What Psoriasis Treatments Are Available
Psoriasis is a chronic skin condition that may worsen and improve in cycles. Any approach to the treatment of this disease must be considered for the long term. Treatment regimens must be individualized according to age, sex, occupation, personal motivation, other health conditions, and available economic resources.
Disease severity is defined by the thickness and extent of plaques present as well as the patient’s perception and acceptance of the disease. Treatment must be designed with the patient’s specific expectations in mind, rather than focusing only on the extent of body surface area involved.
Many treatments exist for psoriasis. However, the construction of an effective therapeutic regimen is not necessarily complicated.
There are three basic types of treatments for psoriasis:
Psoriasis Can Cause Arthritis
For an unknown reason, psoriasis can cause a form of arthritis known as psoriatic arthritis. Symptoms include:
- discomfort, throbbing or swelling in one or many joints
- tenderness in any joint
- pain caused by inflammation in the joints, which stimulates nerve endings.
- The joints most likely to be affected are the last joint in the fingers or toes, the sacrum , wrists, knees or ankles.
What Injections Or Infusions Are Available For Psoriasis
Recently, a new group of drugs called biologics have become available to treat psoriasis and psoriatic arthritis. They are produced by living cells cultures in an industrial setting. They are all proteins and therefore must be administered through the skin because they would otherwise be degraded during digestion. All biologics work by suppressing certain specific portions of the immune inflammatory response that are overactive in psoriasis. A convenient method of categorizing these drugs is on the basis of their site of action:
Drug choice can be complicated, and your physician will help in selecting the best option. In some patients, it may be possible to predict drug efficacy on the basis of a prospective patient’s genetics. It appears that the presence of the HLA-Cw6 gene is correlated with a beneficial response to ustekinumab.
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Can A Diet Cure Psoriasis Naturally
- Avoiding environmental factors that trigger psoriasis, such as smoking, and stress may help prevent or minimize flare-ups of psoriasis. Sun exposure may help in many cases of psoriasis and aggravate it in others.
- Alcohol is considered a risk factor for psoriasis, even moderate amounts of beer. People should minimize alcohol use if they have psoriasis. This is especially important if they are taking medications such as methotrexate or acitretin.
- Specific dietary restrictions or supplements other than a well-balanced and adequate diet are not important in the management of plaque psoriasis.
- Recently, some data has supported that an “anti-inflammatory” diet that is high in fruits and vegetables and low in saturated and trans fats may help manage psoriasis, although the value in preventing its onset is less certain.
What Are The Types Of Psoriasis
There are different types of psoriasis, but the most common kind isplaque psoriasis. It appears as raised, red patches of skin that are covered by silvery-white scales. The patches usually develop in the same pattern on both sides of the body and tend to appear on the:
- Limbs, especially the elbows and knees.
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What Psoriasis Creams And Topical Agents Can I Use
Medications applied directly to the skin are the first line of treatment options for psoriasis.
The main topical treatments are:
- anthralin, or
For more detailed information on each medication, see Understanding Psoriasis Medications. Generic drug names are listed below with examples of brands in parentheses.
- Corticosteroids: Topical corticosteroids are the mainstay of treatment in mild or limited psoriasis and come in a variety of forms. Foams and solutions are best for scalp psoriasis and other thickly hair-bearing areas, such as a hairy chest or hairy back. Creams are usually preferred by patients, but ointments are more potent than any other vehicles, even at the same percentage concentration.
- Super potent topical corticosteroids such as clobetasol propionate and betamethasone dipropionate augmented are commonly prescribed corticosteroids for use on non-facial, non-intertriginous areas .
- As the condition improves, one may be able to use potent steroids such as:
- mometasone furoate or
- halcinonide or
- mid-potency steroids such as triamcinolone acetonide or betamethasone valerate . These creams or ointments are usually applied once or twice a day, but the dose depends on the severity of psoriasis as well as the location and thickness of the plaque.
What Are The 7 Types Of Psoriasis
1. Plaque psoriasis
- In plaque psoriasis, there are raised, inflamed, and scaly patches of skin that may also be itchy and painful
- Can occur anywhere on the body and skin may be red with silvery-white scales or may appear purple-ish, depending on a personâs skin type
- Plaques most often appear on the scalp, knees, elbows, and in or around the belly button and lower back, but can develop on any area of the body
- Itâs the most common type of psoriasis, affecting up to 80% of patients
2. Pustular psoriasis
- In pustular psoriasis, there are white, pus-filled, painful bumps that may be surrounded by inflamed or reddened skin
- May develop only on certain areas of the body, such as the hands and feet as in palmoplantar psoriasis, or it may affect most of the body
- Affects about 3% of people with psoriasis
3. Erythrodermic psoriasis
4. Guttate psoriasis
- In guttate psoriasis, there are many isolated small, red, round scaling bumps.
- It frequently develops on the arms, legs and torso but can affect any part of the body
- Affects about 8% of psoriasis patients
5. Inverse psoriasis
6. Psoriatic arthritis
- Nail tenderness
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Problems With The Immune System
Your immune system is your body’s defence against disease and it helps fight infection. One of the main types of cell used by the immune system is called a T-cell.
T-cells normally travel through the body to detect and fight invading germs, such as bacteria. But in people with psoriasis, they start to attack healthy skin cells by mistake.
This causes the deepest layer of skin to produce new skin cells more quickly than usual, triggering the immune system to produce more T-cells.
It’s not known what exactly causes this problem with the immune system, although certain genes and environmental triggers may play a role.
What Can Trigger Psoriasis
Plenty of everyday things can act as a trigger, causing psoriasis to appear for the first time. Common psoriasis triggers include:
Skin injury, such as a cut or bad sunburn
Infection, such as strep throat
Some medications, including lithium, prednisone, and hydroxychloroquine
Weather, especially cold, dry weather
These triggers can also cause psoriasis flare-ups. Different people have different triggers. For example, periods of intense stress may trigger your psoriasis but cold weather may not.
Thats why its so important for people who have psoriasis to know what triggers their psoriasis. Avoiding triggers can reduce psoriasis flares.
Youll find common triggers and what you can do to avoid them at: Are triggers causing your psoriasis flare-ups?
If you think you have psoriasis, its important to find out. Treatment can help relieve your discomfort and lead to clearer skin. You can find out how board-certified dermatologists diagnose and treat psoriasis at: Psoriasis: Treatment.
Related AAD resources
1 Gottlieb A, Korman NJ, et al. J Am Acad Dermatol 2008 58:851-64.2 Alexis AF, Blackcloud P. J Clin Aesthet Dermatol. 2014 7:16-24.
References Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014 7:16-24.
All content solely developed by the American Academy of Dermatology
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Inflammation And Psoriasis: Making The Connection
The immune system and inflammation play a role in psoriasis. Heres how theyre believed to be connected.
Think of the immune system as your bodys alarm system. When you get a cold, infection, or scrape on your knee, your immune system sends out signals that trigger inflammation in an effort to defend itself.
When you have psoriasis, your immune system is out of balance. In fact, its in overdrive. An overactive immune system can send faulty signals and mistake healthy cells for harmful ones. This results in too much inflammation. For psoriasis patients, this means the body rapidly produces more skin cells than necessary.
Luckily, some treatment options can reduce inflammation, which may help the immune system and help to slow the rapid production of skin cells.
Talk to a dermatologist to learn more about treatment options that may work for you.
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Its important to work with a dermatologist when choosing a psoriasis treatment. Learn how to start that conversation.
Causes And Risk Factors Of Psoriasis
Psoriasis, in general, is a genetic condition passed down through families. “It’s likely that multiple genes need to be affected to allow psoriasis to occur and that it’s frequently triggered by an external event, such as an infection,” says James W. Swan, MD, professor of dermatology at the Loyola University Stritch School of Medicine in Maywood, Illinois.
Certain risk factors, such as a family history or being obese, may increase your odds of developing psoriasis.
According to the National Psoriasis Foundation , at least 10 percent of people inherit genes that could lead to psoriasis, but only 3 percent or less actually develop the disease. For this reason, it is believed that the disease is caused by a combination of genetics and external factors or triggers.
A psoriasis outbreak may be provoked by:
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What Is Scalp Psoriasis And What Causes It
Psoriasis can appear on any part of the skin, even the scalp. With scalp psoriasis, scalp plaques produce excess scales and can cause your scalp to itch.
Symptoms of scalp psoriasis appear as the following:
- A small bump, called a papule, with a scale on top.
- The plaque typically is covered by thick layers of horny scale. When the scale sheds, it can look like dandruff.
- Sometimes these plaques can itch.
- Scratching these plaques can worsen the condition and lead to what’s called the Koebner phenomenon, or isomorphic response, which can cause psoriasis to develop in areas where there’s inflammation and trauma.
The causes of scalp psoriasis, like all psoriasis, is related to genetic defects that affect the immune system. It is not known if stress causes or makes psoriasis worse.
In some severe cases, scalp psoriasis can cause alopecia, or a loss of hair, which is rare and may be controlled with treatment. Scalp psoriasis can be treated with topical medications, which can sometimes be difficult to apply when the scalp is covered with enough hair that can create a barrier.
Psoriasis Susceptibility Genes Identified By Gwass
Advances in high-throughput genotyping technologies and the completion of the genome-wide database of common genetic sequence variation have paved the way to the identification of a number of psoriasis susceptibility genes by means of GWAS and subsequent meta-analysis . Collectively, these studies identified 36 independent psoriasis-associated regions within individuals of European ancestry , plus five more uniquely associated in the Chinese population .
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What Type Of Psoriasis Treatment Will I Need
Several treatment options can relieve psoriasis. Creams or ointments may be enough to improve the rash in small areas of skin. If the rash affects larger areas, or you also have joint pain, you may need other treatments. Joint pain may be a sign that you have arthritis.
Your provider will decide on a treatment plan based on:
- Severity of the rash.
- Vitamin A or retinoid creams.
What Causes Psoriasis Outbreaks
Psoriasis outbreaks differ from person to person. No one knows exactly what causes flare-ups. Common psoriasis triggers may include:
- Skin injury .
- Streptococcal or other infection that affects the immune system.
- Certain prescription medications .
- Cold weather, when people have less exposure to sunlight and humidity and more to hot, dry indoor air.
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What Else Should I Know
Making healthy choices can help with psoriasis. Here are some things you can do:
- If you smoke, quit. Smoking can trigger outbreaks of psoriasis in some people.
- Avoid alcohol. It can make psoriasis treatments less effective.
- Eat healthy foods. Eating a lot of fruits and vegetables can help fend off diseases that might trigger psoriasis.
- Stay at a healthy weight. This decreases the risk of inverse psoriasis.
- Keep skin clean and well moisturized. Bathing daily with bath salts or oils and then applying moisturizer can help ease the symptoms of psoriasis.
People who have psoriasis may feel self-conscious about how it looks. That’s one reason why some people turn to a therapist or join a support group of people who understand what they might be going through.
The key to psoriasis treatment is keeping up on whatever your doctor prescribes. If that means applying an ointment twice a day, then find a way to remind yourself to do it so you don’t forget. Psoriasis is one of those things that you need to stay focused on treating, even when you’re feeling OK.
Whether your psoriasis is mild or severe, learn all you can about it. Talk to your doctor or check websites like:
Is Psoriasis The Same As Eczema
Psoriasis and eczema are two different skin conditions. They differ in where the disease appears on the body, how much it itches and how it looks. Eczema tends to appear more often behind the knees and inside the elbows. Eczema also causes more intense itching than psoriasis. Many people, especially children, can get both eczema and psoriasis.
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Steroid Creams Or Ointments
Steroid creams or ointments are commonly used to treat mild to moderate psoriasis in most areas of the body. The treatment works by reducing inflammation. This slows the production of skin cells and reduces itching.
Topical corticosteroids range in strength from mild to very strong. Only use topical corticosteroids when recommended by your doctor. Stronger topical corticosteroids can be prescribed by your doctor and should only be used on small areas of skin or on particularly thick patches. Overusing topical corticosteroids can lead to skin thinning.
Complications Of Psoriasis :
- Salicylic Acid- Available in shampoo and scalp solutions. Helps in reducing scaling of scalp psoriasis.
- Corticosteroids-Most frequently used. Available as ointments, sprays, gels creams.
- Retinoids- They reduce skin cell production. Most commonly used is Tazarotene.
furtherSide effects: hair loss, inflammation, skin irritation, increased sensitivity to light.
- Vitamin D analogues- These are synthetic form of Vitamin D which slow the growth of skin. It can be used alone or with tropic corticosteroids.
- Calcineurininhibitors Reduce inflammation and heap buildup.
Coal tar :
Reduces scaling , itching and inflammation. Are available in form of cream, oil and many more forms.
- Should not be used during pregnancy and breast feeding.
Light therapy :
It is the first line treatment for moderate to severe psoriasis. Therapy can be given alone or in combination with other medicines. This therapy uses UV rays. In this, affected skin is exposed to controlled amount of natural or artificial light. The over reactive W.B.C that attack healthy skin cell and cause rapid cell growth are killed by sunlight or artificial light.
Oral and injected medicines :
- Biologics These usually include administration by injection. Biologics alter immune system by preventing interaction between immune system and inflammatory pathways.
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Sign And Symptoms Of Psoriasis :
Sign and symptoms of psoriasis may vary from person to person depending upon the type of psoriasis and age group.
- Symptoms of Dry itch skin with cracks, which may bleed too.
- Red skin patches covered with thick silvery scales.
- Soreness, itching and burning sensation around patches.
- Pitted, thick or ridged nails.
- Swollen, painful, stiff joints.
Any of these symptoms may stay for few days and then may clear up unnoticeably. But after few days or weeks symptoms may appear again.The reason may be psoriasis triggers.
Is It Scalp Psoriasis Or Dandruff
More than half of all psoriasis patients have scalp psoriasis, according to the NPF. Itchy plaques can extend beyond the hairline onto the forehead, neck, and around the ears.
“Most people with scalp psoriasis have it on other parts of their body as well,” says Dina D. Strachan, MD, a dermatologist and assistant clinical professor of dermatology at NYU Langone Medical Center in New York City.
Scalp psoriasis is sometimes confused with seborrheic dermatitis, or dandruff. According to Dr. Strachan, dandruff which causes a flaky, itchy scalp without signs of inflammation tends to itch more than scalp psoriasis. It has a greasy-appearing yellow scale, Strachan says. In contrast, psoriasis whether it’s on your scalp or any other body part tends to have a thick, silvery scale.”
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