• Treatments for psoriasis try to slow down the growth of skin cells and eliminate scales. Topical therapy (creams and ointments), phototherapy (light therapy), and oral or injectable medicines are all options.
  
• The type of treatment you use is determined by the severity of your psoriasis and how well it responded to previous therapies. Before you find a treatment that works for you, you may need to try a variety of medications or a combination of treatments, as the sickness usually reappears.

Topical therapy: 

Corticosteroids. These are the most commonly prescribed psoriasis treatments for mild to moderate psoriasis. Ointments, creams, lotions, gels, foams, sprays, and shampoos are all available. Mild corticosteroid ointments (hydrocortisone) are frequently used for delicate areas including the face and skin folds, as well as for treating large patches. During flares, topical corticosteroids may be administered once a day, but only on alternate days or weekends to maintain remission. 

For smaller, less-sensitive, or difficult-to-treat regions, your doctor may prescribe a stronger corticosteroid cream or ointment, such as triamcinolone (Acetonide, Trianex), or clobetasol (Temovate). Strong corticosteroids can thin the skin if used for a long time or in excess. Topical corticosteroids may lose their effectiveness over time.

Analogues of vitamin D. Skin cell growth is slowed by synthetic versions of vitamin D, such as calcipotriene and calcitriol (Vectical). This medication can be used alone or in combination with topical corticosteroids. In sensitive locations, calcitriol may produce less irritation. Topical corticosteroids are frequently more expensive than calcipotriene and calcitriol.

Retinoids. Tazarotene (Tazorac, Avage) is a gel or cream that can be used once or twice a day. Skin discomfort and increased sensitivity to light are the most typical side effects.

Tazarotene should not be used if you are pregnant, breastfeeding, or planning to become pregnant.

Inhibitors of calcineurin. Calcineurin inhibitors like tacrolimus (Protopic) and pimecrolimus (Elidel) lower inflammation and plaque formation. They're especially useful in regions with thin skin, such as around the eyes, where steroid creams or retinoids might irritate or injure the skin.

Calcineurin inhibitors should not be used if you are pregnant, breastfeeding, or planning to become pregnant. Because of the increased risk of skin cancer and lymphoma, this medicine is not recommended for long-term usage.

Salicylic acid. Salicylic acid is a kind of salicylic acid. Shampoos and scalp treatments containing salicylic acid help to minimize scalp psoriasis scaling. It can be taken on its own or in combination with other treatments to help them penetrate the skin more easily.

Coal tar. Scaling, irritation, and inflammation are all reduced by coal tar. It comes in a variety of forms, including shampoo, lotion, and oil, and is accessible over-the-counter or by prescription. These products have the potential to irritate the skin. Coal tar will stain clothing and bedding it comes in contact with and has a strong smell you may find unpleasant.

Women who are pregnant or breastfeeding should avoid coal tar treatment.

Goeckerman therapy. This is a type of psychotherapy developed by Goeckerman. Some doctors use Goeckerman therapy, which combines coal tar treatment with light therapy. Because coal tar makes skin more susceptible to UVB rays, the two therapies are more successful when used combined than when used alone.

Anthralin. Anthralin (another tar product) is a lotion that is used to decrease the proliferation of skin cells. It can also be used to eliminate scales and smooth the skin. It is not recommended for use on the face or genitals. Anthralin irritates the skin and stains practically everything it comes into contact with. It's normally applied for a short period of time before being wiped away.

Light therapy:

Light therapy, alone or in combination with pharmaceuticals, is the first-line treatment for moderate to severe psoriasis. It entails the application of controlled amounts of natural or artificial light to the skin. Treatments must be repeated on a regular basis. Consult your doctor to see if home phototherapy is a viable choice for you.

Sunlight. Heliotherapy (short, daily exposures to sunlight) may help with psoriasis. Ask your doctor about the healthiest approach to using natural light for psoriasis treatment before starting a sun regimen.

UVB broadband. Single patches, extensive psoriasis, and psoriasis that does not respond to topical treatments can all be treated using controlled doses of UVB broadband radiation from an artificial light source. Redness, itching, and dry skin are possible short-term adverse effects. Moisturizing your skin on a regular basis can assist in alleviating your discomfort. 

UVB narrowband. UVB narrowband light therapy may be more successful than UVB broadband light therapy, and it has largely supplanted broadband therapy in many locations. It's normally given two or three times a week until the skin clears up, then less frequently for maintenance. Narrowband UVB phototherapy, on the other hand, may result in more severe and long-lasting burns.

Psoralen plus ultraviolet A (PUVA). Before being exposed to UVA light, you must take a light-sensitizing drug (psoralen). UVA radiation penetrates the skin deeper than UVB light, and psoralen increases the skin's sensitivity to UVA exposure.

This more intensive treatment regularly improves skin and is frequently used for cases of psoriasis that are more severe. Nausea, headaches, burning, and itching are some of the short-term side effects. Dry, wrinkled skin, freckles, increased UV sensitivity, and an increased risk of skin cancer including melanoma are all long-term adverse effects.

Excimer laser. A powerful UVB light is used to target only the afflicted skin in this type of light therapy. Because more strong UVB radiation is utilized in excimer laser therapy, it requires fewer sessions than regular phototherapy. Redness and blistering are possible side effects.

Oral or injected medications:

If prior treatments haven't worked and you have moderate to severe psoriasis, your doctor may give oral or injectable (systemic) medications. Some of these medications are only administered for a short time and may be alternated with other therapies due to the risk of significant adverse effects.

Steroids. Your doctor may recommend injecting triamcinolone directly into the lesions if you have a few small, persistent psoriasis spots.

Retinoids. Acitretin (Soriatane) and other retinoids are medications that suppress skin cell growth. Dry skin and muscle discomfort are possible side effects. These medications should not be used if you are pregnant, breastfeeding, or planning to become pregnant.

Methotrexate. Methotrexate (Trexall) is a drug that reduces the growth of skin cells and reduces inflammation. It is usually given once a week as a single oral dose. Methotrexate not as effective as adalimumab (Humira) or infliximab (Remicade). It may result in an unsettled stomach, a loss of appetite, and fatigue. Long-term methotrexate users require regular blood tests to evaluate their blood counts and liver function.

Men and women should wait at least three months after stopping methotrexate before trying to conceive. When you're breastfeeding, you shouldn't use this medication.

Biologics. These medications, which are commonly given as injections, change the immune system in order to interrupt the disease cycle and relieve symptoms and signs of disease in a matter of weeks. Several of these medications have been approved to treat moderate to severe psoriasis in persons who haven't responded to first-line treatments. The number of therapy choices is continually increasing. Etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), ustekinumab (Stelara), secukinumab (Cosentyx), and ixekizumab (Ixekizumab) are some examples (Taltz). These medications are costly, and health insurance companies may or may not cover them.

Because biologics have the potential to suppress your immune system in ways that increase your risk of serious infections, they should be administered with caution. People who are receiving these medications must be screened for tuberculosis.

Other medications. When alternative treatments aren't available, thioguanine (Tabloid) and hydroxyurea (Droxia, Hydrea) can be utilized. Apremilast (Otezla) is taken twice a day by mouth. It is most beneficial for itching relief. Consult your doctor about the potential negative effects of these medications.

Treatment considerations:

• Although doctors choose treatments based on the type and severity of psoriasis as well as the areas of skin affected, in people with typical skin lesions (plaques), the traditional approach is to start with the mildest treatments — topical creams and ultraviolet light therapy (phototherapy) — and only progress to stronger ones if necessary. Systemic therapy is frequently required from the start of treatment for people with pustular or erythrodermic psoriasis or associated arthritis. The goal is to identify the most effective strategy to reduce cell turnover while causing the fewest negative effects possible.

Alternative medicine:

Psoriasis is treated with a variety of alternative therapies, including special diets, creams, nutritional supplements, and herbs. None of them have been definitively proven to be effective. Alternative remedies are generally considered harmless and may help people with mild to moderate psoriasis reduce itching and scaling. Other alternative therapies can help you avoid triggers like stress.

Aloe extract cream. Aloe extract lotion, made from the leaves of the aloe vera plant, can help with redness, scaling, itching, and irritation. To observe any improvement in your skin, you may need to use the cream multiple times a day for a month or longer.

Fish oil supplements. When combined with UVB therapy, oral fish oil therapy may help to lessen the quantity of damaged skin. Scaling may be improved by applying fish oil to the afflicted area and covering it with a dressing for six hours a day for four weeks.

Oregon grape. This product, also known as barberry, is applied to the skin and may help to reduce the severity of psoriasis.

Essential oils. Aromatherapy with essential oils has been shown to reduce stress and anxiety.

Consult your doctor if you're thinking about using dietary supplements or other forms of alternative medicine to help with psoriasis symptoms. He or she can assist you in weighing the benefits and drawbacks of various alternative therapies.

Reference:

Psoriasis. (2020, May 02). Retrieved from https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845