Understanding Psoriasis -- Treatment

What Are the Treatments for Psoriasis?

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

Video Transcript

Rutledge Forney, M.D. Medical, Surgical, and Cosmetic Dermatologist

Rutledge Forney, M.D. Medical, Surgical and Cosmetic Dermatologist: Oils on the skin can be very helpful for psoriasis. Psoriasis is skin that has gotten too many layers that have not been shed, and so it gets thick and red, and often it’s very itchy. Oils help to loosen some of that extra skin, and help it shed. And just soften it up so the skin feels more comfortable. : Almost any oil I can think of would be helpful like that. Many people love sesame oil because it feels so soothing, and very light. When people have mild psoriasis they often look to the local pharmacy to find solutions. And there are several things worth trying when you go there. There are products that have tar in them, and tar topically applied : to psoriasis is actually a fantastic over the counter anti-inflamatory. Sometimes people will often alternate tar with 1 percent hydrocortisone which can be found in both a cream and ointment. Ointments sometimes are a little bit more effective. : For psoriasis theres a lot of evidence that aloe on the skin is very soothing, and you certainly can take it straight from the plant, a lot of people use it that way for burns as well. Oral aloe hasn’t been shown to be particularly helpful at all for the skin. So I would put my money on anything that is topical and has aloe vera in it. I think you’ll find it helpful. : When people are at the drug store looking at creams to try to help their psoriasis, they often pick up tar and hydrocortisone, but in addition to that, if you look at a lotion or cream and it has oats in it, oats has been found to be a very natural skin soother. People have also found that creams which have capsaicin in them can also soothe the itch and some of the stinging from psoriasis plaques. : Kitchen remedies for psoriasis are available. In the old days many people turned to apple cider vinegar, and they found it was particularly helpful for itchy scalps. People would apply it directly, or somewhat diluted to their scalps. : So one of the most important ways to help a dry scaly psoriasis plaque, is to actually apply almost any cream, and cover it with simple plastic wrap. We call that ocollusion and ocolluding skin, which is dry and thickened is very effective. And people will often do it at bedtime and sleep with that wrap around their feet or their knees, or their elbows. And their skin is much better in the morning. : So at home, one of the secrets to success with psoriasis is actually limited sunlight. I often tell people with particularly irritating psoriasis to get about 10 or 15 minutes of sunlight just on the psoriasis plaques. Obviously as a dermatologist, I’m concerned about sun exposure and skin cancer, but UV is one of the most potent reducers of the inflammation that’s part of psoriasis, and really will help if that’s the only thing you’ve got available.

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Topical Treatments for Psoriasis

Topical treatments are rubbed directly into the affected skin to bring local relief without the system-wide side effects of medicines taken by mouth or a shot. Topical treatments for psoriasis include:

Salicylic acid . Some doctors recommend salicylic acid ointment, which smoothes the skin by promoting the shedding of psoriatic scales. Using salicylic acid over large areas of skin, however, may cause the body to absorb too much of the medication, leading to side effects. Salicylic acid may also cause skin irritation and weaken hair shafts, which can cause breakage and temporary hair loss. The effectiveness of these preparations are modest at best.

Steroid-based creams. The mainstay of psoriasis treatment, steroid creams decrease inflammation, relieve itching, and block the production of cells that are overproduced in psoriasis. Stronger preparations, which are more effective than milder ones, can cause side effects that include burning, dryness, irritation, and thinning of the skin. Be especially careful to follow your doctor's instructions on their use.

Calcipotriene or calcitriol (Vectical) containing topical ointment. Calcipotriene (Dovonex), which is vitamin D, has proven to be effective for treating psoriasis, especially when combined with a topical corticosteroid cream. It's best to use only limited amounts to avoid side effects.

Coal-tar ointments and shampoos. These products can help slow the rapid growth of skin cells and alleviate symptoms, but some 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.

Prescription retinoids. These topical preparations containing a synthetic form of vitamin A can help improve psoriasis. These preparations don't work as quickly as steroids. Topical retinoids can sometimes cause dryness and irritation of the skin.

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Light Therapy for Psoriasis

Even regular doses of sunlight -- not enough to produce sunburn -- can help psoriasis lesions in many people. 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). However, this form of therapy is used far less often today, because it has been shown to increase the risk of developing skin cancer -- even decades after stopping 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 more targeted ultraviolet light treatment, called narrow-band UVB therapy, is less carcinogenic than PUVA and almost as effective.

 

Oral and Injectiable Medications for Psoriasis

When other treatments fail, some doctors prescribe oral or injectable drugs to treat psoriasis. Some of these medications affect the immune system. One such medication, methotrexate (also used as a chemotherapy drug for cancer and for various forms of arthritis), can produce dramatic clearing of the psoriasis lesions. However, it can cause side effects, so the prescribing doctor should perform regular blood tests. Another medication of this type is cyclosporine.

Oral retinoids, compounds with vitamin-A-like properties, can be mildly helpful to people with severe psoriasis. Women of childbearing age need to use birth control with this medication and for three years afterwards, because it is associated with an increased risk for birth defects.

Biologics that control the body’s immune response are routinely used to treat severe psoriasis and psoriatic arthritis. These drugs, which are made from human or animal proteins, are quite effective but extremely expensive. They include adalimumab (Humira), brodalumab (Siliq) etanercept (Enbrel), guselkumab (Tremfya) ixekizumab (Taltz), secukinumab (Cosentyx), and ustekinumab (Stelara).

A newer drug, apremilast (Otezla), has been found to be effective in reducing joint pain and psoriatic skin symptoms. It works by suppressing an enzyme involved in inflammation.

 

Natural Psoriasis Treatments

If medications fail to relieve the symptoms of psoriasis or cause unwanted side effects, people may try natural remedies, such as herbs and vitamins, for relief. Some people with psoriasis find natural sunlight and ocean water helpful. Some seaside resorts offer special programs for people with psoriasis.

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If you are considering natural remedies for psoriasis, here's what you should know about some of the more commonly used remedies:

Aloe vera. Preliminary research suggests that topical cream from the aloe vera plant may improve symptoms of psoriasis. One study showed that topical aloe vera was more effective than placebo. This product is of only minimal benefit, at best.

Fish oil . Fish oil may be helpful for psoriasis when taken orally. Research has suggested that taking daily oral fish oil supplements containing 1.8 to 3.6 grams of eicosapentaenoic acid (EPA) may bring some improvement by reducing inflammation. A survey of more than 1,200 psoriasis patients found that many reported symptom improvement by taking fish oil supplements. Others reported they were helped by vitamin D supplements.

 Dead Sea salts. Bath solutions, such as Dead Sea salts, oil, oilated oatmeal, or Epsom salts can help psoriasis by removing scales and easing itching. To try Dead Sea salts and other bath solutions, mix them in the bath as directed, then soak in the tub for about 15 minutes. As soon as you get out of the tub, apply a moisturizer to the skin. Don't expect a lot of improvement, however.

Cayenne. Cayenne peppers have been used medicinally for thousands of years. Capsaicin, the ingredient in peppers that gives them their heat, is also the active ingredient in many pain-relieving gels and creams. In one study, applying capsaicin cream to the skin relieved itching and skin lesions in people with psoriasis. Capsaicin can cause a burning sensation to the skin, which improves the longer you use it. It's important to wash your hands immediately after rubbing in capsaicin and not touch your eyes or mouth while you have capsaicin on your hands.

Diet. Obese psoriasis patients who lose weight report significant improvement in their symptoms, research has shown. Eliminating gluten also seems to alleviate joint pain and skin symptoms in the 25% of psoriasis patients who are sensitive to the protein, which is found in bread, pasta, crackers, soy sauce, lunch meats, and many other food products. Many of the patients surveyed in the 2014-15 study reported the same, and some said adopting vegan, Paleolithic and the Pagano diet (alcohol-, carb, and red meat-free) also helped reduce their symptoms.

 

WebMD Medical Reference Reviewed by Michael W. Smith, MD on October 30, 2017

Sources

SOURCES:

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Kurd, S.K. Journal of the American Academy of Dermatology, April 2008.
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National Cancer Institute: "Dictionary of Cancer Terms: Turmeric."
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University of Maryland Medical Center: "Aloe."
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Dermatol Ther (Heidelb): "Dietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National Survey," June 7, 2017.

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