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.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
Initial treatment consists of NSAIDs for your joints and creams or ointments for your skin. In many people, this is enough to control symptoms. A few people may experience worse skin symptoms from the NSAID they are taking. In this case, the doctor will prescribe a different NSAID.
There are three basic types of treatments for psoriasis: (1) topical therapy (drugs used on the skin), (2) phototherapy (light therapy), and (3) systemic therapy (drugs taken into the body). All of these treatments may be used alone or in combination.
Topical agents: Medications applied directly to the skin are the first course of treatment options. The main topical treatments are corticosteroids, vitamin D-3 derivatives, coal tar, anthralin, or retinoids. There isn't one topical drug that is best for all people with psoriasis. Because each drug has specific adverse effects, it is common to rotate them. Sometimes drugs are combined with other drugs to make a preparation that is more helpful than an individual topical medication. For example, keratolytics (substances used to break down scales or excess skin cells) are often added to these preparations. Some drugs are incompatible with the active ingredients of these preparations. For example, salicylic acid (a component of
aspirin) inactivates calcipotriene (form of
vitamin D-3). On the other hand, drugs such as anthralin (tree bark extract) may require addition of salicylic acid to work effectively.
Phototherapy (light therapy): The ultraviolet (UV) light from the sun slows the production of skin cells and reduces inflammation. Sunlight helps reduce psoriasis symptoms in some people. If psoriasis is widespread, as defined by more patches than can easily be counted, then artificial light therapy may be used. Resistance to topical treatment is another indication for light therapy. Proper facilities are required for the two main forms of light therapy. The medical light source in a physician's office is not the same as the light sources generally found in tanning salons.
UV-B: Ultraviolet B (UV-B) light is used to treat psoriasis. UV-B is light with wavelengths of 290-320 nanometers (nm). (The visible light range is 400-700 nm.) UV-B therapy is usually combined with one or more topical treatments. UV-B phototherapy is extremely effective for treating moderate-to-severe plaque psoriasis. The major drawbacks of this therapy are the time commitment required for treatments and the accessibility of UV-B equipment. New UVB lasers are also available for the treatment of localized plaques of psoriasis.
The Goeckerman regimen uses coal tar followed by UV-B exposure and has been shown to cause remission in more than 80% of patients. Patients may complain of the strong odor when coal tar is added.
In the Ingram method, the drug anthralin is applied to the skin after a tar bath and UV-B treatment.
UV-B therapy is usually combined with the topical application of corticosteroids, calcipotriene (Dovonex), tazarotene (Tazorac), or creams or ointments that soothe and soften the skin.
PUVA: PUVA is the therapy that combines a psoralen drug with ultraviolet A (UV-A) light therapy. Psoralen drugs make the skin more sensitive to light and the sun. Methoxsalen is a psoralen that is taken by mouth several hours before UV-A light therapy. UV-A is light with wavelengths of 320-400 nm. More than 85% of patients report relief of disease symptoms with 20-30 treatments. Therapy is usually given
two to three times per week on an outpatient basis, with maintenance treatments every
two to four weeks until remission. Adverse effects of PUVA therapy include nausea, itching, and burning. Long-term complications include increased risks of sensitivity to the sun, sunburn, skin cancer, and cataracts.
Systemic agents (drugs that spread throughout the body):
These drugs are generally started only after both topical treatment and
phototherapy have failed. Systemic agents may be considered for active psoriatic
In some cases, your doctor may inject your joint with a steroid
cortisone medication to relieve inflammation.