Treatment - Psoriasis - beta

Treatment for psoriasis usually helps to keep the condition under control. Your GP should be able to treat you.

Your GP may refer you to a skin specialist (dermatologist) if your symptoms are severe.

Treatments depend on the type and severity of your psoriasis and the area of skin affected. Your GP will probably start with a mild treatment. This could be a topical cream applied to the skin, and then stronger treatments if necessary.

A wide range of treatments are available for psoriasis. But identifying the most effective one can be difficult. Talk to your doctor if you feel a treatment is not working or you have uncomfortable side effects.

Treatments fall into 3 categories:

• topical – creams and ointments applied to your skin
• phototherapy – Exposes your skin to certain types of ultraviolet light
• systemic – oral and injected medications that work throughout the entire body

Different types of treatment are often used in combination.

Your GP may need to review your treatment for psoriasis on a regular basis. You may want to make a care plan. This is an agreement between you and your health professional. It can help you manage your day-to-day health.

Topical treatments

Topical treatments are usually the first treatments used for mild to moderate psoriasis. These are creams and ointments you apply to affected areas.

You might find that topical treatments are all you need to control your condition. It may take up to 6 weeks before there's a noticeable effect.

If you have scalp psoriasis, Your GP may recommend a combination of shampoo and ointment.

Emollients

Emollients are moisturising treatments applied to the skin to reduce water loss and cover it with a protective film. If you have mild psoriasis, an emollient is the first treatment your GP will suggest.

The main benefit of emollients is to reduce itching and scaling. Some topical treatments work better on moisturised skin. It's important to wait at least 30 minutes before applying a topical treatment after an emollient.

Emollients are available as a wide variety of products. You can buy these over the counter from a pharmacy.

Steroid creams or ointments

Steroid creams or ointments (topical corticosteroids) are used to treat mild to moderate psoriasis in most areas of the body. The treatment works by reducing inflammation. This slows the production of skin cells and reduces itching.

Topical corticosteroids range in strength from mild to very strong. Only use them when recommended by your doctor.

Your GP can prescribe stronger topical corticosteroids. These should only be used on small areas of skin or on particularly thick patches. Overusing topical corticosteroids can lead to skin thinning.

Vitamin D analogues

Vitamin D analogue creams are used with or instead of steroid creams. These creams are for mild to moderate psoriasis affecting areas such as the limbs, trunk or scalp. They work by slowing the production of skin cells. They also have an anti-inflammatory effect.

Examples of vitamin D analogues are calcipotriol, calcitriol and tacalcitol. There are very few side effects as long as you do not use more than the recommended amount.

Calcineurin inhibitors

Calcineurin inhibitors are ointments or creams that reduce the activity of the immune system. They help to reduce inflammation. They're sometimes used to treat psoriasis affecting sensitive areas. These could be the scalp, the genitals and folds in the skin.

These medications can cause skin irritation when they're started. This usually improves within a week.

Coal tar

Coal tar is a thick, heavy oil and is the oldest treatment for psoriasis. How it works is not exactly known, but it can reduce scales, inflammation and itchiness.

It may be used to treat psoriasis affecting the limbs, trunk or scalp if other topical treatments are not effective.

Coal tar can stain clothes and bedding and has a strong smell.

Dithranol

Dithranol has been used for more than 50 years to treat psoriasis. It is effective in suppressing the production of skin cells and has few side effects. But it can burn if it's too concentrated.

It's used as a short-term treatment, under hospital supervision. It's for psoriasis affecting the limbs or torso. It stains everything it comes into contact with, including skin, clothes and bathroom fittings.

It's applied to your skin (by someone wearing gloves) and left for 10 to 60 minutes before you wash it off.

Phototherapy

Phototherapy uses natural and artificial light to treat psoriasis. Artificial light therapy is usually given under the care of a dermatologist. These treatments are not the same as using a sunbed.

Ultraviolet B (UVB) phototherapy

UVB phototherapy uses a wavelength of light invisible to human eyes. The light slows down the production of skin cells. It is an effective treatment for some types of psoriasis that have not responded to topical treatments.

Each session only takes a few minutes. But you may need to go to hospital 2 or 3 times a week for 6 to 8 weeks.

Psoralen plus ultraviolet A (PUVA)

For this treatment, you'll first be given a tablet containing compounds called psoralens. Psoralen may be applied to the skin. This makes your skin more sensitive to light.

Your skin is then exposed to a wavelength of light called ultraviolet A (UVA). This light penetrates your skin more than ultraviolet B light.

This treatment may be used if you have severe psoriasis that has not responded to other treatment.

Side effects include nausea, headaches, burning and itchiness. You may need to wear special glasses for 24 hours after taking the tablet. This is to prevent the development of cataracts.

Long-term use of this treatment is not encouraged. It can increase your risk of developing skin cancer.

Combination light therapy

Combining phototherapy with other treatments often increases its effectiveness.

Some doctors use UVB phototherapy in combination with coal tar.

The coal tar makes the skin more receptive to light. Combining UVB phototherapy with dithranol cream may also be effective – this is known as Ingram treatment.

Systemic treatments - tablets, capsules and injections

If your psoriasis is severe or other treatments have not worked, you may be prescribed systemic treatments by a specialist. Systemic treatments work throughout the entire body.

These medications can be very effective in treating psoriasis. But they all have potentially serious side effects. All the systemic treatments for psoriasis have benefits and risks.

Before starting treatment, talk to your GP about your treatment options. Ask them about any risks associated with them.

If you're pregnant or are thinking of breastfeeding, talk to your GP before taking any new medicine.

There are 2 main types of systemic treatment. These are non-biological (usually given as tablets or capsules) and biological (usually given as injections).

Non-biological medications

Methotrexate

Methotrexate can help control psoriasis. They slow down the production of skin cells and suppressing inflammation. It's usually taken once a week.

Methotrexate can cause nausea and may affect the production of blood cells. Long-term use can cause liver damage. People who have liver disease should not take methotrexate. You should not drink alcohol when taking it.

Methotrexate can be very harmful to a developing baby. It's important that women use contraception and do not become pregnant while they take this drug and for at least 3 months after they stop.

The safety for men fathering a pregnancy while taking methotrexate is less clear. As a precaution, men are advised to delay trying for a baby until at least 3 months since their last dose of methotrexate.

Ciclosporin

Ciclosporin is a medicine that suppresses your immune system (immunosuppressant). It was originally used to prevent transplant rejection but has proved effective in treating all types of psoriasis. It's usually taken daily.

Ciclosporin increases your chances of kidney disease and high blood pressure. This will need to be monitored.

Acitretin

Acitretin is an oral retinoid that reduces skin cell production. It's used to treat severe psoriasis that has not responded to other non-biological systemic treatments. It's usually taken daily.

Acitretin has a wide range of side effects. These include dryness and cracking of the lips, dryness of the nasal passages and, in rarer cases, hepatitis.

Acitretin can be very harmful to a developing baby. It's important that women use contraception and do not become pregnant while taking this drug, and for at least 3 years after they stop taking it. It's safe for a man taking acitretin to father a baby.

Newer drugs

Apremilast and dimethyl fumarate are newer medicines that help to reduce inflammation. They are taken as daily tablets. These medicines are only recommended for use if you have severe psoriasis that has not responded to other treatments.

Biological treatments

Biological treatments reduce inflammation by targeting overactive cells in the immune system. They are usually used if you have severe psoriasis that has not responded to other treatments.

Etanercept

Etanercept is injected twice a week. You'll be shown how to do this. If there's no improvement in your psoriasis after 12 weeks, the treatment will be stopped.

The main side effect of etanercept is a rash where the injection is given. Etanercept affects the whole immune system. There's a risk of serious side effects, including severe infection.

If you have had tuberculosis in the past, there's a risk it may return.

You'll be checked for side effects during your treatment.

Adalimumab

Adalimumab is injected once every 2 weeks, and you'll be shown how to do this. If there's no improvement in your psoriasis after 16 weeks, the treatment will be stopped.

The main side effects of adalimumab include headaches, a rash at the injection site and nausea. Adalimumab affects the whole immune system. There's a risk of serious side effects, including severe infections.

You'll be checked for side effects during your treatment.

Infliximab

Infliximab is given as a drip (infusion) into your vein at the hospital. You'll have 3 infusions in the first 6 weeks, then 1 infusion every 8 weeks. If there's no improvement in your psoriasis after 10 weeks, the treatment will be stopped.

The main side effect of infliximab is a headache. Infliximab affects the whole immune system. There's a risk of serious side effects, including severe infections.

You'll be checked for side effects during your treatment.

Ustekinumab

Ustekinumab is injected at the beginning of treatment, then again 4 weeks later. After this, injections are every 12 weeks. If there's no improvement in your psoriasis after 16 weeks, the treatment will be stopped.

The main side effects of ustekinumab are a throat infection and a rash at the injection site. Ustekinumab affects the whole immune system. There's a risk of serious side effects, including severe infections.

You'll be checked for side effects during your treatment.

Newer drugs

Guselkumab, brodalumab, ixekizumab and secukinumab are newer biological treatments. They are given as injections.

They're for people who have severe psoriasis that hasn't improved with other treatments or when other treatments aren't suitable.

If there is no improvement in your psoriasis after 12 weeks the treatment will be stopped.

If there is no improvement in your psoriasis after 16 weeks with guselkumab, the treatment will be stopped.