Dermatology Associates of the Bay Area
Although there is no cure for psoriasis, there are a variety of effective treatment options that can clear the skin lesions caused by psoriasis.
Your doctor will recommend one or more psoriasis treatments depending on the following factors:
Treatments are more effective at treating some types of psoriasis than others. For instance, lasers are effective at treating an isolated lesion of plaque psoriasis, but they are not practical for treating the widespread lesions of guttate psoriasis. Similarly, the use of a PUVA lightbox (phototherapy) is usually impractical for the treatment of a single psoriasis lesion.
Some types of psoriasis, such as pustular psoriasis, are associated with greater inflammation and greater risks, so are treated more aggressively than other types.
The location of the psoriasis lesions can determine the optimal treatment. For instance, scalp psoriasis might benefit from the application of a shampoo containing a corticosteroid (i.e. clobetasol). However, lesions that appear in the groin or underarms may require the use of a different medication due to the sensitivity of the skin there.
The severity of a psoriasis flare, as determined by the amount of skin affected (BSA), can determine how aggressively to treat a particular psoriasis flare. For instance, severe psoriasis affecting more than 10% of the body may justify treatment with a biologic or oral medication, whereas a mild psoriasis flare affecting less than 1% of the body might be treated effectively with topical medications, such as an ointment.
Psoriasis medications are prescribed in a step-wise fashion. The first medication(s) prescribed are selected to be effective, convenient and least likely to lead to side effects. If the first medication(s) fails to bring psoriasis under control, a "stronger" medication may be then be prescribed, but these may be associated with additional risks. For instance, a mild or moderate strength corticosteroid may be prescribed prior to using a superpotent corticosteroid.
Some psoriasis treatments are associated with greater risks the longer or more frequently they are used. For instance, cyclosporine and methotrexate can only be used for a limited amount of time prior to switching to alternative treatments. Similarly, the use of PUVA may be limited due to the long-term damage to the skin from excessive use.
Since psoriasis treatments may work better for some patients than others, be prepared to try more than one treatment.
If a particular treatment regimen is found to be safe and effective for an individual, that treatment may be recommended again for a similar flare.
For mild to moderate psoriasis, many people may find sufficient relief from one or more of the following creams or ointments applied to the skin.
Oral medications may be prescribed for people with moderate to severe psoriasis whose psoriasis lesions do not respond sufficiently to topical medications or phototherapy. Because these medications are taken by mouth and absorbed into the blood, they reach the deeper layers of skin throughout the body.
These psoriasis medications can be very effective, but also have serious potential side effects to consider. Oral psoriasis treatments include:
Other oral treatments for psoriasis that might be considered include isotretinoin (Accutane®, Sotret®), hydroxyurea, mycophenolate (Cellcept®), and sulfasalazine.
As the name implies, phototherapy involves the use of light to treat psoriasis.
Phototherapy may use UVA or UVB rays. Although excessive exposure to UV radiation increases a person's risk of developing skin cancer, it has been shown that UV light can suppress T cell activity within the immune system and slow down the uncontrolled growth of skin cell. This leads to a reduction in the scaly plaques of psoriasis.
Before trying a sunlight or phototherapy regimen, seek the guidance of your doctor to make sure you don’t overexpose your skin to UV radiation and aggravate your symptoms.
There are three main types of phototherapy:
Some cases of psoriasis require the combination of different treatments to achieved desired results. For instance, Tazorac® may be combined with a topical corticosteroid, or Soriatane® may be combined with phototherapy. Your doctor may recommend different combinations at different times.
Long-term use of some medications, such a cyclosporine or methotrexate, can lead to an increased risk of side effects. In addition, the benefits of some medications can diminish over time. In such cases, doctors may recommend rotating medications, using one medication for several months followed by a different medication. For example, coal tar may be rotated with cyclosporine.
Biologics (also called “disease-modifying therapy” or “immunomodulators”) are a relatively new treatment option for people with moderate to severe psoriasis. They are given this name because they are derived from human or animal proteins instead of chemicals like most other medications.
Biologics work by targeting specific parts of the immune system, such as T cells or TNF (tumor necrosis factor), a chemical used to transmit messages between immune cells. This focused approach reduces the likelihood of side effects seen with medications that affect the entire immune system.
Biologics must be administered by injection, either into the skin (subcutaneously), into the muscle (intramuscular or IM), or by intravenous infusion (IV). Subcutaneous injections are similar to the insulin shots used by someone with diabetes and can be administered by the person with psoriasis or a caregiver.
Some biologics may require long-term use to keep psoriasis under control.
Image courtesy of Wikipedia. Photo shows results of therapy with infliximab.