and throat conjunctivitis and urticaria. Eczema flares happen because the immune cells in an eczema sufferer’s skin overreact to certain triggers. Therefore it is very helpful to identify and avoid exposure to those triggers.

Many people think of eczema as “just a rash” but for millions it is a frustrating, persistent condition that can make their lives miserable. At times, eczema can be so mild that it may not even be noticeable. Often it can be severe enough to keep a person awake. Eczema is not contagious; it cannot be passed from person to person.

advanced dermatology eczema treatment

Clinical Features:
There are 3 stages of Eczema: infantile, childhood and adulthood. The cardinal symptom is Pruritis. Pruritis is the hallmark of Atopic Dermatitis and often precedes the rash. “Atopic Dermatitis is an itch that rashes”. Uncontrolled and subconscious scratching is frequent and leads to excoriation of the skin and lichenification. Secondary infection often complicates the condition. Pruritis may lead to disturbed sleep resulting in poor school or work performance.

Itching associated with inflammatory charges or lichenification prurigo is different to that associated with excessive drying.


60% Of children will outgrow the condition before 5 – 15 years of age and 85% before 15 – 20 years of age. In adults a chronic hand and foot eczema may develop in later years after outgrowing the childhood phase. Careers exposed to irritants and clamminess like hairdressing, mechanics, labworkers, and builders may be severely affected.

Minor Criteria

Patients with Atopic Eczema have an abnormal stratum corneum which lacks the ability to hold water. Dry skin reflects residual inflammation which results in hyperproliferation of the epidermis. The skin is more brittle and subject to fine fissures through which allergens may enter. Transephidermal water loss is increased thus an impaired barrier function of the stratum corneum. This explains why there’s a potential for relapses or recurrences. Read advice on treatment of eczema.

Environmental aggravating factors:

  • Scratching
  • Detergents (Handy Andy, Jik, etc.)
  • Wool and nylon
  • Acids, cement, petrol
  • Excessive water contact
  • Sand/dust, dry grass
  • Soap/bubble bath
  • Tension (especially at work)
  • Seborric eczema-nappy area
  • Pityriasis Alba-dry white spots especially after swimming or long exposure to the sun. Can outgrow it – 15 to 25 years
  • Wash: wash with a neutral non irritating soap like Crème Classique soap and/or ointment containing Triclosan for the staph super infection. Moisturizing cream like Crème Classique may be used. Pat dry after wash, but do not rub. Use a soft cotton towel. Water should be body temperature. Try to avoid prolonged exposure to water. Only 3 minutes in the bath/shower, avoid excess swimming, sandpits for children and avoid bubble baths and detergents.
  • Moisturizing: Anti-inflammatory moisturizer cream prevent re-occurring. The top epidermis in atopic skin is dehydrated due to a reduced lipid barrier function of the stratum corneum. Excessive vaporation takes place during drying, minute cracks appear in the epidermis, allowing allergens and bacteria to penetrate. Weeping and oozing is noticed due to spongiosis and leaking of tissue fluid through epidermis. Excessive water contact like swimming absorbs excessive water and reduces the barrier function and evaporation take place, AGGRAVATING THE CONDITION! Using Crème Classique Ointment BEFORE any water contact. It improves the barrier function of the skin.
  • Non-cortisone anti-inflammatory creams and ointment: Crème Classique cream or ointment contains Cetomagrocol and Tricosin as preservative. Parabens as preservative may trigger an allergic contact dermatitis if used frequently
  • Diluted cortisone cream: 10-20% dilution of cortisone cream in Crème Classique 3 times a day penetrates better than cortisone by itself and with the anti-inflammatory effect may be more effective, less damaging and cheaper than full strength ointment. A dilution may be applied for long periods with minimal cortisone detrimental effect.

Rather use hydro cortisone on faces than cortisone

Alternative to cortisone creams: Coal tar cream is prescribed and may help if cortisone treatment failed

Anti-itch: The older oral sedating H1 anti-histamins like Phenergan and Aterax are very effective, especially at night.

Narrow Band Ultra-Violet (311nm): This treatment is very effective and remissions for months are noticed with no side effects.UVB Narrowband (311 nm). Ultra violet light is defined as short wave light energy (311nm)(ultra violet B light). Phototherapy works by a combination of anti-proliferative effects and local immune suppression. The combination of Phototherapy and abovementioned topical treatments is highly effective and can put the Eczema in remission for a longer period. UVB NB treatments aim to decrease the intensity of flare-ups as well as prolong intervals. UVB Narrowband treatment is available at Advanced Dermatology, Tel 012 492 7871, Tijger Valley Office Park, block 5, office 5, Silverlakes.

Deka Excilite-µ (308nm): Deka Excilite- is a Monochromatic Excimer Light (MEL@ 308nm) which offers a revolutionary way of treating eczema. MEL@308nm for targeted Phototherapy makes a decisive breakthrough on traditional treatments and methods.

Remember that breast feeding may prevent attacks. Soy may cause allergies in atopic patients. Children with eczema are more likely to have or develop allergies to certain foods (milk, wheat and peanuts) and airborne allergens (dust mites, molds, pet hair). Make sure to pay attention to any allergens that you may have that triggers eczema or make it worse. Consult a Specialist to determine what you are allergic to.

  • An itchy red rash that keeps recurring
  • Dry patchy, bumpy or scaly areas on the skin
  • A family history of hay fever, asthma or eczema

There is no cure for Eczema but there are many products available to provide relief, reduce the redness and help control our Eczema to minimize its impact

Make sure your room is not too warm to avoid sweating while sleeping and don’t let your skin dry out, be careful for air conditioning and electric blankets.

For a definite diagnosis of Eczema contact Advanced Dermatology who will recommend the appropriate treatment programme.