Psoriasis is a chronic, non-contagious skin disease of scaling and inflammation that affects about 2 percent of the US population, or as many as 7.5 million Americans. Psoriasis most often appears on the scalp, elbows, knees, and torso but can develop anywhere. Up to 30% of people with psoriasis will develop psoriatic arthritis, or painful, inflamed, stiff joints.
Impact of Psoriasis on Quality of Life
Individuals with psoriasis may experience significant physical discomfort and some disability. Psoriasis of the hands and feet can prevent individuals from working at certain occupations. Many people with psoriasis feel self-conscious about their appearance and have a poor self-image. The psychological distress can lead to significant depression, alcoholism, and social isolation.
Treatment of Psoriasis
There is no cure for psoriasis, but many different treatments, both topical and systemic, can help clear psoriasis.
First line treatment for psoriasis.
- Salicylic acid – helps remove scale and is often combined with topical steroids.
- Steroids – reduce inflammation and are effective in controlling mild to moderate psoriasis; potential side effects include thinning of the skin.
- Vitamin D based creams – effective non-steroidal alternatives.
- Retinoid creams – Vitamin A derivatives that work to normalize skin turnover.
- Light Therapy – Sunlight, ultraviolet B (UVB) light, and laser treatment can be helpful in treating psoriasis. These treatments can be inconvenient and can raise the risk of skin cancer. Home UVB light devices can be more convenient for patients.
- Biologics – An exciting new group of injectable drugs that has revolutionized the treatment of psoriasis and psoriatic arthritis! They are much safer than older systemic drugs. Biologics that we use include Enbrel, Humira, and Stelara.
Are There Non-Pharmaceutical Psoriasis Treatments?
In some cases, your physician may recommend trying light therapy or laser treatments for psoriasis.
Your doctor may recommend the use of phototherapy or light therapy for your psoriasis treatment, procedures involving exposure of the skin to ultraviolet light administered in a special phototherapy unit. During the course of treatment, your skin may get worse initially due to aggravation caused by reaction to the UBV light, in which case the amount of UBV administered by be reduced. However, with continued treatment improvement should become evident. On occasion, UBV may be combined with systemic therapies.
Psoralen and UVA (PUVA)
A combination of ultraviolet light and a light-sensitizing medication called psoralen, PUVA has been found to slow abnormal cell growth and alleviate psoriasis symptoms for various lengths of time. Side effects of the treatment include nausea, itching and redness which can be alleviated with antihistamines, topical products or oatmeal baths.
Laser treatments have been found effective for some localized psoriasis plaques. Recently FDA-approved for psoriasis, the excimer laser targets localized plaques with a high-intensity ultraviolet light B (UBV) beam. Recommended for mild to moderate cases, the excimer laser may be used with topical therapies. It may take four to 10 sessions to see improvement.
Pulsed Dye Laser
Also used for treating chronic, localized plaques, this laser treatment combines use of a dye and a different light wavelength from other lasers. Four to six 15- to 30-minute sessions are normally required to see improvement.