Slideshow: Moderate and Severe Psoriasis Treatment
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Who's Got Psoriasis?
Almost 7.5 million people in the U.S. have a form of psoriasis. Celebrities such as TV personality Kim Kardashian, singer LeAnn Rimes, and swimmer Dara Torres all have it. The five main kinds of psoriasis are plaque, guttate, pustular, inverse, and erythrodermic. About 80% of people with psoriasis have the plaque kind.
Is It Moderate or Severe?
Psoriasis is a common condition that causes skin cells to grow too fast. The cells build up and produce thick, red, scaly skin. How do you know whether your psoriasis is moderate or severe? Think of your palm as equaling 1% of your skin. Psoriasis that covers 3% to 10% of your body is moderate. Psoriasis that covers more than 10% is severe.
Topicals are medicines that you apply to your skin. You can buy many topicals in a drugstore. Others require a prescription. Common over-the-counter topicals for psoriasis include salicylic acid, which softens scales and promotes shedding. Coal tar may slow the growth of skin cells and calm itching. Other treatments might include zinc pyrithione or capsaicin. Moisturizers and bath solutions may also soften the skin and soothe itching with ingredients like aloe vera or jojoba.
Topical steroids are most commonly prescribed for psoriasis. They help reduce the skin's redness and swelling. Steroids come in several strengths and are available as creams, lotions, gels, ointments, and shampoos. Your doctor may prescribe a topical steroid in combination with other treatments. Only apply steroids to affected skin. Side effects of strong steroids can include thin skin, changes in skin color, redness, bruising easily, and stretch marks. See your doctor for a skin check a few times a year.
Occluding -- covering -- some topicals may help them work better. Occlusion can work with prescription or over-the-counter medicines. But you should only try it with your doctor's permission. Your medicine may be too strong to cover, or occlusion might make side effects worse. After you apply the topical onto your skin, cover the affected areas with plastic wrap, waterproof dressing, nylon fabric, or cotton socks.
For psoriasis relief without a prescription, try water therapy. Add Epsom salts, Dead Sea salts, oil, or oatmeal to your bath. A 15-minute soak may help soothe itchy skin and remove scales. Be sure to put on moisturizer afterward.
Swimming in saltwater removes dead skin, so it may help loosen psoriasis scales. But even swimming in a chlorinated pool may soften and heal your skin. Take a shower or bath after you're done. Chlorine that dries on your skin can be irritating.
Phototherapy or light therapy exposes skin to ultraviolet (UV) rays. UV rays slow the growth of skin cells.
Sunlight: Your doctor will tell you how much you need, but expect just a few minutes of daily sun exposure while wearing sunscreen on areas unaffected by psoriasis. Some topicals can increase risk for sunburn, so check with your doctor first.
UVB phototherapy: A special light panel emits UV rays to treat skin.
PUVA therapy: Combines UV light with light-sensitizing medicine.
Goeckerman or Ingram therapy: Combines UV light with topicals.
Side effects may include red, dry, and itchy skin similar to sunburns. PUVA may also cause nausea, headache, and fatigue.
Lasers clear patches of moderate psoriasis with strong doses of light. This leaves the surrounding skin untouched. Laser therapy usually requires multiple sessions. Studies suggest that treated skin may stay clear from several months to up to a year. Treatment can result in short-term swelling, redness, and a burning feeling.
You might be able to take medicines by mouth if you can't use topicals or have light therapy, or if those treatments don't work. These drugs work by slowing the growth of skin cells. Common oral drugs include acitretin (Soriatane), cyclosporine (Gengraf, Neoral, Sandimmune), and methotrexate (Rheumatrex, Trexall). But the side effects can be serious and may include liver or kidney damage.
Biologics treat moderate or severe psoriasis by injection or IV. They block the action of the cells that cause psoriasis. Biologics can be an option if other treatments have not worked. A biologic might raise your risk of infection because it blocks part of the immune system. Side effects may include breathing infections, irritation at the injection spot, and flu-like symptoms. Biologics include adalimumab (Humira), alefacept (Amevive), etanercept, (Enbrel), golimumab (Simponi), infliximab (Remicade), and ustekinumab (Stelara).
Treatment and Pregnancy
Are you pregnant, nursing, or planning to have a baby? If so, ask your doctor which psoriasis treatments are safe. Some light therapy may be safe for pregnant women. Oral drugs, biologics, and even some topicals may cause birth defects or pass into breast milk. If your doctor approves light therapy for your psoriasis, wear sunscreen to help prevent the melasma or brown spots that occur in some pregnant women.
There may be promise in some alternative treatments for psoriasis. Some people may use herbs such as feverfew and aloe vera or supplements such as fish oil for psoriasis. However, studies have not proved their benefits for psoriasis. Acupuncture may help some psoriasis patients because it helps relieve stress in some people. Research linking psoriasis and acupuncture treatments is mixed. Ask your doctor whether you might benefit from it.
Stress can trigger psoriasis in some people. Knowing how to reduce stress may help you manage psoriasis better. Meditation, massage, or tai chi may help calm your body and mind. Ask your doctor if these are right for you. Sharing your experiences and concerns about psoriasis with others may also help reduce stress. Join a support group or talk with a therapist.
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(3) Maria Mosolova / Photographer's Choice
(4) KOOS/PITA / BSIP
(5) John Todd / WebMD
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(7) LAURENT/LAETICIA / BSIP
(8) M Baumann / Blickwinkel
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National Psoriasis Foundation: "Mind-body medicine," "Body-based and energy practices," "Singer LeAnn Rimes urges people with psoriasis to 'Stop Hiding'' and 'Start Living,'" "U.S. Olympic swimmer Dara Torres teams up with the Psoriasis Foundation to raise psoriasis awareness," "Kim Kardashian has psoriasis," "Types of psoriasis," "Psoriasis severity," "Topical Treatments for Psoriasis, Including Steroids," "Over-the-counter (OTC) Topicals," "Phototherapy," "Traditional systemic medications," "Moderate to severe psoriasis: Biologic drugs," "Treatments during conception, pregnancy and nursing," "Treatment with topical," "Whole medical systems," "Natural elements: Diets and supplements," "Treatment with light therapy," "Ask the Expert - Treatment."
American Academy of Dermatology: "What is Psoriasis?" "How to Make Psoriasis Control More Effective this Summer," "UVB Phototherapy for Psoriasis," "Goeckerman Therapy and Ingram Regimen for Psoriasis," "Laser Treatment for Psoriasis," "Psoriasis Treatment: Medicine that Works throughout the Body."
National Center for Biotechnology Information, PubMed Health: "Psoriasis."
National Library of Medicine, MedlinePlus: "Psoriasis."
National Institute of Arthritis and Musculoskeletal and Skin Diseases: "Questions and Answers about Psoriasis."
Jerner, B. Acta Dermato-Venereologica, March 1997; vol 77(2): pp 154-156.
University of Maryland Medical Center: "Psoriasis."
National Center for Complementary and Alternative Medicine: "Acupuncture: An Introduction."
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.