Treatments for psoriasis

Although there is no cure for psoriasis, most patients can treat psoriasis symptoms by using one or a combination of topical based treatments. Other treatment options for psoriasis include phototherapy (light) or oral medication. Treatment options depend on the affected body part, patient preference, cost of treatment, and side effects.

Treatment for mild to moderate psoriasis:

Topical corticosteroid cream - steroid creams are the first line of therapy for mild to moderate psoriasis. Steroid creams reduce skin inflammation and itchiness by suppressing the immune response that causes psoriasis. Topical steroids should be applied only on active lesions and using the lowest possible dosage. Long-term use of steroid creams can cause skin atrophy. A combination of topical steroid with salicylic acid is more effective at reducing scaly skin symptoms.

Calcipotriene - vitamin D derivative that regulates skin cell growth, which is often combined with topical steroid therapy. Calcipotriene should not be combined with salicylic acid.

Emollient cream - moisturizers can hydrate the skin and reduce water loss. Thicker cream moisturizers are more effective than water based lotions. Emollients are most effective when applied immediately after a warm bath. Should be used daily in combination with other therapies, if necessary.

Salicylic acid - promotes the shedding of scaly skin. Salicylic acid is most effective on thicker or scaly psoriasis lesions. Salicylic acid is available over the counter in several strengths, however concentrations over 10% can lead to more side effects of headache, nausea, or stomach ache.

Urea - a 5% urea solution can moisturize dry and scaly skin. Urea can be used in combination with corticosteroids or salicylic acid that allows deeper skin penetration.

Coal tar - tar is a coal extract used to treat psoriasis and is considered safe. Tar may stain the skin. Tar is more effective when used with UVB treatment.

Retinoids (tazarotene, acitretin) - retinoids are vitamin A derivatives that regulate the growth of skin cells. Some retinoids have long half-lives and stay in the body for an extended time. Women who are considering pregnancy should not take retinoid medication because of the risk of birth defects in babies.

Treatment for moderate to severe psoriasis:

Systemic therapy options may be necessary for lesions that cover a large portion of the body. Systemic wide treatments include ultraviolet light therapy and oral medications.

Ultraviolet B phototherapy (UVB) - skin exposure to ultraviolet light several times a week. A study found that 311-312 nm (narrowband UVB) is the most effective wavelength that clears lesions fastest. UVB treatment can be at home or at the doctor's office and is considered a safe therapy.

Psoralen + Ultraviolet A (PUVA) - psoralen is a light-sensitizing medication that can be taken orally or applied topically. Skin is exposed to ultraviolet A light (320 to 400 nm). PUVA is considered more effective than UVB and recurring lesions are less frequent. However, Psoralen may induce side effects of skin blistering, nausea, or headaches. There is also a concern that PUVA carries a higher risk of skin cancer than UVB. PUVA still remains an option for dark skinned patients with lower risks of skin cancer.

Methotrexate - an oral medication that suppresses the immune system from building excessive skin cells that lead to psoriasis. Methotrexate may also be taken as an injection. Side effects include nausea; long-term use may cause liver damage and decreased red blood cell production.

Cyclosporine (Neoral) - an oral medication that suppresses the immune system. Long-term side effects include kidney damage and higher blood pressure.