What is the treatment of psoriasis
The aim of psoriasis treatment is to make your skin feel comfortable and make you feel good about your skin. Psoriasis is both a medical disease and has a secondary psychological effect on your life.
The medical treatment of psoriasis is aimed to stop the skin cells from growing too quickly and hence reduce the inflammation and red, scaly plaque formation.
Psoriasis treatment aims at removing the skin cells and smoothing the skin, using the topical treatment that you can apply directly onto the psoriatic lesions.
Psoriasis treatments are three main areas:
- Topical treatments
- Light therapy
- Systemic medication.
Topical Psoriasis Treatment
Creams and ointments applied to the skin can very effectively help to treat mild-to-moderate psoriasis. However, when the disease is more severe, these creams are combined with oral medications or light therapy.
Topical psoriasis treatment includes
- topical corticosteroids,
- vitamin D analogues,
- topical retinoids,
- Calcineurin inhibitors,
- Salicylic acid, coal tar, tar and moisturisers
Looking at each one of these in turn:
Topical corticosteroids are often prescribed for treating mild-to-moderate psoriasis. They are a first line treatment as they are powerful anti-inflammatory drugs, which help to slow down cell turnover by suppressing the local immune system and hence reduce inflammation.
Once the inflammation is reduced the associated itching will be greatly relieved. There are different strengths of corticosteroids. The low potency corticosteroid ointments are usually recommended for sensitive areas like the face or in skin folds or for treating widespread patches of damaged skin.
Stronger corticosteroid creams are only used on slight areas of skin of persistent plaques on hands or feet after other treatments have failed. There are also medicated foams and scalp solutions available to treat psoriasis patches on the scalp. Be careful of long-term use or overuse of potent corticosteroid ointments as that can thin the
Skin and reduce the treatment benefit. To minimise side effects of corticosteroid ointments and creams, they are usually only used on current outbreaks until they are under control.
Vitamin D Analogues
Vitamin D Analogues are synthetic forms of vitamin D, which slow down the growth of skin cells such as Calcipotriene (Dovonex), which is a prescription only cream or solution containing a vitamin D analogue.
In other words, a synthesised vitamin D. It is used alone to treat mild-to-moderate psoriasis or in combination with other topical medications or phototherapy. This treatment has to be used as it can irritate the skin.
It also can be quite expensive. For instance, calcitriol (Rocaltrol) is equally efficient and possibly less irritating than Calcipotriene, but it is quite expensive.
Anthralin is the medication believed to normalise your DNA activity of skin cells. It often called Dr tho-Scalp. It can help remove scale, making skin smoother; however, be careful as it can irritate the skin and can stain anything it touches including your skin, your clothing, tops and particularly bedding.
For that reason the dermatologist Dr Jennifer Crawley will often only recommend short contact treatment allowing the cream just to stay on your skin for a brief time after which you wash it off to reduce the side effects of staining of clothing and irritation of the skin.
Topical Retinoids are commonly used to treat acne and the sun-damaged skin. One of them, Tazarotene, was developed specifically for the treatment of psoriasis. Like another vitamin A derivatives it normalises DNA activity in the skin cells and decreases inflammation.
However, it has to be used carefully because its common side effects are actually to cause skin irritation and increase sensitivity to sunlight as do all topical retinoids. Therefore it has to be used in conjunction with sunscreen applied during the day. Tazarotene is not available if you are pregnant or breast-feeding or intend to become pregnant, as it has a potential risk of causing congenital disabilities albeit very low.
Calcineurin Inhibitors (Tacrolimus and Pimecrolimus) are only approved for atopic dermatitis; however, they have also been shown to be effective at times for psoriasis, and they also disrupt the activation of those T-cells, which contribute to psoriasis and hence reduce the inflammation and plaque build-up.
They are not recommended for long-term use but can be useful in areas of thin skin such as around the eyes where steroid creams and retinoids may be too irritating or cause harmful side effects.