Topic Overview
What is psoriasis?
Psoriasis (say "suh-RY-uh-sus")
is a long-term (chronic) skin problem that causes skin cells to grow too
quickly, resulting in thick, white, silvery, or red patches of skin. Normally,
skin cells grow gradually and flake off about every 4 weeks. New skin cells
grow to replace the outer layers of the skin as they shed. But in psoriasis,
new skin cells move rapidly to the surface of the skin in days rather than
weeks. They build up and form thick patches called plaques (say "plax").
The patches range in size from small to large. They most often appear on
the knees, elbows, scalp, hands, feet, or lower back. Psoriasis is most common
in adults. But children and teens can get it too.
Having
psoriasis can be embarrassing, and many people, especially teens, avoid
swimming and other situations where patches can show. But there are many types
of treatment that can help keep psoriasis under control.
See a
picture of
psoriasis.
What causes psoriasis?
Experts believe that
psoriasis occurs when the
immune system overreacts, causing
inflammation and flaking of skin.
In some
cases, psoriasis runs in families. Researchers are studying large families
affected by psoriasis to find out how it is passed from parents to their
children and what might trigger the condition.
People with
psoriasis often notice times when their skin gets worse. Things that can cause
these flare-ups include a cold and dry climate, infections,
stress, and dry skin. Also, certain medicines, such as
nonsteroidal anti-inflammatory drugs (NSAIDs) and
medicines used to treat
high blood pressure or certain mental illnesses, may
trigger an outbreak or make your psoriasis worse.
Smoking,
especially in women, makes you more likely to get psoriasis and can make it
worse if you already have it.
Psoriasis is not contagious. It
cannot be spread by touch from person to person.
What are the symptoms?
Symptoms of psoriasis
appear in different ways. Psoriasis can be mild, with small areas of rash. When
psoriasis is moderate or severe, the skin gets inflamed with raised red areas
topped with loose, silvery, scaling skin. If psoriasis is severe, the skin
becomes itchy and tender. And sometimes large patches form and may be uncomfortable. The patches can join together and cover large areas of skin, such
as the entire back.
In some people, psoriasis causes joints to
become swollen, tender, and painful. This is called
psoriatic arthritis (say "sor-ee-AT-ik ar-THRY-tus").
This arthritis can also affect the fingernails and toenails, causing the nails
to pit, change color, and separate from the nail bed. Dead skin may build up
under the nails.
Symptoms often disappear (go into remission),
even without treatment, and then return (flare up).
How is psoriasis diagnosed?
A doctor can usually
diagnose psoriasis by looking at the patches on your skin, scalp, or nails.
Sometimes a skin
KOH test is used to rule out a fungal infection. But
otherwise, special tests are usually not needed.
How is it treated?
Most cases of psoriasis are
mild, and treatment begins with skin care. This includes keeping your skin
moist with creams and lotions. These are often used with other treatments
including shampoos, ultraviolet light, and medicines your doctor
prescribes.
In some cases, psoriasis can be hard to treat. You
may need to try different combinations of treatments to find what works for
you. Treatment for psoriasis may continue for a lifetime.
What can you do at home for psoriasis?
Skin care
at home can help control psoriasis. Follow these tips to care for
psoriasis:
- Use creams or lotions, baths, or soaks to
keep your skin moist.
- Try short exposure to sunlight or
ultraviolet (UV) light.
- Gently soften and remove psoriasis crusts
by putting cream on the crusts and then peeling the loose crusts off. Removing
crusts may help your skin to absorb creams and lotions. Remove them carefully,
though, so you don't irritate the skin.
- Follow instructions for
skin products and prescribed medicines. It may take a period of trial and error
until you know which skin products or methods work best for you. For mild
symptoms of psoriasis, some
over-the-counter medicines, such as aloe vera, may be
soothing.
It is also important to avoid those things that can cause
psoriasis symptoms to flare up or make the condition worse. Things to avoid
include:
- Skin injury. An injury
to the skin can cause psoriasis patches to form anywhere on the body, including
the site of the injury. This includes injuries to your nails or nearby skin
while trimming your nails.
- Stress and anxiety. Stress can cause psoriasis to appear suddenly (flare) or can
make symptoms worse.
- Infection. Infections
such as
strep throat can cause psoriasis to appear suddenly,
especially in children.
- Certain medicines.
Some medicines, such as NSAIDs,
beta-blockers, and lithium, have been found to make
psoriasis symptoms worse. Talk with your doctor. You may be able to take a
different medicine.
- Overexposure to sunlight. Short periods of sun exposure reduce psoriasis in
most people, but too much sun can damage the skin and cause skin cancer. And
sunburns can trigger flares of psoriasis.
- Alcohol. Alcohol use can cause symptoms to flare
up.
- Smoking. If you smoke, try to quit.
Smoking, especially in women, makes you more likely to get psoriasis and can
make it worse if you already have it.
Studies have not found that specific diets can cure or
improve the condition, even though some advertisements claim to. For some people,
not eating certain foods helps their psoriasis. Most doctors recommend that you
eat a balanced diet to be healthy and stay at a healthy weight.
Frequently Asked Questions
Learning about psoriasis: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Living with psoriasis: | |
Cause
The exact cause of
psoriasis is not known. Many scientists believe that
the condition may be passed down from parents to their children (inherited).
About one-third of people who have psoriasis have one or more family members
with the condition.9 But it is not clear that genetic
factors alone determine whether you develop psoriasis. Psoriasis is not
contagious—it cannot be spread by touch from person to person.
Doctors believe that the
immune system is a factor in the development of
psoriasis. This is because increased numbers of white blood cells are present
between the abnormal layers of skin and because psoriasis responds to drugs
that suppress the immune system.
Other factors may contribute to
the development of psoriasis, make the condition worse, or make it return,
including:
- Climate. Cold, dry
weather causes symptoms to become worse. Hot weather, sunlight, and humidity
may improve symptoms.
- Skin injury. An injury
to the skin can cause psoriasis patches to form anywhere on the body, including
the site of the injury. This includes injuries to your nails or nearby skin
while trimming your nails.
- Stress and anxiety. Stress can cause psoriasis to appear suddenly (flare) or can
make symptoms worse.
- Infection. Infections
such as
strep throat can cause psoriasis to appear suddenly
(guttate psoriasis), especially in
children.
- Certain medicines.Certain medicines, such as
NSAIDs,
beta-blockers, and lithium, have been found to make
psoriasis symptoms worse. Whenever your doctor prescribes any medicines for
you, tell him or her that you have psoriasis.
Symptoms
The classic symptoms of
psoriasis are raised, red
patches of skin topped with loose, silvery scales, usually on the knees or
elbows.
There are several
types of psoriasis. Symptoms for each type may vary in
severity and appear in a wide array of combinations. In general, the major
symptoms of psoriasis include:
- Bright red areas of raised patches (plaques) on
the skin, often covered with loose, silvery scales. Plaques can occur anywhere,
but commonly they occur on the knees, elbows, scalp, hands, feet, or lower
back. Nearly 90% of people with psoriasis have plaque-type psoriasis.9
- Tiny areas of bleeding when skin scales are
picked or scraped off (Auspitz's sign).
- Mild scaling to thick,
crusted plaques on the scalp.
- Itching, especially during sudden
flare-ups or when the psoriasis patches are in body folds, such as under the
breasts or buttocks.
- Nail disorders. Nail disorders are common,
especially in severe psoriasis. Nail symptoms include:
- Tiny pits in the nails (not found with
fungal nail infections).
- Yellowish discoloration of the toenails
and sometimes the fingernails.
- Separation of the end of the nail
from the nail bed.
- Less often, a buildup of skin debris under the
nails.
Other symptoms of psoriasis may include:
- Similar plaques in the same area on both sides
of the body (for example, both knees or both elbows).
- Flare-ups of
many raindrop-shaped patches. Called
guttate psoriasis, this condition often follows a
strep infection and is the second most common type of psoriasis. It affects
less than 10% of those with psoriasis.9
- Joint swelling, tenderness, and pain (psoriatic arthritis).
Koebner's phenomenon can occur when a person with psoriasis
has an injury (such as a cut, burn, or excess sun exposure) to an area of the
skin that is not affected by psoriasis. Psoriasis patches then appear on the
injured skin or any other part of the skin from several days to about 2 weeks
after the injury. Because this response is common, it is important for people
who have psoriasis to avoid irritating or injuring their skin.
Several
other skin conditions have symptoms similar to
psoriasis. Some medicine reactions can cause symptoms (such as reddened skin)
similar to psoriasis. Talk to your doctor about the medicines you are
taking.
What Happens
Psoriasis is
usually long-lasting, returns often (chronic), and can be unpredictable.
Symptoms may come on suddenly (flare) and then improve and go away (remission).
This cycle continues over and over. In some cases, psoriasis may go away
without treatment. But in moderate to severe cases, it is best to treat
psoriasis so that it does not get worse.
Several factors can make
the condition worse, depending on the
type of psoriasis. These factors include cold, dry climates; stress;
infection; skin injury; and certain medicines.
The severity of
psoriasis is indicated by the amount of redness and scaling, the thickness of
the large areas of raised skin patches (plaques), and the percentage of your
skin that is affected.
Mild psoriasis causes plaques that cover a
small portion of the body, such as the elbows or knees.
Moderate
psoriasis causes:
- Several large areas of plaque. For example,
most of the scalp may be affected.
- Plaques that may cover up to 20%
of the skin (about equal to having both arms completely
covered).
- Mild joint pain that is not
disabling.
- Concern about plaques being visible to other
people.
Severe psoriasis includes:
- Plaques that may cover large areas (20% to 30%)
of the body. When determining the percent of coverage, consider that the palm
of your hand equals about 1% of your body surface, and the total surface of
both arms equals about 20%.
- Psoriasis on the
face.
- Pustular psoriasis with large, fluid-filled plaque and
severe scaling, or
erythrodermic psoriasis with severe inflammation and
shedding (sloughing) of the skin.
- Psoriatic arthritis,
which includes ongoing joint swelling, tenderness, limitation of range of
motion, or joint warmth or redness. Severe cases can result in joint
destruction.
Psoriasis may persist for long periods of time without
getting better or worse.
Psoriasis can cause a lot of stress and
lowered self-esteem. You can get specialized treatment and emotional support from
psoriasis day care centers. For more information on
available resources, see the Other Places to Get Help section of this
topic.
What Increases Your Risk
Many doctors believe that
psoriasis may be passed down from parents to their
children (inherited). White (Caucasian) people who carry a certain
gene have a much greater risk of developing
psoriasis.1 About one-third of people who have
psoriasis have one or more family members with the condition.9
Other factors that can contribute to the
development of psoriasis include:
- Cold climates. Cold weather makes symptoms
worse.
- Emotional or physical stress. Stress may cause psoriasis to
appear suddenly or make symptoms worse (although this has not been proven in
studies).
- Infection. Infections such as
strep throat can cause psoriasis to appear suddenly,
especially in children.
- Skin injuries. An injury to the skin can
cause psoriasis patches to form anywhere on the body, including the site of the
injury. This includes injuries to your nails or nearby skin while trimming your
nails.
- Certain
medicines. Certain medicines, including some heart
medicines (beta-blockers) or medicines to treat mental illness
(for example, lithium), may make psoriasis symptoms worse.
- Smoking.
Smoking may make you more likely to get psoriasis and make the symptoms more
severe.2 Smoking may also make your symptoms last longer.11
- Weight gain in women. A large study has shown that women who gain
weight throughout adult life are more likely to develop psoriasis.8
When To Call a Doctor
Call your doctor if you have
symptoms of
psoriasis, such as:
- Bright red areas of raised patches (plaques)
that are covered with loose, silvery, scaling skin.
- Thick, crusted
patches on the scalp.
- Tiny pits or yellowish discoloration in the
nails, separation of the nail from the skin, or buildup of skin debris under
the nail.
- Signs of developing bacterial infection. These include:
- Increased pain, swelling, redness,
tenderness, or heat.
- Red streaks extending from the
area.
- A discharge of pus.
- Fever of
100.4°F (38°C) or higher with
no other cause.
If you are currently being treated for psoriasis, call your
doctor if you:
- Have severe and widespread psoriasis and your
skin is more irritated or inflamed than usual, especially if you have another
illness.
- Are taking medicine for psoriasis and have serious side
effects, such as vomiting, bloody diarrhea, chills, or fever.
Watchful Waiting
If you have symptoms of psoriasis, talk to your
doctor, because treatment when symptoms are first noticed may help stop the
condition from progressing.
Who To See
Health professionals who can
diagnose and treat psoriasis include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Your doctor can often recognize
psoriasis by the appearance and location of the
patches on your skin, scalp, or nails. Psoriasis usually involves bright red
areas of raised patches that are often covered with loose, silvery, scaling
skin and are commonly located on the knees, elbows, scalp, hands, feet, or
lower back.
Special tests are usually not needed. If it is hard to
diagnose the condition by looking at your skin, your doctor may remove a small
skin sample (biopsy) and send it to a lab for analysis. If you have
joint pain,
X-rays may be taken to diagnose
psoriatic arthritis. Blood work may help rule out
other forms of arthritis.
Guttate psoriasis is a less common type
of psoriasis. The small [less than
0.4 in. (1 cm) in diameter],
scaly, circular elevations (papules) that occur with guttate psoriasis appear
more on the trunk of the body than on the arms or legs. If you have these
papules, your doctor may perform a
throat culture to check for strep throat.
Sometimes a skin
KOH test is done to rule out a fungal
infection.
Treatment Overview
Currently there is no cure for
psoriasis. But many types of treatment are available,
including products applied to the skin, phototherapy, and oral medicines, which
can help control psoriasis. Most cases are mild and can be treated with skin
products. In some cases, psoriasis can be hard to treat if it is severe and
widespread. Most psoriasis returns, even mild forms.
The purpose
of treatment is to slow the rapid growth of skin cells that causes psoriasis
and to reduce inflammation. Treatment is based on the type of psoriasis you
have, its location, its severity, and your age and overall health. It also
depends on how much you are affected by the condition, either physically
(because of factors such as joint pain) or emotionally (because of
embarrassment or frustration from a skin rash that may cover a large or visible
area of the body).
Medicines applied to the skin (topical treatments)
Treatment for mild
psoriasis, characterized by a few isolated raised
patches, begins with skin care, which includes
keeping your skin moist. Basic treatment often
involves combining treatments and products that you can get without a
prescription, including:
- Creams, ointments, and lotions to moisturize
the skin.
- Shampoos, oils, and sprays to treat psoriasis of the
scalp.
- Some exposure to sunlight.
It is also important to avoid what can trigger a flare-up
of psoriasis or make the condition worse. Stress, skin injury, infection, and
use of alcohol can all contribute to symptom flare-ups. Streptococcal
infections, which usually affect the upper respiratory tract, are associated
with guttate psoriasis.
Effective treatment
will improve your overall well-being and reduce your physical symptoms.
You may try prescription medicines if your psoriasis is not helped by
products you can get without a prescription. Topical medicines for psoriasis
treatment include:
A treatment called occlusion therapy may be effective for
some people. This involves first applying skin products, such as moisturizers,
medicated creams, or gels, then wrapping the skin with tape, fabric, or
plastic. Occlusion helps keep the area moist and increases the effectiveness of
medicated creams. Talk to your doctor before using occlusion therapy, to make
sure that you do it safely.
Treatment using more than one topical
medicine is often done. This can help prevent side effects from some of the
stronger medicines. For example, you may use one medicine during the week but
another on the weekend.
Creams, ointments, lotions, and other
medicines spread on the skin work better for some people than for others. If
one medicine does not clear up your psoriasis, your doctor will likely advise
you to try another medicine or combination of treatments.
Phototherapy
Creams and ointments may be used in
combination with sunlight or
ultraviolet light (phototherapy) for moderate
psoriasis that affects less than 20% of the skin
surface (about equal to having both arms completely covered).
If
you use
phototherapy (brief exposures to ultraviolet light
such as ultraviolet B light, also known as UVB), follow your doctor's
instructions carefully to avoid serious skin damage.
- UVB light therapy often improves psoriasis.
UVB treatment is usually done 3 times a week. Treatment of psoriasis with UVB
and with medicines spread on the skin, such as tar or calcipotriene, is safe
and effective.10
- Psoralen and UVA light therapy (PUVA) combines a medicine and ultraviolet A light
(UVA) for psoriasis treatment. First, you use a medicine, called a psoralen.
You may take it as a pill, spread it on your skin as a lotion, or use it as
bath salts. The medicine makes the skin more sensitive to UVA light. Then you
walk into a chamber where your skin is exposed to UVA light. PUVA treatment usually is done for weeks before the psoriasis symptoms go away.
Treatment with UVB appears to be safer than PUVA, but it is
less effective.6
Medicines taken by mouth (oral)
If you have
moderate to severe
psoriasis, your doctor may recommend a medicine you
take by mouth (oral medicine), such as
methotrexate, some
retinoids, and
cyclosporine. Oral medicines also may be used if
topical medicines and phototherapy are not controlling your psoriasis well
enough.
- For many people, methotrexate works well to control psoriasis
that has not improved after other treatments. Methotrexate also is used to
treat
psoriatic arthritis. Methotrexate cannot be used for
women who are pregnant or are planning to become pregnant within 3 months. Men
whose partners are planning to become pregnant should also avoid using
methotrexate.6
- Retinoids are medicines
related to vitamin A. Acitretin is the most common oral retinoid used to treat
psoriasis. Because retinoids do not weaken the
immune system, they are sometimes used for children
and for people who have psoriasis along with other conditions such as
HIV infection.6 Retinoids
cannot be used for women who are pregnant or who are planning to become
pregnant.
- Cyclosporine may be used as a short-term treatment for
moderate to severe psoriasis. But this medicine weakens the immune system and
so is often rotated with other medicines to treat psoriasis.
These oral medicines are usually used along with
medicated products you spread on your skin (topical treatments). They also may
be used along with exposure to ultraviolet light.
Oral treatment
for children is reserved for severe psoriasis, because the safety of these
medicines in children has not been well tested.
In rare cases, medicine may be injected into a
skin sore or patch (plaque).
Biologics
Biologics are medicines similar to or the same as
proteins made by the body. These medicines, such as
alefacept and etanercept, block the harmful response of the body's
immune system that causes the symptoms of
psoriasis.
Biologics are used mainly for people who cannot use
other treatments or whose psoriasis did not improve with other types of
therapy. Although biologics may not be more effective than other treatments for
psoriasis, they may be safer for organs, such as the liver or kidneys, that
some oral medicines can damage. But the long-term safety of biologics is not
known.
What To Think About
You may need to try different
treatments before you find one that works well for you. It is important to
discuss your treatment and progress with your doctor.
One study
found that education, stress reduction, and muscle relaxation training can help
many people who have psoriasis. Adding these elements to a treatment plan can
reduce disability, anxiety, and stress related to dealing with
psoriasis.3
Treatments for psoriasis have
potential side effects. People with moderate or severe psoriasis may need
treatment for the rest of their lives. Many doctors will recommend that
treatments be changed or rotated after a certain period of time to make
treatment more effective and to reduce side effects.
Prevention
There is no way to prevent
psoriasis. But the following tips may improve symptoms
or help reduce the number of psoriasis flare-ups.
- Keep your skin moist.
- Avoid
cold, dry climates. Cold weather may make symptoms worse. Hot, humid weather
and sunlight may improve symptoms. (But hot, humid weather may make certain
types of psoriasis worse.)
- Avoid scratching and picking skin, and
avoid skin injuries (cuts or scrapes). An injury to the skin can cause
psoriasis patches to form anywhere on the body, including the site of the
injury. This includes injuries to your nails or nearby skin while trimming your
nails.
- Avoid stress and anxiety. Stress may cause psoriasis to
appear suddenly (flare) or can make symptoms worse, although this has not been
proved in studies.
- Avoid infection. Infections such as
strep throat can cause one type of psoriasis (called
guttate psoriasis) to appear suddenly, especially in
children.
- Try to avoid
certain medicines. Some, including
beta-blockers and lithium, have been found to make
psoriasis symptoms worse. When your doctor prescribes any medicines for you,
tell him or her that you have psoriasis.
- Limit alcohol to no more
than 2 drinks a day for men or 1 drink a day for women. Alcohol use can cause symptoms to flare up.
- Don't smoke. Smoking may make you
more likely to get psoriasis and may make it more severe.2 Smoking may also make
your symptoms last longer.11
Home Treatment
Skin care at home can help control
psoriasis. Skin care and treatment may include using
creams or lotions, pills, baths or soaks, and ultraviolet (UV) light. Skin care
for psoriasis includes the following:
- Take care of your skin, and
keep your skin moist.
- Gently soften and remove psoriasis crusts
by putting cream on the crusts and then peeling the loose crusts off. This may
help creams and lotions be absorbed into the skin. But removing crusts should
be done very carefully so that the skin is not irritated.
- Follow
instructions for skin products and prescribed medicines. It may take a period
of trial and error until you know which skin products or methods work best
for you. For mild symptoms of psoriasis, various over-the-counter products,
such as aloe vera, may be soothing.
- Follow your schedule for
sunlight or ultraviolet light treatments.
- Seek information or
counseling from your doctor.
Psoriasis day care centers, where you can get
intensive treatment for severe psoriasis, may be available in some areas. To
find a center near you, ask your doctor or contact the National Psoriasis
Foundation at www.psoriasis.org.
For more information on caring for your skin, see:
Psoriasis: Skin care.
Other helpful suggestions to control psoriasis
include:
- Protect your skin. Treat all infections
promptly, and try to avoid skin injuries and irritation.
- Take care of your scalp. When you have psoriasis on your scalp, treat your scalp,
not your hair.
- Trim your nails. Keep your nails
trimmed to prevent the spread of psoriasis or flare-ups.
- Be careful in the sun. Although short periods of sun exposure reduce psoriasis in
most people, too much sun exposure can damage the skin and cause skin cancer. Also, sunburns can trigger flares of psoriasis.
- Be aware of possible medicine reactions. Certain medicines can trigger psoriasis or make
symptoms worse.
Studies have not found any "psoriasis diet" that can cure
or improve the condition, despite claims over the years. Try to eat a balanced,
low-fat diet, and stay at a healthy weight.
Medications
Treatment for
psoriasis usually begins with topical medicines that
you spread on the affected areas of your skin. You may use one medicine or a
combination of medicines to clear up the psoriasis patches. For mild psoriasis,
you may be able to control psoriasis using an over-the-counter medicine.
Softening and removing psoriasis crusts and scales can help creams and
other skin products be absorbed into the skin. Psoriasis crusts can be removed
by gently rubbing cream into the crusts to soften them and then carefully
peeling the crusted patches off. But this should be done with great care so
that the skin is not irritated.
For moderate to severe psoriasis,
you may need to use a topical medicine prescribed by your doctor, such as a
corticosteroid or a medicine related to vitamin D called calcipotriene. Other
topical medicines include anthralin and tars.
Occlusion therapy uses moisturizers or medicated creams or gels
applied to the skin. After the product is applied, the skin is wrapped with
tape, fabric, or plastic. Occlusion keeps the area moist and can make the
medicated creams work better. Steroid cream may be used with the occlusion
treatment method for small areas, but not for more than a few days. Occlusion of large areas may cause side effects such as
thinning of the skin. Talk to your doctor before using occlusion therapy, to
make sure that you do it safely.
Creams and ointments may be used
together with sunlight or
ultraviolet light, such as ultraviolet A (UVA) or B
(UVB), to treat moderate psoriasis. This is called phototherapy. Treatment of
psoriasis with UVB and medicines spread on the skin, such as tar or
calcipotriene, is safe and effective.10
UVA light therapy may be combined with a
medicine (called a psoralen) that makes your skin more sensitive to the UVA
light. This treatment is known as PUVA (psoralen and UVA). First, you use the
psoralen. You may take it as a pill, spread it on your skin as a lotion, or use
it as bath salts. Then you walk into a chamber where your skin is exposed to
UVA light.
Medicines taken by mouth (oral medicines) also may be
used to treat moderate to severe psoriasis. The most commonly used oral
medicines include methotrexate, cyclosporine, and retinoids, which are
medicines related to vitamin A. In rare cases, medicine may be injected
directly into a psoriasis sore or patch.
Scalp and
nail psoriasis can be difficult to treat. Both conditions are more likely to
improve with oral medicine. Treatment for the scalp often includes tar
shampoos, corticosteroid solutions, or zinc and selenium sulfide
shampoos.
If you are taking topical or oral medicines for
psoriasis, you will need regular follow-up visits with your doctor to check for
possible side effects. You may take one medicine for a while, then switch to
another to reduce the chance that a serious side effect will occur.
Medicines called biologics have shown promise for the treatment of severe
psoriasis or psoriasis that has not improved after other treatments. Biologics
are similar to or the same as
proteins made by the body. These medicines, including
alefacept and etanercept, block the harmful response of the body's
immune system that causes the symptoms of psoriasis.
The long-term safety of biologics is not known.
Medication Choices
In general, treatment for psoriasis starts with medicines
you spread on the affected areas of your skin (topical medicines).
Many types of nonprescription products are available to treat psoriasis. Examples of active ingredients include:
- Salicylic acid, found in products such as Psoriasin Body Wash or Dermasolve e70.
- Coal tar, found in products such as Elta Tar or Neutrogena T/Gel.
- Zinc pyrithione, found in products such as SkinCure and Derma-Cap. These are new products that come in spray, soap, or
solution form.
These products are used to treat small patches of psoriasis and symptoms,
including itching, redness, flaking, and scaling of the skin and scalp. For some people, they may eliminate
scales and sores caused by psoriasis.
Topical medicines that may be prescribed by your
doctor to treat psoriasis include:
- Corticosteroids, which are the most
common treatment for psoriasis. Betamethasone is an
example of a topical corticosteroid.
- Calcipotriene, which
is a form of vitamin D.
- Retinoids, which are medicines related
to vitamin A. An example is tazarotene.
- Anthralin and
tars. The use of anthralin and tars has decreased
recently, replaced by other medicines such as calcipotriene and
tazarotene.
If topical medicines alone do not relieve your psoriasis
symptoms, they may be combined with exposure to
ultraviolet (UV) light (phototherapy).
Examples include combinations of:
- Psoralen and UVA light (called
PUVA).
- Tars and UVB light (called
Goeckerman treatment).
- Anthralin and UVB light (called the Ingram
regimen).
If psoriasis cannot be controlled with topical medicines
and ultraviolet light therapy, you may consider taking medicines by mouth (oral
medicines). Oral medicines used to treat psoriasis include:
Newer medicines, which change the
immune system response to reduce the symptoms of
psoriasis, may be used to treat psoriasis that other medicines don’t help.
- Biologics.
- Alefacept (Amevive), etanercept
(Enbrel), and infliximab (Remicade) have been approved by the U.S. Food and Drug Administration (FDA) for treatment
of moderate to severe psoriasis.
- Adalimumab (Humira), etanercept,
golimumab (Simponi), and infliximab have been approved to treat
psoriatic arthritis.
These medicines are given through a needle. Early clinical trials of biologic therapies for
moderate to severe psoriasis have produced promising results. But the medicines
are expensive, and long-term effects are not known. Biologics may increase the
long-term risk of cancer or infections.12, 4, 5
What To Think About
People respond differently to
psoriasis treatments. A treatment that worked one time may not work again. A
treatment that didn't work the first time may work when tried again
later.
Some medicines used to treat psoriasis can cause serious
side effects. You and your doctor will discuss how long to use treatments that
could cause harm. You will also need to see your doctor regularly and may have
blood tests while using some medicines.
Many oral or injected
medicines used to treat psoriasis are not safe during pregnancy. If you are
pregnant, talk to your doctor before taking any medicines.
Researchers are studying other medicines for their safety and
effectiveness in treating psoriasis. These include medicines that affect the
immune system and medicines used to treat
cancer.
Surgery
Surgery is not used to treat
psoriasis of the skin or scalp. But surgery may be
used to treat nails that are severely disfigured or damaged from psoriasis.
Surgical removal of a nail may be done in a clinic or doctor's office as an
outpatient procedure.
Other Treatment
Other treatment for
psoriasis includes
phototherapy. Phototherapy uses
ultraviolet (UV) light exposure to slow the rapid
growth of cells that occurs in psoriasis. Exposure to UV light to treat this
condition can be effective, but your skin should be checked often by your
doctor (at least once or twice a year) for any skin damage or skin
cancer.
Complementary or alternative therapies are often used by
people with skin diseases, including psoriasis. Complementary therapies include
the use of herbs, vitamins, certain diets, and stress reduction. These
therapies may relieve psoriasis symptoms in some people.7 Some notice that natural sunlight and seawater
(climatotherapy) help their psoriasis symptoms. People seeking this treatment
may go to seaside resorts, some of which have special programs and medical help
for people with psoriasis. For more information, see the Web site of the
National Psoriasis Foundation at www.psoriasis.org.
Other Places To Get Help
Organizations
| American Academy of Dermatology |
| P.O. Box 4014 |
| Schaumburg, IL 60168 |
| Phone: | 1-866-503-SKIN (1-866-503-7546) toll-free
(847) 240-1280 |
| Fax: | (847) 240-1859 |
| Web Address: | www.aad.org |
| |
The American Academy of Dermatology provides information
about the care of skin, hair, and nails. You can find a dermatologist in your
area by calling 1-888-462-DERM (1-888-462-3376). |
|
| National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), National Institutes of Health |
| 1 AMS Circle |
| Bethesda, MD 20892-3675 |
| Phone: | 1-877-22-NIAMS (1-877-226-4267) toll-free
(301) 495-4484 |
| Fax: | (301) 718-6366 |
| TDD: | (301) 565-2966 |
| Email: | niamsinfo@mail.nih.gov |
| Web Address: | www.niams.nih.gov |
| |
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research. The NIAMS Web site provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases. |
|
References
Citations
- Gudjonsson JE, et al. (2002). HLA-Cw6-positive and
HLA-Cw6-negative patients with psoriasis vulgaris have distinct clinical
features. Journal of Investigative Dermatology, 118(2):
362–365.
- Gudjonsson JE, Elder JT (2008). Psoriasis. In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 1, pp. 169–193. New York:
McGraw-Hill Medical.
- Fortune DG, et al. (2002). A cognitive-behavioural
symptom management programme as an adjunct in psoriasis therapy.
British Journal of Dermatology, 146(3):
458–465.
- Reich K, et al. (2005). Infliximab induction and
maintenance therapy for moderate-to-severe psoriasis: A phase III, multicentre,
double-blind trial. Lancet, 366(9494):
1367–1374.
- Krueger GG, et al. (2005). Patient-reported outcomes
of psoriasis improvement with etanercept therapy: Results of a randomized phase
III trial. British Journal of Dermatology, 153(6):
1192–1199.
- Menter A, Griffiths CEM (2007). Current and future
management of psoriasis. Lancet, 370(9583):
272–284.
- Aloe (2004). In A DerMarderosian, J Beutler, eds.,
Review of Natural Products. St. Louis: Wolters Kluwer
Health.
- Setty AR, et al. (2007). Obesity, waist circumference,
weight change, and the risk of psoriasis in women: Nurses' Health Study II.
Archives of Internal Medicine, 167(15):
1670–1675.
- Abel E, Lebwohl M (2008). Psoriasis. In EG Nabel, ed., ACP Medicine, section 2, chap. 3. Hamilton, ON: BC Decker.
- Naldi L, Rzany B (2009). Psoriasis (chronic plaque),
search date August 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Behnam SM, et al. (2005). Smoking and psoriasis.
Skinmed, 4(3): 174–176.
- Abramowicz M (2008). Drugs for acne, rosacea and
psoriasis. Treatment Guidelines From The Medical Letter,
6(75): 75–82.
Other Works Consulted
- Giezen TJ, et al. (2008). Safety-related regulatory actions for biologicals approved in the United States and the European Union. Journal of the American Medical Association, 300(16): 1887–1896.
- Kimball AB, et al. (2008). National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening. Journal of the American Academy of Dermatology, 58(6): 1031–1042.
- Nestle FO, et al. (2009). Psoriasis. New England Journal of Medicine, 361(5): 496–509.
- Schmitt J, et al. (2008). Efficacy and tolerability of biologic and nonbiologic systemic treatments for moderate-to-severe psoriasis: Meta-analysis of randomized controlled trials. British Journal of Dermatology, 159(3): 513–526.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Alexander H. Murray, MD, FRCPC - Dermatology |
|---|
| Last Revised | January 13, 2010 |
|---|
Gudjonsson JE, et al. (2002). HLA-Cw6-positive and
HLA-Cw6-negative patients with psoriasis vulgaris have distinct clinical
features. Journal of Investigative Dermatology, 118(2):
362–365.
Gudjonsson JE, Elder JT (2008). Psoriasis. In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 1, pp. 169–193. New York:
McGraw-Hill Medical.
Fortune DG, et al. (2002). A cognitive-behavioural
symptom management programme as an adjunct in psoriasis therapy.
British Journal of Dermatology, 146(3):
458–465.
Reich K, et al. (2005). Infliximab induction and
maintenance therapy for moderate-to-severe psoriasis: A phase III, multicentre,
double-blind trial. Lancet, 366(9494):
1367–1374.
Krueger GG, et al. (2005). Patient-reported outcomes
of psoriasis improvement with etanercept therapy: Results of a randomized phase
III trial. British Journal of Dermatology, 153(6):
1192–1199.
Menter A, Griffiths CEM (2007). Current and future
management of psoriasis. Lancet, 370(9583):
272–284.
Aloe (2004). In A DerMarderosian, J Beutler, eds.,
Review of Natural Products. St. Louis: Wolters Kluwer
Health.
Setty AR, et al. (2007). Obesity, waist circumference,
weight change, and the risk of psoriasis in women: Nurses' Health Study II.
Archives of Internal Medicine, 167(15):
1670–1675.
Abel E, Lebwohl M (2008). Psoriasis. In EG Nabel, ed., ACP Medicine, section 2, chap. 3. Hamilton, ON: BC Decker.
Naldi L, Rzany B (2009). Psoriasis (chronic plaque),
search date August 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Behnam SM, et al. (2005). Smoking and psoriasis.
Skinmed, 4(3): 174–176.
Abramowicz M (2008). Drugs for acne, rosacea and
psoriasis. Treatment Guidelines From The Medical Letter,
6(75): 75–82.
Seton is proud to have four hospitals – the only hospitals in Central Texas - that have earned the Magnet designation, the highest award for nursing excellence given by the American Nurses Association.