Treatment Options

Based on the most current research and data, psoriasis is now understood as a non-contagious, chronic inflammatory auto immune whole life disease that manifests in the skin, joints and other organs as associated co-morbities. These could be psoriatic arthritis, cardiovascular disease, diabetes, depression, obesity, metabolic syndrome and other immune-related conditions such as Crohn’s disease and lymphoma.

It is important for people to know that it can greatly affect a patient’s quality of life. Severity can range from mild to moderate to severe, often determined by a percentage of body area affected. Treatments are often chosen based on the type and severity of the psoriasis for a patient. A combination of treatments is also a common approach, but generally doctors will begin patients on a mild treatment.

Despite a wide-range of options, psoriasis can be a challenging disease to treat and live with; educate yourself about your disease and how best to manage it.
There are many ways to treat psoriasis and what works for one person may not work for another. It is important to keep working with your doctor until you find the treatment plan that reduces or eliminates your symptoms. Since there is currently no cure for psoriasis, the goal is to attain remission (period in the course of a disease when symptoms become less severe or disappear). With each treatment or treatment combination that you try, keep track of the medication and the dosage, keep track of its effects and of any side effects. Ask your doctor how long before you should see a change in your symptoms or know that the treatment is not working effectively for you.

The new CPN brochure, “Understanding Your Treatment Options” is now available.

Click to view the CPN Treatments Brochure.

Determining the most appropriate treatment is very individual and based on the type and severity of disease, how large or widespread plaques are, on what the patient agrees to use based on benefits and risks and how well a patient responds to a given treatment.

Prescription or over-the-counter? Spray, ointment or cream? Light treatment or injections? Remember, when you find an effective treatment, it’s important to stick with it. Even if the treatment is not effective immediately, it is still important to stick with it to determine if it is effective. Just because the condition clears does not mean you should stop the therapy. Whatever treatment your doctor prescribes, staying with it may mean longer periods between flares. DO accept that it may take some trial and error to find what works best for you, as a particular treatment may be appropriate for one person but not another. DO get to know the triggers of your psoriasis. Triggers may often include emotional stress, injury to the skin, some types of infections and reaction to certain drugs. Whatever the cause, know which triggers affect you so you can protect yourself and be prepared to deal with them.

While there is no cure for Psoriasis, a wide variety of treatment options exist for people living with the inflammatory disease. Treatments are usually categorized into three groups: topical, light- or photo- therapy and systemic. There are also lifestyle options for patients that can help alleviate symptoms for some people.

Despite a wide-range of options, psoriasis can be a challenging disease to treat and live with; educate yourself about your disease and how best to combat it.

Psoriasis and Lifestyle

  • Take daily baths with warm water and gentle cleansers to help calm the skin and remove scaling. Avoid hot water; soak for at least 15 minutes.
  • Pat your skin gently dry after bathing, then immediately apply a heavy, ointment-based moisturizer while your skin is still moist. For very dry skin, oils may be preferable — they have more staying power than creams or lotions do and are more effective at preventing water from evaporating from your skin. During cold, dry weather, you may need to apply moisturizer several times a day.
  • Find out what causes, if any, worsen your psoriasis by diarizing the things that happen before a flare up. If you see any patterns emerge, try to prevent or avoid them. Infections, injuries to your skin, stress, smoking and intense sun exposure can all worsen psoriasis.
  • Limit or eliminate alcohol consumption, which is known to cause flare-ups or interfere with psoriasis treatments.
  • Experts agree that quitting smoking is one of the best things you can do to care for your psoriasis. Don’t forget that quitting also lowers your risk of heart disease, and a host of other health conditionsAlthough there’s no evidence that certain foods will effect psoriasis, it’s important to eat a healthy diet, especially when you have a chronic disease. A healthy diet includes eating a variety of fruits and vegetables of all colors and whole grains. If you eat meat, focus on lean cuts and fish. Incorporate low-fat dairy options and drink lots of water.

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Types of Treatments

Topicals

Topical treatments such as creams and ointments are usually recommended first, particularly for mild psoriasis. The aim is primarily to slow down and regulate skin cell turnover, reduce inflammation and suppress the immune system. Topicals are often used in combination with other treatments. Applied to the skin as a lotion, spray, cream, ointment or shampoo, they can slow down cell reproduction and reduce inflammation. Some require a prescription; others don’t. When the disease is more severe, creams are likely to be combined with oral medications or light therapy.

Anthralin

This medication also normalizes DNA activity in the skin as well as removing scale, to keep the skin smooth. It is not easy to use, because it will stain everything, such as clothing, bedding, countertops and your skin. Due to this staining problem, often people are told to apply it temporarily and then wash it off.

Coal Tar

Coal tar is likely the oldest known treatment for psoriasis, resulting as a by-product from the manufacture of coal and petroleum products. It helps reduce scaling, irritation and itching, but how it works is a mystery. It is very messy, stains clothing and bedding and has a pungent smell. It is commonly found in shampoos, creams and oils.

Corticosteroids

Creams, lotions or ointments containing corticosteroids are powerful anti-inflammatories that, when applied to the affected areas of the skin help reduce itching, irritation and redness. They also slow cell turnover and help reduce the build-up of plaques. Prolonged use can cause a thinning of the skin and your body can resist its effects. Typically, corticosteroids are only used off and on to help keep symptoms under control.

Reinoids

These are vitamin A derivatives believed to normalize DNA activity in skin cells. The most common side effect is skin irritation, but using it topically also increases the skin’s sensitivity to sunlight. Care must be taken to ensure skin is protected from the sun.

Salicylic Acid

This is available over the counter and by prescription. It promotes the sloughing of dead skin cells, which prevents the build of up plaques. Most often, salicylic acid is found in shampoos or lotions to treat scalp psoriasis.

Vitamin D Analogue

These are creams or ointments containing synthetic forms of vitamin D. Their purpose is to slow down the growth of skin cells. Calcipotriene (Dovonex) is a prescription cream or solution containing a vitamin D analogue that may be used alone to treat mild to moderate psoriasis or in combination with other topical medications or phototherapy. This treatment can irritate the skin. Calcitriol (Rocaltrol) may be equally effective and possibly less irritating than Calcipotriene.

Light Therapy

As the name suggests, this psoriasis treatment uses natural or artificial ultraviolet light. The simplest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light. In any form, the light treatment is only effective if the patient gets short-exposure – burns and skin damage can worsen psoriasis symptoms.

Phototherapy requires repeated exposure of the skin to ultraviolet light, using one of several techniques. The procedure is done under medical supervision and may be advised when topicals alone are not effective. A dermatologist will know if this treatment is right for you. Exposure tosunlight and water can help, too. The sun’s ultraviolet rays slow the growth of skin cells and water helps soften lesions.

Laser Light Therapy

Excimer or pulsed-dye lasers can be used to treat psoriasis. The laser light is directed only at the affected areas of the skin. Excimer laser uses controlled UVB light whereas pulsed-dye lasers kill tiny blood vessels thought to contribute to psoriasis patches.

PUVA Photochemotherapy

Photochemotherapy comprises taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure. This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. PUVA involves two or three treatments a week for a prescribed number of weeks. UVA is often administered in a stand-up booth at a medical clinic or office.

UVB Phototherapy

UVB light therapy can be narrow-band or broad-band treatment. Narrow-band is typically more effective than broad-band. Both are administered using artificial light sources in a bed or booth, often located at a medical clinic or office.

Systemics

The Canadian Psoriasis Network has taken the position that Subsequent Entry Biologics, also known as biosimilars, must be studied, tested and regulated as any new drug entering the Canadian market. While we are supportive of effective treatment for psoriasis and psoriatic arthritis, no treatment must be interchangeable with another unless they are 100% exact as required by law with generic drugs. Systemic medications are available by prescription only. Taken by mouth or by injection or infusion, they affect the entire body.

Within this category are newer drugs called biologics, which block psoriasis early in its development— in the immune system. Be sure to work with your doctor when considering a treatment plan. Your doctor will be able to assess your needs and suggest a therapy that will work best based on your condition.

Cyclosporine

Cyclosporine taken orally suppresses the immune system and is similar to methotrexate in effectiveness. Like other immunosuppressant drugs, cyclosporine increases your risk of infection and other health problems, including cancer.

Methotrexate

Taken orally, Methotrexate helps psoriasis by decreasing the production of skin cells and suppressing inflammation. It may slow the progression of psoriatic arthritis in some people. Methotrexate is generally well tolerated in low doses, but may cause upset stomach, loss of appetite and fatigue.

Oral Retinoids

Related to vitamin A, this group of drugs may reduce the production of skin cells if you have severe psoriasis that does not respond to other therapies. Signs and symptoms usually return once therapy is stopped.

Other Orals

Hydroxyurea and Thioguanine are nearly as effective as cyclosporine and methotrexate, but not as strong and have fewer side effects. Both can cause anemia and cannot be taken by pregnant women due to birth defect risks.

Biologics

Biologics, or immunomodulator drugs are approved for the treatment of moderate to severe psoriasis. These drugs are given by intravenous infusion, intramuscular injection or subcutaneous injection and are usually used for people who have failed to respond to traditional therapy or who have associated psoriatic arthritis. Biologics work by blocking interactions between certain immune system cells and particular inflammatory pathways. Although they are derived from natural sources rather than chemical ones, they must be used with caution because they have strong effects on the immune system and may permit life-threatening infections.

Don't Give Up!

As with treatment options for any disease, there are side effects to consider. Take an active role in your treatment by asking questions and keeping your doctor informed of your concerns. Talk to your doctor about your options, especially if you are not seeing improvement after using a particular treatment or if you are having uncomfortable side effects. He or she can adjust your treatment plan or modify your approach to ensure the best possible control of your symptoms. Treatment goals are within your reach.