### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi, may I answer your health queries right now ?  Please type your query here... I have psoriasis for abt close to two yrs now, have tried creams and ointments like halotop, halovate which have been effective, i have applied them for a week continuously and when stopped for 4-5 days, it comes back.  When i first noticed it, it was on back on my scalp, now has spread on my entire, scalp, are injections good for long-term benfit, suggest me some remedies so that i have good long lasting relief

### output:

Hello. Thanks for writing to us at Chat Doctor Psoriasis is a chronic disease; it can recur after seemingly complete cure. Treatment of psoriasis is guided by the extent of involvement. Limited disease is best managed with just topical applications (creams, ointments, gels, lotions, shampoos); whereas extensive disease (involving >20% body surface area) is usually managed with systemic treatments in addition to topical applications. Psoriasis is steroid responsive, as you have noticed in your case; the disease gets better with topical steroids, however, it may recur; sometimes as soon as you stop steroids. One has to be very careful in using steroids because though steroids are effective in psoriasis, one cannot use them forever because steroids can lead to side effects like skin atrophy if used over long term; moreover, steroids if stopped suddenly can lead to a rebound flare, which may be of increased intensity as compared to previous episodes.Therefore, while steroids are good for providing initial rapid improvement, they should be substituted with alternatives like vitamin D analogues like calcitriol, calcitriol once the initial rapid response is attained. Vitamin D analogues are devoid of the side effects of steroids and can also be used safely over long term; moreover rebound flare is not an issue with vitamin D analogues. Since you have limited disease (scalp involvement), therefore topical would be adequate for you. If I was the treating doctor I would have also added a coal tar+salicylic acid based shampoo, to be used thrice weekly. I would have asked you to use vitamin D analogues for scalp psoriasis rather than topical steroids. You may ask more about these from your treating dermatologist. Psoriasis, as I said before is a recurrent condition, therefore I would suggest that you follow up regularly with your treating dermatologist. Your dermatologist can modify your treatment depending on the response. Regards