How Is Psoriasis Treated?
As you start to explore psoriasis treatment options for yourself or for your child, keep in mind that there are several different kinds of psoriasis (your dermatologist will diagnose your psoriasis type,) and that no single psoriasis treatment is guaranteed to work for all people. But the good news is that there are several different kinds of medically-approved psoriasis treatments proven effective at limiting flare-ups and lessening your symptoms, so you’ll work in tandem with your board-certified dermatologist to find the treatment that works best for you.
The goal of your psoriasis treatments, from your point of view, is to clear up your red scaly patches, and from your doctor’s point of view, the best treatments for psoriasis accomplish the following:
- Stop skin cells from growing so quickly, which reduces inflammation and plaque formation
- Remove scales and smooth the skin, which is particularly true of topical treatments applied to your skin.
You always want to treat the underlying cause of any skin condition first and foremost, as well as improving the outer appearance of any skin condition, which is why it’s important to work with a dermatologist and not take the easy road of buying a psoriasis cream in a supermarket or drugstore. Your doctor can tell the difference between the various types of psoriasis, and start you on the path of treatment.
There are three main types of psoriasis treatments: topical treatments, light therapy and systemic medications.
Topical treatments: Topical psoriasis treatments are creams and ointments that you apply to your skin to treat mild to moderate psoriasis from the outside in. Types of topical psoriasis treatments include:
- Topical corticosteroids. These anti-inflammatory drugs are the most frequently-prescribed medications for treating mild to moderate psoriasis. They slow cell turnover by suppressing your immune system, which reduces inflammation and can relieve your itching. Your dermatologist will prescribe a topical corticosteroid in mild to very strong formulas, depending on the severity of your psoriasis and where your flare-up is located. For instance, you may be given a low-potency corticosteroid for sensitive areas like your face or skin folds or for treating large patches of affected skin. Stronger formulas may be prescribed for smaller patches of psoriasis, or for plaques on your hands and feet. Medicated foams and scalp solutions may be used to treat psoriasis patches on your scalp. An important tip is to use medication prescribed for a part of your body only on that part of the body. Don’t use your stronger corticosteroid cream on, say, your face if you develop a flare-up there. Always see your doctor for location-specified medications. And use all corticosteroids according to your doctor’s instructions and timing, since long-term use can thin your skin and cause resistance to your medication.
- Vitamin D analogues. A prescription cream or solution containing a synthetic form of Vitamin D. Again, don’t go it alone by applying Vitamin D cream to your or your child’s psoriasis outbreaks. This is a Vitamin D analogue, specially-formed for prescriptions.
- Topical retinoids. If the name sounds familiar, it’s because topical retinoids are commonly used to treat acne and sun-damaged skin, and formulas of topical retinoids are available to help treat psoriasis. It’s a special derivative of Vitamin A that can decrease inflammation. A common side effect of this type of medication is sun sensitivity, so use sunscreen if you need to be out and about, attend outdoor special events, and generally be outdoors in any weather, sunny or cloudy. UV rays get through those clouds and can cause you greater skin issues without protection. Also, talk to your doctor if you are, could be or plan to get pregnant, as this medication is not to be used during those conditions.
- Salicylic acid. You’ve also seen this ingredient in your skincare products, and likely during your facials. Salicylic acid treatments are available over the counter and by prescription, and they promote the sloughing off of dead skin cells, as well as reducing scaling. Your doctor may combine this with other treatments, and it’s also an ingredient in medicated shampoos and scalp solutions to treat scalp psoriasis.
- Coal tar. Coal tar is one of the oldest treatments for psoriasis, but it’s still used to reducing itching, scaling and inflammation. The thick, black product may not be as pleasant to use as other topical treatments, since it has a strong odor, stains clothing and bedding and is messy. But doctors still prescribe formulas including coal tar for its effectiveness, provided you’re not pregnant or breastfeeding.
- Moisturizers. These do not heal psoriasis on their own, but are often used in tandem with other treatments to help combat dryness resulting from those other psoriasis treatments. Ointment-style moisturizers have been found to be more effective than lighter lotions and creams, and your doctor can recommend the best brands and types for you.
When psoriasis is more severe, creams are likely to be combined with oral medications or light therapy.
Light therapy (phototherapy): This category of psoriasis treatment uses natural or artificial light to help heal your scales and patches. Some of the light therapy treatments include:
- Exposure to sunlight. When exposed to UV rays in sunlight or artificial light, activated T cells in the skin die off, which slows skin turnover and reduces scaling and inflammation. Ask your doctor about the correct levels and timing of sun exposure, so that you do not cause more skin damage from too much exposure to UV rays.
- UVB phototherapy. Controlled doses of UVB light from an artificial light source may improve mild to moderate psoriasis symptoms. UVB phototherapy, also called broadband UVB, can be used to treat single patches, widespread psoriasis and psoriasis that resists topical treatments.
- Narrow band UVB therapy. A newer type of psoriasis treatment, narrow band UVB therapy may be more effective than broadband UVB treatment. It’s usually administered two or three times a week until the skin improves, then maintenance may require only weekly sessions. Narrow band UVB therapy may cause burns, however, so talk to your doctor about expected outcomes with this treatment.
- Excimer laser. This form of light therapy (phototherapy,) used for mild to moderate psoriasis, treats only the involved skin. A controlled beam of UVB light of a specific wavelength is directed to the psoriasis plaques to control scaling and inflammation. Healthy skin surrounding the patches isn’t harmed.
And other forms of light therapy are available as well, some for more severe psoriasis outbreaks.
Oral or injected medications
If you have severe psoriasis or if you haven’t experienced lessening of your symptoms from other treatments, your dermatologist may prescribe oral or injected drugs. Because of the possibility of severe side effects, some of these medications are used for only brief periods and may be alternated with other forms of treatment.
- Retinoids. Related to vitamin A, this group of drugs may reduce the production of skin cells if you have severe psoriasis that doesn’t respond to other therapies. Side effects may include lip inflammation and hair loss. And because some retinoids can cause severe birth defects, women must avoid pregnancy for at least three years after taking the medication.
- Methotrexate. Taken orally, methotrexate helps psoriasis by decreasing the production of skin cells and suppressing inflammation. It may also slow the progression of psoriatic arthritis in some people. Methotrexate is generally well-tolerated in low doses but may cause upset stomach, loss of appetite and fatigue, and is not for long-term treatment due to serious side effects and organ damage.
And other medications that can treat extreme psoriasis symptoms, but bring with them the risk of serious side effects and are not for long term use.
Your doctor will often start with the mildest treatments like topical creams and UV light therapy, then progress to stronger treatments, if needed.