Psoriasis Management

By Kira Mayo

As we discussed in Psoriasis 101, the treatment for psoriasis depends on how severe it is, how much of the body is affected, the type of psoriasis and how well the skin responds to the initial treatment. A topical treatment, applied directly to the skin, is usually attempted first. Phototherapy, treatment with light, is used if topical therapy doesn’t cut it. The last resort is systemic treatment; patients who have severe psoriasis have to take oral or injectable medications.

Topical treatments are applied directly to the skin:

Emollients, topicals that soften the skin, include creams, ointments, petroleum (Vaseline) and cooking oils. They reduce scaling and are most effective when applied after bathing. Emollients are safe and are commonly used for mild-moderate plaque psoriasis.

Topical corticosteroids can improve psoriasis if the lesions are confined to limited areas. Using powerful steroids for too long can lead to skin atrophy, loss of effect, and may actually worsen psoriasis, so make sure you consult a doctor before starting any medication.

Topical therapies made from vitamin D can help control the excessive production of skin cells, thereby improving symptoms. These can be used in combination with topical corticosteroids.

Topical therapies containing retinoids, a compund derived from vitamin A, can also help control psoriasis. Although they are not as fast-acting as steroids, they have fewer side effects. Women beware—if you take any medication derived from vitamin A, it can lead to birth defects if you get pregnant, so make sure you are on oral contraceptives if you are using these medications.

Other topical therapies include coal tar, Anthralin, and salicylic acid. Ask your doctor about the benefits and side effects of any medication before you start taking it.

Phototherapy, also known as light therapy, is based on the premise that UV rays reduce DNA synthesis, slowing the overproduction of skin cells. This helps decrease scaling and inflammation.

PUVA therapy: There are two types of UV rays: UVA and UVB. PUVA therapy combines the use of UVA rays and psoralen. Psoralen is a medication that is used topically or taken orally to sensitize the skin to UV light; it is applied before exposure to UVA light. This treatment requires frequent office visits, and there is some concern regarding long-term treatment and an increased risk of skin cancer.

Lasers: The FDA has approved a special type of laser to be used to treat mild-to-moderate psoriasis. Lasers have the benefit of delivering a much more controlled beam of light to the affected skin.

Systemic treatment is reserved for those with severe psoriasis and include:

Immunosuppresants, such as methotrexate, cyclosporine, and hydroxyurea, suppress the immune system, thereby reducing inflammation. These medications can have significant side effects and should only be taken under your doctor’s watchful eye. These medications, like those related to vitamin A, can cause serious birth defects if women become pregnant. Therefore, women of childbearing age should use some form of birth control beginning 1 month before treatment until at least 2 years after treatment.

Biologics, such as Amevive, Raptiva and Enbrel, are the newest systemic psoriasis treatments. These are immunosuppresants that are injected either under the skin, in the muscle or in the bloodstream. Since they are immunosuppresants, biologics can increase your chance of infection and cancer.

Finally, antibiotics may help when an infection triggers an outbreak of psoriasis, as seen with some cases of guttate psoriasis.

Those are just some of the therapies available for treating psoriasis. So which one should be used?! That depends on many factors. While there is no single ideal combination, treatment should be kept as simple as possible. Be sure to ask your doctor about the benefits and side effects of these therapies; together you can up with a personalized plan that will work best for you!

Reference: Psoriasis: Psoriasis and Scaling Diseases. The Merck Manual for Healthcare Professionals, Nov. 2005. Web.

Originally written for DermHub.com

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