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Psoriasis is treated according to the severity of the disease and its responsiveness to initial treatments, including:
Topical treatment
The first stage of treatment is topical (medicines are applied to the skin). When a person has only a few small plaques, psoriasis generally responds quickly.
- Applying an emollient once or twice a day helps your skin retain moisture.
- Some doctors recommend salicylic acid ointment, which smoothes the skin by promoting the shedding of psoriatic scales.
- Ointments containing corticosteroids are effective, and can be made more effective if the area is wrapped in cellophane after applying them (only do this if advised to by your doctor). However, because they can have harmful side effects, you should be careful not to overuse them. This may thin the skin and lose its efficacy.
- Coal-tar ointments and shampoos can alleviate symptoms, but many psoriasis patients seem vulnerable to the side effects – in particular folliculitis, a pimple-like rash affecting the hair follicles.
- Calcipotriol is a synthetic form of vitamin D3 (this is not the same as vitamin D supplements). It controls the excessive production of skin cells, and can help those who can’t tolerate some of the other creams. It works best in conjunction with phototherapy.
- Anthralin therapy is usually reserved for severe forms of psoriasis. If not properly applied, anthralin can irritate healthy skin and leave stains that can last several weeks. It's therefore not commonly used anymore.
- Tazarotene (a topical vitamin A derivative or retinoid) is very useful for plaque and scalp psoriasis. It is applied at night. It may be an irritant and the concurrent use of emollients is recommended.
- Tacrolimus can be used, especially for psoriasis of the face and skin folds.
Topical therapies are often used in combination with each other, or other treatment modalities.
Phototherapy
Exposure to ultraviolet light, for example during the summer months, may help exposed regions of affected skin clear up spontaneously. Sunbathing can help to clear up the plaques on larger areas of the body (although this is not recommended due to the risk of developing sun-related skin cancers).
For persistent, difficult-to-treat cases of psoriasis, ultraviolet (UV) light therapy may be prescribed; and is often extremely successful.
- UVB phototherapy is used to treat widespread psoriasis and lesions that resist topical treatment. A light panel or light box is used, either at the doctor’s surgery or at home. Sometimes it's combined with topical treatments.
- PUVA treatment (UVA phototherapy with application or ingestion of substances called psoralens) can be used. Psoralen makes the skin extra sensitive to the effects of ultraviolet light.
There is also a risk of UV-related skin cancers developing after treatment with UV light. It seems that PUVA presents a higher risk.
Excimer LASER
This modality can be used to treat individual plaques of psoriasis. It can be very expensive.
Systemic treatment
For more severe forms of psoriasis, a doctor may prescribe internal medications. This is not a decision to be undertaken lightly, as most of these drugs can have severe side effects and require regular blood tests and monitoring.
- Methotrexate: Used to treat some forms of cancer, this drug interferes with the growth and multiplication of skin cells and suppresses the immune system. It can be effective in extreme cases but may cause liver damage or decrease the production of oxygen-carrying red cells, infection-fighting white blood cells and clot-enhancing platelets.
- Acitretin: This is a derivative of vitamin A. It has many side effects, the most concerning of which is that it causes birth defects if taken during pregnancy. In fact, pregnancy should be avoided for at least 2 years after completing treatment with this drug.
- Ciclosporin: This is a drug used to suppress the immune system in patients who have had kidney transplants. It has many side effects, and interacts with many other drugs.
- Hydroxyurea
- Sulfasalazine
Biologicals
These drugs are a relatively new and exciting development in the treatment of psoriasis. They represent more targeted therapy than the traditional systemic medications. This group includes adalimumab, etanercept, infliximab and usteokinumab. Some result in an increased risk of developing infections. As these are relatively new drugs, we cannot be certain of their long-term effects.
