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An Overview of Psoriasis Treatments
There are no once-and-for-all psoriasis cures. Treatment aims to minimise the rash and different psoriasis creams etc work with different degrees of success in different people. You may find that different creams work better or not-so-well over the course of a lifetime of psoriasis.
Note: All medications have a drug name and a brand name. There are some examples of both the drug and brand names here. (The brand names are shown with a Capital letter.)
General measures for dealing with psoriasis.
Wash with a soap substitute such as aqueous cream or use a bath additive such as Polytar emollient or Balneum with Tar.
Apply a moisturiser after washing. This helps to soften hard skin and plaques and reduce itching.
For plaque psoriasis use psoriasis creams and discuss which to use with your doctor who will be able to guide you.
· Tar-based creams such as Alphosyl or Carbo-some help to reduce the inflammation and have anti-scaling properties
· Tar+steroid mixtures such as Alphosyl HC or Tarcortin
· Steroid cream eg 0.05% clobetasone butyrate (brand name example Eumovate), 1% hydrocortisone or 0.025% (Alphaderm), betamethasone valerate (Betnovate).
Be aware that sometimes when you stop using them, a steroid cream can make the psoriasis symptoms rebound worse than they were before. Also, they shouldn’t be used over long periods.
For the scalp, palms and soles of the feet a stronger concentration can be used. Note that using more cream or putting it on more thickly or frequently doesn’t increase the concentration – ie make it stronger.
Vitamin D analogues such as calciptriol (example brand name Vectical) work by reducing the rate at which the skin cells replace themselves.
Dithranol cream (eg Dithrocream) is often used as a short-contact agent (applied for a short time and then washed off). But it can irritate healthy skin, the backs of the knees and elbow flexures so use in low strengths first and them over to stronger ones over a few weeks.
A calcipotriol + betamethasone combination (example brand names Daivobet, Dovobet, Xamiol) is applied to the problem areas according to the manufacturer’s instructions for people with a lot of plaques which don’t do well with other psoriasis creams. Other treatments are available and your skin expert (dermatologist) will guide you.
Salicylic acid shouldn’t be used by anyone with an allergy to aspirin. It is often combined with coaltar or steroid creams and works by loosening and lifting the skin scales. It can be used on the body or the scalp and is useful because other treatments work better if the scales are lifted from the skin first.
Tazarotene (Tazorac) is a vitamin A based drug. It can irritate the good skin around the psoriasis plaques and shouldn’t be used if you’re breast feeding or pregnant.
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For more problematic psoriasis:
Phototherapy: UVB light therapy is effective for guttate and plaque psoriasis.
Photochemotherapy (PUVA) which combines tablets or creams of psoralens with UVA light treatment is widely used. Tablets of psoralens are taken about 2 hours before treatment and with meal. This helps to optimise their use by the body and minimise nausea side effects.
You will also need to wear sunglasses on treatment days (for 24 hours after having the tablets) to prevent cataract formation.
Phototherapy and photochemotherapy are given at the hospital and you may need further courses rather than a one-off session, but your specialist will guide you.
Because the treatments use ‘sunlight’ there is an increased risk of melanoma skin cancers with prolonged treatment.
For widespread disease:
For people whose psoriasis doesn’t respond to psoriasis creams, who have to be admitted for hospital for problem psoriasis or have widespread psoriasis , drugs like methotrexate (example brand name Trexall), ciclosporin (Neoral, Sandimmune), hydroxycarbamide (Hydrea) or fumaric acid esterase can be helpful.
And in severe psoriasis ‘biological interventions’ may be appropriate. These include drugs such as etanercept (Ebrel), infliximab (Remicade) or adalimumab (Humira), which target specific factors in the body. Common side effects from these drugs include back pain; headache; mild pain, redness, or swelling at the injection site; nausea; sinus inflammation; stomach pain.
Other biological interventions targeting other specific factors are efalizumab (Raptiva) (not available in the UK and Europe) and alefacept (Amevive).
You can see that there is a range of treatments for different types of psoriasis that can be used at different stages and according to the disease severity. Discuss them with your dermatologist as they each come with varying side effects.