Psoriasis can be graded as:
- Mild – Few, scattered, small areas of involvement (about two-thirds of people have mild disease)
- Moderate – More widespread disease affecting larger areas, sometimes affecting the joints
- Severe – Most of the skin surface is affected, sometimes affecting the joints
- Bathe daily to help remove scale and moisten the skin. Avoid harsh soaps; soap substitutes are milder for your skin.
- Apply moisturizers to all scaly psoriasis patches after any water exposure or bathing. Heavier oil-based moisturizers help to retain water in the skin better than water-based moisturizers.
- Apply hydrocortisone cream (0.5 or 1%), available over the counter, to help reduce itch and redness.
- Use products with salicylic acid (shampoos, cleansers, and ointments) to help soften and remove heavy scale.
- Small doses of natural sunlight may be helpful, such as 10–15 minutes 2 or 3 times a week. Avoid too much sun, however, and protect your healthy skin from sun exposure.
The National Psoriasis Foundation is a useful resource that has additional information on treating your psoriasis. Their Web site is http://www.psoriasis.org/.
- The mainstay of therapy for psoriasis is topical steroids, either in creams or ointment form. Higher-potency topical steroids are used for the body or scalp, and lower-potency topical steroids are best for the face and skinfold areas. Steroid solutions or liquids can be used on the scalp. Use should be limited to 1–4 weeks at a time because long-term use of steroids can lead to stretch marks (striae) and thinning of the skin.
- Calcipotriene (Dovonex®) is a vitamin D derivative cream that works as well as steroids, and it is even more effective when combined with topical steroids.
- Tazarotene (Tazorac®) is a vitamin A-based cream that may be prescribed. Women of childbearing age should be counseled to avoid pregnancy while using tazarotene because this treatment may cause birth defects.
- Topical immunosuppressants such as tacrolimus (Prograf®) and pimecrolimus (Elidel®) may also be used, but they can cause skin burning and itching and are expensive. These treatments may possibly increase your risk for skin cancer and lymphoma.
- Coal tar-based therapies and anthralin creams are sometimes used, but they are used less frequently than other treatments because they have an odor, cause skin irritation, and can stain clothing and because neither is any more effective than calcipotriene.
- If a large percentage of your skin is affected, ultraviolet (UV) light therapies may be considered. These include UVB phototherapy and PUVA (psoralen [a photosensitizer] and UVA therapy). PUVA may increase your risk for non-melanoma skin cancers.
- Oral medications may be used for extensive psoriasis, including acitretin (made from vitamin A), methotrexate, and cyclosporine. If you are prescribed any of these medicines, you will need to see your doctor regularly so he or she can monitor for possible side effects such as liver and kidney damage.
- Biologics are the newest medicines to be used for psoriasis. These are proteins that treat psoriasis by blocking certain actions of the immune system. These medications include etanercept (Enbrel®), alefacept (Amevive®), and infliximab (Remicade®). These are very costly and may have serious side effects, including infection, immunosuppression, and cancer.
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Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.407, 1393-1394. New York: McGraw-Hill, 2003.
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