There are various treatments available for psoriasis that may be administered topically, systemically or with phototherapy. Biologic response modifiers are a specific class of medications that target the immune response in the body. Each of these treatment types is discussed below.
Topical corticosteroid medications are the first-line treatment for psoriasis and provide effective relief from the symptoms due to their anti-inflammatory action that helps to reduce redness and swelling. Adverse effects may include skin atrophy and increased sensitivity.
Corticosteroids can be used as a stand-alone therapy in mild to moderate psoriasis but for more severe cases a combination with other treatments is typically required.
Other topical treatments include:
- Calcineurin inhibitors (e.g. Protropic, Elidel)
- Coal tar
- Salicylic Acid
- Vitamin D Derivatives (e.g. Dovonex, Taclonex, Vectical)
- Vitamin A Derivatives (e.g. Tazorac)
- Non-steroidal anti-inflammatory drugs (NSAIDS)
Moisturizing creams are also indicted in relieve itching of psoriasis and may include herbal ingredients such as aloe vera, jojoba or capsaicin.
Sunlight has long been known to have an effect on the severity of psoriatic symptoms and this property can be enhanced with phototherapy, which administers a dose of UVB radiation that is present in sunlight.
The radiation penetrates the skin and slows down the rate of production of skin cells, which is a key factor in the pathophysiology of psoriasis. The exposure time can be adjusted according to the skin type of the patient to deliver the appropriate dose in the management of symptoms.
Adverse effects associated with phototherapy include irritation of the skin, sunburn, premature aging and increased risk of skin cancers.
PUVA refers to psoralen with ultraviolet A phototherapy, which involves the topical or oral administration of a drug shortly before exposure to UVA radiation, to increase the sensitivity of the skin to the light.
This is useful in the treatment of psoriasis due to its effects to slow down the production and growth of the skin cells that have become overactive to cause psoriasis.
The technique has been found to be useful in 85% of patients with psoriasis and is able to induce remission in the majority of individuals, although the length of time before symptoms reappear is highly variable.
This treatment is associated with more adverse effects than UVB therapy, including nausea, headache and fatigue. The risk of skin cancers is also significantly increased, particularly for patients that have had many treatments.
Systemic treatments are usually reserved for patients with psoriasis that has failed to respond to topical treatments and phototherapy due to the adverse effects associated with their use.
Administration of cyclosporine or methotrexate can be beneficial due to their action on the immune system to suppress the growth of new cells and inhibit inflammation. Both of these treatments take several weeks for the effect to become evident and the full scope of their action does not show until three to six months following the initiation of therapy. Side effects may include nausea, headache, fatigue, sensitivity to sunlight, liver damage and increased risk of cancer.
Soritane is a vitamin A derivative, also known as a retinoid that can help to control the production of skin cells and relieve symptoms of psoriasis. Symptoms often worsen with initial treatment and then improve after two to four months.
Other oral medications used in the treatment of psoriasis include:
- Antimalarial medications
- Mycophenolatemofetil (Cellcept)
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Sulfasalazine (Azulfidine)
- Otezla (apremilast)
- Stelara (ustekinumab)
Biologic Response Modifiers
The newest treatments used for psoriasis are biologic response modifiers, such as:
- Cimzia (certolizumab pegol)
- Enbrel (etanercept)
- Humira (adalimumab)
- Remicade (infliximab)
- Simponi (golimumab)
The action of these medications is targeted towards the specific proteins in the body that play a role in the immune system and inflammatory response to relieve symptoms.