1. Moderate to Severe Psoriasis Slideshow
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Medical Author:

Gary W. Cole, MD, FAAD

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.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

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.

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Usually, this type of psoriasis goes away in a few weeks without treatment. Simple reassurance and moisturizers to soften the skin may be sufficient care. The choice of treatment depends on the severity of the outbreak and the individual's preferences. For example, applying topical steroids, although effective, could be bothersome because the outbreak occurs over a large portion of the body in most cases of guttate psoriasis.

• Antibiotics: If you have a history of psoriasis, the doctor will most likely take a throat culture when you have a sore throat. If the culture results are positive (meaning that you have a streptococcal infection), then starting immediately on antibiotics for the infection is very helpful. See Medications.
• Phototherapy: Sunlight can help clear up this type of psoriasis. The ultraviolet (UV) light in sunlight helps to reduce psoriasis symptoms in some people.

The doctor may prescribe a short course of artificial light therapy (phototherapy). Broadband ultraviolet B or narrowband ultraviolet B light may be used.

More resistant cases may benefit from PUVA therapy, which combines a psoralen drug with exposure to ultraviolet A light. Psoralen drugs make the skin sensitive to the sun. The drug is taken a few hours before the light therapy. Precautions need to be taken to prevent exposure to the sun for 24 hours after treatment because the skin is sensitive to the sun. Aside from the usual way in which UV light functions to reduce psoriasis symptoms, an increase in a type of white blood cells (mast cells) has been observed in guttate psoriasis. This may be part of the reason that ultraviolet light clears up lesions. For more information on psoralen drugs, see Understanding Psoriasis Medications.

People using PUVA therapy may experience a number of adverse effects, such as nausea and vomiting. These effects are sometimes remedied by taking psoralen pills after a meal. The sensitivity to the sun persists up to 24 hours after someone takes the drug. The person on PUVA therapy should wear special sunglasses and should avoid sun exposure during this treatment period.

Narrowband UVB phototherapy is relatively new compared with PUVA therapy, and it may show similar satisfying results without taking oral medicines with the treatments.

It is probably advisable to avoid the ultraviolet wavelengths provided in tanning salons because these rays are less beneficial than those of PUVA therapy and more expensive than ordinary sunlight.

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