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Psoriasis Medications

Medical Treatment of Psoriasis
Topical Agents
Systemic Agents
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Psoriasis - on WebMD

Medical Treatment of Psoriasis

No cure for psoriasis exists, but a number of good treatment options are available to control the skin lesions. Any approach to the treatment of psoriasis must be considered for the long term. Three basic types of treatments of psoriasis exist: topical agents (drugs applied to the skin), phototherapy (light therapy), and systemic agents (drugs taken within the body). 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 have been used to treat adults with psoriasis:

Topical agents: Medications applied directly to the skin are the first course of treatment options. The main topical treatments are corticosteroids (cortisonelike creams, gels, liquids, sprays, or ointments), 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 or loses potency 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): 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. Medical light sources use special wavelengths 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 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. 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.
- 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 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 2-3 times per week on an outpatient basis, with maintenance treatments every 2-4 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 age 12 years.

Systemic agents (drugs taken within the body): These drugs are started only after both topical treatment and phototherapy have failed. Systemic agents may be considered for very active psoriatic arthritis. People whose disease is disabling because of physical, psychological, social, or economic reasons may also be considered for systemic treatment.