Main Types of Psoriasis Treatment

The three main types of treatments for psoriasis are those that are applied to the surface of the skin (topical treatments), light therapy or phototherapy, and oral medications.  Mild to moderate cases of psoriasis are often initially treated with creams or ointments applied directly to the affected areas of the skin.  For more advanced cases, or if the symptoms do not respond to the topical medications, light therapy or oral medications may be added. Some of the most commonly prescribed creams to treat psoriasis are the class known as topical corticosteroids. They are powerful drugs that reduce inflammation of the skin eruptions. The corticosteroids slow cell turnover by suppressing the immune system, which reduces inflammation and decreases the itching associated with the inflamed areas. There are a number of different strengths available for this class of drugs.  The corticosteroid ointments that have low potency are usually recommended for application to sensitive areas such as the face.  They can also be used to treat widespread patches of damaged skin. The more potent corticosteroid creams can be applied to small eruptions on the skin, for stubborn plaques on hands or feet, or when other treatments fail.  Corticosteroids do have side effects, and so to minimize side effects they are generally prescribed only on active outbreaks until the outbreaks are under control.  This judicious use of the creams also keep the patient from becoming desensitized to the steroid, so that it will continue to be effective in future applications. Pharmacists have developed a synthetic form of vitamin D, which seems to inhibit skin cells from replicating, and also reduces skin inflammation.  Several prescription creams that contain one of these synthetic forms of vitamin D are prescribed to treat mild to moderate psoriasis.  It may be used by itself, or in combined with other topical medications or phototherapy.  Anthralin is a drug that is believed to normalize DNA activity in skin cells, and also reduces inflammation. It can remove scale and smooth skin very well, but it has the problem that it easily stains anything it comes in contact with.  This includes skin, clothing, any sheets or other bedding material, and even the sinks and counters it is used on.  Due to the side effect that has little to do with health, the physician may recommend only using the medicine for a brief period — apply the cream for the time that it can be easily monitored, and then wash it off before it comes in contact with other things. Anthralin can be used by itself or with phototherapy. Another class of medications used to treat affected skin are the topical retinoids, which are often mentioned for acne treatment or treatment for significant sunburn. The particular retinoid tazarotene was developed for the special purpose to treat the outbreaks caused by psoriasis.  The class of retinoids is derived from vitamin A, and they also normalize DNA activity in skin cells.  Retinoids do have some common side effects.  One is that even normal skin may be irritated, and it also may make skin more sensitized to sunlight.  Another side effect is that retinoids may be implicated in birth defects, though applying a retinoid has a much lower chance for birth defects than one taken orally.  However, anyone that is pregnant or planning to become pregnant should make sure his or her physician is aware of this. One recent medication that disrupts the activity of T cells is calcineurin.  Since the activity of the T cells starts the cycle of inflammation in psoriasis, this medication holds great promise for treatment.  However, these medications are presently approved only for certain cases of dermatitis, but there are ongoing studies indicating that these medications will be very effective in the treatment of psoriasis flare-ups.  If the T cells are not as active, the cell production will decrease, which will decrease both the inflammation and buildup of plaques.  The drawback to using calcineurin for a prolonged period is that it increases the risk of developing skin cancer or lymphoma. One of the more surprising treatments for psoriasis is coal tar, which is obtained from the manufacturing process of coal.  It is a thick, smelly, black, goo and is an ingredient in several strongly smelling dandruff shampoos.  It is one of the oldest treatments for psoriasis, and does effectively reduce the scales, itching, and inflammation in a large number of patients.  Physicians are still trying to determine how it successfully effects the mechanisms in psoriasis.  It is not expensive and has few known side effects.  Many patients do not like it because it has an intense unpleasant odor, and easily stains clothing. Additionally, physicians may suggest particular moisturizers or other creams to be applied to the inflamed areas.  These do not address any of the reasons for the inflammation, but they can and do reduce the unpleasant aspects of an inflamed area.  They reduce itching and the appearance of scales, and are especially important because other therapies for psoriasis may make the skin especially dry.  As already mentioned above, moisturizers in a thick ointment are longer lasting and more effective for psoriasis patient than simple lotions.