How doctors treat psoriasis depends on each patient’s medical situation. Since there isn’t one kind of psoriasis, there are many treatments that control the disease. They also reduce the disease and, in some cases, the symptoms:
Overall, the different treatments for psoriasis are:
- Topical therapies
- Phototherapy and photochemotherapy
- Synthetic oral medications
- Biological therapy
Today, we’ll take a look at all of them in detail.
First of all, topical treatment is used to treat most cases of psoriasis. It involves external, localized cream and lotion application. The creams are applied to the area of the breakout.
Among the topical medications that are the most used for psoriasis, we find:
- Synthetic vitamin D
- Traditional corticosteroids
- Topical retinoids
Synthetic vitamin D: calcitriol, calcipotriol, or tacalcitol
Overall, the most effective of these is calcipotriol. The clinical reaction to these is slower than that of high-powered steroids. However, since they have a safer profile, they make it very useful for long-term treatment.
It’s recommended to use them together with a topical corticosteroid. This combination is more effective than any of them alone.
Despite its elevated safety, vitamin D synthetics have a rather adverse, noticeable effect: They can cause irritation in the area of the breakout. Because of this, you need to avoid sun exposure after applying it.
Next, this group of medications primarily acts by clearing up plaque and reducing inflammation. This is used at low intensity on delicate areas (the face and under joints).
It’s recommended to use the most powerful ones at the beginning. Then, continue using the lowest intensity treatment. You can even combine them with other treatments like synthetic vitamin D.
However, you need to be careful with corticosteroids. This is because they have adverse effects both locally and systematically.
- A reduction of skin thickness
- Lightening of the skin because of melanin inhibition
- Rosaceiforme dermatitis
In addition, the systemic effects are infrequent but severe. Among them, we see the inhibition of the hypothalamic-pituitary axis and Cushing’s syndrome.
To avoid them, it’s recommended that you only use a maximum of two applications per day. However, keep in mind that you will rebound if you stop taking the treatment.
Keratolytics: acetylsalicylic acid (aspirin)
Using acetylsalicylic acid limits and eliminates flaky plaque. Also, it increases the renovation of your tissue and increases the effectiveness of medications that are associated with facilitating its absorption. Because of this, it’s a complementary treatment.
These are synthetic analogs of vitamin A. Tazarotene is the only one available for treating psoriasis. It’s used in combination with corticosteroids.
Unfortunately, this causes irritation of the skin (avoid using it on your face or under joints). Plus, like all synthetic vitamin A‘s, it’s photosensitive and teratogenic. Because of this, pregnant women shouldn’t take it.
This is the oldest treatment for psoriasis. They are made with a base of coal pitch. This is used intermittently under your joints. However, sometimes this upsets people because of its smell and how easily it marks clothes.
In addition, it’s photosensitive. Because of this, you need to avoid sun exposure after applying it.
Photo-therapy and photochemotherapy
These treatments are used when the patient doesn’t respond well to topical therapy. They are also used if the plaque is very extensive.
- Phototherapy: UVB rays (these are the most effective and least burning wide-spectrum rays) are used together with tazarotene, synthetic vitamin D or systemic treatments.
- Photochemotherapy: also called PUVA. This consists of the combination of UVA radiation after giving a topical or oral dose of psoralens. These act as a photosensitizer. This is an alternative for patients who don’t get results with UVB. This is because PUVA has a greater efficiency and a longer-lasting effect. However, it’s associated with basiloma (cellular carcinoma) and melanoma.
Synthetic oral medications
Systemic treatment is recommended if other therapies don’t work. This treatment is based on the administration of:
Of these medications, the most used is methotrexate. This is especially true if you use it for a long time.
In this case, the patient should be monitored due to its severe adverse effects. Also, you should avoid getting pregnant for three months after treatment with this drug. This applies to both women and men.
Another immunosuppressant used is oral ciclosporin. This provides an equal to greater effectiveness as methotrexate However, it’s nephrotoxic and causes hypertension. Because of this, it requires monitoring in the patients who take it.
This is recommended for short term, interment treatments.
Acitretin, a vitamin A synthetic analog, can be considered as an alternative for patients with pustular psoriasis who are immunosuppressed and can’t use immunosuppressant medication.
This can be combined with UVB or PUVA. However, it’s less effective than cyclosporin. In addition, it keeps its teratogenicity up to 2 years after the treatment.
Biological therapies that treat psoriasis
These are only used on patients who can’t take or are intolerant to PUVA and systemic oral treatments. The drugs used require monitoring to control their adverse effects. This s because their safety still isn’t known for long-term treatment.