Treating psoriasis typically requires several different approaches that may possibly include lifestyle changes, nutrition, and medication. The extent of treatment depends on the severity of the symptoms, a person's age, overall health, and other factors.
As there is no cure for psoriasis, doctors and dermatologists will often try several methods before finding the right one for a patient.
Treatment options for psoriasis depend on the following factors:
- severity of the psoriasis
- how much of the body is affected
- type of psoriasis
- how well skin responds to initial treatments
Many common treatments are meant to treat symptoms of psoriasis, including itching and flaking skin. Regular use of over-the-counter moisturizers after baths and showers can help keep moisture in the skin to prevent flaking, but won't address the underlying inflammation.
Dermatologists also recommend that people with psoriasis use perfume-and-dye-free products, such as soaps, detergents, and moisturizers to keep irritation of the skin to a minimum.
Prescription medications help combat the spread of the disease by addressing inflammation.
Doctors usually prefer to use the lowest level of treatment necessary to stop symptoms—in many cases, this is a topical treatment. That way, as the skin becomes resistant and no longer responds to one treatment, a stronger treatment can be used.
Treatments applied directly to the skin (creams, ointments, lotions, and gels) or topical treatments are usually the first line of treatment for most patients with mild to moderate psoriasis. In some cases, they're used in combination with another type of psoriasis treatment.
Topical treatments include:
- cortisone creams and ointments
- topical retinoids
- vitamin D analogues
- coal tar creams or ointments
- dandruff shampoos
- salicylic and lactic acids
Phototherapy is a procedure in which skin is carefully exposed to natural or artificial ultraviolet (UV) light. Long-term phototherapy is associated with increased incidences of skin cancer, particularly melanoma, the most deadly form of skin cancer. For that reason, it's important you discuss with your dermatologist the use of phototherapy before exposing yourself to high doses of UV light. Never try to self-treat with a tanning bed or sunbathing.
The most natural source of UV light is the sun; it produces UV-A rays. UV light reduces T-cell production and eventually kills any activated T-cells, which slows down the inflammatory response and skin cell turnover. Brief exposures to small amounts of sunlight may improve psoriasis. However, intense sun exposure or long-term sun exposure can worsen symptoms, cause skin damage, and may increase your chances of developing skin cancer.
For mild cases of psoriasis, artificial light treatments with UV-B light may be used. Because UV-B-emitting light boxes are used frequently for this type of treatment, single patches or smaller areas of skin can be treated, instead of exposing the whole body. Side effects include itchy, dry skin and redness in treated areas.
Combining UV-B treatment with coal tar treatment makes the two therapies more effective than either therapy alone. (Coal tar makes skin more receptive to UV-B light.) This therapy is used for mild to moderate cases.
A promising development in the treatment of mild to moderate psoriasis is laser therapy. Lasers can target concentrated beams of UV-B light on psoriatic patches without affecting surrounding skin. However, because the laser cannot cover large areas, it may only be useful in treating small patches.
Photochemotherapy, or Psoralen Plus Ultraviolet A (PUVA)
Psoralen, a light-sensitizing medication, may be combined with UV-A phototherapy as a treatment for psoriasis. Patients take the medicine or apply a cream version to the skin and enter a UV-A light box. This treatment is more aggressive and is often only used in patients with moderate to severe cases of psoriasis.
Pulsed Dye Laser
If other treatments have limited success, your doctor may recommend pulsed dye laser. This process destroys tiny blood vessels in areas around psoriasis plaques, cutting off blood flow and reducing cell development in that area.
For more severe forms of psoriasis or cases that are resistant to other treatments, traditional oral or injectable medicines or drugs may be used.
These medicines include:
- immunomodulator drugs (biologics)
Antibiotics are not prescribed for psoriasis unless the skin has become infected, or symptoms are made worse by bacteria.