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There are several treatments available to help manage psoriasis. Determining the most appropriate treatment is very individual and based on the type and severity of disease, how large or widespread plaques are, on what the patient agrees to use based on benefits and risks and how well a patient responds to a given treatment. A physician may change a patient’s treatment dose, combine one kind of therapy with another, or switch treatments if one doesn’t work for a patient.
 Topical
Topically applied treatments, such as creams and ointments, are usually recommended first, particularly for mild psoriasis. The aim of this kind of treatment is primarily to slow down and regulate skin cell turnover, reduce inflammation and suppress the immune system. These options include topical corticosteroids, topical derivatives of vitamin D (calcitriol and calcipotriol), topical derivatives of vitamin A (tazarotene), and coal tar. Physicians may recommend a combination of these topical agents or combine them with oral and/or light therapy.
Systemic
A number of oral drugs can help to manage psoriasis and are usually reserved for the treatment of more severe and/or widespread symptoms. Traditional systemic treatments are methotrexate, also used to treat arthritis, acitretine, used for psoriasis only and cyclosporine, a potent mmunosuppressive agent to be used only for short periods. In addition to these traditional drugs, novel agents such as biologic response modifiers (or biologics), are given by injection. Many biologics are now available: alefacept, etanercept, adalimumab, infliximab, ustekinumab. Ongoing research will also bring new options. Systemic treatments work generally by helping to regulate and normalize skin cell turnover and suppressing the immune response that causes inflammation and plaques.
 Light therapy
Both natural and artificial ultraviolet (UV) light are used to treat psoriasis. Many patients with psoriasis find that sunlight exposure seems to improve their skin symptoms. However, sunburn can worsen the condition, which is why only a modest amount of exposure is recommended. One form of light herapy is Narrow Band UVB phototherapy, which emits a short wavelength of UV light that penetrates the epidermis or outermost layer of skin. Another form of light therapy is psoralen and UVA (PUVA), which combines an oral or topical form of the drug, psoralen, and UVA light exposure. The drug makes the skin more sensitive to the UVA light, helping it to work better.
Combination therapy
There are many treatment options for patients with psoriasis. The challenge for both physician and patient is to find what works most effectively for the individual. In many cases, a physician may choose to combine 2 or more treatments for the best outcome. |
