Psoriasis Treatment - Health Tips

Fortunately, many treatments can help with psoriasis flare-ups despite the condition’s lack of a cure. With personalized care at Allan Mineroff, MD, PC, you can minimize the number of flare-ups you get and manage them when they occur.  

Your treatment options for psoriasis include:

• Topical medications You can apply certain topical medications directly to your skin to ease the symptoms of a psoriasis flare-up. The team may prescribe corticosteroids, topical retinoids, salicylic acid, vitamin D analogs, or anthralin, among other topicals.  
• Systemic medications come in the form of pills or injections. For moderate and severe cases, the doctors may prescribe treatment from a class of medications called Biologics. These are proteins that interrupt the immune process involved in psoriasis. These medications have been life-changing for many patients with severe disease.
• Light therapy, believe it or not, the same form of light responsible for causing sun damage to your skin is often helpful in reducing a psoriasis flare-up. Ultraviolet (UV) light therapy involves spending a moderate amount of time in the sun. 

Over the past 20 years, treatments for psoriasis have exploded.  Prior to 2000, there were less than 5 internal treatments for psoriasis.  Since that time, more than 15 new internal treatments for psoriasis have been developed and come to the market.  These new medications are much more effective than older medications.  With these new medications, many psoriasis sufferers obtain clear or nearly clear skin.  And although not completely free of potential side effects, these newer medications are much safer than our older medications.

Psoriasis is a chronic skin condition that causes inflamed areas of thickened skin. There are several types of psoriasis with plaque psoriasis being the most common.

Although there is no cure for psoriasis, there are effective psoriasis treatments that can help bring psoriasis under control. Psoriasis medications include those applied to the skin (topical corticosteroids, vitamin D derivatives, and topical retinoids) and those taken by mouth. In addition, phototherapy and new biologic medications provide additional treatment options for moderate to severe psoriasis that fails to respond to other treatments.

Your dermatologist will recommend a treatment based on the type of psoriasis, its location, severity, medical comorbidities and your response to previous treatments.

Psoriasis is an inflammatory disease that causes dry, scaly rashes just about anywhere on your body. Psoriasis is caused by the rapid overgrowth of certain skin cells. Most sufferers are pre-disposed to the disease and often frustrated in their attempts to find adequate relief. We understand your frustration and discomfort and we are here to help.

There are three main types of treatment for psoriasis: topical, light therapy and medication. We often start with mild topical treatments and progress to stronger treatments, if necessary. The good news is that there is an abundance of new, more effective medications available now for psoriasis sufferers, and we're determined to help you find the right one for you. 

Psoriasis is a chronic, autoimmune skin disease. There are different types of psoriasis, including plaque psoriasis, scalp psoriasis, hand and foot psoriasis and even nail psoriasis. Corederm professionals will prescribe the right medications for each patient based on the type of psoriasis, its location, severity, duration and history of previous treatments. Among the treatment options available are corticosteroids, vitamin D derivatives, retinoids, photo-therapy (PUVA), and new “biologic” treatments.

Psoriasis is not a condition that can be cured. However, there are treatment options available to help you manage your experiences and reduce the presence of frustrating dry skin. It is important to keep in mind the recommended treatments will vary for each person and the type of psoriasis they have, and results for all treatments will vary.

It is important to keep the skin moisturized. Additional over-the-counter medications may be recommended to reduce the effects of the condition. Avoiding triggers as much as possible can help minimize the risk of a flare up.

I consult individually with each patient to help them understand their condition as well as recommend prescription treatments if necessary.

I assess the areas affected including scalp, genitals, nails and ask my patients about pain in the joints (PSA). Then I ask how much the psoriasis affects their lives. Sometimes location including hands in view is important. I see if there are comorbidities such as cardiac or GI problems. I discuss all treatments with my patients as a small lecture drawing in the chart:  topicals, orals, biologics including the pros and cons of various medications.  Then, with my patient's contribution as to what they are willing to do, I limit the choices and we choose an appropriate treatment plan. I also include that this can all be re-evaluated and changed with follow-up visits. I always mention the new experimental treatments in our discussion.

All patients have a topical at their disposal to help control psoriasis. Mild psoriasis can be controlled nicely with topical steroids and steroid preparations like Duobrii, Enstaller, and Taclonex. Lotions, foams, and solutions help applications to hairy and hard to reach areas of the body. There is an impregnated tape that can be used as well as intralesional steroid injections to increase penetration and results.

Step 1 to treating psoriasis is to educate patients about the condition and the available treatments. A great way to do that is to encourage them to join that National Psoriasis Foundation and to use the Foundation’s resources that are available at www.psoriasis.org.

Step 2 is to screen for psoriatic arthritis. If there are signs of arthritis, I want the patient to have a thorough evaluation from a rheumatologist.

Step 3 is to determine if the patient has limited (mild-to-moderate) psoriasis that can be treated effectively with topical treatments or if they have extensive (moderate-to-severe) disease that needs more than just topicals.  If topicals alone are chosen, I generally recommend topical clobetasol in a vehicle the patient won’t mind using. If more than that is needed, I would consider phototherapy or internal treatments.

Coal Tar is a substance which has been used for many years to treat skin conditions,  especially psoriasis and eczema.  Derived from coal, coal tar contains some 10,000 compounds, some of which have not been characterized yet. These various constituents impart healing, antiinflammatory, antibacterial, antifungal,  and anti-proliferative (ie slow down excessive cell growth as is seen in psoriasis) properties.  Crude coal tar (CCT)  is a less elegant unrefined form of coal tar and has a gritty tarry consistency.  While a little difficult to find,  it can be uniquely effective in some more stubborn psoriasis cases.  Coal tar extract, also called liquor carbonis detergens is an extract of CCT, which, while slightly less potent, is easier to combine with ointments. 

There are several over-the counter coal tar products; Dr Berger recommends Elta Tar for its easy spreadability, low odor, and ready-mixed value sized jar.  Elta Tar is available without a prescription and in stock at Dr. Berger's office 435-673-7546 for $30 for the 480g tub. 

For treating psoriasis, don’t use banana peels on the lesions, as folks once did! For mild cases, topical corticosteroids, such as hydrocortisone, can provide relief. There are different strengths of cortisone creams, higher potency are only available by prescription, while lower strength ones can be found over the counter.

Apply these medications after showering for maximum benefit.

There are well-established treatments, such as phototherapy and coal tar, which can be used successfully. Coal Tar is not currently used as frequently as before due to the issues with odor and potential of staining certain clothes. Newer technology for localized disease are the laser systems which deliver ulraviolet radiation. One such device is called Xtract.

There is also a new class of psoriasis medications, called biologics, that can be used to treat moderate to severe psoriasis. These are administered by injection or intravenous infusion. These medications tame the body’s T-cells that cause the hyperactivity of the skin cells that leads to the disease. Instead of just treating symptoms, these drugs get to the root cause of the skin disease.

The newest biologic drug is called Stelara, which was approved by the FDA in 2009. The main advantage with Stelara is that it doesn’t have to be used as often as other biologics. It’s given twice in the first month of a flare-up followed by just four more treatments a year.

When psoriasis flare-ups occur, women should avoid makeup that is heavily scented and look for products formulated for sensitive skin. Wash your face with nonabrasive cleansers. Use moisturizers that contain ceramides and lipids. Treating the skin gently is very important as Psoriasis can cause Keabnerization which means that the disease can be reproduced in areas of trauma.

I like to tell my psoriasis patients that we are living in an era that offers alot more effective treatment options for what used to be a huge “hassle” to manage.

So called “biologic” therapy describes another systemic treatment option for psoriasis. ("Systemic" therapy means that it acts on the whole body and is not something that is applied to the skin.)

Biologic medications are proteins that act upon parts of the immune system and differ from other medications that are synthetic chemicals. Most biologics are injected subcutaneously, like insulin for diabetes. In fact, insulin is a biologic molecule, but we don’t describe it that way.

Biologics suppress inflammation that patients experience as red and flaking areas of skin. Biologics also decrease the inflammation that can lead to the form arthritis that often accompanies psoriasis (psoriatic arthritis).

It is becoming more clear that those with psoriasis have an increased risk of developing coronary artery disease compared to patients without psoriasis.

The biologics can inhibit inflammatory signals, like TNF-alpha, and may help reduce this additional risk of developing heart disease and other vascular problems in the future. This could offer a potentially signficant advantage for biologics over other treatment options. However, this benefit has not been fully proven yet.

I encourage my patients with psoriasis to utilize the resources on our website or go directly to the National Psoriasis Foundation website to learn more about their disease and treatment options. Then we can work together to balance the benefit and risks associated with these treatment and make a decision that is good for them.