Psoriasis Treatments

Generally speaking, there are three categories of treatments for psoriasis: topical, phototherapy, and systemic.

Topical Treatments for Psoriasis

Topical psoriasis treatments are most often appropriate and effective when there are a few, localized areas of involvement. For example, a few plaques the size of a dollar bill or smaller plaques scattered on an arm or back.  If the psoriasis is too wide spread – a number of small papules or plaques scattered over the arms and legs or trunk, or if the psoriasis is more extensive (practically speaking, if more than 5% of the body surface is affected – roughly five hand sized plaques over the body), topical therapies are less effective or less acceptable as treatments.

Phototherapy for Psoriasis

Phototherapy uses ultraviolet light to suppress psoriasis.  While phototherapy can be used for people with very extensive psoriasis, phototherapy is often used for psoriasis which is scattered over the body or psoriasis which involves difficult to treat areas such as palms and soles.  Inconvenience, the potential for “sun burns”, and the possible increased risk of skin cancers are the main cons of phototherapy.  On the other hand, phototherapy can work very well and can be used to control psoriasis for long periods of time.

Systemic Treatments for Psoriasis

Systemic therapy comes in two forms: small molecules and biologics.  Systemic therapy is most useful for extensive psoriasis, difficult to treat psoriasis – meaning not very responsive to either topical treatments or phototherapy.  Small molecules are taken as injections or pills.  The small molecules that are currently available include neo-tegison, methotrexate, and cyclosporine.  Because the current list of small molecules were developed before modern clinical research, we are uncertain about their optimal use and potential side-effects.  Generally, neo-tegison works well but only at higher doses where it is not easily tolerated: dry skin, dry and cracked lips, hair loss, and aching joints.  Methotrexate works well 1/3 of the time, does not work well 1/3 of the time and is not tolerated 1/3 of the time.  I suggest reading the relevant chapter in the Canadian Guide to Psoriasis to get more information on the pros and cons of methotrexate.  While cyclosporine works very well for treating psoriasis, it has many potential side-effects and should only be prescribed by physicians experienced with its use.  Again, The Canadian Guide to Psoriasis is a good resource.

Biologics are so called because they are produced by living cells and ultra-purified.  They can only be given by injection.  The biologics currently available for psoriasis include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira) and ustekinumab (Stelara).  All the biologics work well for treating psoriasis.  Because they are very specialized medications, they should be prescribed only by a specialist knowledgeable about biologics.

The Canadian Guide to Psoriasis is a great resource with more detailed information about treatments for psoriasis.

What Happens if I Don't Do Anything about My Psoriasis?

Psoriasis can be uncomfortable and unsightly. Whether it does anything else to the body if untreated, we do not know.

About 1/3 of people with psoriasis develop psoriatic arthritis. We do not know if early treatment could prevent the arthritis.

We know that people with psoriasis are more likely to develop diabetes, high blood pressure, and elevated cholesterol. We also know that people with psoriasis are more likely to suffer heart attacks. We still do not know if treatment will prevent diabetes or reduce the risk of heart attacks.

What Are My Psoriasis Treatment Options?

Finally, we can understand why some treatments work and others do not. Any effective treatment must affect the immune response: interfere with T-cell activity, interfere with cell trafficking into skin, or interfere with cell activity in the skin. The treatment must affect cells directly or affect the signals. All effective treatments that we know of alter the immune response by stopping or eliminating the cells involved or by altering or blocking cytokine signals.

Knowing the process is only part of the solution. With each new treatment carries a better understanding, and with better understanding comes the hope of finding a new and better therapy; one that will provide more relief, largely more effective, and softer than the others. Research for us must continue. Each new therapy brings us a little closer to the ultimate goal - cure or prevention.

In 1992, Dr. Kim Papp, established a clinical research centre located in Kitchener-Waterloo, Ontario. To learn more about Dr. Papp's research and ongoing studies for psoriasis visit: - K. Papp Clinical Research.

For more information on psoriasis please visit: Psoriasis

National Psoriasis Foundation: