Treatment

Psoriasis Treatment Options

Although there is currently no cure for psoriasis, there are multiple psoriasis treatments available that can usually help to clear up symptoms and provide long term control. The goal of treatment is to stop the skin cell overgrowth that leads to plaque formation and inflammation.

Treatment options include topical medications applied to the skin, oral medications, phototherapy, lasers, and a new class of medications called “biologics”.

Your doctor will recommend one or more of these treatments depending on the following factors:

• Type of psoriasis. The type of psoriasis can determine the recommended treatment. For example, inverse psoriasis appears in the skin-folds and may benefit from the use of a medicine that is well tolerated in sensitive areas, such as Vectical  (calcitriol), rather than a topical retinoid that may be irritating.
• Location (scalp, trunk, hands feet, etc.). Different treatments may be selected based on the location of the lesions. For example, scalp psoriasis may benefit from the use of a foam-based formulation rather than a cream.
• Psoriasis severity. The severity of psoriasis can make some therapies better options than others. Severe cases of psoriasis involving large portion of the body may benefit from systemic treatments that reaches all of the skin, such as phototherapy, methotrexate or biologics rather than topical treatments that must be applied to all affected areas.
• Results of previous treatments. You and your dermatologist will need to take into account the results of any past treatments you have used. Although medications can be very effective for a majority of people, individual differences can require tailoring the treatment plan.
• Ease or convenience of a treatment. Some treatment plans, though effective, may be difficult for some people follow because of the time and effort required. For instance, PUVA therapy requires regular visits to the office that can be difficult to schedule if the person does not drive or lives a long distance from the clinic. Home phototherapy can be an option for some, but this can be difficult to maintain if someone has to travel frequently for work.
• Possible side effects. Every effective medication has side effects. Finding an appropriate treatment plan requires finding a balance between the benefits and the risks. Some treatments are not good options for those people who might suffer significant consequences. For instance, methotrexate should not be taken by women who are pregnant.

Approved Uses of Medications

All medications made available for the treatment of psoriasis must be FDA approved for the treatment of a specific disease, or “indication”. Many of the psoriasis medications commonly used have been specifically approved for the treatment of plaque psoriasis.

These medications may be just as safe and effective for the treatment of other other types of psoriasis, but they have not been formally approved for these types by the FDA. Nonetheless, doctors can prescribe any medication for any condition if clinical studies and their clinical judgment leads them to conclude that its use can benefit the patient.

The use of a medication for a non-approved condition is sometimes referred to as an “off-label” use.

Many medications used in dermatology are prescribed “off-label” because they have been found to be of value for patients for a variety of skin conditions.

Phototherapy

Phototherapy for psoriasis is the controlled use of ultraviolet light from natural or artificial sources to alter the immune response in the skin and slow the growth of skin cells. This leads to a reduction in the build-up of skin plaques.

For the treatment of psoriasis, both ultraviolet A (UVA) and ultraviolet B (UVB) can be used.

UVB can be used alone or in combination with other treatments.

UVA must be used with other medications to sensitize the skin, usually psoralen. The combined use of a psoralen and UVA is called “PUVA” (psoralen UVA).

Phototherapy can be time-consuming and inconvenient, but it’s an effective treatment for certain types of psoriasis and a useful alternative to other medications.