Psoriasis - Medications

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Wednesday, 28 November 2007

Medications applied to the skin or taken by mouth are usually used to treat psoriasis. For moderate or severe cases, topical and oral medications may be combined with exposure to sunlight or ultraviolet (UV) light. In rare cases, medications may be injected into a psoriasis sore or patch.

Softening and removing psoriasis crusts and scale can help creams and other skin products be absorbed into the skin. Psoriasis crusts can be removed by gently rubbing cream into the crusts to soften them and then carefully peeling the crusted patches off. However, this should be done with great care so that the skin is not irritated.

Scalp and nail psoriasis can be difficult to treat. Both conditions are more likely to improve with oral medication. Treatment for the scalp often includes tar shampoos, corticosteroid solutions, or zinc and selenium sulfide shampoos.

If you are taking topical or oral medications for psoriasis, you will need regular follow-up visits with your doctor to check for possible side effects or skin cancer. You may take one medication for a while, then switch to another to reduce the chance that a serious side effect will occur.

Occlusion

The occlusion treatment method uses moisturizers or medicated creams or gels applied to the skin. After the products are applied, the skin is then wrapped with tape, material, or plastic. Occlusion keeps the area moist and can increase the effectiveness of medicated creams. Steroid cream may be used with the occlusion treatment method for small areas, but not for more than a few days.⁵ Occlusion of large areas may cause side effects such as thinning of the skin.

Medication Choices

Topical medications to treat psoriasis include:

Corticosteroids. Corticosteroids are the most common treatment for psoriasis.¹⁰
Calcipotriene, which contains vitamin D₃.
Retinoids, including tazarotene and acitretin.
Anthralin and tars. The use of anthralin and tars has decreased recently, replaced by other medications such as calcipotriene and tazarotene.⁵
Zinc pyrithione. Zinc pyrithione (for example, Derma-Cap) is a new product available without a prescription that comes in spray, soap, or solution form. It is used to treat small patches of psoriasis and symptoms, including itching, redness, flaking, and scaling of the skin. It is also used to treat psoriasis of the scalp. For some people, it appears to eliminate scales and sores caused by psoriasis. Very few studies of zinc pyrithione have been completed.

Oral medications to treat psoriasis include:

Retinoids.
Cyclosporine.
Methotrexate.

Newer medicines, approved by the U.S. Food and Drug Administration (FDA) for treatment of psoriasis, are available. Biologics, which must be injected, modify the immune system response that produces the symptoms of psoriasis. Early clinical trials of biologic therapies for moderate to severe psoriasis have produced promising results, but the drugs are expensive and long-term effects are not known.^11,¹²

Alefacept (Amevive), efalizumab (Raptiva), and etanercept (Enbrel) have been approved by the FDA for treatment of moderate to severe psoriasis.
Infliximab (Remicade), which is used to treat other inflammatory diseases such as rheumatoid arthritis, is beginning to be used for psoriasis with good results.¹¹
Etanercept, infliximab, and adalimumab (Humira) have been approved to treat psoriatic arthritis.

In general, treatment for psoriasis starts with topical medications, such as corticosteroids, calcipotriene, and tazarotene.⁵ These medications may be used alone or in combination.

If these medications are unsuccessful, phototherapy or psoralens plus ultraviolet A (PUVA) may be used.
If the above treatments are not successful, oral medications, such as cyclosporine, may be tried.

For severe cases of psoriasis, certain medications (such as tars, anthralin, calcipotriene, tazarotene, and psoralens) may be combined with exposure to ultraviolet (UV) light. Examples include combinations of:

Psoralen and UVA light (called PUVA).
Tars and UVB light (called Goeckerman treatment).
Anthralin and UVB light (called the Ingram regimen).

Treatments that are known to be effective for psoriasis include calcipotriol (made from vitamin D) and PUVA. Other treatments, including tazarotene, etanercept, and UVB phototherapy, are likely to help, but research is less clear. While topical corticosteroids, the most common treatment for psoriasis, may be effective, they also may be harmful if not used carefully according to directions.¹³ The new biologic therapies have been shown to be effective in the short term, but no long-term results are available yet.

What To Think About

People respond differently to psoriasis treatments. A treatment that worked once may not work again. A treatment that didn't work the first time may work when tried again later.

Many oral medications for psoriasis have serious side effects, such as liver and kidney damage or cancer. Be sure that the treatment you choose does not have side effects that are more dangerous than the condition you are treating.

You and your doctor will need to discuss how long to use treatments that have serious potential side effects. You will also need to see your doctor frequently and may have blood tests regularly while using some medications.

Many medications used to treat psoriasis are not safe during pregnancy. If you are pregnant, talk to your doctor before taking any medications.

Researchers are studying other drugs for their safety and effectiveness in treating psoriasis. These include drugs that alter the immune system and some used to treat cancer.

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VitaDocs Medical Reference from Healthwise

Last Updated: January 06, 2006

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