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Psoriasis treatment: Topicals
Over-the-counter topicals
Salicylic acid
Tar
Other OTC topical
Prescription topical
Anthralin
Dovonex
Taclonex
Tazorac
Vectical
Topical steroids
Psoriasis treatment: Light therapy
UVB phototherapy
PUVA
Lasers
Psoriasis treatment: Systemics
Biologics
Other biologics are being developed for treating psoriasis and psoriatic arthritis.
Biologics are fairly new treatments for psoriasis and psoriatic arthritis. Their overall safety is still being evaluated; long-term side effects are not fully known.
For more information, please see the Biologics section.
Cyclosporine
Methotrexate
Soriatane
Other systemicPsoriasis
Column #407, 4/16/09
by Jake Mossman, Owner of Taos Pharmacy
Psoriasis is a chronic disease of the immune system that appears on the skin, usually in the form of thick, red, scaly patches. Up to 30 percent of people with psoriasis also develop psoriatic arthritis. Psoriasis is associated with other serious conditions such as diabetes, heart disease and depression. According to the National Institutes of Health, as many as 7.5 million Americans have psoriasis. It occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells. There are five types of psoriasis. The most common form, plaque psoriasis, appears as raised, red patches or lesions covered with a silvery white buildup of dead skin cells, called scale. Psoriasis can occur on any part of the body.
There are many over-the-counter and prescription treatments for psoriasis including topical products, traditional systemic medications, light therapy and biologic drugs. Additionally, there are complementary and alternative therapies available. Work with your doctor to find a treatment—or treatments—that reduce or eliminate your symptoms. What works for one person with psoriasis might not work for another. So it's important to know the different treatment options and keep trying until you find the right regimen for you.
Topical treatments—medications applied to the skin—are usually the first line of defense in treating psoriasis. Researchers believe psoriasis occurs when faulty signals in the immune system cause skin cells to grow too rapidly. Topicals slow down or normalize that excessive cell reproduction and reduce inflammation (redness) associated with psoriasis.
There are many effective topical treatments. While many can be purchased over the counter (OTC), others are available by prescription only.
Also known as "sal acid," salicylic acid helps remove scales and is often combined with topical steroids, anthralin or tar to enhance effectiveness. Available in both OTC and prescription forms.
Coal tar is available in topical, shampoo and bath solution forms. Tar can help slow the rapid proliferation of skin cells and help reduce inflammation, itching and scaling. It can also be used in combination with phototherapy.
Information about bath solutions, moisturizers and nonprescription medications that can be used to moisturize, soothe, remove scale or relieve itching.
This prescription topical can be very effective in treating plaque psoriasis. It does not work as quickly or as thoroughly as superpotent topical steroids, but unlike steroids, it has no known long-term side effects.
A form of synthetic vitamin D3 that slows down the rate of skin cell growth, flattens psoriasis lesions and removes scale. Dovonex also can be used on the scalp and for nail psoriasis.
This prescription ointment contains calcipotriene (the active ingredient in Dovonex) and the potent steroid betamethasone dipropionate. The calcipotriene slows down the rate of skin cell growth, flattens psoriasis lesions and removes scale, while the steroid helps reduce inflammation and itch. For treating scalp psoriasis, Taclonex Scalp is available.
Available as a presciption gel or cream (also known by its generic name tazarotene), Tazorac is a vitamin A derivative and is also known as a topical retinoid. It can be used on the face, scalp and nails.
This prescription ointment contains calcitriol, a naturally occurring, active form of vitamin D3, and has shown in clinical trials to be well-tolerated even when used on sensitive skin fold areas.
Corticosteroids, ordinarily called "steroids" by doctors and patients, are routinely used to treat psoriasis. Topical steroid medications can be very effective in controlling mild to moderate psoriasis lesions. They are easy to use and work relatively quickly. Most are available by prescription.
Light therapy involves exposing the skin to wavelengths of ultraviolet light under medical supervision. Treatments usually take place in a doctor's office or psoriasis clinic. However, it is possible to follow a treatment regimen at home with a unit prescribed by your doctor. The key to success with phototherapy is consistency.
UVB treatment involves exposing the skin to an artificial UVB light source for a set length of time on a regular schedule, either under a doctor's direction in a medical setting or with a home unit purchased with a doctor's prescription.
PUVA is an acronym for psoralen (a light-sensitizing medication) combined with exposure to ultraviolet light A (UVA). UVA, like UVB, is found in sunlight. By itself, however, UVA is not usually used to clear psoriasis. It is relatively ineffective unless used with a light-sensitizing medication such as psoralen.
Targeted UVB treatment and pulsed dye lasers can be used to treat chronic localized plaque lesions.
Systemic medications are prescription medications that affect the entire body, and are usually reserved for patients with moderate to severe psoriasis who are not responsive to or eligible for conventional
topical medications
or ultraviolet (UV) light treatments.
Biologic medications are developed from living sources, such as cells, rather than combinations of chemicals like traditional drugs. As of January 2008,
Amevive,
Enbrel,
Humira,
Raptiva
and Remicade
are approved by the U.S. Food and Drug Administration (FDA) for treating psoriasis. On April 8, 2009, Genentech, Inc. announced a phased voluntary withdrawal
of Raptiva from the U.S. Market; the drug will no longer be available after June 8, 2009. Enbrel,
Humira
and Remicade
are FDA-approved for the treatment psoriatic arthritis.
Cyclosporine is a prescription systemic medication used to treat psoriasis. In 1995, Neoral (one brand name for cyclosporine) was FDA-approved to help prevent organ rejection in transplant patients. In 1997, the FDA approved Neoral as a treatment for psoriasis.
Methotrexate is a prescription systemic medication usually sold as a generic. Initially used to treat cancer, methotrexate was discovered to be effective in clearing psoriasis in the 1950's and was eventually approved for this use by the FDA in the 1970s.
Soriatane is a prescription medication called an oral retinoid, which is a synthetic form of vitamin A. Synthetic retinoids were introduced as experimental drugs in the mid-1970's and were approved in the United States in the 1980's. Soriatane is the only oral retinoid approved by the FDA specifically for treating psoriasis.
Accutane, Hydrea, mycophenolate mofetil, sulfasalazine, 6-Thioguanine.