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Medical Treatment for Psoriasis: Understanding Your Options

“With so many great treatment options available, nobody should have to suffer with psoriasis.”

Of the 7.5 million Americans who suffer from psoriasis—a chronic disease that develops when a person’s skin cells grow too quickly due to faulty signals from the immune system—about 60 percent report that the condition significantly affects their quality of life.

“Psoriasis does have a profound effect on someone’s quality of life. It can lead to depression and feelings of hopelessness,” says Suzanne Friedler, MD, a dermatologist in New York City. “Patients should realize that there is better hope now than ever before in treatments that can clear your skin and keep it clear for long periods of time.”

 

How Dermatologists Treat Psoriasis

“The first thing that we want to establish is a good skin care routine and good skin hygiene,” says Dr. Friedler. This might mean doing things like taking shorter showers and moisturizing more frequently to help keep psoriasis symptoms in check.

Along with having a healthy psoriasis skin care regimen, there are also plenty of other lifestyle adjustments that help psoriasis—like eating a psoriasis-friendly diet, relieving stress, and avoiding habits that can cause psoriasis flare-ups.

 

Medical Treatments for Psoriasis

Topical therapies. “Once you have a good skincare routine established, the next step might be topical therapies,” says Dr. Friedler. Topical treatments are applied to the skin and are usually the first treatment to try when diagnosed with psoriasis. Topicals can be purchased over the counter or by prescription. Examples of topical therapies are:

  • Corticosteroids. “Topical steroids work to reduce inflammation and slow down turnover of the skin cells,” says Dr. Friedler.
  • Vitamin D analogs. Topical vitamin D analogs also work to decrease skin cell turnover time. “They don’t work quite as quickly or effectively as steroids do, so they’re really a second line therapy,” says Dr. Friedler.
  • Retinoids. Retinoids are derivatives of vitamin A. “They are less frequently used in psoriasis, however there are good studies that support the use of retinoids in prolonging remission time for patients with psoriasis,” says Dr. Friedler.

Phototherapy or light therapy. “If patients aren’t achieving an adequate response with topical therapies, their next step might be using treatments that contain UV light,” says Dr. Friedler.

Phototherapy or light therapy involves exposing the skin to ultraviolet light on a regular basis and under medical supervision. Treatments are done in a doctor's office or psoriasis clinic or at home with phototherapy unit. “The skin is irradiated with a wavelength of light that’s particularly good at treating the psoriasis,” says Dr. Friedler.

Oral medications and biologics. If a patient isn’t responding to topical or light therapies, the next step may be to take an oral medication or biologic.

Types of oral medications include:

  • Anti-inflammatories, such as cyclosporine (brand names Neoral, Sandimmune, Gengraf) or methotrexate (brand names Trexall, Rasuvo, Otrexup).
  • Oral retinoids, such as acitretin (brand name Soriatane).
  • PDE4 inhibitors, such as apremilast (brand name Otezla).

Biologics are a new form of medication that uses a more targeted approach to treat psoriasis. “These treatments tend to work on the immune systems and target a specific part of the immunologic pathway that causes the development of psoriasis,” says Dr. Friedler. Biologics must be administered by injection or intravenous (IV) infusion; they are usually prescribed for moderate to severe psoriasis and psoriatic arthritis that has not responded to other treatments.

There’s no one-size-fits all approach to psoriasis treatment. Each patient’s needs and preferences are different. Be open and honest with your doctor about your lifestyle and concerns, so they can work with you to find the best treatment for your needs.

“With so many great treatment options available, nobody should have to suffer with a severe case of psoriasis, or even a mild case of psoriasis, that’s impacting their lifestyle,” says Dr. Friedler.

Suzanne Friedler, MD

This video features Suzanne Friedler, MD. Dr. Friedler is a dermatologist and clinical instructor at The Mount Sinai Hospital and St. John's Episcopal Hospital.

Duration: 2:27. Last Updated On: July 2, 2018, 5:16 p.m.
Reviewed by: Preeti Parikh, MD . Review date: July 2, 2018
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