Psoriasis

Treatment

The goal of treatment is always to suppress the growth of skin cells, but treatment should be tailored to the needs of each patient and the type and severity of the psoriasis. Different approaches are listed below. To increase effectiveness or decrease side effects, they may be combined.

Creams and Ointments

Calcipotriene (Dovonex) is a prescription ointment that contains a derivative of vitamin D and controls the overproduction of skin cells for mild to moderate psoriasis. Steroid creams, coal tar, anthralin and a recently available topical form of retinoic acid are other topical treatments.

Light Therapy

Ultraviolet B (UV-B)

UV-B therapy is usually combined with one or more topical treatments. It is extremely effective for treating moderate-to-severe plaque psoriasis. However, with long-term use there is a risk of skin cancer, just as there is from natural sunlight.

Narrow-band Ultraviolet B

Narrow-band ultraviolet B does not require oral medications before each treatment, nor is it suspected to carry as high a potential for skin cancer as PUVA. It is not as widely available as PUVA or UV-B.

PUVA

PUVA, a combination of light-sensitizing medications (psoralens) and ultraviolet A light, is effective in suppressing the growth of skin cells in severe psoriasis. However, long-term use of PUVA — 250 treatments or more — may increase the risk of skin cancer. The higher risk begins about 15 years after the first PUVA treatment.

Goeckerman Treatment

This treatment, discovered in 1925 by a Mayo Clinic dermatologist, is used to treat severe psoriasis. It combines a coal tar ointment, applied three times daily, with daily ultraviolet light exposure and scalp treatment. Treatment takes place over approximately three weeks in a special unit at Rochester Methodist Hospital. (See patient story.)

Exposure to Natural Sunlight

Many people with psoriasis have found natural sunlight exposure helps clear their skin. Precautions need to be taken to avoid sunburn.

Oral Medications

These oral medications are effective in treating severe psoriasis, but they may cause liver or kidney toxicity.

• Methotrexate (an anticancer drug that blocks the growth of skin cells)
• Cyclosporine (Gengraf, Neoral) which suppresses the immune system and is an antirejection drug used in organ transplants
• Retinoids, a group of drugs related to vitamin A, which reduce the proliferation of skin cells for severe psoriasis (but causes birth defects if taken during pregnancy)

Immune-Modulating Drugs (Biologics)

The Food and Drug Administration has approved several immune-modulating drugs for the treatment of moderate to severe cases of psoriasis. They include alefacept (Amevive), efalizumab (Raptiva) and etanercept (Enbrel). These drugs are given by intravenous infusion or intramuscular injection; they are usually reserved for patients who fail to respond to traditional therapy or who have associated arthritis.