Treatments
 It is estimated that between 4.5 and nearly 7 million people in the U.S. live with psoriasis—but they’re remarkably different in what they know about treating it. Perhaps you are one of those people who want to learn everything you can. You talk with your doctor regularly, ask questions, read up on the latest treatments. Or perhaps you are one of the people who are more laid back. You don’t see a doctor too often, don’t bother him or her with questions when you’re there, and don’t always take the time to keep up on the latest on psoriasis.
So here’s a quick review of currently available psoriasis treatments. And no matter which group you fall into, it can help you stay in control, and be as proactive as you can be about finding the treatment that’s best for you.
Today, psoriasis treatments fall into three broad categories:
Topical treatments
 A topical medication is one used externally, applied directly to the skin rather than taken internally.
Topical treatments—“topicals”—are most often those a dermatologist turns to first in managing psoriasis. They range from over-the-counter treatments, including remedies based on coal tar, to more powerful prescription steroids, and work in very different ways. Occlusion is sometimes used with topical medications—after applying the medication the area affected is completely covered up.
Coal tar
This centuries-old psoriasis treatment is found today in shampoos for mild scalp psoriasis and intensive hospital regimens.
Anthralin
Another century-old treatment used as ointment or in solution for the inflammation and itching of scalp psoriasis.
Calcipotriene
A man-made form of vitamin D3 used to treat mild-to-moderate psoriasis.
Salicylic acid
"Sal acid," found in shampoos, soaps, lotions and gels—products known as keratolytics (“scale lifters”).
Steroids
Among the treatments most often prescribed for mild-to-moderate psoriasis, steroids, or "corticosteroids," can clear up lesions quickly, but aren’t good at maintaining remissions. Over-the-counter steroids are generally too weak to be effective with psoriasis.
Tazarotene
A topical retinoid—a prescription vitamin A derivative—used to treat mild-to-moderate plaque psoriasis.
Other topical applications
Moisturizers, bath and shower oils, and nonprescription medications can all help lubricate dry skin and decrease redness and itching.
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Light treatments
When light treatment is prescribed for you , your skin is exposed to carefully measured doses of ultraviolet (UV) light, usually in a dermatologist's office.
UV is used to treat moderate-to-severe psoriasis that is resistant to topical creams and ointments.
While UV can be carcinogenic, no connection has been found between dermatologist administered UVB treatments and skin cancer.
It is not known exactly how UV works on the skin, but researchers believe it may kill abnormal skin cells, alter the skin's immune reactions, or slow their reproduction.
There are currently three types of UV treatment:
UVB treatment
UVB is used to treat moderate-to-severe psoriasis that is resistant to topical creams and ointments. UVB should be administered only by an experienced photodermatologist. The patient enters a special light box (not a tanning bed) and, wearing goggles and other protection, is exposed to UVB rays for a specific period of time. Most patients need 18-30 treatments before they see substantial clearing.
PUVA treatment (pronounced “poova”)
PUVA (Psoralen UVA) combines UVA exposure with a photosensitizing agent, taken internally or as a bath. The photosensitizing agent allows for a lower dose of UVA. PUVA treatments can be highly effective, but recent studies strongly suggest it poses some threat of skin damage and cancer.
Narrow-band UVB, or laser phototherapy
High-intensity ultraviolet radiation is delivered precisely to the affected skin cells. Because the UV exposure of normal skin cells is restricted, many dermatologists consider this safer than other treatments. It shows results after approximately 10
to 13 exposures over 3 to 4 weeks. Newer and less studied than other light
treatments, early results suggest it may clear skin faster and produce fewer burning reactions and longer remissions.
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Systemic treatments
Unlike topical medications or light therapy—which only affect the skin—systemic treatments affect your entire body. For this reason, they are usually used only for the more severe forms of psoriasis, especially when more than 10% of a person’s body is affected.
There is a wide range of systemic medications that your doctor can prescribe. These include:
Methotrexate
A drug that slows down the rapid growth of skin cells and suppresses the immune system.
Oral retinoids
Derived from vitamin A, these drugs regulate how skin cells grow and are shed from the surface of the skin.
Cyclosporine
Another drug that slows skin growth by preventing some of the activity of the immune system.
Some systemic medications may have serious side effects. These include liver damage, birth defects, decreased kidney function, and anemia.
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Biologic medicines
Biologic response modifiers (BRMs) are a breakthrough. They are an entirely new class of drugs made from living sources to work in the immune system. Biologic drugs harness the proteins and cells involved in psoriasis.
Several older systemic drugs treat psoriasis by suppressing the entire immune system. Biologic medicines can fight more selectively. Instead of limiting the action of the entire immune system, they’ve been specially created to target the specific chemicals involved in psoriasis.
Biologic medications are just beginning to be approved for the treatment of psoriasis. Learn about a different way to treat psoriasis.
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