How is psoriasis treated?

Dr. Lee A. Kaplan, MD
Dermatologist (Skin Specialist)

Psoriasis can be treated with topical treatments that contain corticosteroids. These creams and lotions help control the immune response that causes rapid cell growth and scaly patches on the skin. Skin creams that include vitamin D can also help slow skin cell growth. Some patients find that phototherapy helps with symptoms.

There is also a new class of systemic psoriasis drugs that target tumor necrosis factor, a protein in the body believed to be responsible for the inflammation and rapid cell growth of psoriasis. With this therapy, patients receive injections of medications such as Enbrel and Humira every week or two.

Dr. Mark W. Moronell, MD
Cardiologist (Heart Specialist)

Treating moderate to severe psoriasis usually involves a combination of treatment strategies. Besides topical treatments, your doctor may prescribe phototherapy (also known as light therapy) and/or systemic medications, including biologic drugs.

Light therapy includes:

  • Laser therapy, where a dermatologist uses a laser to target the psoriasis with a strong dose of light, without touching surrounding skin. It is effective for small, stubborn patches of psoriasis, such as on the scalp, feet or hands.
  • Ultraviolet B (UVB) light therapy is where a patient stands in a light box or in front of a light panel. If the psoriasis responds, about 24 treatments over a two-month period usually clears the psoriasis. Although UVB is safe and effective, it does have possible side effects. These include burns, freckling, and premature skin aging.
  • PUVA: Dermatologists prescribe PUVA when psoriasis does not respond to other treatments. This treatment combines a medication called "psoralen" with UVA light therapy. Research shows that PUVA is effective in about 85 percent of cases.
  • Goeckerman Treatment: Under a dermatologist's care, light therapy can provide safe and effective treatment for many patients with psoriasis. Because too much ultraviolet (UV) light can make psoriasis worse, it is important to see a dermatologist for treatment. Never try to self-treat by using a tanning bed or sunbathing.

Drugs include:

  • Topical medicines applied to the skin to treat mild to moderate psoriasis. Corticosteroids (cortisone), Anthralin, Retinoids (vitamin A Preparations) and coal tar.
  • Corticosteroids are the most frequently prescribed medication for treating mild to moderate psoriasis. They are available as a cream, ointment, gel, foam, spray and lotion.
  • Systemic medicines to treat moderate to severe psoriasis include: Methotrexate, Retinoids (vitamin A derivatives) and Cyclosporine.

Although there is no cure for psoriasis, treatments can reduce the skin inflammation it causes. Topical steroid medications are frequently prescribed, but the condition often returns quickly once treatment ends. UVB light therapy, sunlight, oral and topical vitamin A derivatives, coal tar, salicylic acid, hydroxyurea (which can be combined with light therapy), anthralin and topical vitamin D derivatives often help.

Anthralin (Dritho-Scalp), a medication believed to normalize DNA activity in cells, can help improve smoothness of the skin. The oral medication tacrolimus (Prograf) and new injectable medications used for treating arthritis, such as etanercept (Enbrel) or infliximab (Remicade), seem to be very effective for some individuals with psoriasis.

For more severe forms of psoriasis, methotrexate (Trexall), an immunosuppressant drug used to treat rheumatoid arthritis and other conditions, is sometimes prescribed. This medication, which can be taken by pill or injection, slows cell production by suppressing the immune system. People taking methotrexate must be closely monitored to avoid possible liver damage and/or decreased cell counts. Pregnant women or those who are planning to become pregnant should not use methotrexate.

Cyclosporine, another immunosuppressant drug, is also sometimes prescribed. This medication increases risk for high blood pressure and kidney problems.

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Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

Treating psoriasis is hit or miss, so docs typically try a number of approaches to see what works. Some common treatments include using moisturizers, mineral oil, or petroleum jelly to help reduce the dryness that comes with the buildup of skin cells. Docs may also use medicated topical agents to help not only minimize the appearance but also quell the immune reaction, reduce the inflammation and stop the overproduction of skin cells.

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Dr. Adam J. Mamelak, MD
Dermatologist (Skin Specialist)

There are literally numerous therapies that exist for psoriasis, including creams and lotions, topical agents, oral medication, light therapies and biologic drugs. The type of therapy selected often depends on the extent of your disease, the symptoms and how it affects your life. Your dermatologist can advise you by examining your skin and devising a treatment plan that suits all your needs.

While there's no cure for psoriasis, a good treatment plan will reduce its symptoms, improve your appearance, and enhance the quality of your life. Initial treatment usually focuses on clearing your skin. After that, a maintenance plan will aim to keep the lesions from returning. It may take trial and error to develop, because there are many treatments, and they're often most effective used in combination. They may include creams and other topical (external) medications, light therapy, and, sometimes, powerful systemic (internal) medications.

What doctors start with generally depends on the size of the affected area, the type of psoriasis, and is the severity. This is sometimes called the 1-2-3 approach.

  • In step 1, medications are applied to the skin (topical treatment).
  • Step 2 uses light-based treatments (phototherapy).
  • Step 3 brings in the big guns: medicines that treat the immune system (systemic therapy).

Treatment for psoriasis usually starts with topical drugs. Corticosteroid creams or ointments can be very effective at minimizing your symptoms and providing relief from itching. They come in several different strengths. Which one is right for you depends on the severity of your psoriasis and what part of your body is being affected. Other effective topical treatments include vitamin D, salicylic acid, anthralin, and even coal tar. All of these medications can be used in conjunction with phototherapy. You may have already noticed that natural sunlight helps improve your psoriasis. Doctors can take advantage of this by harnessing ultraviolet light and using it to help your condition. If these treatments aren't effective you may be directed to use an oral drug or an injection. Immunomodulators, cyclosporine and methotrexate are all drugs that may be used to suppress your immune system and diminish your psoriasis symptoms.

Yogi Cameron Alborzian
Alternative & Complementary Medicine Specialist

Ayurvedic tradition typically considers psoriasis to be a buildup of excessive heat in the body. This is a heat that may also lead to indigestion, acid reflux, acne, irritable bowel syndrome, and other indications of irritation in the body. When the heat that is supposed to be contained within the digestive system (i.e., the digestive fire) becomes excessive, it spreads to other parts of the body and may create a toxic reaction on the skin. This is what happens when someone gets psoriasis.

To resolve this condition, an Ayurvedic practitioner will help the patient to lessen this heat and allow the digestive fire to once again be contained. This will happen through the taking of herbs, a diet that cools the body off, cooling breathing practices, and the application of topical herbal remedies as well as other treatments.

Dr. Erik O. Gilbertson, MD
Dermatologist (Skin Specialist)

There are several different ways to treat psoriasis, an autoimmune disorder that can cause inflammation on the skin. Psoriasis is caused by skin cells multiplying too rapidly, resulting in a scaly growth plaque that grows on the skin and other areas.

Some treatments are applied directly to the skin while others are injected or taken as pills. Topical treatments include corticosteroid creams or lotions that help calm immune system inflammation. These treatments, however, may lose their effectiveness over time. Topical Vitamin D treatments can also help slow skin cell growth.

Another treatment choice for psoriasis involves phototherapy, or light therapy. The sun's UV light rays can actually destroy the cells that cause psoriasis. But too much UV exposure can also make things worse. Many dermatologists use more controlled versions of phototherapy, such as narrowband UVB light.

Finally, there are systemic drug therapies called biologics. These medications target a protein in the body that is largely responsible for the inflammation and rapid cell growth associated with psoriasis.

Biologic drugs like Enbrel and Humira, given by injection every week or two, can be very effective. However, it’s important to note that these medications can include side effects, some of them severe.

Psoriasis increases the risk for other serious conditions, including cancer, cardiovascular disease, arthritis, diabetes and depression. Doctors take these risks into consideration as they treat the whole person.

Psoriasis can be treated with medicine to soothe red, itchy and sore skin. Topicals, like creams, lotions or gels, are usually used first. These are applied to the affected skin, even to the scalp.

If topicals aren’t working, light therapy might help. Light from a special bulb shining on the skin a few times a week may help people with psoriasis feel better. If that doesn’t work sometimes a doctor will prescribe pills or injections. These medicines work inside the body to calm the immune system.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.