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Treating Psoriasis

There are 4 types of treatments available to effectively manage the symptoms of Psoriasis.

Topical treatment

Topical treatment

These are medicines that are applied on the skin

Phototherapy

Phototherapy

This involves exposing the affected part of the skin to specialised light rays

Oral Systemic

Oral systemic treatment

They are medicines in the form of oral tablets or pills

Biologics

Biologic treatment

These are often injections or infusions that target the immune system

Topical treatment[1]

These are various medicines for itchy skin and other Psoriasis associated symptoms. They range from emollients, corticosteroids, calcitriol or tar based therapies.
Here’s a brief overview on topicals used for Psoriasis.

Emollients:
Emollients can be in the form of creams, ointments or lotions.

  • Keep the skin soft.
  • Effective against itching and tenderness.
  • Should be applied immediately after bathing.

Topical corticosteroids:

  • Help in reducing inflammation.
  • Available in many forms such as lotions, gels, sprays, etc.
  • May have side effects if used over long periods.

Calcitriol:

  • These are related to Vitamin D.
  • Work by slowing down the growth of skin cells.
  • Commonly causes skin irritation.

Tar:

  • Tar is a substance distilled from coal that has been used to treat Psoriasis for many years.
  • May have a role in reducing skin cell growth.
  • Staining is a common problem with tar use.

Phototherapy[1]

Special lamps which emit ultra violet light is directed towards the plaques or scales.

  • Reduces swelling.
  • Slows down production of skin cells.
  • Improves overall symptoms of Psoriasis.
  • Long term phototherapy may increase the risk of skin cancer.

Oral systemic treatment[1][2]

These are used as a treatment option for moderate to severe Psoriasis.

  • They may act on the whole body or on a specific part of the immune system to decrease inflammation.
  • Can be used in combination with other medications.
  • Side effects range from mild flu like symptoms to kidney damage.
  • Each oral medication is associated with some risks.

Questions to ask your Dermatologist before initiating oral systemic treatment

Systemic medicines work differently from topical treatments. It is therefore important for you to have a frank conversation with your Dermatologist before you begin your treatment. Here are a few questions about systemic treatment you can ask your Dermatologist.

  • Can I still use topical treatment while I am on systemic treatment?
  • What are the possible side effects or risks?
  • Are there any routine blood tests that I would need to do while on this treatment?
  • Can I take this treatment if I plan to start a family?
  • How will I know that my treatment is working for me?
  • How long will I have to take these medications?
  • Would I need to change my lifestyle or other routines while I am on this treatment?
  • Is there any other treatment option for me if this therapy doesn’t work?

Biologic treatment[3][4]

Biologics for Psoriasis target the immune system and are used for those with moderate to severe itchy skin and other Psoriasis associated symptoms. There are various types of biologics for Psoriasis, and your Dermatologist will be the best judge to decide which biologic suits you best.

  • Can be given subcutaneously or via infusion depending upon the type of biologic.
  • Reduces pain, itching and scaling.
  • Improves overall quality of life.
  • Newer biologics help achieve almost clear to clear skin.

Questions to ask your Dermatologist before initiating biologic treatment

Your Dermatologist will initiate biologics if you suffer from moderate to severe Psoriasis. Here are a few questions about biologics you can ask your Dermatologist that will help you make an informed choice:[5]

  • How do biologics for Psoriasis work?
  • Why do you think this particular biologic would work best for me?
  • Will this biologic also take care of my joint symptoms?
  • Are there any risks or side effects that I should be aware of?
  • Are there any precautions I need to take while on this therapy?
  • Are any other medications contra-indicated while I’m on biologics?
  • How often do I have to take it?
  • How will it be administered?
  • Are there any routine tests to be done while I am on this therapy?
  • Are there any biologics that can be administered at home?
  • What are the consequences of missing a dose?
  • Can I continue my topical treatment while on biologics?
  • How will I know my treatment is working for me?
  • What are the next steps if this biologic doesn’t work for me?

It is important that you talk to your Dermatologist about the benefits and drawbacks of the prescribed therapy. A healthy discussion on your treatment will ensure best results.

Setting treatment goals[2]

Setting a treatment goal is an important step towards knowing if your treatment is working for you. There are a few defined treatment goals for Psoriasis treatment.

Time after starting a new treatment plan

Treatment target

3 months Less than 1% of your body affected by Psoriasis*
6 months Less than 1% of your body affected by Psoriasis

* It may be acceptable to have less than 3% of your body affected by Psoriasis (or have 75% improvement) at this time.

Setting treatment goals is a joint decision between your Dermatologist and you. It is a good idea to understand your treatment goals and review them regularly with your Dermatologist.

Talk to your Dermatologist
about biologics for clear* skin

*No plaque elevation, erythema or
scaling, hyperpigmentation maybe present.

Know if your treatment is working for you.

References

  1. Feldman SR, et al. Patient information: Psoriasis (Beyond the Basics). Available [online] at: http://www.uptodate.com/contents/psoriasis-beyond-the-basics As accessed on 12 October 2017.

  2. National Psoriasis Foundation. Systemic treatments biologics and oral treatments. Available [online] at URL: https://www.psoriasis.org/sites/default/files/systemic_treatments_-_biologics_and_oral_treatments.pdf. As accessed on September 18, 2017.

  3. Thaçi D, et al. J Am Acad Dermatol. 2015 Sep;73(3):400-9.

  4. Gustafson CJ, et al. Patient Education for Biologic Therapy of Psoriasis and Psoriatic Arthritis. Available[online] at URL: https://www.the-dermatologist.com/content/patient-education-biologic-therapy-psoriasis-and-psoriatic-arthritis As accessed on October 30, 2019.

  5. National Psoriatic Foundation. About Psoriasis and Psoriatic Arthritis. Available [Online] at: https://www.psoriasis.org/sites/default/files/about_psoriasis_and_psoriatic_arthritis1.pdf  Accessed on 22 Jan 2020.