Psoriasis

For mild to moderate psoriasis, some people may find sufficient relief from one or more of the following creams or ointments applied directly to the lesion:

• Moisturizers—While moisturizers won’t actually heal lesions or plaques, they can reduce the itching and scaling. For psoriasis, the greasier the better, so choose ointments over lighter creams and lotions. 
• Coal tar—One of the oldest known treatments for psoriasis, coal tar is available without a prescription as a shampoo, gel, and cream. Coal tar reduces inflammation, slows the growth of skin cells, and relieves itching and irritation. It can be messy to apply and has a strong odor.
• Salicylic acid—This medication is available in shampoos, creams, lotions, pads, paste, and soap. It works as a peeling agent, removing scales from the skin, and it’s often combined with other topical treatments.

• Anthralin (Micanol) - An established, safe treatment for psoriasis (especially of the scalp), anthralin slows down skin cell growth and reduces inflammation. The medication may stain clothing and non-affected skin. 
• Calcipotriene (Dovonex, Taclonex) - This synthetic form of vitamin D slows skin cell growth, flattens psoriasis lesions, and removes scales. While it doesn’t address inflammation specifically, most patients notice a reduction of skin redness.
• Calcitriol (Vectical) - Vectical contains calcitriol, the naturally occurring and active form of vitamin D3. This topical psoriasis treatment slows down the over production of skin cells that occurs with psoriasis, and it is thought to help decrease the excessive immune response on the skin of patients with psoriatic lesions. Because it is well-tolerated, Vectical may be prescribed for use on skin folds.
• Corticosteroids ("topical steroids") - Corticosteroids slow skin cell growth and relieve itching by suppressing the immune system. They work quickly and are easy to use. They may be used alone for mild psoriasis or combined with other therapies for severe lesions. Side effects include thinning of the skin, stretch marks, and reduced immune function, so prolonged use should be avoided.
• Topical retinoids (Tazorac) - Retinoids are a class of medications derived from vitamin A that are used for a variety of skin conditions. Some retinoids, such as Tazorac, have been formulated for application to the skin. (Oral retinoids, such as Soriatane, are taken by mouth.) Tazorac is FDA-approved for the treatment of psoriasis and helps slow the growth of quickly multiplying skin cells.
• Calcineurin inhibitors (Elidel, Protopic) - These medications, typically used for atopic dermatitis (eczema), may be prescribed in some cases of psoriasis.

Oral medications may be prescribed for people with moderate to severe psoriasis whose lesions don’t respond sufficiently to topical medications or phototherapy. Because they are taken by mouth and absorbed into the blood, they reach the deeper layers of skin throughout the body. They can be very effective but have serious potential side effects to consider.

Systemic treatments include:

• Cyclosporine (Neoral)—By suppressing the immune system, cyclosporine slows the overgrowth of skin cells and is particularly effective against plaque and nail psoriasis. Because of cyclosporine’s significant side effects, people taking this medication are monitored closely.
• Methotrexate—Like cyclosporine, this medication suppresses the immune system and is sometimes prescribed for the treatment of erythrodermic and pustular psoriasis, as well as psoriatic arthritis. Because of methotrexate’s significant side effects, people taking this medication are monitored closely.
• Soriatane (acitretin)—"Retinoids" refers to a class of medications derived from vitamin A that are used for a variety of skin conditions. Soriatane is retinoid that is FDA-approved specifically for the treatment of multiple types of psoriasis. It is often combined with other treatments, including calcipotriene (Dovonex, Taclonex) and phototherapy. Soriatane is particularly useful for severe psoriasis, but it has significant side effects, including chapped lips and dry skin. Because the medication can cause serious birth defects, women who might become pregnant must have two negative pregnancy tests before starting treatment, use two forms of birth control during treatment, and continue birth control for three years after stopping the medication.

Other systemic treatments that might be considered include isotretinoin (Accutane, Sotret), hydroxyurea, mycophenolate (Cellcept), and sulfasalazine.
 

The excimer laser�recently approved by the Food and Drug Administration (FDA) for treating chronic, localized psoriasis plaques�emits a high-intensity beam of ultraviolet light B (UVB).

The excimer laser can target select areas of the skin (including scalp) affected by mild to moderate psoriasis. Individual response to the treatment varies. It can take an average of four to 10 sessions to see results, depending on the particular case of psoriasis. It is recommended that patients receive two treatments per week, with a minimum of 48 hours between treatments.

The treatments are painless and the is very little associated risk with this procedure.

Some cases of psoriasis require combining different therapies for improved results. For instance, Tazorac may be combined with a topical steroid, or Soriatane may be combined with phototherapy. Your doctor may recommend different combinations at different times.

Long-term use of some medications, such a cyclosporine or methotrexate, can lead to an increased risk of side effects. In addition, the benefits of some medications can diminish over time. In such cases, doctors may recommend rotating medications, using one medication for several months followed by another. For example, coal tar may be rotated with cyclosporine.

Biologics (also called "disease-modifying therapy" or "immunomodulators") are a relatively new treatment option for people with moderate to severe psoriasis. They are given this name because they are derived from human or animal proteins instead of chemicals like most other medications.

Biologics work by targeting specific parts of the immune system, such as T cells or TNF, a chemical used to transmit messages between immune cells. This focused approach reduces the likelihood of side effects seen with medications that affect the entire immune system.

Biologics must be administered by injection, either into the skin (subcutaneously), into the muscle (intramuscular or IM), or by intravenous infusion (IV). Subcutaneous injections are similar to the insulin shots used by someone with diabetes and can be administered by the person with psoriasis or a caregiver.

Some biologics may require long-term use to keep psoriasis under control. Stopping treatment can lead to a premature return of symptoms.

Currently, five biologic medications are FDA-approved for psoriasis:

• Amevive (alefacept)
• Enbrel (etanercept)
• Humira (adalimumab)
• Remicade (infliximab)
• Stelara (ustekinumab)

Raptiva (efalizumab) was withdrawn from the market in 2009.