Psoriasis Treatment Strategies

There are many psoriasis treatments that can be used alone or in combination. They include topical treatments, phototherapy (ultraviolet light therapy), and oral and injected medications.

Deciding on a treatment approach is something that you'll do with your doctor. Your decision will be based on a number of things: the severity of your psoriasis, any treatments that you've used before, whether you have other medical conditions, and finally, your own opinion about what sounds right to you.

Doctors have traditionally used a "1-2-3" approach to treating psoriasis. You start with topical creams and ointments. If they aren't enough, you might move on to phototherapy. If your psoriasis still isn't under control, you then might try systemic or biologic medications. However, this incremental approach is only a rule of thumb. Your doctor may suggest a different strategy in your case. Here's a brief outline of the major approaches to treatment.

• Topical treatments. Using topical treatments, such as creams and ointments, is often the first step in treating psoriasis. Some are available OTC, while others require a prescription from you doctor. Salicylic acid helps remove scales. The most commonly used medicines are steroid creams and ointments. Others include Dovonex, retinoids such as Tazorac, and more traditional remedies such as coal tar. For psoriasis that covers more than 10% to 20% of the skin, topical treatment usually won't work, at least not on its own.
• Phototherapy. Psoriasis responds to phototherapy (UVB, UVA, and laser). Regular exposure to the sun or artificial ultraviolet lights can cause the symptoms to subside. Approaches include UVB (exposure to ultraviolet B light) and PUVA (exposure to UVA combined with the drug psoralen, which increases the light sensitivity of the skin). Newer techniques include lasers, which can focus the beneficial effects of light specifically on psoriatic lesions.
• Systemic treatments. For psoriasis that doesn't respond to other treatments, medications such as methotrexate, cyclosporine and Soriatane (a synthetic form of vitamin A) may help. However, many of these drugs have potentially severe side effects and are usually reserved for moderate to severe psoriasis. You'll need to be monitored closely when using them. Other systemic medications include Accutane, Hydrea, mycophenolate mofetil, sulfasalazine, and 6-thioguanine.
• Biologic Drugs. Recent discoveries about the causes of psoriasis have led to some new approaches to treatment. Biologic medicines target the immune system response that causes the symptoms of psoriasis. The evidence suggests that these new drugs have significantly fewer side effects than traditional systemic therapy. So far, these drugs have been approved by the FDA for the treatment of psoriasis: Amevive, Enbrel, Humira, Remicade, and Raptiva. Enbrel, Remicade, and Humira are approved for the treatment of psoriatic arthritis.