Treatments of Psoriasis
There can be substantial variation between individuals in the effectiveness
of specific psoriasis treatments. Because of this, dermatologists often use
a trial-and-error approach to finding the most appropriate treatment of
psoriasis for their patient. The decision to employ a particular psoriasis
treatment is based on the type of psoriasis, its location, extent and
severity. The patient’s age, gender, quality of life, and attitude toward
risks associated with the treatment are also taken into consideration.
Medications with the least potential for adverse reactions are
preferentially employed. If the treatment goal is not achieved then
therapies with greater potential toxicity may be used. Medications with
significant toxicity are reserved for severe unresponsive psoriasis. This is
called the psoriasis treatment ladder. As a first step, medicated ointments
or creams are applied to the skin. This is called topical psoriasis
treatment. If topical psoriasis treatment fails to achieve the desired goal
then the next step would be to expose the skin to ultraviolet (UV)
radiation. This type of psoriasis treatment is called phototherapy. The
third step involves the use of medications which are ingested orally or by
injection. This approach is called systemic psoriasis treatment.
Over time, psoriasis can become resistant to a specific therapy. Treatments
may be periodically changed to prevent resistance developing (tachyphylaxis)
and to reduce the chance of adverse reactions occurring. This is called
Topical Psoriasis Treatment
Bath solutions and moisturizers help sooth affected skin and reduce the
dryness which accompanies the build-up of skin on psoriatic plaques.
Medicated creams and ointments applied directly to psoriatic plaques can
help reduce inflammation, remove built-up scale, reduce skin turn over, and
clear affected skin of plaques. Ointment and creams containing coal tar,
dithranol (anthralin), corticosteroids, vitamin D3 analogues (for example,
calcipotriol), and retinoids are routinely used. The mechanism of action of
each is probably different but they all help to normalize skin cell
production and reduce inflammation.
The disadvantages of topical agents are variably that they can often
irritate normal skin, can be time consuming and awkward to apply, cannot be
used for long periods, can stain clothing or have a strong odor. As a
result, it is sometimes difficult for people to maintain the regular
application of these medications. Abrupt withdrawal of some topical agents,
particularly corticosteroids, can cause an aggressive recurrence of the
condition. This is known as a rebound of the condition.
Some topical psoriasis treatments with innovative concepts and cosmetic feel
are coming into the market (for example Dermist cream in India). Though
these claimed to be side-effects free, cosmetically adjusted for day time
use and safe for long term use; these are non-conventional medicines, comes
under traditional system of ayurveda hence not very popular in the western
Some topical agents are used in conjunction with other therapies, especially
Phototherapy Psoriasis Treatment
It has long been recognized that daily, short, non-burning exposure to
sunlight helped to clear or improve psoriasis. Niels Finsen was the first
physician to investigate the therapeutic effects of sunlight scientifically
and to use sunlight in clinical practice. This became known as phototherapy.
Sunlight contains many different wavelengths of light. It was during the
early part of the 20th century that it was recognized that for psoriasis the
therapeutic property of sunlight was due to the wavelengths classified as
ultraviolet (UV) light.
Ultraviolet wavelengths are subdivided into UVA (380–315 nm), UVB (315–280
nm), and UVC (< 280 nm). Ultraviolet B (UVB) (315–280 nm) is absorbed by the
epidermis and has a beneficial effect on psoriasis. Narrowband UVB (311 to
312 nm), is that part of the UVB spectrum that is most helpful for
psoriasis. Exposure to UVB several times per week, over several weeks can
help people attain a remission from psoriasis.
Ultraviolet light treatment is frequently combined with topical (coal tar,
calcipotriol) or systemic treatment (retinoids) as there is a synergy in
their combination. The Ingram regime, involves UVB and the application of
anthralin paste. The Goeckerman regime combines coal tar ointment with UVB.
Photochemotherapy Psoriasis Treatment
Psoralen and ultraviolet A phototherapy (PUVA) combines the oral or topical
administration of psoralen with exposure to ultraviolet A (UVA) light.
Precisely how PUVA works is not known. The mechanism of action probably
involves activation of psoralen by UVA light which inhibits the abnormally
rapid production of the cells in psoriatic skin. There are multiple
mechanisms of action associated with PUVA, including effects on the skin
Dark glasses must be worn during PUVA treatment because there is a risk of
cataracts developing from exposure to sunlight. PUVA is associated with
nausea, headache, fatigue, burning, and itching. Long-term treatment is
associated with squamous-cell and melanoma skin cancers.
Systemic Psoriasis Treatment
Psoriasis which is resistant to topical treatment and phototherapy is
treated by medications that are taken internally by pill or injection. This
is called systemic psoriasis treatment. Patients undergoing systemic
psoriasis treatment are required to have regular blood and liver function
tests because of the toxicity of the medication. Pregnancy must be avoided
for the majority of these treatments. Most people experience a recurrence of
psoriasis after systemic treatment is discontinued.
The three main traditional systemic psoriasis treatments are the
immunosupressant drugs methotrexate and ciclosporin, and retinoids, which
are synthetic forms of vitamin A. Other additional drugs, not specifically
licensed for psoriasis, have been found to be effective. These include the
antimetabolite tioguanine, the cytotoxic agent hydroxyurea, sulfasalazine,
the immunosupressants mycophenolate mofetil, azathioprine and oral
tacrolimus. These have all been used effectively to treat psoriasis when
other treatments have failed. Although not licensed in many other countries
fumaric acid esters have also been used to treat severe psoriasis in Germany
for over 20 years.
Biologics are manufactured proteins that interrupt the immune process
involved in psoriasis. Unlike generalised immunosuppressant therapies such
as methotrexate, biologics focus on specific aspects of the immune function
leading to psoriasis. These drugs are relatively new, and their long-term
impact on immune function is unknown. They are very expensive and only
suitable for very few patients with psoriasis.
Alternative therapy for Psoriasis
* Antibiotics are not indicated in routine treatment of psoriasis. However,
antibiotics may be employed when an infection, such as that caused by the
bacteria Streptococcus, triggers an outbreak of psoriasis, as in certain
cases of guttate psoriasis.
* Climatotherapy involves the notion that some diseases can be successfully
treated by living in particular climate. Several psoriasis clinics are
located throughout the world based on this idea. The Dead Sea is one of the
most popular locations for this type of treatment.
* New natural options for mild to moderate psoriasis relief with clinically
proven efficacity and safety have been developed and are now available in
Canada and online. XP-828L (Dermylex) is extracted through a patented
process from whey and has an immuno-regulatory effect.
* In Turkey, doctor fish which live in the outdoor pools of spas, are
encouraged to feed on the psoriatic skin of people with psoriasis. The fish
only consume the affected areas of the skin. The outdoor location of the spa
may also have a beneficial effect. This treatment can provide temporary
relief of symptoms. A revisit to the spas every few months is often
* Some people subscribe to the view that psoriasis can be effectively
managed through a healthy lifestyle. This view is based on anecdote, and has
not been subjected to formal scientific evaluation. Nevertheless, some
people report that minimizing stress and consuming a healthy diet, combined
with rest, sunshine and swimming in saltwater keep lesions to a minimum.
This type of "lifestyle" treatment is suggested as a long-term management
strategy, rather than an initial treatment of severe psoriasis.
* A number of patients have reported significant improvements from sun and
sea water: unfortunately, salt alone does not have any effect. Sea water
contains so many minerals and different life forms (thousands of species of
bacteria alone) that it will be hard to determine which of these is causing
the observed effects. Interestingly, people in the tropics differentiate
between "live" and "dead" sea water: "live" sea water is water that has
never been covered.
* Some psoriasis patients use herbology as a holistic approach that aims to
treat the underlying causes of psoriasis.
* A psychological symptom management program has been reported as being a
helpful adjunct to traditional therapies in the management of psoriasis.
* It is claimed that Epsom salt may have a positive effect in reducing the
effects of psoriasis.
* The use of Neem oil in India has been in documented for 6000 years.
* It is claimed that yoga and meditative practices help psoriasis patients
by 'detoxifying' the body and by the reduction of stress.
* Sulphur has been used for many years as a safe treatment in the
alleviation of Psoriasis.
Historical Psoriasis Treatment
The history of psoriasis is littered with treatments of dubious
effectiveness and high toxicity. These treatments received brief popularity
at particular time periods or within certain geographical regions. The
application of cat feces to red lesions on the skin, for example, was one of
the earliest topical treatments employed in ancient Egypt. Onions, sea salt
and urine, goose oil and semen, wasp droppings in sycamore milk, and soup
made from vipers have all been reported as being ancient treatments.
In the more recent past Fowler's solution, which contains a poisonous and
carcinogenic arsenic compound, was used by dermatologists as a treatment for
psoriasis during the 18th and 19th centuries. Grenz Rays (also called
ultrasoft X-rays or Bucky rays) was a popular treatment of psoriasis during
the middle of the 20th century. This type of therapy was superseded by
Undecylenic acid was investigated and used for psoriasis some 40 years ago.
All these treatments have fallen out of favor. One alternative treatment,
fashionable in the Victorian and Edwardian eras, was Sulfur. Recently Sulfur
has re-gained some credibility as a safe alternative to steroids and coal
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