Psoriasis Treatment

There is no curative treatment to completely eradicate psoriasis; despite the effectiveness of the medications, you can never be sure that the disease will not return. However, there are effective medical treatments that are able to control the symptoms, reduce or eliminate the lesions and improve your life. In addition, treatments vary depending on the type of psoriasis, location and its severity

There are two types of treatment for psoriasis: 

Topical treatment - creams and ointments are often effective in mild to moderate forms of psoriasis. They are used to relax the tissues, reduce inflammation, and soften the skin. Emollient bath or keratolytics can be used to facilitate exfoliation of excess epidermal cells. The reduction of redness can be done by a group of products called reducers: coal tar, anthralin , calcineurin inhibitors, topical corticosteroids, and Vitamin D analogues. 

• Coal tar - Coal tar is a brown or black over-the-counter medication often used in the treatment of psoriasis. In fact it is considered as the most ancient form of psoriasis treatment. When used regularly, coal tar can reduce inflammation and scaling with no or few side effects.  Some products containing coal tar include Balnetar, Psoriasin and Tegrin 
• Vitamin D analogues - Vitamin D and its analogues are sometimes effective in the treatment of psoriasis. They are used to reduce or control the excessive growth of skin cells. The most common drug used in the US is Calcipotriene (Dovonex or Daivonex). Calcipotriene is available in the form of cream, ointment and scalp solution. Calcipotriene can be sued alone or in combination with other topical medications. Usually, improvement is seen within 2 weeks of regular use. 

• Corticosteroids - corticosteroids are used to reduce inflammation and stop outbreaks in mild to moderate psoriasis. To start the treatment, your dermatologist will likely prescribe to you low-potency corticosteroid ointments. They reduce inflammation and itching by suppressing your immune system. In some patients, however, low-potency corticosteroids cause a form of insensitivity, which requires increasing doses over time.In general, corticosteroids are used for a short period of time and on limited areas of the body. The problem is that in the majority of people, the plaques tend to come from the discontinuation of the treatment.
• Anthralin - this drug is applied on the skin to dry psoriatic plaques and remove the scales. It controls the abnormal growth of skin cells, thus preventing future outbreaks. For most people, anthralin stop the symptoms of psoriasis and prevent their recurrence for a long period of time. However, anthralin usually starts working after several weeks of application. In addition, it tends to stain your skin, clothing and bedding.  
• Calcineurin inhibitors - calcineurin inhibitors (tacrolimus and pimecrolimus) are mainly used to treat atopic dermatitis symptoms. Studies have shown, however, that the drug can also provide relief in the life of people struggling with moderate psoriasis.   

Prolonged use of calcineurin inhibitors can lead to serious health problems including lymphoma and skin cancer.  

• Topical retinoids - Retinoids are commonly used in the treatment of acne. However, tazarotene (Tazorac, Avage), a derivative of vitamin A, works effectively in fighting psoriasis symptoms. Retinoids are used mainly in the treatment of pustular psoriasis. It is available in ointment.  

Before using tazarotene, it is important to talk to your doctor if you are pregnant or may become pregnant; although rare, the drug can cause birth defect. In addition, application of tazarotene should always be associated with sunscreen to prevent sun damage to your skin.  

Phototherapy – if other treatments do not produce any satisfying results, your dermatologist will expose your skin to ultraviolet (UV) radiation to treat the psoriasis; this form of psoriasis therapy is called phototherapy; depending on method used, phototherapy may include: 

• Sunlight - daily sun exposure in moderation can have a curative effect on mild to moderate form of psoriasis. However, direct and prolonged exposure to sun rays can be harmful. You must follow this treatment after the advice of a medical specialist. In addition, you must monitor closely how your body reacts to sun exposure. 

·         UVB phototherapy (ultraviolet therapy) – this is a form of psoriasis treatment using artificial ultraviolet light. UVB phototherapy is realized with tubes providing specific wavelength specific (311-313nm). The therapy is usually performed three times a week for a few minutes per session.  

UVB phototherapy can be effective in combating the symptoms of psoriasis. However, it must be done under strict medical supervision to avoid health problems such as skin cancer. In addition, it is necessary to use a natural moisturizer during the therapy to prevent skin problems including but not limited to redness, itching and dryness. 

• Photochemotherapy or PUVA therapy - this method consists of exposing the infected area of your skin to ultra-violet A, after taking a light-sensitizing medication called psoralen (or psoralene). Exposure to ultraviolet A alone does not always give good results. Therefore, 1½ to 2 hours before the therapy, you will be recommended to take psoralen tablets to allow skin sensitization. Typically, 3 sessions per week for about 5-15 minutes are sufficient.  

However, PUVA therapy is less used due to its multiple side effects: nausea, headache, burning and itching, and wrinkled skin. In addition, the therapy may increase your risk of getting melanoma, a serious form of skin cancer. Talk to your doctor and think twice before doing this therapy. 

Systematic treatment - For the most severe forms of psoriasis, your doctor can prescribe systemic treatments in which the medications are spread throughout your body. These drugs can be taken orally or by injection:  

Methotrexate - is an antagonist of folic acid. It used in the treatment of a variety of diseases associated with abnormally rapid cell growth including psoriasis. Methotrexate is primarily used in psoriatic arthritis to suppress inflammation. Side effects may include:  

• weakened immune system 
• mouth sores 
• stomach upset
• headache and dizziness 
• skin rash and itching 
• although rare, methotrexate can cause toxicity of the liver, kidneys and lungs.

• Retinoids – retinoids are vitamin A derivatives; they are recommended in moderate to severe psoriasis, or when the other alternatives fail to produce a satisfying result. Those drugs are, however, teratogenic; they can impact the growth and development of embryo or fetus not only during the treatment but also two years after the last dose. Women of reproductive age should not take retinoids if you consider becoming pregnant.  
• Cyclosporin : this drug is an immunosuppressant commonly is used in psoriasis. The drug can be effective, but always accompanied by side effects due to the immune system weakness effect. If you are taking cyclosporine, it is important to avoid all pathogenic factors because your risk of infection and other serious health problems is higher.
• Other medications that your dermatologist may prescribe you include: Hydroxyurea, alefacept (Amevive), etanercept (Enbrel) and infliximab (Remicade). 

It is important during the treatment to avoid alcohol and tobacco; adopt a healthy diet containing omega-3 fatty acids. In addition, regular exercise and good night sleep (at least eight hours) are vital.  

     Psoriasis Diagnosis