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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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Topical medications effective for psoriasis available by prescription include those that contain topical steroids of various potencies, tar, and vitamin D-like molecules (calcipotriol [Taclonex]/calcipotriene [Dovonex]). Ultraviolet light administered under controlled conditions in a physician's office in various wavelengths (narrow-band UVB) with or without supplemental medication (8-methoxypsoralen) (PUVA treatment) is a very effective therapy. Systemic therapies include a vitamin A-like drug, acitretin (Soriatane), short-term cyclosporine (Gengraf, Neoral, Sandimmune) therapy for severe flares, and methotrexate (Rheumatrex Dose Pack, Trexall). New and very expensive targeted drugs (etanercept [Enbrel], adalimumab [Humira], infliximab [Remicade], ustekinumab [Stelara]) are now available. These newer products have been termed "biologics" because they are produced by new technologies requiring their synthesis by living cells. They are proteins and all currently must be given by injection at various intervals into the subcutaneous tissue by the patient or by intravenous infusion in a medical facility. They are unique in that they have precise targets in the immune system that they block. Since the biologics are very, very specific in their mode of action, they claim to offer increased safety and improved efficacy over older less specific immunosuppressive drugs.

All of these treatments must be continued indefinitely because when they are stopped, the psoriasis will typically return. It has recently been appreciated that the presence of psoriasis is a sign of a systemic inflammatory predisposition. Patient with psoriasis are predisposed to being obese, having diabetes, and having a destructive arthritis and premature cardiovascular disease.

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