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.
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.
No cure for psoriasis exists, but a number of good treatment options are available to control the skin lesions. Since this disease is incurable, psoriasis control must be considered for the long-term. The spectrum of treatment options depends on the extent and severity of the disease: topical agents (drugs applied to the skin), phototherapy (controlled exposure to ultraviolet light), and systemic agents (orally or percutaneously administered agents). All of these treatments may be used alone or in combination with one another. Psoriasis in children younger than age 15 is extremely rare; therefore, the following treatments are confined to adult use.
Topical agents: Medications applied directly to the psoriatic skin lesions are the safest approaches to treatment but is only practical if treating localized disease. The main topical treatments are corticosteroids (in vehicles such as foams, creams, gels, liquids, sprays, or ointments), vitamin D-3 derivatives, coal tar, anthralin, or retinoids (vitamin A analogs). There isn't one topical drug that is best for all people with psoriasis. Because each drug has adverse effects or becomes less effective over time, it is common to rotate them. Sometimes topical preparations are combined together. For example, keratolytics (substances used to break down scales or excess skin cells) are often added to these preparations. Some preparations should never be mixed together because they interfere with each other. For example, salicylic acid inactivates calcipotriene cream or ointment (a 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): Ultraviolet (UV) light, a portion of the sunlight spectrum with wavelengths between 290-400 nm, can have beneficial effects on psoriatic skin presumably by altering certain immune functions. Disease considered too extensive to be treated by topical approaches is usually greater than 5%-10% of the total body surface area is an appropriate indication for this sort of treatment. Resistance to topical treatment is another indication for light therapy. Although normal sunlight contains these wavelengths, self-exposure to sunlight must be done in under controlled conditions to minimize the potential problems. In a physician's office, proper facilities are required to administer the two main forms of light therapy. Medical light sources use special wavelengths of light and timers to assure the correct dosage of light. Sunlamps and tanning booths are usually not acceptable substitutes for medical light sources.
UV-B: Ultraviolet B
(UV-B) light is used to treat psoriasis. UV-B is light with wavelengths of
290-320 nanometers (nm), shorter than the range of visible light. (Visible
light ranges from 400-700 nm.) UV-B therapy may 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. With long-term use, there is a risk of skin cancer, just as there is from natural sunlight.
The Goeckerman regimen uses coal tar followed by UV-B exposure and has been shown to give improvement in more than 80% of patients. When coal tar is added, it has a strong odor from the tar and this limits its popularity.
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.
Narrow-band UVB light sources produce wavelengths of ultraviolet light about 313 nm which seem to be particularly effective for controlling psoriatic plaques while minimizing side effects. It rivals PUVA in its efficacy.
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 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. Protective glasses must be worn during and after treatment to prevent cataracts. PUVA therapy is not used for children younger than 12 years
Systemic agents (drugs taken within the body): These drugs are started only after both topical treatment and phototherapy have been carefully considered. Certain systemic agents are also very effective in controlling psoriatic arthritis. People whose disease is disabling because of physical, psychological, social, or economic reasons may also be considered for systemic treatment.
Currently there is no cure for psoriasis. But many types of treatment are
available, including products applied to the skin, phototherapy, and oral
medicines, which can help control psoriasis. Most cases are mild and can be
treated with skin products. In some cases, psoriasis can be hard to treat if it
is severe and widespread. Most psoriasis returns, even mild forms.
The purpose of treatment is to slow the rapid growth of skin cells that
causes psoriasis and to reduce inflammation. Treatment is based on the type of
psoriasis you have, its location, its severity, and your age and overall health.