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How is psoriasis

How is psoriasis treated?

There are a variety of treatment options for psoriasis, some of which you can only access via specialist care.

You will usually be offered mild topical therapies at first (creams and ointments), moving on to stronger treatments dependent on severity, such as phototherapies, systemic non-biologic medications (drugs which work throughout the body), and finally, biologic medications which are created from living cells and target specific parts of the immune system known to be involved in psoriasis.

mild topical therapies psoriasis

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There are a wide variety of topical therapies, including:

  • Creams
  • Lotions
  • Gels
  • Ointments

These may include creams which hydrate the skin and stop it drying out (emollients), or other topical treatments (applied to the skin) which contain other helpful ingredients, including corticosteroids (though these can cause side effects, like thinning of the skin), vitamin D or coal tar.

If you’re taking corticosteroids, you should take breaks from applying these, and alternate with something that does not contain steroids, so you can control your symptoms when you’re taking a break. If you are unsure about how to properly take corticosteroids and alternate treatments, seek advice from your healthcare professional.

Topical therapies for psoriasis affecting the scalp may also include formulations such as mousses or shampoos, and some products remove the scaling of plaques, which can be applied before another treatment.

If your psoriasis has not improved as much as you or your healthcare professional would like with treatments applied to your skin, you may be offered short wave ultraviolet B (UVB) phototherapy 2-3 times a week. Ultraviolet light reduces skin inflammation which is why it could help with your psoriasis.

Another type of phototherapy you could be offered is long wave ultraviolet A (UVA) light in combination with a chemical called psoralen in tablet form, which increases the skin’s sensitivity to light. This is called P-UVA and is often used to treat pustules on the palms and soles of the feet, although it can’t be used in some people who are at a higher risk for skin cancers.

The first choice of systemic therapy you would usually be offered is methotrexate, which supresses an overactive immune system in psoriasis.

If you and your dermatologist decide methotrexate isn’t appropriate, or it isn’t effective, other options include:

  • Ciclosporin, another drug that suppresses the immune system.
  • Acitretin, which reduces how fast your skin grows.
  • Apremilast, which changes the way your body deals with inflammation.
  • Fumaric acid esters, which normalise the balance of cytokines in your body, which are chemicals related to the immune system.

Like all medications, each systemic therapy has specific benefits and risks; for example, methotrexate can cause liver problems and cannot be taken by people who are pregnant, have kidney problems, liver disease, or certain cancers.

All systemic therapies for psoriasis must be prescribed by a specialist dermatologist, who will discuss the type of medication with you and check if taking it is appropriate. If you have been prescribed a systemic therapy, you should be monitored for side effects and treatment response.

Because of the possibility of side effects, your dose should be started low and slowly increased until you reach the lowest dose that helps you with your symptoms.

Biologic medications are a type of systemic treatment that work throughout your body, primarily approved for treating plaque psoriasis. They are grown in a lab using living cells and target specific parts of the immune system. These should only be prescribed by a specialist dermatologist with experience treating psoriasis, although your symptoms and side effects may be monitored by a clinical nurse specialist.

In England, there are several biologics recommended for psoriasis, some are listed here:

  • Adalimumab
  • Etanercept
  • Infliximab
  • Ustekinumab
  • Secukinumab
  • Certolizumab
  • Ixekizumab
  • Guselkumab
  • Tildrakizumab
  • Risankizumab

Before being prescribed a biologic, your dermatologist will consider:

  • The severity of your psoriasis
  • If you have psoriatic arthritis
  • Your age
  • If you have other health conditions
  • Your body weight
  • If you have plans to become pregnant
  • Your views on what kind of treatment you would prefer and how often you wish to take medication

Most biologics for psoriasis are given by an injection under the skin, or in the case of infliximab, an infusion (into the veins). If you are going to be taking a biologic, you will be required to have blood tests before and during treatment. Like all medications, each biologic has specific benefits and risks, which you should discuss with your dermatologist before they prescribe one.

Living with psoriasis does not have to be a daily struggle; many different treatments and techniques can help you to control your symptoms. Speak to your healthcare professional about the options.

For more information, see Psoriasis symptom advice.

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