Psoriasis treatment overview.

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Psoriasis treatment overview.

Postby Nick Balgowan » Thu Dec 21, 2006 12:42 pm

Psoriasis Treatments


The goal of psoriasis treatment is to manage the signs and symptoms and improve the quality of life. Initial treatment focuses on clearing away lesions during outbreaks of the disease, followed by lower-dose maintenance medications that prevent lesions from returning. Different treatments are often most effective when used in combination and may include creams and other topical (external) medications, light therapy, and more powerful systemic (internal) medications.

Topical Treatments

Topical treatments are medications that are applied directly to the affected skin and that can effectively control many mild cases. These are all available by prescription.

Psoriasis Topical Treatments


Corticosteroids (known by the generic name cortisone) have long been used to treat psoriasis by clearing the skin for a limited time. Cortisone is available in creams, ointments, lotions, shampoos, oils, and foams convenient for scalp treatment or other special applications. A dermatologist also may provide low-dose cortisone injections. Depending on which part of the body is being treated, different strengths can be applied; weaker formulas are used for the face and other sensitive areas. Long-term use of corticosteroids can cause severe side effects; stopping treatment also can cause severe side effects.

Psoriasis Topical Treatments

Side Effects of Corticosteroids

Side effects of corticosteroids are extremely rare but may include high blood pressure, infections, cataracts, glaucoma, diabetes, psychosis, and osteoporosis. Avoid combining corticosteroids with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin because it can increase the chance of NSAID side effects. Additional side effects that may cause concern include weight gain, fluid retention, irregular menstruation, acne, excess hair, bruising easily, irritability, and insomnia.

Corticosteroids replace hormones that usually are produced by your adrenal glands. Once acclimated to artificial steroids for an extended period of time, the adrenal glands will not immediately resume hormone production if you stop corticosteroid use. This withdrawal is risky and steroids should only be discontinued under a doctor’s supervision.


Calcipotriene, a synthetic form of vitamin D3, can be used in small amounts for psoriasis lesions that are confined to less than 20% of the body’s surface. The prescription ointment known as calcipotriene (Dovonex®) is different from regular vitamin D that is available over the counter. Other compounds related to vitamin D, including calcitrol, are currently being investigated as alternative treatments.


Retinoids such as tazarotene (Tazorac®) and other gels and creams that include vitamin A-like compounds are slower-acting but have fewer side effects than corticosteroids. Women who may become pregnant should not use retinoids, neither externally (topical) nor internally (oral).


Anthralin can be effective on skin lesions that resist other treatments, but it does not always remove the lesion completely. Side effects include a discoloring or staining of the skin.

Coal Tar

Coal tar is a traditional treatment for psoriasis that has been used for the past century. It has fewer side effects than corticosteroids, and treatments are long lasting. Coal tar is available in different strengths for direct application as a shampoo or as a bath solution. It has a strong odor and stains the skin.

Although coal tar contains carcinogens, the FDA currently maintains that the level of exposure from medications containing coal tar is not significant enough to increase the risk of cancer over time. If you are concerned about prolonged coal tar use, talk to your doctor.

Topical Immunomodulators (TIMs)

Topical immunomodulators (TIMs) such as tacrolimus ointment and pimecrolimus cream may be especially useful for sensitive areas such as the eyelids and face. It was originally developed to treat another skin condition (atopic dermatitis) and appears to have fewer of the serious side effects associated with corticosteroids.

Psoriasis Treatments

Light Therapy

For psoriasis, light therapy may be combined with other forms of topical treatment. Regular, brief exposure to ultraviolet light in a special chamber or to natural sunlight kills inflammation-causing cells in the skin. This can counter the overly rapid skin growth caused by psoriasis and can reduce symptoms. Light therapy also is known as phototherapy or UVB.

When psoriasis symptoms do not respond to other treatments, a more potent form of light therapy known as PUVA may be applied. The American Academy of Dermatology reports that PUVA has been effective in 85%-90% of cases in which other treatments have failed. However, ultraviolet light and especially PUVA must be used conservatively because they age the skin and elevate skin cancer risk.

Narrow Band UVB, as found in the Dermalight80 device, offers similar benefits and results as PUVA without the drugs, side effects and skin damage found with UVA therapy.
Nick Balgowan.
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Nick Balgowan
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