Psoriasis: Find the Right Treatment

First, you have to find the right doctor. Like any autoimmune disease, psoriasis is complicated to treat. It requires the expertise of a dermatologist who has experience with the condition. Ask your primary-care doctor for a referral, or log on to the physician locator at the National Psoriasis Foundation's Web site.

Your treatment will largely depend on the severity of your condition:

  • If less than 3 percent of your body is affected by psoriasis, it's considered mild and is typically treatable with topical medications.
  • If it affects 3 to 10 percent of your body, it's at the moderate level. You may need light therapy in combination with topical medications.
  • When psoriasis covers more than 10 percent of your body or affects body parts that limit normal functioning, such as your hands and feet, it's labeled severe and may require oral or injectable drugs.

The following treatments may be used alone or in combination.

Topical Treatments

Creams, ointments, gels, shampoos or foams that contain one or more of these active ingredients:

  • Steroids—to reduce swelling and redness, and prevent new patches
  • Salicylic acid—to help soften and remove scales from the skin
  • Anthralin and vitamin A derivatives or retinoids—to slow the rapid growth of skin cells
  • Calcipotriene (a vitamin D derivative)—to flatten lesions, remove scales and reduce inflammation
  • Coal tar—to slow the growth of skin cells and reduce inflammation, itching and scaling

Light Therapy
Ultraviolet light, naturally present in sunlight, causes a reaction in the skin that decreases the number of cells that are growing too quickly or slows the rapid growth of skin cells. It is usually added to topical treatments when medicines alone don't work or the patient has widespread psoriasis.

PUVA Therapy is a combination of ultraviolet A and a drug called psoralen, which enhances skin sensitivity so the skin can better absorb the light. It can successfully treat several types of psoriasis, but it's usually reserved for people who haven't responded well to other treatments. PUVA can take months of multiple treatments to begin working and causes side effects ranging from nausea and headaches to increased skin-cancer risk.

Ultraviolet B Light Therapy works best on plaque psoriasis and is given two to five times weekly. Skin is exposed to UVB light lamps or lasers, sometimes in combination with topical therapies. Lesions may clear in as little as two weeks, and side effects are minimal when treatment is administered by experienced care providers.

Oral and Injectable Medications

  • Immunosuppressive medications, such as methotrexate and cyclosporine, blunt the immune response, reducing flares. These drugs may raise your risks of serious infection and kidney or liver damage
     
  • Acitretin, a retinoid, reduces skin inflammation and cell turnover and improves symptoms in about 50 percent of psoriasis patients. Do not use this drug during pregnancy.
  • Biologic drugs, such as etanercept and adalimumab, given by injection or infusion, block psoriasis-causing actions of certain immune cells but also raise your risk for infection.

"Psoriasis is a trial-and-error-based disease," says Aimee Bosland, health educator for the National Psoriasis Foundation. "Give treatments at least eight weeks to three months to work (as long as you're not having severe side effects) before trying something else."

Reviewed by: Mary Ellen Luchetti, M.D., AAD

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