Treatments for Psoriasis: What Works and the Best Treatment

Emily is a young woman who has recently started noticing rashes on her legs. She was not worried at first but now these rashes have started to appear in other body parts as well. She visits her dermatologist who diagnoses her with psoriasis.

Emily researches treatments for psoriasis and finds out a lot about different kinds of treatments. She discusses the different treatments with her dermatologist and tries the best-suited one for her. The substantial information about treatments for psoriasis that Emily finds are as follows:

What is Psoriasis?

Psoriasis is a chronic skin disorder that causes thick pink or red skin patches covered with white or silvery scales. These patches mostly appear on elbows, scalp, knees, and lower back, but they can show up anywhere on the body. Sometimes, the patches may be itchy.

Psoriasis varies in severity from person to person. Since it is a chronic disease there are periods when there are no symptoms or mild symptoms, followed by periods of severe symptoms.

 Something wrong in the immune system can cause inflammation which triggers new skin cells to form rapidly. Normally, it takes 10 to 30 days to replace skin cells. But, psoriasis causes new skin cells to grow every 3 to 4 days. Silver scales are created by the buildup of old cells replacing new ones.

Treatment for psoriasis

Psoriasis treatment is determined by the kind of psoriasis and its severity. It begins with a mild treatment, like topical skin cream, and then if necessary stronger treatments are used.

Treatment for psoriasis falls under 3 categories:

• Topical treatment
• Phototherapy 
• Systemic treatment.

Different types of treatments are used in combination for effective treatment.

• Topical treatments

Tropical treatments are commonly used as the first treatment for mild to moderate psoriasis. Topical treatments are creams and ointments that can be applied to the area that is affected. In the case of scalp psoriasis, a shampoo and ointment combination may be recommended. For some people, topical treatments are all that is needed to control the condition. It takes up to 6 weeks to see a noticeable effect with this treatment.

Emollients – moisturizing treatments that are applied to the skin to reduce water loss from the skin. Emollients form a protective film on top of the skin. Emollients help in reducing itching and scaling. Topical treatments should be applied 30 minutes after an emollient. Emollients can be bought over the counter or by prescription.

Steroid creams or ointments (topical corticosteroids)- used for treating mild to moderate psoriasis all over the body. This treatment reduces inflammation, reduces itching, and slows down the production of skin cells. Stronger topical corticosteroids are only prescribed by doctors and should be used in small areas of skin or on particularly thick patches only. Overusing topical corticosteroids can cause thinning of the skin.

Vitamin D analogues- vitamin D analogue creams are used in combination with steroid creams for mild to moderate psoriasis. They slow down the production of skin cells and have an anti-inflammatory effect. They are used in affected areas of limbs, trunk and scalp. Calcipotriol, calcitriol and tacalcitol are examples of vitamin D analogues.

Calcineurin inhibitors – creams or ointments that reduce the activity of the immune system and help in inflammation reduction. If steroid creams are not effective, calcineurin inhibitors are sometimes used for psoriasis in sensitive areas, like the scalp, genitals and folds in the skin. In the first week, this medication causes skin irritation, burning and itching sensations but that is resolved quickly.

Coal tar- the oldest treatment for psoriasis. Coal tar is a thick, heavy oil that reduces scales, itchiness and inflammation. Used in affected areas of limbs, trunk or scalp. Coal tar has a strong smell and can stain clothes and bedding. It can be used with phototherapy.

Dithranol- is effective in suppressing the production of skin cells. It has been used for more than five decades for treating psoriasis. Dithranol is typically used as a short-term treatment, under hospital supervision. This is because it stains everything it comes in contact with.

It is applied with the help of gloves and washed off after 10 to 60 minutes. Highly concentrated dithranol can cause burns. This treatment can also be used with phototherapy.

• Phototherapy

Phototherapy is the use of natural and artificial light to treat psoriasis. Artificial light therapy is given under the care of a dermatologist in either a hospital or some specialist centres.

Ultraviolet B(UVB) phototherapy – is phototherapy using a wavelength of light that is invisible to human eyes. This light slows down the production of skin cells.

Psoralen plus ultraviolet A (PUVA)- is a phototherapy treatment used for severe psoriasis, where a compound called psoralens is either given in tablet form or applied to the skin. This compound makes the skin more sensitive to light. The skin is then exposed to ultraviolet A (UVA) light. This treatment may cause side effects like nausea, headaches, itchiness and burning.

Combination light therapy – is the combining of phototherapy with other treatments. One example of this is the Ingram treatment where UVB phototherapy and dithranol cream are combined and used together.

• Systemic treatment

Systemic treatment- helps severe cases of psoriasis. Though they are effective in treating psoriasis, systemic treatments have serious side effects. They are divided into non-biological and biological treatments

Biological treatments- work by blocking the part of the body’s immune system that is overactive in psoriasis. These include ixekizumab (Taltz),adalimumab (Humira), brodalumab (Siliq), certolizumab pegol (Cimzia) etanercept (Enbrel),,tildrakizumab (Ilumya), infliximab (Remicade),), risankizumab-rzaa (SKYRIZI), secukinumab (Cosentyx),guselkumab (Tremfya), and ustekinumab (Stelara).

Non -biological medications- Methotrexate is a drug that helps in slowing the production of skin cells and suppressing inflammation. It is used for severe cases of psoriasis only because of its serious side effects. 

Cyclosporine is another drug that helps psoriasis by suppressing the immune system of the patient. Apremilast (Otezla) is a newer kind of drug that blocks a specific enzyme, helping in slowing other reactions that lead to inflammation.

Conclusion

Psoriasis affects millions of people worldwide. The degree of their severity varies among individuals. It is very easy for doctors to diagnose psoriasis and luckily there are many treatments available. 

The treatments given to you are planned by doctors based on the size of the rash, your age, body area and overall health. Though there is no permanent cure, treatments help in curbing the symptoms immensely.