What is the treatment for psoriasis?
Psoriasis continues to be one of the more difficult skin conditions to treat. The wide range of treatments available for psoriasis illustrates this; no one treatment will work for everyone. There is no cure for psoriasis but several new medications have recently been introduced and ongoing research looks promising. In general the treatment is chosen on the basis of the pattern of psoriasis and its severity. Sometimes several treatments may need to be tried before the most suitable regime is
established. Different medications may need to be used together or in rotation for best effect or to minimise side effects.
Doctors generally treat psoriasis in steps based on the severity of the disease, size of the areas involved, type of psoriasis, and the patient's response to initial treatments. This is sometimes called the "1-2-3" approach. In step 1, medicines are applied to the skin (topical treatment). Step 2 uses ultraviolet light treatments (phototherapy). Step 3 involves taking medicines by mouth or injection that treat the whole immune system (called systemic therapy).
Over time, affected skin can become resistant to treatment, especially when topical corticosteroids are used. Also, a treatment that works very well in one person may have little effect in another. Thus, doctors often use a trial-and-error approach to find a treatment that works, and they may switch treatments periodically (for example, every 12 to 24 months) if a treatment does not work or if adverse reactions occur. In general, the following three treatment options are used for psoriasis from least to greatest potency:
Topical medications - Options include lotions, ointments, creams, and shampoos. These may be useful for mild-to-moderate psoriasis. Topical medicines rarely produce complete clearance, however.
Phototherapy - Options include light-wave radiation treatments using ultraviolet B (UVB) or psoralen with ultraviolet A (PUVA). This therapy is effective for moderate-to-severe psoriasis. In a 1999 study, phototherapies were much more effective than systemic drugs in achieving the longest remission. It also appears to have fewer side effects than most systemic agents. Even more promising, in a 2000 analysis comparing a number of psoriasis treatments, an advanced phototherapy called narrow band UVB achieved the highest complete clearance rate (86% of patients). (New lasers using UVB may even be more effective for certain patients.)
Systemic agents - This treatment employs various oral drugs that affect the whole body system, not just the skin. These agents have significant side effects and are generally reserved for severe psoriasis.
These treatments can be combined in various ways to try to get the best outcome. Finding the most effective treatment for an affected individual can involve a lot of trial and error. What works for one person may not work for someone else. People with severe and extensive psoriasis may get the most relief and avoid or reduce side effects when treatments are rotated.
Treatments for psoriasis can often control the disease for long periods. However, none of the available treatments is a cure. The disease can come back when treatment stops.
Biologic agents are being introduced for the treatment of psoriasis and have substantial advantages over previously used systemic therapies because they have fewer risks and side effects. Two of the therapies currently being used, etanercept and remicade, are already available for the treatment of rheumatoid arthritis and Crohn’s disease. Both therapies are tumor necrosis factor (TNF) blockers, which work by interfering with specific immune responses that are responsible for psoriasis.