Psoriasis Treatment: A Dermatologist Answers Your Questions

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A diagnosis of psoriasis can be very stressful. You may have many questions for your doctor about how to manage this chronic skin disorder. The primary question most psoriasis patients have is "How do I get rid of this?" Although there currently is no cure for psoriasis there are many choices for effective treatment. We have invited Dr. Lawrence Green to give his expertise as both a dermatologist and as a psoriasis patient to discuss psoriasis treatment options.

You can find out more about Dr. Green, who is a member of the board of trustees at the National Psoriasis Foundation, by visiting his website: Aesthetics, Skin Care, and Dermasurgery.

Question: Which psoriasis treatments have you used? Which treatments worked the best for you?

Dr. Green: I have used topical treatments (cortisone ointments), cortisone injections directly into psoriasis, the excimer ultraviolet light laser, and ultraviolet light box therapy. All of these treatments worked for me, but the one I used depended on what part of my body and how extensive my psoriasis was at the time.

Question: What are the latest treatments for psoriasis? Is there anything new to help patients with this skin disorder?

Dr. Green: The latest treatments are injectable medications (someone gives themselves in the same way someone with diabetes gives themselves insulin) to treat people with more severe or extensive psoriasis. Unlike cortisone injections which go directly into psoriasis plaques (and stay only in that area), injectable medications travel everywhere in the body. These injections-called biologics- are given anywhere from once a week to once every 3 months depending on the medication selected. They are reserved for people with severe psoriasis because unlike ointments or ultraviolet light lasers, injections travel throughout the body and so can potentially cause side effects anywhere in the body. This may not be so important if you have a lot of psoriasis on many parts of your body and need medicine to go pretty much everywhere, but it's not so safe if you just have a few affected areas on your body (like someone with milder psoriasis) and the medication still will travel everywhere. There have not been many new ointment or topical treatments for people with milder psoriasis for some time, but I know that there are a few novel ointments that are in clinical trials now that I hope will make it to us in the near future.

Question: What treatment would you recommend for someone with scalp psoriasis?

Dr. Green: Treatment for scalp psoriasis really depends on how extensive and how thick the psoriasis is in the scalp. You can use lotions, foams, or oils. Most of these topical preparations are based on cortisones (steroids). Salicylic acid gels or foams are used first to debride the scalp if there is really thick scale on the scalp over the psoriasis. This prepares the scalp so the cortisone medications will get into the psoriasis better. But there are instances when people have really severe scalp psoriasis when a biologic-injectable medication is used.

Question: What are some examples of treatments for mild, moderate, and severe psoriasis?

Dr. Green: Mild psoriasis is usually treated by on the spot therapy with cortisone ointments or injections right into the psoriasis plaque. In some instances, an ultraviolet laser (also called an excimer laser) can be used as a spot treatment to affected areas to treat mild, but stubborn psoriasis.

Moderate psoriasis can be treated with the excimer laser, or if more extensive a narrow band ultraviolet B light box (which can cover larger areas of the body).

Severe psoriasis can be treated with the aforementioned ultraviolet light box or injectable biologic medications. Sometimes, the biologic injectable medications are combined with lower doses of an older chemotherapy pill called methotrexate.

Thank you Dr. Green for your answers