Treatment of Psoriasis

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There is no known cure for psoriasis. However, treatment is usually effective and will control the condition by clearing or reducing the patches of psoriasis. Most patients with psoriasis can be treated by their GP. Your GP may refer you to a dermatologist (skin specialist) and their team based in a hospital if symptoms are particularly severe or have not responded well to treatments already tried.

Psoriasis tends to come and go so relapses are difficult to predict and cannot be prevented with topical treatment There are many preparations and treatment combinations and your treatment will depend on the severity and the type of psoriasis you have, whether it is on the scalp or other areas of the body. It usually takes several weeks of treatment to clear plaques and some treatments take longer than others to work.

Self care There are several tar based shampoos and emollient preparations that you can buy over- the- counter . Tell your pharmacist if you are allergic to peanuts because some preparations contain peanut (arachis) oil.

Emollients hydrate and sooth the skin and soften the plaques of psoriasis. For mild psoriasis, treatment with an emollient may be all that is needed. You can also use emollients in addition to any other treatment, to keep the skin moist and supple. Use them regularly to care for all of your skin. See general section on emollients for more information.

Topical steroids may be used in on their own or in rotation with other treatments to achieve a more effective result. Face and flexures (under breasts, behind knees/elbows) are treated with a mild steroid (e.g. hydrocortisone 1%). Thicker patches on the scalp, hands and feet are treated with a potent (e.g. betamethasone valerate) or very potent (e.g. clobetasol propionate) steroid as these areas can be more difficult to treat. Sometimes, in cases of more severe psoriasis of flexures, a moderately potent steroid steroid used in combination with an antibiotic and anti-fungal medicine may be used. This is because the psoriasis and surrounding skin may be broken and more susceptible to infection. Various preparations such as lotions, gels, creams and ointments are available to suit the different areas to be treated. See general section on topical steroids for more information.

Calcipotriol and tacalcitol belong to a group of medicines known as Vitamin D analogues (which are chemically related to vitamin A). Calcipotriol is available as a cream or ointment to treat plaque psoriasis and as a lotion for scalp psoriasis. It is also available in combination with betamethasone, a potent topical steroid. Tacalcitol is available as an ointment to treat plaque psoriasis. Calcitriol is a form of Vitamin D and is available as an ointment for the treatment of mild to moderate plaque psoriasis. These are effective treatments and usually well tolerated but sometimes cause irritation. These preparations do not smell or stain. Some people find that after several weeks, the treatment is not as effective. It may be helpful to alternate with another treatment every few weeks.

Dithranol is an effective treatment. It is sometimes used in combination with salicylic acid, coal tar or with hospital based treatments such as UV irradiation (particularly UVB). Dithranol is only used on areas affected by psoriasis because it is an irritant. You can protect the surrounding normal skin with yellow or white soft paraffin. To avoid irritation, dithranol treatment normally begins with the lowest strength, which is gradually increased if necessary. Do not try to persevere with treatment if it causes irritation, it might make the psoriasis worse. Depending on the type and strength of preparation being used, dithranol may be left on overnight or washed off after ten minutes. Dithranol stains skin, hair, material, plastics and enamel. Stains on skin and hair disappear when you finish the course of treatment but it may take several weeks or months.

Coal tar helps to reduce inflammation and also helps to remove loose scales from the patches of psoriasis. Coal tar can be applied to or allowed to come into contact with normal skin. Some tar products can be used on the face and in the flexures (behind elbows/knees and on the shins). Tar baths and shampoos can also be helpful. Higher strengths of coal tar may be needed to treat the thicker patches of psoriasis. The disadvantages of coal tar preparations are that they can cause skin irritation, they can also stain clothing and sheets or pillowcases. If you are using a coal tar preparation for your scalp, which needs overnight application, wear a shower cap to help the treatment penetrate and also protect your pillowcase from stains.

Tazarotene is a retinoid (a substance chemically similar to vitamin A). It is available as an ointment and is an effective treatment. It does not smell or stain. It is only used on areas affected by psoriasis and not on normal skin and it can cause irritation. You can protect the surrounding normal skin with yellow or white soft paraffin.

Other topical treatments Salicylic acid is known as a keratolytic agent. This means that it softens the scaly layers of the psoriasis plaques and eases their removal. It is often combined with other treatments such as coal tar and/or dithranol in ointments and scalp applications. Coconut oil helps to soften the psoriasis plaques. It is used in combination with salicylic acid and coal tar for treatment of scalp psoriasis

Hospital based treatments You may need to be referred to a dermatologist if your psoriasis is severe or resistant to treatment. Preparations you have used previously may be applied at different strengths, with various dressings or alternative methods of application and combinations. These treatments may also be used in combination with systemic treatments (treatments taken by mouth), with phototherapy (light treatment) or with photochemotherapy (light treatment plus a medicine called psoralen). You may be treated as an outpatient or admitted to hospital depending on the severity of your condition or the treatment to be used.

Complementary treatments Aromatherapy (such as angelica, bergamot and true lavender), acupuncture, fish oils, zinc and aloe vera have all been used to treat psoriasis. There is little evidence to prove how these treatments work or how safe or effective many of them are. Certain herbs and preparations contain ingredients that can be harmful if not used with care or if not obtained from reputable sources.

Sun
You may find that exposure to sun improves your condition. Even if the sun does help, you should always use a high factor sunscreen.

Before using any of these treatments for psoriasis, you should talk to your GP or pharmacist (chemist). You can also phone NHS Direct on 0845 4647.