How Plaque Psoriasis Is Treated

Newer biologic drugs offer hope to chronic sufferers

While there is no cure for chronic plaque psoriasis, there are a variety of treatments that can help remove scales and prevent skin cells from growing so quickly. Options include topical ointments, light therapy, and prescription drugs taken either orally or by injection. Proper skin care and lifestyle choices can also help you gain control over of a disorder that continues to affect as many as 7.5 million Americans, according to American Academy of Dermatology.

Prescriptions

Topical corticosteroids, also known as steroids, are considered the most effective means of treating mild plaque psoriasis. However, as a chronic autoimmune disorder, plaque psoriasis may require more that. In some cases, the autoimmune response will need to be tempered to prevent the body from causing further harm. To this end, doctors often turn to drugs that target the immune response, either systemically (as a whole) or in part.

Topical Corticosteroids

Topical corticosteroids are often used as a solo treatment for people with mild plaque psoriasis, and they can be used alongside other drugs in people with moderate to severe cases.

If prescribing a topical steroid, your dermatologist will consider the location and severity of your plaques. For those on the face or genitals, a lower-strength preparation may be prescribed, while a medium- to high-potency steroid can be used on other parts of the body.

Topical steroids are available by prescription as well as over the counter in a variety of lotions, creams, ointments, shampoos, foams, and sprays. While effective, prolonged use or overuse can lead to skin atrophy (thinning of the skin), a condition which is often irreversible.

Non-Biologic Drugs

Non-biologic drugs are those that have been synthesized in the lab. There are three non-biologics commonly used to treat plaque psoriasis:

  • Methotrexate is an immune-suppressive drug that has been around for more than 50 years and works by dampening the immune response as a whole. It is typically used in the first-line treatment of moderate to severe plaque psoriasis. By suppressing the immune system in its entirety, methotrexate can cause side effects ranging from liver toxicity to bone marrow suppression. Periodic blood tests are needed to avoid treatment complications.
  • Cyclosporine is an immune-suppressive drug similar to methotrexate. It is used when psoriasis is either extensive or has not responded to at least one other systemic drug. While cyclosporine works quickly on the immune system, it also requires the frequent monitoring of side effects, including high blood pressure, liver toxicity, and kidney impairment.
  • Otezla (apremilast) was approved in 2014 to treat psoriasis and psoriatic arthritis, a form of rheumatoid arthritis closely related to psoriasis. Otezla works by blocking an enzyme, known as phosphodiesterase 4, which regulates cellular inflammation. While Otezla is well-tolerated, it may cause diarrhea, nausea, or headaches when first started. Less commonly, people may experience weight loss or symptoms of depression.

    Biologic Drugs

    Biologic drugs are those made from human or animal proteins. An increasing number of biologics have been approved for the treatment of moderate to severe plaque psoriasis; others may be used off-label. Unlike methotrexate, biologics target a specific component of the immune response rather than the immune system as a whole.

    Biologics are delivered either by injection or intravenously (through a vein). They are usually prescribed for people with moderate to severe psoriasis who have not responded to other treatments.

    These options target one of three components of the immune response:

    *These drugs do not yet have FDA approval for treatment of psoriasis, but may be used off-label. (They are, however, approved for the treatment of psoriatic arthritis.)

    As biologic drugs can increase the risk of infection, any cut, sore, or sign of infection be should be treated by a doctor. Common side effects include injection site pain, respiratory infections, and flu-like symptoms. In rare cases, certain cancers and neurologic symptoms (such as seizures and multiple sclerosis) may develop.

    Supportive Medications

    There are also a number of prescription drugs commonly used to support the primary treatment of psoriasis:

    • Calcipotriol (calcipotriene) is a synthetic vitamin D3 analog first introduced in the 1990s to treat chronic plaque psoriasis. It is believed to improve symptoms by tempering the overproduction of keratinocytes in the skin. Other vitamin D3 analogs include calcitriol and tacalcitol.
    • Tazorac (tazarotene) is a topical retinoid derived from vitamin A that can slow skin cell production and reduce inflammation. It is also marketed under the brand names Avage and Fabior. Side effects include skin irritation and sun sensitivity.
    • Soriatane (acitretin) is an oral retinoid that is sometimes combined with UV light therapy. Side effects include lip inflammation, hair loss, and the drying of the eyes, nose, and mouth.

    Tazorac and Soriatane are both classified as a pregnancy category X drugs and cannot be used during pregnancy due to the risk of birth defects.

    Therapies

    Sunlight can be effective in alleviating plaque psoriasis, but prolonged exposure can lead to sunburns and a worsening of symptoms. To this end, UV light therapy, also known as phototherapy, has become a safe option for those who fail to respond to medications alone.

    Ultraviolet B (UVB) radiation, in particular, is able to penetrate the skin and slow the hyperproduction of skin cells without harm. Treatments can be performed in a doctor's office or with a home unit. In either case, the procedure should be directed by a dermatologist experienced in phototherapy. While your skin may initially get worse before it gets better, consistency usually ensures the best results.

    Another form of light therapy, known as psoralen + UVA (PUVA), combines UVA radiation with a light-sensitizing drug known as psoralen, taken either orally or topically. PUVA is more effective for stable plaque psoriasis than for acute flares.

    Over-the-Counter Treatments

    In addition to non-prescription versions of topical corticosteroids, there are a number of other over-the-counter (OTC) products available to treat plaque psoriasis.

    As some can work better than others (and some may be too harsh for you), it is important to speak with your dermatologist before using any.

    Among some of the more popular options:

    • Coal tar has been used to treat psoriasis for more than 100 years, and there are some who still swear by it. Coal tar is available without a prescription and can be found in a variety of preparations, including shampoos, ointments, lotions, creams, and foams. While soothing, some of the products can be messy and even a little smelly.
    • Salicylic acid is a peeling agent that can help soften and remove flaking scales. It is contained in a variety of moisturizing creams, lotions, and topical ointments. Avoid combining salicylic-containing products, and do not use it on more than 20 percent of the body, as this can lead to excessive topical absorption and toxicity. Do no use it on children.

    Home Remedies and Lifestyle

    While there is an ever-increasing array of prescription and OTC products available to treat plaque psoriasis, there are home therapies and skin care practices that can also help.

    Home Remedies

    The primary aim of home therapies is to alleviate the itchiness, burning, and discomfort of plaques while gently removing accumulated skin cells without bleeding. 

    Among some of the effective options:

    • Therapeutic baths made with Epsom salt, mineral oil, milk, or olive oil can soothe the skin while gently lifting scales from the outer layer of skin (epidermis). Use only lukewarm water; hot water can quickly strip away body oils and leave the skin drier than ever.
    • Fragrance-free moisturizers, such as petroleum jelly, aloe vera gel, or mineral oils, can aid in the shedding of cells while trapping moisture in the skin. These emollient-rich lotions should be applied after a bath to counteract moisture loss.
    • As mentioned, natural sunlight can slow the overproduction of skin cells but needs to be limited to no more than 10 minutes of direct exposure per day. You can gradually increase exposure time but always do so while wearing a minimum SPF 30 sunscreen.

    A holistic approach to psoriasis treatment should always involve exercise, stress reduction, a low-fat diet rich in omega-3 fatty acids, and the avoidance of alcohol and cigarettes.

    Skin Care

    Good skin care is essential to controlling your plaque psoriasis symptoms. Central to this is the avoidance of deodorant soaps, exfoliating scrubs, and alcohol-based astringents and cleansers. These can inflame your sensitive skin and can even trigger a flare-up.

    Other key skin care tips include:

    • Cleanse and moisturize your skin just once daily to avoid drying.
    • Choose a mild soap or cleanser formulated for psoriasis.
    • Use a soft cloth or your hands to lather up. Never use a loofah or anything that can scratch or irritate your skin.
    • Wash with lukewarm water. Hot water causes already-inflamed blood vessels to swell even further and can strip away too much of the body's natural oils.
    • Do not over-soap your skin. The more you do, the drier your skin will be. Only soap those parts of your body that need it.
    • In winter months, switch from a lighter lotion to a heavier moisturizing cream to compensate for the loss of humidity.
    • Avoid perfumes and colognes that contain alcohol.
    • While you should avoid makeup if you have facial psoriasis, you can try using a skin-safe concealer like Dermablend or Covermark, which some use to conceal burns and scars.
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