So Many Options
Psoriasis has more treatment options than most skin diseases. You can be treated externally, with creams and similar topical medications, as well as internally, with pills or injections. For more difficult or severe psoriasis, you may wish to consult with a dermatologist.
Physical treatments, such as natural or artificial sunlight (phototherapy), are also extensively used.
Finding a treatment or combination of treatments that's just right and effective for you may take some trial and error, and sometimes the logistics (such as the stickiness of topicals or the frequent office visits required by phototherapy) can be daunting. Despite this, you can expect significant clearing of your skin with appropriate treatment over time.
Psoriasis treatment is available both over-the-counter and by prescription. Topical preparations are available as creams, ointments, lotions, oils, foams, and tapes, make treating any body part possible. When these fail, or the amount of skin to be treated is too great (typically >10% of the body), then systemic treatments are recommended.
Systemic treatments are those medications that treat the whole body, rather than just the affected area. For psoriasis, this includes pills and injections.
Prescription pills for psoriasis include methotrexate and Soriatane. Although studied for psoriasis, other pills (such as sulfasalazine and hydroxyurea) are seldom used, but may be recommended to specific patients. Potent immunosuppressive drugs, such as cyclosporine and 6-mercaptopurine based drugs, play a role in psoriasis treatment for very select patients.
Injectable biologics are the new kids on the block, but they have made a tremendous impact on the way we treat moderate to severe psoriasis. Now, with as little as twice monthly injections at home, psoriasis patients can be relatively disease-free. There are many biolotics to choose from. Like all medications, these too have side effects and require monitoring by the physician to observe for complications. Nevertheless, they represent a quantum leap in therapy and a big change in the life of many patients with otherwise debilitating psoriasis.
Phototherapy using ultraviolet light can be very effective for psoriasis. Previously, UVB and PUVA (UVA exposure after ingestion of a sun-sensitizing pill) were the most common forms of light therapy. A newer treatment called narrow-band UVB (NB-UVB) seems to work at least as well as these if not better, and with fewer side effects. The latest equipment uses laser to deliver NB-UVB with pinpoint accuracy. Heliotherapy uses the sun as a source of natural ultraviolet radiation to treat psoriasis. Treatment with light is not appropriate for every patient.