Psoriasis - Treatment Overview

Treatment Overview

Currently there is no cure for psoriasis. However, many types of treatment are available, including products applied to the skin, phototherapy, and oral medications, that can keep psoriasis under control. Most cases are mild and can be treated with skin products. In some cases, psoriasis can be hard to treat if it is severe and widespread. Most psoriasis returns, even mild forms.

The purpose of treatment is to slow the rapid growth of skin cells that causes psoriasis and to reduce inflammation. Treatment is based on the type of psoriasis you have, its location, its severity, and your age and overall health. It also depends on how much you are affected by the condition, either physically (because of factors such as joint pain) or emotionally (because of embarrassment or frustration from a skin rash that may cover a large or visible area of the body).

Initial treatment

Treatment for mild psoriasis, characterized by a few isolated raised patches, begins with skin care, which includes keeping your skin moist and lubricated. Basic treatment approaches often involve combinations of therapies and products that can usually be purchased without a prescription, including:

• Creams, ointments, and lotions, to lubricate the skin.
• Shampoos, oils, and sprays, to treat psoriasis of the scalp.
• Ointments, to treat psoriasis of the nails.
• Some exposure to sunlight.

It is also important to eliminate factors that can trigger a flare-up of psoriasis or make the condition worse. Stress, skin injury, infection, and use of alcohol can all contribute to symptom flare-ups. Streptococcal infections, which usually affect the upper respiratory tract, are associated with guttate psoriasis.

Effective treatment will address the impact the condition has on overall well-being as well as the physical symptoms.

Ongoing treatment

Creams and ointments may be used in combination with sunlight or ultraviolet light (phototherapy) for moderate psoriasis that affects less than 20% of the skin surface (about equal to having both arms completely covered). However, creams, ointments, lotions, and topical (applied to the skin) medications work better for some people than for others. If one topical treatment does not clear up your psoriasis, your doctor will likely recommend that you try different combinations of treatments.

If you use phototherapy (brief exposures to ultraviolet light such as ultraviolet light B, also known as UVB), follow your doctor's instructions carefully to avoid serious skin damage.

• Exposure to UVB light can often improve psoriasis. UVB treatment, commonly done 3 times per week, combined with topical therapy, such as tar or calcipotriene, is well tolerated and has been shown to be effective.^{5, 6}
• Psoralen and UVA light therapy (PUVA) combines medication and treatment with ultraviolet A light. A photosensitizer such as methoxsalen is taken, either orally or by soaking in a tub containing the medication, before exposure to UVA in a walk-in chamber. Treatments are generally done 2 or 3 times per week, with clearing of symptoms occurring in most people after 19 to 25 treatments.⁷

Topical medications used for psoriasis include:

• Vitamin D compounds such as calcipotriene.
• Topical corticosteroids.
• Retinoids such as tazarotene.
• Anthralin and tars.

The occlusion treatment method may be effective for some people. Occlusion involves first applying skin products, such as moisturizers, medicated creams, or gels, then wrapping the skin with tape, material, or plastic. Occlusion helps keep the area moist and increases the effectiveness of medicated creams.

Medicines called "biologic drugs" have shown great promise for the treatment of moderate to severe psoriasis. These medications, including alefacept (Amevive) and efalizumab (Raptiva), block the harmful response of the body's immune system that causes the symptoms of psoriasis. See the Medication Choices section of this topic for more information.

Treatment if the condition gets worse

If you have severe psoriasis, in which the rash, or plaque, covers more than 20% of your skin surface, your doctor may recommend systemic therapy. (Having both your arms completely covered with plaque is equivalent to 20% of your skin surface.) Systemic therapy involves the use of medications such as retinoids, methotrexate, and cyclosporine, usually in addition to continued topical treatments and exposure to ultraviolet light.

Systemic treatment for children is reserved for the most severe cases, as there is a lack of evidence on how well children can tolerate these drugs.⁶

In rare cases, medication may be injected into a skin sore or patch (plaque).

Treatment for psoriasis may continue for a lifetime. Counseling and stress reduction may improve symptoms and help prevent flare-ups.

What To Think About

You may need to try different treatments before you find one that works well for you. It is important to discuss your treatment and progress with your doctor.

A recent study found that education, stress reduction, and muscle relaxation training can be beneficial to many people with psoriasis. Adding these elements to a treatment plan can reduce disability, anxiety, and stress related to dealing with psoriasis.⁸

Treatments for psoriasis have potential side effects. People with moderate or severe psoriasis may need treatment for the rest of their lives. Many doctors will recommend that treatments be changed or rotated after a certain period of time to make treatment more effective and reduce side effects.