Diagnosis of psoriasis is fairly forthright in most cases. Your doctor can diagnose psoriasis by taking your medical history and examining your skin, scalp and nails. Your doctor may take a small sample of skin (biopsy), in severe cases.
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Psoriasis treatments reduce inflammation and clear the skin. Treatments can be divided into three main types: topical treatments, light therapy and systemic medications.
Topical therapy use creams and ointments that you apply to your skin to treat mild to moderate psoriasis. When the disease is more severe, creams are likely to be combined with oral medications or light treatment. Topical psoriasis treatments include:
- Topical corticosteroids.These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They reduce inflammation and relieve itching and may be used with other treatments.
- Vitamin D analogues.These synthetic forms of vitamin D slow skin cell growth. Calcipotriene (Dovonex) is a prescription cream or solution containing a vitamin D analogue that treats mild to moderate psoriasis along with other treatments. Calcipotriene might irritate your skin. Calcitriol (Vectical) is expensive but may be equally effective and possibly less irritating than calcipotriene.
- This medication helps slow skin cell growth. Anthralin (Dritho-Scalp) can also remove scales and make skin smoother. But anthralin can irritate skin, and it stains almost anything it touches. It’s usually applied for a short time and then washed off.
- Topical retinoids.These are vitamin A derivatives that may decrease inflammation. The most common side effect is skin irritation. These medications may also increase sensitivity to sunlight, so while using the medication apply sunscreen before going outdoors.
The risk of birth defects is far lower for topical retinoids than for oral retinoids. But tazarotene (Tazorac, Avage) isn’t recommended when you’re pregnant or breast-feeding or if you intend to become pregnant.
- Calcineurin inhibitors.Calcineurin inhibitors — tacrolimus (Prograf) and pimecrolimus (Elidel) — reduce inflammation and plaque buildup. Calcineurin inhibitors are not recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma. They may be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.
- Salicylic acid.Salicylic acid is available OTC and by prescription. It promotes sloughing of dead skin cells and reduces scaling. Sometimes it’s combined with other medications, such as topical corticosteroids or coal tar, to increase its effectiveness.
- Coal tar.Coal tar reduces scaling, itching and inflammation. Coal tar is derived from coal and can irritate the skin. It’s also messy, stains clothing and bedding, and has a repugnant odor. Coal tar is available in over-the-counter shampoos, creams and oils. It’s also available in higher concentrations by prescription.
- Moisturizing creams alone won’t heal psoriasis, but they can reduce itching, scaling and dryness. Moisturizers in an ointment base are usually more effective than are lighter creams and lotions. Apply immediately after a bath or shower to lock in moisture.
Light therapy (phototherapy)
This treatment uses natural or artificial ultraviolet light. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with medications.
- Exposure to ultraviolet (UV) rays in sunlight or artificial light slows skin cell turnover and reduces scaling and inflammation. Brief, daily exposures to small amounts of sunlight may improve psoriasis, but intense sun exposure can worsen symptoms and cause skin damage. Before beginning a sunlight regimen, ask your doctor about the safest way to use natural sunlight for psoriasis treatment.
- 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. Short-term side effects may include redness, itching and dry skin. Using a moisturizer may help decrease these side effects.
- Narrow band UVB phototherapy.A newer type of psoriasis treatment, narrow band UVB phototherapy may be more effective than broadband UVB treatment. It’s usually administered two or three times a week until the skin improves, and then maintenance may require only weekly sessions. Narrow band UVB phototherapy may cause more-severe and longer lasting burns, however.
- Goeckerman therapy.Some doctors combine UVB treatment and coal tar treatment, which is known as Goeckerman treatment. The two therapies together are more effective than either alone because coal tar makes skin more receptive to UVB light.
- Psoralen plus ultraviolet A (PUVA).This form of photochemotherapy involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.
This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. Short-term side effects include nausea, headache, burning and itching. Long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma.
- Excimer laser.This is used for mild to moderate psoriasis, treats only the involved skin without hurting healthy skin. A controlled beam of UVB light is directed to the psoriasis plaques to control scaling and tenderness..
Oral or injected medications
If you have severe psoriasis or it’s resistant to other types of treatment, your doctor may prescribe oral or injected drugs. This is known as systemic treatment. Because of severe side effects, some of these medications are used for only brief periods and may be alternated with other forms of treatment.
- This group of drugs related to Vit A, may help if you have severe psoriasis that doesn’t respond to other therapies. Side effects may include lip inflammation and hair loss. Women must avoid pregnancy for at least three years after taking the medication because it can lead to severe birth defects.
- Taken orally, methotrexate (Rheumatrex) helps psoriasis by decreasing the production of skin cells and suppressing inflammation. Cyclosporine. Cyclosporine (Gengraf, Neoral) suppresses the immune system and is similar to methotrexate in effectiveness, but can only be taken short-term. Like other immunosuppressant drugs, cyclosporine increases your risk of infection and other health problems, including cancer. Cyclosporine also makes you more susceptible to kidney problems and high blood pressure — the risk increases with higher dosages and long-term therapy.
- Drugs that alter the immune system (biologics).Several of these drugs are approved for the treatment of moderate to severe psoriasis. They include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), ustekinumab (Stelara), golimumab (Simponi), apremilast (Otezla), secukinumab (Cosentyx) and ixekizumab (Taltz). Most of these drugs are given by injection (apremilast is oral) and are usually used for people who have failed to respond to traditional therapy or who have associated psoriatic arthritis. Biologics must be used with caution because they have strong effects on the immune system and may permit life-threatening infections. In particular, people taking these treatments must be screened for tuberculosis.
- Other medications.Thioguanine (Tabloid) and hydroxyurea (Droxia, Hydrea) are medications that can be used when other drugs can’t be given.
A number of alternative therapies claim to ease the symptoms of psoriasis, including special diets, creams, dietary supplements and herbs. None have definitively been proved effective. But some alternative therapies are believed generally safe, and they may be helpful to some people in reducing signs and symptoms, such as itching and scaling.
- Fish oil.Omega-3 fatty acids in fish oil supplements may reduce inflammation associated with psoriasis. Taking 3 grams or less of fish oil daily is generally recognized as safe.
- Aloe vera.Aloe vera extract cream may reduce scaling, redness, itching and inflammation. You may need to use the cream severally for a month to see any improvements in your skin.
- Oregon grape.Also known as barberry, topical applications of Oregon grape may reduce inflammation and ease psoriasis symptoms.