If you've been coping with psoriasis for a long time, you know that it is an unpredictable condition. Options that work for others may not work for you. And treatments that do work may lose their effectiveness over time. Keeping this in mind can help you maintain the positive attitude you'll need to meet the challenges you'll face.
Doctors typically treat psoriasis in steps, based on how severe it is, the areas involved, its form, and your past responses. Treatments include topical (applied to the skin) drugs, body-wide medications and phototherapy.
Mild to moderate cases of psoriasis often respond to topical treatments, including medicated lotions, ointments, creams, gels or shampoos. Some are available over the counter, but most require a prescription. These are commonly recommended medications.
If your psoriasis is moderate or severe, or has resisted other types of treatment, your doctor may suggest medications that treat your entire system. Taken orally, by injection or by IV infusion, these medications fall into two broad categories:
- Systemics. These drugs work with the immune system to control skin cell production. They can have serious side effects, so your doctor will monitor you carefully during therapy.
- Biologics. Derived from proteins, these drugs treat moderate to severe psoriasis by blocking interactions between immune cells. Because biologics have only recently been developed, their long-term side effects aren't yet known.
This approach uses ultraviolet (UV) light to treat moderate to severe psoriasis. It's often helpful when topical treatments don't work and can be used in combination with medications. There are three basic types of phototherapy:
- Ultraviolet B (UVB). Here, your skin is exposed to UVB rays generated from a special lamp or laser. The exposure causes reactions in skin cells that decrease their overproduction and help clear up plaques. Broadband UVB is effective for everything from a few small lesions to widespread psoriasis, but requires frequent treatments at a doctor's office. (Some patients use UVB light boxes at home, following their doctors' instructions.) Not as widely available, narrowband UVB emits a more specific range of UV wavelengths and may clear psoriasis more quickly.
- Psoralen and ultraviolet A (PUVA). You'll first either ingest, apply topically or bathe in a drug called psoralen, then undergo UVA exposure. Psoralen makes the skin more sensitive to UVA light, which penetrates deeper into the skin than UVB. The combination slows skin cell growth and kills T cells in both plaque and guttate types of psoriasis. It's often used for psoriasis on the palms of the hands or soles of the feet.
- Excimer laser. A controlled beam of UVB light targets only affected areas, reducing inflammation and fast-growing skin cells. Excimer laser therapy requires fewer sessions, but is only practical for people with very mild, localized disease.