Treatments for Psoriasis

Treatment list for Psoriasis:

The list of treatments mentioned in various sources for Psoriasis includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

• Topical skin care
  • Topical corticosteroids (Diprolene®,* Temovate®, Ultravate®, or Psorcon®)
  • Vitamin D3
  • Calcipotriene (Dovonex®)
  • Coal tar
  • Vitamin A (retinoids)
  • Tazarotene (Tazorac)
  • Anthralin
  • Salicylic acid
  • Bath solutions
  • Moisturizers
• Phototherapy
  • Sunlight - in mild doses, but taking care to avoid sunburn.
  • UVB phototherapy
  • Ingram regime - combined coal tar and UVB therapy, and anthralin-salicylic acid paste
  • Goeckerman treatment - combined coal tar and UVB therapy
  • PUVA - Psoralen and UVA light combination
• Medications
  • Methotrexate
  • Cyclosporine (Neoral®)
  • Hydroxyurea (Hydrea®)
  • Retinoids
  • Acitretin (Soriatane®)
  • Enbrel (Amgen)
  • Antibiotics - for Streptococcus infections associated with guttate psoriasis.
• Hospitalization - for severe cases

Treatments of Psoriasis: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Psoriasis.

Psoriasis: Treatment
(Professional Guide to Diseases (Eighth Edition))

Treatment depends on the type of psoriasis, the extent of the disease and the patient’s response to it, and what effect the disease has on the patient’s lifestyle. No permanent cure exists, and all methods of treatment are merely palliative. Ideally, all patients should see a dermatologist at least once.

Removal of psoriatic scales necessitates application of occlusive ointment bases, such as petroleum jelly, salicylic acid preparations, or preparations containing urea. Baker P & S liquid (phenol, sodium chloride, and liquid paraffin), applied to the scalp at bedtime, or liquid carbonis detergens in Nivea oil applied for 6 to 8 hours, is also effective. Shampoo or tar-based preparations are also used. These medications soften the scales, which can then be removed by scrubbing them carefully with a soft brush while bathing. Some preparations, such as tar-based preparations, can be used in whirlpools for extensively involved areas.

Methods to retard rapid cell production include exposure to ultraviolet light (UVB or natural sunlight) to the point of minimal erythema. Tar preparations or crude coal tar itself may be applied to affected areas about 15 minutes before exposure or may be left on overnight and wiped off the next morning. A thin layer of petroleum jelly may be applied before UVB exposure (the most common treatment for generalized psoriasis). Exposure time can increase gradually. Outpatient or day treatment with UVB prevents long hospitalizations and prolongs remission.

Steroid creams and ointments are useful to control psoriasis. A potent fluorinated steroid works well, except on the face and intertriginous areas. These creams require application twice daily, preferably after bathing to facilitate absorption, and overnight use of occlusive dressings, such as plastic wrap, plastic gloves or booties, or a vinyl exercise suit (under direct medical or nursing supervision). Small, stubborn plaques may require intralesional steroid injections. Anthralin, combined with a paste mixture, may be used for well-defined plaques but must not be applied to unaffected areas because it causes injury and stains normal skin. Apply petroleum jelly around the affected skin before applying anthralin. Commonly used concurrently with steroids, anthralin is applied at night and steroids during the day.

In a patient with severe chronic psoriasis, the Goeckerman regimen — which combines tar baths and UVB treatments — may help achieve the longest remission and clear the skin in 3 to 5 weeks. The Ingram technique is a variation of this treatment, using anthralin instead of tar. A therapy called PUVA combines administration of psoralens with exposure to high-intensity UVA. As a last resort, a cytotoxin, usually methotrexate or cyclosporine, an immunosuppressant, may help severe, refractory psoriasis.

Etretinate, a retinoid compound, is effective in treating extensive cases of psoriasis. However, because this drug is a strong teratogen, it’s unsafe for use in women of childbearing age. It also has numerous adverse effects that many patients find intolerable. Tacarotene, a newer topical retinoid, combined with a medium-strength topical corticosteroid is also effective.

Low-dose antihistamines, oatmeal baths, emollients, and open wet dressings may help relieve pruritus. Aspirin and local heat help alleviate the pain of psoriatic arthritis; severe cases may require nonsteroidal anti-inflammatory drugs.

Therapy for psoriasis of the scalp consists of a tar shampoo followed by application of a steroid lotion; ketoconazole and anthralin may also be effective. No effective treatment exists for psoriasis of the nails.

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Psoriasis: Treatment
(Handbook of Diseases)

Appropriate treatment depends on the type of psoriasis, the extent of the disease and the patient’s response to it, and the effect the disease has on the patient’s lifestyle. No permanent cure exists, and all methods of treatment are palliative.

UVB exposure

Methods to retard rapid cell production include exposure to ultraviolet (UV) light (UVB or natural sunlight) to the point of minimal erythema. Tar preparations or crude coal tar itself may be applied to affected areas about 15 minutes before exposure or may be left on overnight and wiped off the next morning.

A thin layer of petroleum jelly may be applied before UVB exposure (the most common treatment for generalized psoriasis). Exposure time can increase gradually. Outpatient or day treatment with UVB prevents long hospitalizations and prolongs remission.

Drug therapy

Steroid creams and ointments are useful to control psoriasis. A potent fluorinated steroid works well, except on the face and intertriginous areas. These creams require application two times a day, preferably after bathing to facilitate absorption, and the overnight use of occlusive dressings, such as plastic wrap, plastic gloves or booties, or a vinyl exercise suit (under direct medical or nursing supervision).

Small, stubborn plaques may require intralesional steroid injections. Anthralin ointment or paste mixture may be used for well-defined plaques but must not be applied to unaffected areas because it causes injury and stains normal skin. Apply petroleum jelly around the affected skin before applying anthralin. Typically used with steroids, anthralin is applied at night and steroids during the day. A new topical agent is calcipotriene ointment, a vitamin D₃ analogue.

CLINICAL TIP: Calcipotriene treatment also works best when alternated with a topical steroid, as noted above with anthralin.

Other treatments

Low-dose antihistamines, oatmeal baths, emollients, and open wet dressings may help relieve pruritus. Aspirin and local heat help alleviate the pain of psoriatic arthritis; severe cases may require nonsteroidal anti-inflammatory drugs.

Therapy for psoriasis of the scalp consists of a tar shampoo followed by application of a steroid lotion. No effective topical treatment exists for psoriasis of the nails.

READ BOOK EXCERPT ONLINE »

Medications used to treat Psoriasis:

Note:You must always seek professional medical advice about any treatment or change in treatment plans.

Some of the different medications used in the treatment of Psoriasis include:

• Dexamethasone
• Fluticasone
• Advair
• Advair Diskus
• Cutivate
• Methotrexate
• Abitrexate
• Folex
• Folex PFS
• Mexate
• Mexate AQ
• Rheumatrex Dose Pack
• Trexall
• Prednisone
• Apo-Prednisone
• Aspred-C
• Deltasone
• Liquid Pred
• Meticorten
• Metreton
• Novoprednisone
• Orasone
• Panasol-S
• Paracort
• Prednicen-M
• Prednisone Intensol
• SK-Prednisone
• Sterapred
• Sterapred-DS
• Winpred
• Acitretin
• Soriatane
• Alefacept
• Amevive
• Anthralin
• Drithocreme
• Dritho-Scalp
• Psoriatec
• Anthraforte
• Anthranol
• Anthrascalp
• Micanol
• Betamethasone (systemic)
• Celestone
• Celstone Soluspan
• Betaject
• Betnesol
• Soluspan
• Betamethasone (topical)
• Beta-Val
• Diprolene
• Diprolene AF
• Luxiq
• Maxivate
• Betaderm
• Betnovate
• Celestoderm-EV/2
• Celestoderm-V
• Glycol
• Diprosone
• Ectosone
• Prevex B
• Taro-Sone
• Topilene
• Topisone
• Valisone Scalp Lotion
• Clobetasol
• Clobevate
• Clobex
• Cormax
• Embeline
• Embeline E
• Dermovate
• Gen-Clobetasol
• Novo-Clobetasol
• Clocortolone
• Cloderm
• Cutar
• DHS Tar
• DHS Targel
• Doak Tar
• Estar
• Exorex
• Ionil T
• Ionil T Plus
• MG 217
• MG 217 Medicated Tar
• Neutrogena T/Gel
• Neutrogena T/Gel Extra Strength
• Oxipor VHC
• Pentrax
• Polytar
• PsoriGel
• Reme-t
• Tegrin
• Zetar
• SpectroTar Skin Wash
• Targel
• Coal tar and salicylic acid
• Sebcur/T
• Lidex
• Lidex-E
• Fluocinonide
• Lidemol
• Lyderm
• Lydonide
• Tiamol
• Topsyn
• Flurandrenolide
• Cordran
• Cordran SP
• Rheumatrex
• Trexal
• Apo-Methotrexate
• Ratio-Methotrexate
• Ledertrexate
• Texate
• Trixilem
• Methoxsalen
• Dermox
• Meladinina
• Oxsoralen
• 8-MOP
• Oxsoralen-Ultra
• Uvadex
• Tiseb
• Salicylic Acid
• Ionil
• Ionil Plus
• LupiCare II Psoriasis
• LupiCare Psoriasis
• Neutrogena Body Clear
• Stri-dex
• Stri-dex Body Focus
• Sebcur
• DHS Sal
• MG217 Sal-Acid
• Salicylic Acid and Propylene Glycol
• Keralyt Gel
• Allantoin
• Alphosyl
• Calcipotriol
• Daivonex
• Resorcinol

Unlabelled alternative drug treatments include:

• Sulfasalazine
• Alti-Sulfasalazine
• Azaline
• Azulfidine
• Azulfidine EN-Tabs
• PMS Sulfasalazine
• PMS Sulfasalazine E.C
• Salazopyrin
• Salazopyrin EN
• SAS-Enema
• SAS Enteric-500
• SAS-500
• Sulfazine EC
• Triamcinolone
• Aristocort R
• Aristoform D
• Aurecort
• Kenalog H
• Flutex
• Triacet
• Triaderm Mild
• Triaderm Regular
• Kenacort
• Mytrex
• Mytriacet II
• Triderm
• Mycogen II
• Kenacomb
• Mycolog
• Mycomar
• SK-Triamcinolone
• Viaderm-K.C
• Mycophenolate
• CellCept
• Myfortic

Medical news summaries about treatments for Psoriasis:

The following medical news items are relevant to treatment of Psoriasis:

• Compound related to anti-anxiety drugs may provide an effective treatment for psoriasis
• New drug treatment for Wilson’s disease show’s promise

Discussion of treatments for Psoriasis:

Questions and Answers About Psoriasis: NIAMS (Excerpt)

Doctors generally treat psoriasis in steps based on the severity of the disease, the extent of the areas involved, the type of psoriasis, or the patient’s responsiveness 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 focuses on light treatments (phototherapy). Step 3 involves taking medicines internally, usually by mouth (systemic treatment).

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 commonly 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 resistance or adverse reactions occur. Treatment depends on the location of lesions, their size, the amount of the skin affected, previous response to treatment, and patients’ perceptions about their skin condition and preferences for treatment. In addition, treatment is often tailored to the specific form of the disorder.

Topical Treatment

• Corticosteroids--Available in different strengths, corticosteroids (cortisone) are usually applied twice a day. Short-term treatment is often effective in improving but not completely clearing psoriasis. If less than 10 percent of the skin is involved, some doctors will begin treatment with a high-potency corticosteroid ointment (for example, Diprolene^®,* Temovate^®, Ultravate^®, or Psorcon^®). High-potency steroids may also be used for treatment-resistant plaques, particularly those on the hands or feet. Long-term use or overuse of high-potency steroids can lead to worsening of the psoriasis, thinning of the skin, internal side effects, and resistance to the treatment’s benefits. Medium-potency corticosteroids may be used on the torso or limbs; low-potency preparations are used on delicate skin areas.

  *Brand names included in this fact sheet begin with a capital letter and are provided as examples only. Their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

• Calcipotriene--This drug is a synthetic form of vitamin D₃. (It is not the same as vitamin D supplements.) Applying calcipotriene ointment (for example, Dovonex^®) twice a day controls excessive production of skin cells. Because calcipotriene can irritate the skin, however, it is not recommended for the face or genitals. After 4 months of treatment, about 60 percent of patients have a good to excellent response. The safety of using the drug for cases affecting more than 20 percent of the skin is unknown, and using it on widespread areas of the skin may raise the amount of calcium in the body to unhealthy levels.
  
  

• Coal tar--Coal tar may be applied directly to the skin, used in a bath solution, or used on the scalp as a shampoo. It is available in different strengths, but the most potent form may be irritating. It is sometimes combined with ultraviolet B (UVB) phototherapy. Compared with steroids, coal tar has fewer side effects, but it is messy and less effective and thus is not popular with many patients. Other drawbacks include its failure to provide long-term help for most patients, its strong odor, and its tendency to stain skin or clothing.
  
  

• Anthralin--Doctors sometimes use a 15- to 30-minute application of anthralin ointment, cream, or paste to treat chronic psoriasis lesions. However, this treatment often fails to adequately clear lesions, it may irritate the skin, and it stains skin and clothing brown or purple. In addition, anthralin is unsuitable for acute or actively inflamed eruptions.
  
  

• Topical retinoid--The retinoid tazarotene (Tazorac) is a fast-drying, clear gel that is applied to the surface of the skin. Although this preparation does not act as quickly as topical corticosteroids, it has fewer side effects. Because it is irritating to normal skin, it should be used with caution in skin folds. Women of childbearing age should use birth control when using tazarotene.
  
  

• Salicylic acid--Salicylic acid is used to remove scales, and is most effective when combined with topical steroids, anthralin, or coal tar.
  
  

• Bath solutions--People with psoriasis may find that bathing in water with an oil added, then applying a moisturizer, can soothe their skin. Scales can be removed and itching reduced by soaking for 15 minutes in water containing a tar solution, oiled oatmeal, Epsom salts, or Dead Sea salts.
  
  

• Moisturizers--When applied regularly over a long period, moisturizers have a cosmetic and soothing effect. Preparations that are thick and greasy usually work best because they hold water in the skin, reducing the scales and the itching.

Phototherapy

UVB phototherapy--Some artificial sources of UVB light are similar to sunlight. Newer sources, called narrow-band UVB, emit the part of the ultraviolet spectrum band that is most helpful for psoriasis. Some physicians will start with UVB treatments instead of topical agents. UVB phototherapy is also used to treat widespread psoriasis and lesions that resist topical treatment. This type of phototherapy is normally administered in a doctor’s office by using a light panel or light box, although some patients can use UVB light boxes at home with a doctor’s guidance. Generally at least three treatments a week for 2 or 3 months are needed. UVB phototherapy may be combined with other treatments as well. One combined therapy program, referred to as the Ingram regime, involves a coal tar bath, UVB phototherapy, and application of an anthralin-salicylic acid paste, which is left on the skin for 6 to 24 hours. A similar regime, the Goeckerman treatment, involves application of coal tar ointment and UVB phototherapy.

PUVA--This treatment combines oral or topical administration of a medicine called psoralen with exposure to ultraviolet A (UVA) light. Psoralen makes the body more sensitive to this light. PUVA is normally used when more than 10 percent of the skin is affected or when rapid clearing is required because the disease interferes with a person’s occupation (for example, when a model’s face or a carpenter’s hands are involved). Compared with UVB treatment, PUVA treatment taken two to three times a week clears psoriasis more consistently and in fewer treatments. However, it is associated with more short-term side effects, including nausea, headache, fatigue, burning, and itching. Long-term treatment is associated with an increased risk of squamous cell and melanoma skin cancers. PUVA can be combined with some oral medications (retinoids and hydroxyurea) to increase its effectiveness. Simultaneous use of drugs that suppress the immune system, such as cyclosporine, have little beneficial effect and increase the risk of cancer. In very rare cases, patients who must travel long distances for PUVA treatments may, with a physician’s close supervision, be taught to administer this treatment at home.

Systemic Treatment

For more severe forms of psoriasis, doctors sometimes prescribe medicines that are taken internally:

• Methotrexate--This treatment, which can be taken by pill or injection, slows cell production by suppressing the immune system. Patients taking methotrexate must be closely monitored because it can cause liver damage and/or decrease the production of oxygen-carrying red blood cells, infection-fighting white blood cells, and clot-enhancing platelets. As a precaution, doctors do not prescribe the drug for people with long-term liver disease or anemia. Methotrexate should not be used by pregnant women, by women who are planning to get pregnant, or by their male partners.
  
  

• Cyclosporine--Taken orally, cyclosporine (Neoral^®) acts by suppressing the immune system in a way that slows the rapid turnover of skin cells. It may provide quick relief of symptoms, but it is usually effective only during the course of treatment. The best candidates for this therapy are those with severe psoriasis who have not responded to or cannot tolerate other systemic therapies. Cyclosporine may impair kidney function or cause high blood pressure (hypertension), so patients must be carefully monitored by a doctor. Also, cyclosporine is not recommended for patients who have a weak immune system, those who have had substantial exposure to UVB or PUVA in the past, or those who are pregnant or breast-feeding.
  
  

• Hydroxyurea (Hydrea^®)--Compared with methotrexate and cyclosporine, hydroxyurea is less toxic but also less effective. It is sometimes combined with PUVA or UVB. Possible side effects include anemia and a decrease in white blood cells and platelets. Like methotrexate and cyclosporine, hydroxyurea must be avoided by pregnant women or those who are planning to become pregnant.
  
  

• Retinoids--A retinoid, such as acitretin (Soriatane^®), is a compound with vitamin A-like properties that may be prescribed for severe cases of psoriasis that do not respond to other therapies. Because this treatment also may cause birth defects, women must protect themselves from pregnancy beginning 1 month before through 3 years after treatment. Most patients experience a recurrence of psoriasis after acitretin is discontinued.
  
  

• Antibiotics--Although not indicated in routine treatment, antibiotics may be employed when an infection, such as Streptococcus, triggers the outbreak of psoriasis, as in certain cases of guttate psoriasis.

Understanding Autoimmune Disease: NIAID (Excerpt)

Most treatments focus on topical skin care to relieve the inflammation, itching, and scaling. For more severe cases, oral medications are used. (Source: excerpt from Understanding Autoimmune Disease: NIAID)

Psoriasis: NWHIC (Excerpt)

Doctors generally treat psoriasis in steps according to the severity of the disease or responsiveness 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 involves treatments with light (phototherapy). Step 3 involves taking medicines internally, usually by mouth (systemic treatment).

Over time, affected skin tends to resist some treatments. Also, a treatment that works like magic in one person may have little effect in another. Thus, doctors commonly use a trial and error approach to find a treatment that works, then switch treatments every 12 to 24 months to reduce resistance and adverse reactions. Selection of treatment depends on the location of lesions, their size, the amount of the skin affected, previous response to treatment, and a patient's perceptions about their skin condition and patient preferences for treatment. In addition, treatment is often tailored to the specific form of the disorder.

Treatments can include:

Topical Treatment:sunlight, steroid ointments, medicines made from vitamin D3, coal tar, or anthralin. Other topical measures, such as bath solutions and moisturizers, may be soothing but are seldom strong enough to clear lesions for a sustained length of time and may need to be combined with more potent remedies.

Phototherapy: UVB Phototherapy, PUVA -

Systemic Treatment: Doctors sometimes prescribe medicines that are taken internally for more severe forms of psoriasis, particularly when more than 10 percent of the body is involved. (Source: excerpt from Psoriasis: NWHIC)

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