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Psoriasis is a chronic condition that is not curable. However, with a well integrated, medically monitored plan of care, symptoms can be controlled, and people with psoriasis can lead active, comfortable lives. A good treatment plan is individualized to a person's medical history, severity of psoriasis and other factors.
A combination of treatments that include lifestyle changes with medications and other treatments as appropriate is the most effective way to best control psoriasis.
Treatment of psoriasis includes prevention of flare-ups by avoiding exposure to triggers, such as stress, sunburn, skin injury and excessive alcohol consumption. A variety of topical and oral medications may also be prescribed. These include a topical Vitamin D cream and corticosteroid medications. Another type of treatment that may be effective for psoriasis is phototherapy.
Antibiotics may be prescribed to treat secondary bacterial infections.
The list of treatments mentioned in various sources for Psoriasis includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
Alternative treatments or home remedies that have been listed as possibly helpful for Psoriasis may include:
The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Psoriasis may include:
Hidden causes of Psoriasis may be incorrectly diagnosed:
Products, offers and promotion categories available for Psoriasis:
Possibly curable types of Psoriasis may include:
Research all specialists including ratings, affiliations, and sanctions.
Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment or change in treatment plans.
Some of the different medications used in the treatment of Psoriasis include:
Unlabelled alternative drug treatments for Psoriasis include:
These medical statistics relate to hospitals, hospitalization and Psoriasis:
The following medical news items are relevant to treatment of Psoriasis:
Doctors generally treat psoriasis in steps based on the severity of the disease, the extent of the areas involved, the type of psoriasis, or the patient’s responsiveness to initial treatments. This is sometimes called the “1-2-3” approach. In step 1, medicines are applied to the skin (topical treatment). Step 2 focuses on light treatments (phototherapy). Step 3 involves taking medicines internally, usually by mouth (systemic treatment).
Over time, affected skin can become resistant to treatment, especially when topical corticosteroids are used. Also, a treatment that works very well in one person may have little effect in another. Thus, doctors commonly use a trial-and-error approach to find a treatment that works, and they may switch treatments periodically (for example, every 12 to 24 months) if resistance or adverse reactions occur. Treatment depends on the location of lesions, their size, the amount of the skin affected, previous response to treatment, and patients’ perceptions about their skin condition and preferences for treatment. In addition, treatment is often tailored to the specific form of the disorder.
Sunlight--Daily, regular, short doses of sunlight that do not produce a sunburn clear psoriasis in many people.
Corticosteroids--Available in different strengths, corticosteroids (cortisone) are usually applied twice a day. Short-term treatment is often effective in improving but not completely clearing psoriasis. If less than 10 percent of the skin is involved, some doctors will begin treatment with a high-potency corticosteroid ointment (for example, Diprolene®,* Temovate®, Ultravate®, or Psorcon®). High-potency steroids may also be used for treatment-resistant plaques, particularly those on the hands or feet. Long-term use or overuse of high-potency steroids can lead to worsening of the psoriasis, thinning of the skin, internal side effects, and resistance to the treatment’s benefits. Medium-potency corticosteroids may be used on the torso or limbs; low-potency preparations are used on delicate skin areas.
*Brand names included in this fact sheet begin with a capital letter and are provided as examples only. Their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.
Calcipotriene--This drug is a
synthetic form of vitamin D3. (It is not the same as
vitamin D supplements.) Applying calcipotriene ointment (for example,
Dovonex®) twice a day controls excessive production of skin
cells. Because calcipotriene can irritate the skin, however, it is not
recommended for the face or genitals. After 4 months of treatment,
about 60 percent of patients have a good to excellent response. The
safety of using the drug for cases affecting more than 20 percent of
the skin is unknown, and using it on widespread areas of the skin may
raise the amount of calcium in the body to unhealthy
levels.
Coal tar--Coal tar may be applied
directly to the skin, used in a bath solution, or used on the scalp as
a shampoo. It is available in different strengths, but the most potent
form may be irritating. It is sometimes combined with ultraviolet B
(UVB) phototherapy. Compared with steroids, coal tar has fewer side
effects, but it is messy and less effective and thus is not popular
with many patients. Other drawbacks include its failure to provide
long-term help for most patients, its strong odor, and its tendency to
stain skin or clothing.
Anthralin--Doctors sometimes use a 15-
to 30-minute application of anthralin ointment, cream, or paste to
treat chronic psoriasis lesions. However, this treatment often fails
to adequately clear lesions, it may irritate the skin, and it stains
skin and clothing brown or purple. In addition, anthralin is
unsuitable for acute or actively inflamed eruptions.
Topical retinoid--The retinoid
tazarotene (Tazorac) is a fast-drying, clear gel that is applied to
the surface of the skin. Although this preparation does not act as
quickly as topical corticosteroids, it has fewer side effects. Because
it is irritating to normal skin, it should be used with caution in
skin folds. Women of childbearing age should use birth control when
using tazarotene.
Salicylic acid--Salicylic acid is used
to remove scales, and is most effective when combined with topical
steroids, anthralin, or coal tar.
Bath solutions--People with psoriasis
may find that bathing in water with an oil added, then applying a
moisturizer, can soothe their skin. Scales can be removed and itching
reduced by soaking for 15 minutes in water containing a tar solution,
oiled oatmeal, Epsom salts, or Dead Sea salts.
Moisturizers--When applied regularly over a long period, moisturizers have a cosmetic and soothing effect. Preparations that are thick and greasy usually work best because they hold water in the skin, reducing the scales and the itching.
UVB phototherapy--Some artificial sources of UVB light are similar to sunlight. Newer sources, called narrow-band UVB, emit the part of the ultraviolet spectrum band that is most helpful for psoriasis. Some physicians will start with UVB treatments instead of topical agents. UVB phototherapy is also used to treat widespread psoriasis and lesions that resist topical treatment. This type of phototherapy is normally administered in a doctor’s office by using a light panel or light box, although some patients can use UVB light boxes at home with a doctor’s guidance. Generally at least three treatments a week for 2 or 3 months are needed. UVB phototherapy may be combined with other treatments as well. One combined therapy program, referred to as the Ingram regime, involves a coal tar bath, UVB phototherapy, and application of an anthralin-salicylic acid paste, which is left on the skin for 6 to 24 hours. A similar regime, the Goeckerman treatment, involves application of coal tar ointment and UVB phototherapy.
PUVA--This treatment combines oral or topical administration of a medicine called psoralen with exposure to ultraviolet A (UVA) light. Psoralen makes the body more sensitive to this light. PUVA is normally used when more than 10 percent of the skin is affected or when rapid clearing is required because the disease interferes with a person’s occupation (for example, when a model’s face or a carpenter’s hands are involved). Compared with UVB treatment, PUVA treatment taken two to three times a week clears psoriasis more consistently and in fewer treatments. However, it is associated with more short-term side effects, including nausea, headache, fatigue, burning, and itching. Long-term treatment is associated with an increased risk of squamous cell and melanoma skin cancers. PUVA can be combined with some oral medications (retinoids and hydroxyurea) to increase its effectiveness. Simultaneous use of drugs that suppress the immune system, such as cyclosporine, have little beneficial effect and increase the risk of cancer. In very rare cases, patients who must travel long distances for PUVA treatments may, with a physician’s close supervision, be taught to administer this treatment at home.
For more severe forms of psoriasis, doctors sometimes prescribe medicines that are taken internally:
Methotrexate--This treatment, which
can be taken by pill or injection, slows cell production by
suppressing the immune system. Patients taking methotrexate must be
closely monitored because it can cause liver damage and/or decrease
the production of oxygen-carrying red blood cells, infection-fighting
white blood cells, and clot-enhancing platelets. As a precaution,
doctors do not prescribe the drug for people with long-term liver
disease or anemia. Methotrexate should not be used by pregnant women,
by women who are planning to get pregnant, or by their male partners.
Cyclosporine--Taken orally,
cyclosporine (Neoral®) acts by suppressing the immune
system in a way that slows the rapid turnover of skin cells. It may
provide quick relief of symptoms, but it is usually effective only
during the course of treatment. The best candidates for this therapy
are those with severe psoriasis who have not responded to or cannot
tolerate other systemic therapies. Cyclosporine may impair kidney
function or cause high blood pressure (hypertension), so patients must
be carefully monitored by a doctor. Also, cyclosporine is not
recommended for patients who have a weak immune system, those who have
had substantial exposure to UVB or PUVA in the past, or those who are
pregnant or breast-feeding.
Hydroxyurea
(Hydrea®)--Compared with methotrexate and
cyclosporine, hydroxyurea is less toxic but also less effective. It is
sometimes combined with PUVA or UVB. Possible side effects include
anemia and a decrease in white blood cells and platelets. Like
methotrexate and cyclosporine, hydroxyurea must be avoided by pregnant
women or those who are planning to become pregnant.
Retinoids--A retinoid, such as
acitretin (Soriatane®), is a compound with vitamin A-like
properties that may be prescribed for severe cases of psoriasis that
do not respond to other therapies. Because this treatment also may
cause birth defects, women must protect themselves from pregnancy
beginning 1 month before through 3 years after treatment. Most
patients experience a recurrence of psoriasis after acitretin is
discontinued.
Antibiotics--Although not indicated in routine treatment, antibiotics may be employed when an infection, such as Streptococcus, triggers the outbreak of psoriasis, as in certain cases of guttate psoriasis.
Most treatments focus on topical skin care to relieve the inflammation, itching, and scaling. For more severe cases, oral medications are used. (Source: excerpt from Understanding Autoimmune Disease: NIAID)
Doctors generally treat psoriasis in steps according to the severity of the disease or responsiveness to initial treatments. This is sometimes called the "1-2-3" approach. In step 1, medicines are applied to the skin (topical treatment). Step 2 involves treatments with light (phototherapy). Step 3 involves taking medicines internally, usually by mouth (systemic treatment).
Over time, affected skin tends to resist some treatments. Also, a treatment that works like magic in one person may have little effect in another. Thus, doctors commonly use a trial and error approach to find a treatment that works, then switch treatments every 12 to 24 months to reduce resistance and adverse reactions. Selection of treatment depends on the location of lesions, their size, the amount of the skin affected, previous response to treatment, and a patient's perceptions about their skin condition and patient preferences for treatment. In addition, treatment is often tailored to the specific form of the disorder.
Treatments can include:
Topical Treatment:sunlight, steroid ointments, medicines made from vitamin D3, coal tar, or anthralin. Other topical measures, such as bath solutions and moisturizers, may be soothing but are seldom strong enough to clear lesions for a sustained length of time and may need to be combined with more potent remedies.
Phototherapy: UVB Phototherapy, PUVA -
Systemic Treatment: Doctors sometimes prescribe medicines that are taken internally for more severe forms of psoriasis, particularly when more than 10 percent of the body is involved. (Source: excerpt from Psoriasis: NWHIC)
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