how is psoriasis treated?
There is no cure for psoriasis, which means that we cannot give a single treatment to make it go away forever. However, there are many treatments that are highly effective, and most patients can achieve ‘normal-looking’ skin. Psoriasis does not scar but can leave post-inflammatory pigmentation.
There are a variety of treatments for psoriasis, which come in different forms. A GP or dermatologist will recommend the treatment that is best for you.
Treatment of psoriasis starts with avoiding the triggers that can make it worse, such as:
- Stress can cause psoriasis to flare up for the first time or can aggravate existing psoriasis.
- Damage to the skin can cause psoriasis to appear in these areas. Examples include sunburn, cuts, and scratches.
- Medications can worsen psoriasis, including lithium, antimalarial drugs, certain heart medications (‘beta-blockers’), some anti-inflammatory drugs, and some blood pressure medications.
- Infections by bacteria and certain viruses can trigger psoriasis for the first time or aggravate existing disease.
- Changes in hormones, such as in pregnancy, can cause changes in psoriasis severity.
- Smoking increases the risk of developing psoriasis and its severity.
Topical treatments are those applied directly to the skin.
- Moisturisers (emollients) help to reduce the build-up of scale and itch. They may also help increase the effectiveness of other topical treatments.
- Steroid (cortisone) creams, ointments, gels, lotions and shampoos come in a variety of strengths and help reduce inflammation, thickness, and scale.
- Vitamin D analogue (Calcipotriol) preparations are available as topical treatments, combined with steroid in the form of gels, ointments and foam spray. Calcipotriol and steroid combination treatment is effective in reducing inflammation, thickness and scale.
- Tar-based soaps, bath oils, shampoos and creams can help reduce inflammation, itch and scale. Some may be mixed with a weak acid to help dissolve scale.
Phototherapy or ultraviolet (UV) therapy mimics the beneficial effect of sunlight on psoriasis. There are two types:
- Narrow-band UVB is the more commonly used form of phototherapy. Patients usually visit a treatment centre with a UV machine two to three times per week for a treatment course of two to three months.
- Psoralen and UVA (PUVA) combines psoralen (a treatment that makes the skin more sensitive to light) in either a tablet, ointment or bath form with UVA light. Availability is limited.
There are also several treatments taken by mouth, which are mainly used when topical treatments have failed or when there is a large amount of skin affected:
- Methotrexate is the most commonly prescribed oral treatment for psoriasis. It is given weekly as a tablet and works by suppressing and modulating the immune system. It is also available as an injection. Methotrexate can be useful in both psoriasis of the skin and joints.
- Acitretin is a type of vitamin A, which works by slowing down how fast the skin replaces itself, which reduces thickness and scale. Acitretin is sometimes used in combination with phototherapy (ultraviolet light therapy). Acitretin can cause birth defects and hence is not used in women of child-bearing age.
- Cyclosporin is a medication which suppresses the immune system and is used for short periods of time for severe psoriasis.
- Apremilast is a medication that modulates the immune system. It is taken by mouth. Sometimes it may cause gastrointestinal side effects or mood changes. It is available for patients who cannot tolerate, or who have not responded to, methotrexate treatment.
Biologics are the most recently developed treatments for psoriasis. These treatments are given as injections, which can be self-administered, at specified intervals.
Biologic treatments work by blocking specific pathways of the immune system in a targeted way. Biologic treatments are often very effective in treating psoriasis; however, they are not curative and are long-term, ongoing treatments.
Because they are newer treatments, some of the effects of long-term treatment are still being studied, and they are only used where other treatments have failed. PBS Australia has strict criteria that must be met before biologics can be prescribed by a dermatologist.
Want to learn more about psoriasis? Check out our Psoriasis Awareness Hub