Treatment of Psoriasis

How is psoriasis treated? — There are treatments that can relieve the symptoms of psoriasis. But the condition cannot be cured.

Treatments for psoriasis come in creams and ointments, pills, or shots. There is also a form of light therapy that can help with psoriasis. All treatments for psoriasis work by slowing the growth of skin, controlling the immune response that causes psoriasis, or both. Most people need to try different treatments or combinations of treatments before they figure out what works best. The medicines that are used most often are called steroids. These medicines are applied to the skin.

Numerous topical and systemic therapies are available for the treatment of psoriasis. Treatment modalities are chosen on the basis of disease severity, relevant comorbidities, patient preference (including cost and convenience), efficacy, and evaluation of individual patient response.

Mild-to-moderate disease — Limited plaque psoriasis responds well to topical corticosteroids and emollients. Alternatives include tar, topical retinoids (tazarotene), and vitamin D analogs including calcipotriene and calcitriol. For facial or intertriginous areas, topical tacrolimus or pimecrolimus may be used as alternatives or as corticosteroid sparing agents, though improvement may not be as rapid. Localized phototherapy is another option for recalcitrant disease.

Combinations of potent topical corticosteroids (table 1) and either calcipotriene, calcitriol, tazarotene, or UVB phototherapy are commonly prescribed by dermatologists. Calcipotriene in combination with Class I topical corticosteroids is highly effective for short-term control. Calcipotriene alone can then be used continuously and the combination with potent corticosteroids used intermittently (on weekends) for maintenance. A combination product containing calcipotriene and betamethasone dipropionate is available for this use. With proper adherence, considerable improvement with topical therapies may be seen in as little as one week, though several weeks may be required to demonstrate full benefits.

Severe disease — Severe psoriasis requires phototherapy or systemic therapies such as retinoids, methotrexate, cyclosporine, or biologic immune modifying agents. Biologic agents used in the treatment of psoriasis include the anti-TNF agents adalimumab, etanercept, and infliximab and the anti-IL-12/23 antibody ustekinumab. Improvement usually occurs within weeks. Patients with severe psoriasis generally require care by a dermatologist.

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