Psoriasis is a multifactorial condition that primarily affects the skin. Up to 40% of patients develop psoriatic arthritis and other complications over time. It is treatable but not curable, and its manifestations can compromise a patient’s way of life. Current therapeutic strategies focus on alleviating the symptoms.
Your medical experts at BHSkin Dermatology understand that being free of these symptoms can be empowering. Here, we discuss the different psoriasis treatment options to guide you in deciding which regimen is best for you.
What Is the Main Cause of Psoriasis?
Psoriasis has strong autoimmune features and tends to run in families. Environmental factors like stress, trauma, infection and drugs can also trigger psoriasis flares. However, its exact cause remains unclear up to now.
Psoriasis lesions develop after exposing the skin’s innate immune cells, the “dendritic cells,” to an environmental trigger. In turn, they activate the T-cells, which respond by mobilizing other immune cells. In the process, pro-inflammatory substances increase in the skin. The most important of these is TNF-α, which is mostly responsible for the development of plaque psoriasis, psoriatic arthritis and other systemic symptoms.
What Psoriasis Treatment Options Are Currently Available?
Psoriasis is a chronic relapsing condition that warrants long-term therapy. The treatments inhibit skin growth, immune activity or both. They are classified under the following categories:
Agents Used for Topical Therapy
Topical treatment may be considered initially for mild to moderate psoriasis when less than 10% of the body surface area is involved.
The downtime depends on the postop wound’s size and complexity. Most patients are advised to refrain from strenuous activities in the first 1-2 weeks after a Mohs procedure. This helps avoid postop wound reopening, which may lead to bleeding, infection and significant scarring.
Topical corticosteroid formulations suppress the immune system and skin growth in the treated areas. Examples are clobetasol and betamethasone, which are available in creams, foams and other forms. Prolonged use may lead to skin thinning and irritation, loss of efficacy and, rarely, suppression of the body’s stress responses.
Vitamin D-Like Drugs
Vitamin D-like agents inhibit the proliferation and abnormal transformation of the skin cells. They are often combined with steroids and other therapies. Calcipotriene and tacalcitol are the most commonly used in this class for psoriasis treatment.
These agents resemble the skin’s vitamin D, so they can block ultraviolet (UV) light and interfere with phototherapy. So you must use them after, and not before, your phototherapy sessions if you are prescribed the combined regimen.
Excessive or prolonged use may lead to skin irritation and blood calcium elevation.
Vitamin A-Like Medications
Tazarotene gel is a retinoid commonly used for the topical treatment of psoriasis. It curbs both skin growth and the immune cells’ secretion of pro-inflammatory chemicals. It can counter the skin-thinning effects of corticosteroid therapy when they are combined. Its most common side effect is local tissue irritation.
Skin Cell Growth Inhibitors
These agents block DNA synthesis, restricting the growth of skin cells. Coal tar and anthralin belong in this category. Doctors prescribe them less these days because of unpleasant side effects like odor, uncontrolled spread and localized skin irritation.
These treatments remove psoriatic scales and dissolve excess skin. They usually contain salicylic acid, which is effective against mild scalp psoriasis. Excessive use or accidental ingestion may lead to systemic toxicity, with symptoms such as nausea, vomiting, confusion, diarrhea, hearing loss, etc.
Emollients are given to patients with mild psoriasis. They reduce moisture loss and prevent skin breakage that leads to more inflammation. Examples are baby oil, moisturizing cream and Vaseline. You may apply a layer of these softeners right before putting on another topical medication.
Symptom relief is modest and brief when these medications are used alone. However, combining them with other treatments produces better results and fewer side effects.
Phototherapy is the first line of treatment for severe disease and cases that fail to improve with topical drugs. Nail and scalp psoriasis also respond to this modality. It works by suppressing the immune system and aberrant skin growth. Its cosmetic effects last for several months, while its side effects are mostly limited to the skin.
The most common radiation type used is narrowband UVB because of its cost-effectiveness, safety and wide availability. UVA is another option, but the need for photosensitizing chemicals makes it a little less safe.
Excimer laser treatment is a modified form of UVB phototherapy that works great on small psoriatic lesions. The Goeckerman treatment combines broadband UVB therapy with a topical medication like coal tar. Climatotherapy entails exposure to sunlight rather than just UV radiation.
The most frequent side effects of phototherapy are redness and swelling. It also has a small risk of skin cancer but limiting the regimen to once yearly reduces this risk.
Drugs Used for Systemic Treatment
Systemic therapy may be considered for psoriasis patients not relieved by topical and UV light treatment. They may also be given when arthritis or other complications start to manifest. The drugs in this class affect the entire body, so their side effects are more widespread.
Methotrexate interferes with DNA synthesis, suppressing skin and immune cell proliferation. Excessive intake can injure the bone marrow, liver and kidneys. Once you start on methotrexate, your doctor will take blood tests periodically to monitor the health of these vital organs.
Acitretin is an oral medication that reduces skin cell growth and only modestly affects the immune system. It is commonly combined with phototherapy. Like other systemic retinoids, it can cause birth defects. Women on this medication must use birth control during therapy and up to three years after. Acitretin may also cause hair loss, nail thinning, lip fissuring and liver and muscle damage.
Cyclosporine is touted as the most effective systemic medication for psoriasis. It modulates skin cell growth while inhibiting the T-cells. Doctors will give it for a brief period to induce remission. Side effects include nerve injury, uric acid elevation and inappropriate hair growth. Taking it continuously for more than a year can cause significant kidney damage.
Apremilast is an anti-inflammatory drug that reduces TNF-α activity, among others. It effectively treats scalp and nail psoriasis and psoriatic arthritis. Its side effects are minor and include an upset stomach and vulnerability to upper respiratory infections.
Remission of severe psoriasis is possible with systemic therapy. However, your doctor may lower the dose, use combined regimens or shorten the treatment course to reduce collateral organ damage.
Biological Response Modifiers
Biologics are drugs extracted or synthesized from biological sources. They are reserved for severe psoriasis cases that do not respond to other interventions. They block T-cell activation, TNF-α’s effects and other inflammatory mechanisms. Agents in this class include secukinumab, ustekinumab, infliximab, etanercept, etc.
Immunosuppression is the main outcome of biologic therapy. Before starting patients on these medications, they must first be tested for HIV and opportunistic infections like tuberculosis and blood-borne hepatitis. Patients must avoid live vaccines while on this type of treatment.
Cancer risk increases when the immune function is depressed. Biologic therapy may also worsen psoriasis symptoms or lead to autoimmunity against the blood cells and vital organs.
Psoriasis treatments range from targeted therapies to broad-acting medications, so their safety profiles also vary. Working with a highly trained skincare specialist will help you achieve your treatment goals while minimizing the side effects.
What Is the Best Treatment for Psoriasis?
There is not one form of therapy that works for every patient. Your doctor at BHSkin Dermatology will talk to you about the following when formulating your treatment plan:
- The severity of your symptoms. Topical treatments may suffice for mild psoriatic disease but not for severe cases.
- The success of any past treatments and if they had adverse effects on you.
- Medical conditions that can make you unfit for some forms of therapy.
- If combination treatment is being considered.
- Costs. Psoriasis treatment is usually covered by health insurance.
- Your quality of life while on therapy, as some side effects may severely restrict your activities.
Each patient faces unique circumstances. Your doctor will give you a thorough check then tailor your regimen based on your needs.
What Happens if Psoriasis Is Left Untreated?
Psoriasis is not merely a skin condition but a lifelong systemic inflammatory disease. Serious health risks result from lack of treatment.
- Uncontrolled inflammation damages the joints and vital organs. Psoriasis increases the risk of heart disease, a known inflammatory condition.
- Psoriasis is linked to cancer and unexplained death.
- Delay of care reduces treatment effectiveness and may force you to rely on aggressive but less safe therapies.
Starting therapy early gives you a better chance at controlling your symptoms and preventing complications.
How Important Is It to Have a Psoriasis Expert Treat You?
Psoriasis is a complex condition that requires medical expertise. Your doctor’s job is tricky, balancing the effectiveness of your therapy with its potential side effects. Additionally, you will need continuous care for this lifelong illness. Finding the right specialist helps ensure that you get optimal treatment in a timely fashion every single time.
Psoriasis is a multifactorial condition with prominent autoimmune and genetic characteristics. The currently available treatments focus on suppressing immune function and the abnormal changes in the skin cells. There is no magic bullet that works for all cases. So when you consult for psoriasis symptoms, your doctor may start you on medicated creams, UV treatment, systemic therapy, or biologics, depending on your personal factors.
If left untreated, psoriasis will increase your risk of developing severe complications. On the other hand, seeking help early gives you better control of your symptoms and lets you avoid serious side effects from aggressive therapies. That said, only when you work continuously with a highly trained professional can you be sure of having long symptom-free periods.
Be in the Best Hands with LA’s Top Psoriasis Specialists
Psoriasis symptoms can be worrisome. They can even affect your job and social life. The best way to handle the disease is to start treatment early.
At BHSkin Dermatology, LA’s top skincare professionals are working to change the lives of psoriasis patients every day. Book your appointment today at our Encino or Glendale clinic or telederm portal. Rest assured that you’ll be in good hands with our award-winning dermatologists.
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