Prostate cancer treatment options

Psoriasis treatment - is it effective?

Psoriasis, a skin disease that causes lumpy, scaly, pink and itchy patches, can occur anywhere on the body, including the scalp. It can be treated, but it cannot be cured. Many different psoriasis treatments are available; GPs and dermatologists usually recommend the mildest therapies first, moving on through more intense treatments to try to get the condition under control.

The nature of psoriasis, which is thought to be caused when the immune system starts to target normal and healthy skin cells, means that it is unpredictable. Whether it responds to any treatment will depend on an individual person, and can vary over time. The question to really ask, therefore, is not whether psoriasis treatments are effective, but whether they work for you, and whether they continue to work for you. In this article, we review the available options.

Psoriasis treatments applied directly to the skin

These are often referred to as first-line psoriasis treatments and they are often useful if your psoriasis is not too severe or extensive.

They include the easier to use treatments:

• Steroid creams and lotions: corticosteroids applied directly to the red and scaly patches of the skin help to reduce irritation and inflammation as they reduce the immune response to skin cells. Lotions are usually recommended as a scalp psoriasis treatment, and your GP may also recommend an anti-fungal, medicated or anti-dandruff shampoo to use with it. Side effects include skin thinning and hair loss when used over a long time period.

• Creams containing a vitamin D analogue: these include calcitriol and calcipotriol, which reduce the rate at which skin cells divide. This reduces the lumpiness and redness of the skin. Vitamin D analogue creams are often used in combination with steroid treatments.

And the more tricky ones:

• Coal tar: this has been used as a psoriasis treatment for many years. No-one has discovered how it works, but it seems to help reduce the symptoms of psoriasis. Applying it, however, is very messy as it needs to be left on the skin for the best results. It is sticky and smells strongly, so using old towels and bedding is recommended.

• Dithranol: another older psoriasis treatment, this needs to be applied all over the skin, from top to toe, and left there for up to an hour. It can help with more severe psoriasis but is usually applied by a health professional rather than at home because it stains all that it touches.

• Tazarotene: is easy to apply but more difficult to use effectively because it tends to irritate normal skin. It works best when applied very carefully to just the areas of skin affected by psoriasis. It is also advisable to apply it to well-moisturised skin.

Light therapy as a treatment option

It has been well established that exposure to sunlight can help clear up psoriasis, so the next logical step was to develop light therapy using ultraviolet light within the wavelengths of light identified as the most helpful. This treatment is now available and is usually called narrowband UVB treatment, or ultraviolet light therapy. Light can be used in combination with a drug used to make the areas of psoriatic skin more sensitive to its effects. Psoralen plus UVA light, PUVA therapy, can be an effective treatment for some of the more severe forms of psoriasis.

Drugs used in treatment

If your psoriasis is severe, or does not respond to the usual first-line treatments, or you are diagnosed with psoriasis with arthritis (psoriatic arthritis), you will usually see a skin specialist to try some stronger treatments. These may take several weeks before you start to see an improvement in symptoms.

Dermatologists usually start with one of three drugs, which may be given as tablets, or by injection:

• Methotrexate: this is a drug that suppresses the immune system throughout the body, and is given as a tablet or by injection once or twice a week. It works very well on all forms of psoriasis, as it reduces the growth rate of skin cells, lowers the immune response in the skin, and reduces inflammation. You will need to be monitored carefully when taking it as it can increase the risk of serious infections, and it can also lead to liver and kidney problems.

• Ciclosporin: another immunosuppressive drug commonly used by people who have had an organ transplant. Usually taken as a daily tablet, its effects are very similar to those of methotrexate.

• Acitretin: this is also taken as a daily tablet but its action is different from either methotrexate or ciclosprorin. Acitretin is a retinoid and is related to vitamin A; we do not really know how it works but it is useful in severe cases of psoriasis and can be used with the two drugs above, and in combination with light therapy.

Biological treatments

If all else fails and your psoriasis is still severe and not improving, a class of fairly new drugs is then an option. Biological therapy for psoriasis was originally developed to treat inflammatory arthritis – rheumatoid arthritis, primarily. Studies have shown that biologicals are also very valuable treatments for psoriatic arthritis, and for psoriasis itself. Again, their use is carefully monitored as these treatments also suppress the immune system and can increase the risk of serious infections.

The four biological drugs currently available as psoriasis treatments are etanercept (Enbrel®), infliximab (Remicade®), adalimumab (Humira®) and ustekinumab (Stelara®).