Although there is no cure for psoriasis, treatments can help reduce the symptoms and clear your skin. There are several types of psoriasis treatments. Your treatment choice will depend on your individual needs and how well you respond to a chosen therapy. Provided below is a topline overview of treatment options including both the benefits and risks:
Creams, lotions and ointments are usually the first step to treating psoriasis if it is not too severe. These treatments can help in a variety of ways. Some slow down the growth or turn-over of skin cells, others can reduce itching, redness, flaking, inflammation or scaling. Topical treatments can also be used in combination with phototherapy (this involves exposing the skin to ultraviolet light on a regular basis and under medical supervision).
Corticosteroids are a commonly used topical treatment. Corticosteroids can reduce inflammation and skin cell turnover. With long-term or inappropriate use they can cause thinning of the skin, abnormal hair growth, secondary infection, changes in skin colour and other side effects. The most common side effects of topical treatments are skin irritation or rash.
Phototherapy is commonly used in the management of moderate to severe plaque psoriasis. Both natural sunlight and artificial ultraviolet (UV) light seem to improve psoriasis symptoms. Importantly, you’ll want to avoid sunburn, which can actually worsen your psoriasis. Artificial light therapy uses UV light, as either UVB or UVA phototherapy. The UV light penetrates the upper layer of skin. Certain forms of light therapy are used together with creams or oral treatments, which make the skin more receptive to the light.
UV light exposure should be carefully adjusted until desired outcomes are achieved (this process is known as titration). The dose of UV light is based on the individual’s complexion and likeliness to burn or tan. Acute (or short-term) safety issues are rare but can include treatment-related effects as erythema (redness of the skin) or blistering. For longer-term, it is important to limit cumulative exposure as this could pose a risk of carcinogenesis (the process in which normal cells turn into cancer cells).
3. Combination Therapy
Combining two or more treatments can be more effective than a single treatment and can result in reduced incidence of adverse events when compared to using just one form of therapy. The risk- benefit profile would vary depending on what combination of therapies are used. Talk to your healthcare provider to find out what treatment options might work best for your situation.
“Follow-up with your healthcare provider regularly to review and adjust your treatment plan, and consider asking about using the PASI.”
4. Oral Treatments
There are oral treatments available that either slow the rate of skin cell growth, normalize the pattern of skin cell growth, suppress certain immune system functions, or reduce the activity of specific enzymes which results in less skin inflammation. Some can be used for severe psoriasis where conventional treatment is inappropriate or ineffective. Others are intended for moderate or severe psoriasis.
As with most medicines, interactions with other drugs are possible. Tell your healthcare practitioner or pharmacist about all the medications you take, including drugs prescribed by other healthcare practitioners, vitamins, minerals, natural supplements, or alternative medicines. These products should not be taken by women who are pregnant or plan to become pregnant.
Side effects may differ depending on the medication and can range from diarrhea, nausea, vomiting, fatigue and headaches to lowering the level of white blood cells that can decrease the ability to fight infection. Be sure to speak with your healthcare provider about the side effects of the specific medication you are considering so that you understand the side effects and how to manage them.
Biologics can be used for the treatment of chronic moderate to severe plaque psoriasis in adults that are candidates for systemic or phototherapy. They block the action of various proteins in the immune system that play a role in inflammation. They are administered by injection or infusion.
Safety concerns include the development serious infections (such as tuberculosis and other infections caused by bacteria, viruses or fungi), autoimmune conditions (such as lupus and demyelinating disorders). Demyelinating disorders result in damage to the protective covering (myelin sheath) that surrounds nerve fibers which can result in neurological problems. Use of biologics also carry the risk of malignancies such as lymphoma. In some cases blood and/or liver problems can develop. These products should not be used by those who have active, serious infections.
Like all medicines, biologics can cause side effects. Most side effects are mild to moderate. However, some may be serious and require treatment. Side effects may differ depending on the medication, however, some common side effects may include: injection site reactions, upper respiratory tract infections, headaches, severe rash or hives, and difficult breathing or swallowing. Be sure to speak with your healthcare provider about the side effects of the specific medication you are considering so that you understand the side effects and how to manage them.
Follow-up with your healthcare provider regularly to review and adjust your treatment plan, and consider asking about using the PASI score to validate your progress.
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