“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:
- Oral retinoids
- PDE4 inhibitors
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.
Dr. Friedler is a dermatologist and clinical instructor at The Mount Sinai Hospital and St. John's Episcopal Hospital.
00:00:00,173 --> 00:00:02,999
00:00:02,999 --> 00:00:07,294
The first thing that we want to
establish is good skin care, routine and
00:00:07,294 --> 00:00:08,521
good skin hygiene.
00:00:08,521 --> 00:00:15,131
00:00:15,131 --> 00:00:20,066
That might involve taking short showers,
moisturizing frequently, keeping stress
00:00:20,066 --> 00:00:24,810
levels low, having a good diet, all of
that can affect the baseline of psoriasis.
00:00:24,810 --> 00:00:27,090
Once you have a good skin
care routine established,
00:00:27,090 --> 00:00:29,170
the next step might be topical therapies.
00:00:29,170 --> 00:00:31,810
Topical therapies may include
00:00:31,810 --> 00:00:35,290
topical vitamin D analogs,
and also topical retinoids.
00:00:35,290 --> 00:00:37,750
So topical steroids work
to reduce inflammation and
00:00:37,750 --> 00:00:39,980
slow down turnover of the skin cells.
00:00:39,980 --> 00:00:44,840
Vitamin D analogs also help to decrease
the turnover time of your skin cells.
00:00:44,840 --> 00:00:46,970
They don't work quite as quickly or
00:00:46,970 --> 00:00:51,950
as effectively as do steroids, so
they're really a second line therapy.
00:00:51,950 --> 00:00:54,040
Retinoids are derivatives of vitamin A.
00:00:54,040 --> 00:00:56,140
They are less frequently
used in psoriasis,
00:00:56,140 --> 00:00:59,430
however there are good studies
that support the use of retinoids
00:00:59,430 --> 00:01:02,690
in prolonging remission times for
patients with psoriasis.
00:01:02,690 --> 00:01:06,710
So if patients aren't achieving an
adequate response with topical therapies,
00:01:06,710 --> 00:01:10,480
their next step might be using
treatments that contain UV light.
00:01:10,480 --> 00:01:14,270
Phototherapy and laser treatments
usually involve the patient coming in to
00:01:14,270 --> 00:01:18,510
the office two or three times a week where
the skin is irradiated with a wavelength
00:01:18,510 --> 00:01:21,950
of light that's particularly
good at treating the psoriasis.
00:01:21,950 --> 00:01:25,560
If patients are not responding
to topical therapies and
00:01:25,560 --> 00:01:30,010
light therapies, the next step might
be an oral medication or biologics.
00:01:30,010 --> 00:01:34,540
Types of oral medications include types of
anti-inflammatories, such as cyclosporine,
00:01:34,540 --> 00:01:37,780
retinoids such as acitretin.
00:01:37,780 --> 00:01:40,680
There's a new PDE4 inhibitor
that's called Otezla that's come
00:01:40,680 --> 00:01:42,720
on the market that's also
an oral treatment for psoriasis.
00:01:42,720 --> 00:01:47,770
There's a new category of psoriasis
treatments called biologics.
00:01:47,770 --> 00:01:51,370
These treatments tend to work on
the immune systems and target a specific
00:01:51,370 --> 00:01:55,745
part of the immunologic pathway that
causes the development of psoriasis.
00:01:55,745 --> 00:01:59,765
These were injectable drugs and some
treatments may be required to be injected
00:01:59,765 --> 00:02:03,075
twice a week and some aren't injected for
several months apart.
00:02:03,075 --> 00:02:05,895
So these are the power-play
medications and psoriasis.
00:02:05,895 --> 00:02:10,145
These will work if you have severe
psoriasis and they often can promote
00:02:10,145 --> 00:02:12,875
prolonged remissions in
patients with severe psoriasis.
00:02:12,875 --> 00:02:15,429
many great treatment options available,
00:02:15,429 --> 00:02:18,527
no one should have to suffer with
a severe case of psoriasis or
00:02:18,527 --> 00:02:21,954
even a mild caseof psoriasis
that's impacting their lifestyle.
00:02:21,954 --> 00:02:31,954
Psoriasis Treatments. National Psoriasis Association. (Accessed on July 2, 2018 at https://www.psoriasis.org/about-psoriasis/treatments)
Psoriasis Resource Center. Psoriasis Treatments. American Academy of Dermatology Association. (Accessed on July 2, 2018 at https://www.aad.org/public/diseases/scaly-skin/psoriasis#treatment)