Understanding Psoriasis - Treatment

What Are the Treatments for Psoriasis?

Despite the fact that psoriasis is incurable, it responds well to many treatments for dermatitis. Even people with severe psoriasis can get relief during flare-ups in about 85% to 90% of cases.

Topical Treatments

• Some doctors recommend salicylic acid ointment, which smoothes the skin by promoting the shedding of psoriatic scales.
• Steroid-based creams are effective, but because they can have harmful side effects, be especially careful to follow your doctor's instructions on their use.
• A topical ointment containing calcipotriene, which is related to vitamin D, has proven to be as effective as hydrocortisone creams for treating psoriasis. But use only limited amounts to avoid side effects.
• Coal-tar ointments and shampoos can alleviate symptoms, but many people are vulnerable to the side effects -- especially folliculitis, a pimple-like rash affecting the hair follicles. These medicines should be used only under a doctor's supervision.
• Anthralin therapy, which is made from the bark of a South American tree, is generally reserved for severe forms of psoriasis. Anthralin salve is carefully applied to the affected areas and removed after 10 to 30 minutes. All the white scales should be gone, revealing an underlying layer of fresh, normal skin. If not properly applied by a trained therapist, however, anthralin may irritate healthy skin and leave stains that can last several weeks.
• Prescription vitamin A-related gels don't work as quickly as steroids but tend to have fewer side effects. Women of childbearing age should use birth control while taking this medication because of the risk of birth defects if they become pregnant.

Light Therapy

Even regular doses of sunlight -- not enough to produce sunburn though -- can help lesions in many people. But try to avoid sunburns and other psoriasis triggers, such as skin injuries, insect bites, viral or bacterial infections, stress, and being overweight.

For persistent, difficult-to-treat cases of psoriasis, many doctors recommend light therapy. One of the most effective treatments is PUVA (the drug psoralen combined with ultraviolet A, or UVA, light). Some people aren't good candidates for PUVA, since it has been shown to contribute to an increased risk of skin cancer, even decades after stopping to use this therapy.

Some doctors may prescribe ultraviolet B light (UVB) treatment using a light box alone or with other therapies such as coal tar. A relatively new type of light treatment, called narrow-band UVB therapy, may be less carcinogenic than PUVA but just as effective.

Oral Medications

When other treatments fail, some doctors prescribe oral medications to treat psoriasis. Some of these medications affect the immune system. One such medication is methotrexate, an anticancer drug, which can produce dramatic clearing of the psoriasis lesions. However, it can cause side effects, so the prescribing doctor should perform regular blood tests. Other medications of this type include cyclosporine or hydroxyurea.

Retinoids, compounds with vitamin A-like properties, can be helpful to people with severe psoriasis. As with topical vitamin A-like creams, women of childbearing age need to use birth control with this medication.

New treatments for people with severe psoriasis and psoriatic arthritis are now available. Several "biologic" drugs, which are made from human or animal proteins, focus on controlling the body's immune response. Some of these drugs are quite effective but are extremely expensive.