Psoriasis Treatment
Psoriasis is a condition that is easily controlled, but not cured. A variety of Psoriasis treatments are available, ranging from a change of lifestyle, to injectables.
1. Lifestyle
People who are fit, not overweight and who eat well tend to have less severe psoriasis. A reduction of alcohol intake and avoidance of stress are important in limiting the activity of psoriasis. There is some evidence that a specific psoriasis diet can help.
2. Allergies
Psoriasis is not an allergic condition and allergy testing is not appropriate.
3. Topical psoriasis treatments
Topical treatments are the mainstay of treatment for mild forms of psoriasis. It is best to use these intermittently when psoriasis patches are active. Topical psoriasis creams are not effective in widespread psoriasis due to the amount of cream that needs to be used and the inconvenience of applying it over large areas of the body.
- Topical corticosteroids – these are used widely for psoriasis. Topical corticosteroids are not designed for widespread use or long term use and the strength of the topical steroid used must be monitored. Topical corticosteroids are often combined with Coal Tar preparations to make them more effective. When appropriately used, they remain very effective for control of mild psoriasis.
- Vitamin D analogues – used by themselves or in combination with corticosteroids, these are very effective in the treatment of mild to moderate psoriasis. They can be used longer term.
- Emollients – emollients (moisturisers) are used to treat the dryness associated with psoriasis.
- Scalp psoriasis treatment – psoriasis on the scalp is a particularly troublesome and common form of psoriasis. Shampoos and cortisone scalp lotions are used, but are not effective for severe forms. Other treatments are available to be used in these cases, and this can be discussed with us, your dermatologists.
4. Phototherapy
Both UVA and UVB therapy is good for psoriasis due to its anti-inflammatory effect. Most patients with psoriasis note that in summertime with natural sun their psoriasis does improve. However, sun burn will aggravate psoriasis.
Phototherapy is normally delivered using light machines, which provide a safer more predictable exposure to either UVA or UVB. UVA therapy in the form of PUVA is not used often these days due to safety concerns and most forms of phototherapy are narrow band UVB. This is indicated for second-line treatment for more widespread forms of psoriasis and can be easily arranged at Wellington Dermatology.
5. Psoriasis Medication
Systemic treatment (oral therapy/pills) is warranted for more severe forms of psoriasis covering large areas of the body or for acute flares in psoriasis. They do not cure psoriasis, but provide good control for more severe forms. Ideally they should be used for periods of six to 12 months only. The most common systemic treatments used are:
- Acitretin
- Methotrexate
- Cyclosporin
While these are effective in more severe forms of psoriasis, they do have a number of side effects and issues associated with their use. It is best to talk about these with us, your dermatologists, to find out which is the most appropriate for your psoriasis.
6. Injectable treatments (biologics)
Biological agents are relatively new in the treatment of severe forms of psoriasis. They are more targeted therapies at suppressing the immune system causing psoriasis and are normally used in patients who are resistant to the above therapies. There are three funded biological agents available in New Zealand:
- Adalimumab
- Etanercept
- Infliximab
To qualify to have these funded, one must have tried the older systemic treatments first and have a psoriasis severity index score or PASI score of >15%. Biological agents have revolutionised the treatment of severe psoriasis and provide exceptional clearance rates as long as the treatment is continued. These agents are very powerful immune suppressing agents and the main concern with their use is an increased risk of infections. However, with up to 10 years’ experience of using these agents now, from a practical point of view, the concerns have not been a major issue.
