Psoriasis: Treatment Options to Manage Your Symptoms & Skin
Psoriasis Uncovered: Myths Versus Truths
Truth: Psoriasis is an immune disorder with often embarrassing effects, and can affect skin and joints, too.
Myth: Psoriasis is contagious.
Truth: You cannot "catch" psoriasis from someone else, even if you come into contact with their skin. It is not an infectious disease.
Myth: Psoriasis can be cured.
Truth: Psoriasis is a chronic condition that has no cure; however, there are many effective treatments, and ongoing research for this condition is active.
What is Psoriasis? It's More Than Skin Deep
There is no cure for psoriasis, but advanced medications allow roughly 80 to 90 percent of patients to have successful treatment to lessen symptoms and improve the appearance of the plaques.
What Does Psoriasis Look Like?
Psoriasis can affect small areas of the body or be very widespread. For many people, psoriasis can lead to embarrassment, self-consciousness, or stress; some people may require treatment for depression or anxiety. Family doctors, dermatologists, or rheumatologists may treat your psoriasis depending upon site and severity.
What Causes the Heartbreak of Psoriasis?
In psoriasis, new skins cells are formed too quickly and result in a layer of dead, scaly skin and white blood cells that remain on the top layer of skin instead of sloughing off. These patches of skin and lesions are known as psoriatic lesions or plaque psoriasis.
Who Gets Psoriasis? It's Not All in the Family.
About 30 percent of people that develop psoriasis may also develop psoriatic arthritis, a type of rheumatoid arthritis that tends to affect the joints of the hands and feet. Some, but not all, patients will have a family history of psoriasis. Remember, psoriasis is not contagious; you cannot catch it from someone else.
Is There More Than One Type of Psoriasis?
- Plaque Psoriasis: Most common form that causes raised, red skins areas that may be itchy or flaky.
- Guttate Psoriasis: May be a past history of streptococcal infection; may occur in children or younger adults. Small plaques form on the midsection of the body.
- Pustular Psoriasis: Painful and severe form of psoriasis, with pus-filled sacs in the psoriasis plaques that can break. Fever may occur.
Additional Types of Psoriasis, Continued
- Inverse Psoriasis: This psoriasis may affect skin fold areas such as the genital area, under the breast or arms, or around the groin area. The lesions are flat, red, and often without scales.
- Nail Psoriasis: Nails may become yellow-brown, pitted, flake away or detach from the nail bed.
- Psoriatic Arthritis: May occur in up to 30 percent of patients with psoriasis; symptoms include swelling of the knee, ankles, hands and toe joints, pain, and nail psoriasis.
Flare Ups: Common Psoriasis Triggers
Treatments for Psoriasis: Where Do I Begin?
Treatment can lessen the formation of the excessive cells and help to return your skin to a smoother appearance. Treatments may include topical creams or lotions, phototherapy (light therapy) with or without certain medications, or prescription drugs that may be taken by mouth or injected. Some injectable medications can be used by the patient at home, too.
The First Line of Therapy - Topical Corticosteroids
Lower potency products, such as fluocinolone (Synalar, Derma-Smooth) can be use on the face or other sensitive areas. Lotions or foams are best for the scalp, creams are best for oozing lesions, and ointments can treat dry, raised, or scaly lesions.
Higher potency topicals are reserved for thicker, tough-to-treat areas like elbows or knees. Topical treatments work best on mild and smaller areas of psoriasis.
Topical Corticosteriods - Safety and Side Effects
More serious side effects may occur with topical corticosteroids if used in high doses for prolonged periods. You may become resistant to the helpful effects of topical corticosteroids over time, too.
Combined Use of OTC Emollients and Creams
These preparations are available over-the-counter (OTC) without a prescription - common examples include Aquaphor, Lac-Hydrin Five, Nivea, or Eucerin. Ask your pharmacist for more information on how to best use these products for psoriasis.
Vitamin D Analogues: How They Help
The most common side effect with these agents is mild skin irritation. Some topical vitamin D analogues may take up to 6 to 8 weeks for their full effect. Oral calcitriol (Rocaltrol) can also be used for psoriasis.
Topical Retinoids: Vitamin A to the Rescue
Acitretin (Soriatane) is an oral retinoid that comes in capsule form and is used for more severe forms of psoriasis. Treatment with acitretin should be limited to less than 6 months; test for liver enzymes and blood lipids will need to be followed. Noticeable improvements may take up to 2 months; the full effect might take 3 to 6 months.
These agents may be used in combination with topical emollients. Topical retinoids should NOT be used in pregnant women or those planning pregnancy due to the risk for birth defects.
Phototherapy: Lighten Your Symptoms
Light therapy can increase the risk of skin burns and cancer and should not be used in people with a history of skin cancer.
Topical Coal Tar: An Old Stand-By
The exact way that coal tar treats psoriasis is not known. Coal tar can be found over-the-counter in shampoos, creams and lotions and can be used in combination with corticosteroids and emollients to soften the skin. Coal tar is also combined with UVB light in a treatment known as Goeckerman treatment. Coal tar increases the skin's absorption of UVB light for an added effect.
Heads Up: Anthralin for Scalp Psoriasis
Like coal tar, anthralin may be used in combination with UV light to help with skin symptoms of psoriasis, including dryness, redness, flaking, scaling, and itching.
Salicylic Acid: A Keratolytic
Salicylic acid is available in both over-the-counter and prescription strengths and loosens dead skin from the psoriasis plaque to reduce scaling (keratolytic). Salicylic acid (Dermarest, Psoriasin) is available in many different OTC formulations to treat both skin and scalp psoriasis.
Salicylic acid can be used in combination with other treatments, like corticosteroid creams, anthralin, or coal tar to increase effectiveness. It may take up to several days before your symptoms improve. Common side effects of salicylic acid may include skin irritation, peeling, rash, or blanching of the skin area.
Methotrexate (MTX): A Longer-Term Option
MTX can be toxic to the liver; lab monitoring will be needed. MTX should NOT be used in women who are pregnant or planning a pregnancy; men should also stop its use 3 months before conception.
Cyclosporine: A Short-Term Option
Cyclosporine can increase the risk for infections, and use for greater than one year is not recommended. Some healthcare professionals will suggest that patients take a "holiday" from cyclosporine, use other treatments in the interim, and then return to cyclosporine therapy again later. This may help to lessen severe side effects like kidney damage or high blood pressure. Cyclosporine can be used in combination with emollients.
The Latest Treatments: Biologics Agents
Medications may include adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi), secukinumab (Cosentyx), ixekizumab Taltz, and ustekinumab (Stelara). Prior to starting biologics, patients must be screened for tuberculosis (TB). Some biologics can be given at home via a pen for subcutaneous injection, while some treatments require a office visit for IV injection. Treatments can costs several thousand dollars per month, and may increase the risk for certain types of infections, including tuberculosis (TB).
Don't Let Psoriasis Settle: Fight Back
Join force with other patients who share your same condition and have similar concerns. Ask questions of other group members, voice concerns, and stay up the with latest psoriasis news, all in the Drugs.com Psoriasis Q&A Center and Support Groups. There is always power in numbers!
Finished: Psoriasis: Treatment Options to Manage Your Symptoms and Skin
- American Academy of Dermatology. Clinical Guidelines. Psoriasis. Guidelines of care for the management of psoriasis and psoriatic arthritis. Accessed August 12, 2013. http://www.aad.org/education/clinical-guidelines
- National Psoriasis Foundation. Psoriasis. Topical steroids potency chart. Accessed August 15, 2013. http://www.psoriasis.org/about-psoriasis/treatments/topicals/steroids/potency-chart
- National Psoriasis Foundation. Topical treatments for psoriasis, including steroids. Accessed August 15, 2013. http://www.psoriasis.org/Document.Doc?id=164
- Mayo Clinic. Psoriasis. Accessed August 15, 2013. http://www.mayoclinic.com/health/psoriasis/DS00193
- UpToDate. Wolters Kluwer Health. Patient Information: Psoriasis (Beyond the Basics). Accessed August 14, 2013. http://www.uptodate.com/contents/psoriasis-beyond-the-basics