Psoriasis (cont.)
Gary W. Cole, MD, FAAD
Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Psoriasis facts
- What is psoriasis?
- What causes psoriasis?
- What does psoriasis look like? What are psoriasis symptoms and signs?
- Can psoriasis affect my joints?
- How is psoriasis diagnosed?
- Can psoriasis affect only my nails?
- How many people have psoriasis?
- Is psoriasis curable?
- Is psoriasis contagious?
- Can I transmit the gene for psoriasis to my children?
- What kind of doctor treats psoriasis?
- What is the treatment for psoriasis?
- What creams, lotions, and home remedies are available for psoriasis?
- What oral medications are available for psoriasis?
- What injections or infusions are available for psoriasis?
- What about light therapy for psoriasis?
- Where can I get more information on psoriasis?
- Is there a national psoriasis support group?
- What is my long-term prognosis with psoriasis? What are complications of psoriasis?
- Moderate to Severe Psoriasis Slideshow
- Take the Psoriasis Quiz
- Psoriasis FAQs
- Find a local Dermatologist in your town
What is the treatment for psoriasis?
There are many effective treatment choices for psoriasis. The best treatment is individually determined by the treating physician and depends, in part, on the type of disease, the severity, and the total body area involved.
For mild disease that involves only small areas of the body (like less than 10% of the total skin surface), topical (skin applied) creams, lotions, and sprays may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriatic plaque may be helpful.
For moderate to severe disease that involves much larger areas of the body (like 20% or more of the total skin surface), topical products may not be effective or practical to apply. These cases may require ultraviolet light treatments or systemic (total body treatments such as pills or injections) medications. Internal medications usually have greater risks.
For psoriatic arthritis, systemic medications are generally required to stop the progression of permanent joint destruction. Topical therapies are not effective.
It is important to keep in mind that as with any medical condition, all medications carry possible side effects. No medication is 100% effective for everyone, and no medication is 100% safe. The decision to use any medication requires thorough consideration and discussion with your physician. The risks and potential benefit of medications have to be considered for each type of psoriasis and the individual patient. Of two patients with precisely the same amount of disease, one may tolerate it with very little treatment, while the other may be almost completely become incapacitated and require treatment internally.
A proposal to minimize the toxicity of some of these medicines has been commonly called "rotational" therapy. The idea is to change the anti-psoriasis drugs every six to 24 months in order to minimize the toxicity of one medication. Depending on the medications selected, this proposal can be an optimal option.
In another example, a patient who has been using strong topical steroids over large areas of their body for prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy, like calcitriol (Vectical), light therapy, or an injectable biologic.
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