What to Expect From Topical, Phototherapy, and Other Psoriasis Treatments
Psoriasis is a disease that, in its various forms, is characterized by patches or widespread areas of irregularly textured and colored skin. The condition is caused by the overproduction of skin cells, up to ten times more rapidly than normal. These cells move outward through the skin, and through sheer quantity cause buildups, called plaques, on the surface. When this occurs, the immune system interprets these plaques as invasive masses that threaten the body as a whole. T cells are dispatched to the site and, in their attempts to eliminate the plaques, cause swelling and inflammation. This immune reaction stimulates the production of more skin cells, which in turn causes the creation and dispatch of additional T cells, all of which can lead to prolonged and painful flare ups.There are a variety of different treatments that have proven effective when dealing with psoriasis. In cases of plaque psoriasis, the most common form of the disease, topical approaches and phototherapy are employed first; other forms of treatment are reserved for more severe and nonresponsive cases.
Topical treatments for psoriasis are common. They focus on three means of treating symptoms: reducing inflammation, slowing the growth of skin cells, and removing and reducing scaling.Among the most common anti-inflammatory treatments, corticosteroids are available in over-the-counter and prescription strengths for varying degrees of severity. These are best used for short-term treatment of flares, as they can stop working over time and can cause thinning of the skin when used for extended periods.Other topical anti-inflammatories include retinoids and calcineurin inhibitors. Topical retinoids are derived from vitamin A and can increase sensitivity to sunlight. Oral retinoids are also available, but the topical forms reduce the chances of birth defects in the children of people using the treatment. Calcineurin inhibitors are associated with an increased chance of lymphoma and skin cancer, but have proven useful over short terms for treating areas of thin skin when other topical treatments may prove too irritating.To inhibit the rampant cell growth that characterizes psoriasis flares, vitamin D analogues are available in various forms and intensities. Anthralin can also be used to control and normalize the growth of scales, and it can remove scales and make skin smoother. As with other topical treatments, though, anthralin can cause irritation and it additionally stains anything it touches; it is usually applied for a short time and then removed.To remove dead skin cells and reduce scaling, the most common solution is salicylic acid, which is available over the counter and, for more intense flares, in prescription strength. It is often combined with other topical treatments to increase its effectiveness. Salicylic acid is also available in shampoos and moisturizers for scalp psoriasis.
Some approaches to treating psoriasis involve intense light, either natural sunlight or artificial ultraviolet light. In either case, the course of treatment uses short, closely controlled exposure to ultraviolet radiation. In these doses, exposure can inhibit the growth of skin cells; failure to properly manage exposure, however, can instead increase the cell division and reproduction.Ultraviolet treatment can be administered in specific forms, such as the application of narrow-band UVB rays and UVB lasers. Phototherapy can be employed on its own, but it is often combined with oral or topical treatments to increase the effectiveness of both. It is typically used in tandem with treatments that increase sensitivity to light.
Other approaches to treating psoriasis include medications that can be administered orally or by injection. These are typically reserved for severe cases or when psoriasis proves resistant to other, more mild forms of treatment. Some of these internal treatments aim to reduce inflammation, as with the oral retinoids mentioned above. Some, like methotrexate, are anti-inflammatories as well as cell growth inhibitors. The side effects of these medications are often more severe and risky than those of topical treatments. These systemic therapies are usually reserved for pustular or erythrodermic varieties of the disease, or if psoriasis is accompanied by arthritis.One option offered by internal treatments is modification of the immune system. Cyclosporine, for example, is an immunosuppressant that prevents the body from attacking itself. Another category of drugs called biologics likewise alters the functioning of the immune system. While these present effective methods of dealing with psoriasis, they also leave the patient open to life-threatening infections that an unimpeded immune system would be able to fight off. Some of these drugs incur other side effects, such as organ damage and abnormal blood pressure, which increase in likelihood and severity the longer the treatment is employed. Because the precise, underlying causes of psoriasis are still murky in the eyes of medical science, new treatments are being devised and explored. Currently, research into protein therapy promises more direct and targeted manipulation of the immune system as a means of easing psoriasis symptoms. As more sophisticated methods and knowledge are uncovered, uncomfortable and risky treatments may yet yield way to a cure for the disease.