Conventional Psoriasis Treatment
Psoriasis treatment options are extensive and include emollients, salicyclic acid, coal tar, anthralin, corticosteroids, calcipotriol, tazarotene, methotrexate, retinoids, immunosuppressants, immunotherapeutic agents and light therapy. These treatment can be divided into topical and systemic treatment for psoriasis.
Topical Treatments
Topical treatment include the usage of emollient creams, ointments, petrolatum, paraffin and hydrogenated vegetable oils. They reduce scaling and are most effective when applied immediately after bathing. Lesions may appear redder as scaling decreases or becomes more transparent. Emollients are safe and should always be used for mild to moderate plaque psoriasis.
Emolient Cream
Salicylic acid is a keratinolytic that softens scales, facilitates their removal, and increases absorption of other topical agents. It is especially useful as a component of scalp treatments.
Salicylic Acid
Coar tar ointments, solutions, or shampoos are anti-inflammatory and decrease keratinocyte hyperproliferation through an unknown effect. They are typically applied at night and washed off in the morning. They can be used in combination with topical corticosteroids or with exposure to natural or artificial ultraviolet (UV) B light (280 to 320 nm) in slowly increasing increaments.
Corticosteroids are usually used topically but may be injected into small or recalcitrant lesions.
Warning: systemic corticosteroids may precipitate exacerbrations or development of pustular psoriasis and should not be used for any form of psoriasis therefore it is not adviseble to take corticosteroids orally.
Topical corticosteroids are used sometimes with anthralin or coal tar which are applied before retire for the night. Corticosteroids are most effective when used overnight under covering or tape.
Calcipotriol is a topical vitamin D3 analogue that induces normal keratinocyte proliferation and differentiation; it can be used in combination with topical corticosteroids.
Tazarotene is a tropical retinoid but less effective than corticosteroids as a monotherapy.
UV light therapy (phototherapy) is typically used in patients with extensive psoriasis. UVB light reduces DNA synthesis. In pasoralen-ultraviolet light therapy (PUVA), oral methoxypsoralen, a photosensitizer, is followed by exposure to long-wave UVA light (330 to 360 nm). PUVA has a antiproliferative effect and also helps to normalize keratinocyte differentation. Dosses of light are started low and advanced as tolerated. Severe burns can result if the dose of drug or UVA is too high. Although the treatement is less messy than topical treatment and may produce remissions lasting several months, repeated treatments may increase the incidence of UV-induced skin cancer.
PUVA
Systemic Treatments
Methotrexate taken orally is the most effective treatment in severe disabling psoriasis, especially severe psoriatic arthritis or widespread erythrodermic or pustular psoriasis that are unresponsive to topical agent. Methotrexate interfere with the rapid proliferation of epidermal cells.
Systemic retinoids (acitretin, isotretinoin) may be effective for severe and recalcitrant cases of psoriasis vulgaris, pustular psoriasis (preferred use is isotretinion), and hyperkeratotic palmoplantar psoriasis. Because of the teratogenic potential and long-term retention of acitretin in the body, women must not be pregnant and should be warned agains becoming pregnant for at least 2 years after treatment ends.
Cyclosporine is an immunosuppressant that can be used for severe psoriasis but should be limited to courses of several months and rarely up to 1 year. Its affect on the kidneys and potential long-term effects on the immune system therefore it is recommended to use cyclosporine liberally.
The choice of conventional treatment is based on the severity of the psoriasis patients and the inclination of the medical practinioner. However as most of these conventional methods do not results in long term remissions, many patients have explored other non-conventional methods (which are explain in different part of this website).