With mild psoriasis, such as patches on the scalp, knees, elbows, hands and feet, topical treatments are sufficient to manage. Moderate to severe disease usually involves a combination of treatments: topical, phototherapy, and systemic medications.
Topical treatments - medications applied to the skin - are the first line of defense in treating psoriasis. They slow down, or normalize, excessive skin cell reproduction and reduce inflammation. Some are available over the counter (OTC); others require a prescription.
There are two active ingredients in OTC preparations which are approved by the FDA for the treatment of psoriasis: salicylic acid and coal tar. Salicyclic acid is a peeling agent, causing the outer layers of skin to shed. It softens and removes psoriasis scales. It can cause irritation if left in contact with the skin for too long. It can cause temporary hair loss. Tar, derived from coal, can slow the rapid growth of skin cells and restore the skins appearance. It can also reduce inflammation and itching. Be aware of the potential health risks when using any substance.
There are other products that contain substances such as aloe vera, jojoba, zinc pyrithione, and capsaicin, which are used to moisturize, soothe, remove scale or relieve itching. The effectiveness of these agents is not known. They can cause side effects or allergic reactions. If irritation occurs, discontinue use.
Keeping the skin lubricated is important to reduce redness and itching. Use fragrance-free products. Apply moisturizers after showering and washing hands. Use moisturizing soaps. Limit lukewarm showers to 10 minutes or less. Baths with oil, oatmeal, Epsom salts or Dead Sea salts can remove scales and relieve itching.
Several ingredients have been approved by the FDA for treating itch. Some are calamine, hydrocortisone, camphor, diphenhydramine, benzocaine and menthol. They can cause irritation and dryness.Use discretion when using potentially harmful chemicalsand substances on your skin.
Prescription, nonsteroidal topical treatments include Taclonex, Tazorec, Vectical, and Zithranol-RR. Topical steroids can be used for mild psoriasis.
Phototherapy involves exposing the skin to ultraviolet light on a regular basis, under medical supervision. Treatments are done in a doctors office, psoriasis clinic, or at home with a phototherapy unit. The key to success is consistency. The National Psoriasis Foundation does not support the use of indoor tanning beds as a substitute for medically-supervised phototherapy. The American Academy of Dermatology, the FDA, and the Centers for Disease Control and Prevention (CDC) all discourage the use of tanning beds and sun lamps.
Ultraviolet light B (UVB)/Ultraviolet light A (UVA) treatments penetrate the skin and slow the growth of affected skin cells. The psoriasis may worsen temporarily before improving. Occasionally, temporary flares occur with UV light therapy. It can be combined with topical or systemic treatments, dramatically increasing effectiveness of the systemic agents, which can allow lowering doses of the systemic medications. UVA is used with the light-sensitizing medication psoralen.
The eximer laser, recently approved by the FDA for treating chronic, localized psoriasis, emits a high-intensity beam of UVB. The pulsed dye laser is approved for the same. It destroys the tiny blood vessels that contribute to the formation of psoriatic plaques.
Systemic medications are taken by mouth in liquid or pill form, or given by injection. They include:
Soriatane is a synthetic form of vitamin A. The exact way it works is unknown.
Cyclosporine suppresses the immune system. It was first used to help prevent rejection in organ transplant patients. The FDA has approved it for adults with severe psoriasis but otherwise normal immune systems.
Methotrexate was initially used to treat cancer. It inhibits an enzyme involved in the rapid growth of skin cells. Its use must be monitored very closely; it carries many warnings of adverse effects and side effects.
Biologic drugs, also called biologics, are used for moderate to severe psoriasis. They are given by injection or intravenous (IV) infusion, targeting specific parts of the immune system. Biologics work by blocking the action of a specific type of immune cell, called T cells, or by blocking proteins in the immune system that trigger the body to create inflammation. Some of the biologics are: Enbrel, Humira, Remicade, Simponi and Stelara. There are significant risks and side effects.
Alternative therapies include:
Aromatherapyis the use of pleasant smells to help with relaxation and lift moods. Chamomile, tea tree, rose, and lavender are the most-used oils for aromatherapy.
Meditationis believed to result in greater physical relaxation and mental calmness.
Spa Therapyis the use of mineral waters. It is believed to help the skin trap hydration and to soften the skin, breaking down the plaques that characterize psoriasis.
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