Psoriasis - Treatment

Treatment

Many creams, ointments, lotions, and pills are available to treat psoriasis. Some patients require only over-the-counter treatment, or even no treatment.

Many patients with psoriasis, however, do not respond to over-the-counter remedies and lifestyle changes, and require aggressive treatments. In some cases, such treatments need to be lifelong.

In general, there are three treatment options for patients with psoriasis:

• Topical medications such as lotions, ointments, creams, and shampoos
• Body-wide (systemic) medications, which are pills or injections that affect the whole body, not just the skin
• Phototherapy, which uses light to treat psoriasis lesions

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Individual needs vary widely, and treatment selection must be carefully discussed with the doctor.

Treatment Sequences

Giving treatment in a stepwise order can help provide quick symptom relief and long-term maintenance. It involves three main steps:

• The quick fix, to clear the psoriatic lesions during an acute outbreak (for example, a high-strength topical steroid in mild-to-moderate psoriasis, or an oral immunosuppressant in more severe cases)
• The transitional phase, intended to gradually introduce the maintenance drug
• Ongoing maintenance therapy

Choices for transitional or maintenance treatments depend on the severity of the condition.

In severe chronic cases, the doctor may recommend rotational therapy. This approach alternates treatments. The goal is to prevent severe side effects or the build-up of resistance from long-term use of a single medicine. An example of a rotational schedule may be the following:

• The patient gets phototherapy for about 2 years.
• The patient then takes one or two powerful body-wide drugs for 1 - 2 years and stops.
• Phototherapy starts again, and the cycle repeats.

Doctors increasingly use combinations of pills, creams, ointments, and phototherapy instead of single medications. Combinations of oral treatments are particularly useful, because the doses of each drug can be reduced. This lowers the risk of severe side effects. Thousands of combinations are possible, and patients should discuss with their doctors the best treatment for their individual needs.

Review Date: 10/21/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).