If you suffer from psoriasis, you're probably eager to scratch the itch and soothe the red, scaly patches that this inflammatory immune system disorder can cause on your arms and legs.

"Like most immune system disorders, psoriasis cannot be cured by current medicine or technology," according to Craig Kraffert, MD, a board certified dermatologist who practices in Redding, California. "But the good news is that the management of psoriasis has undergone a complete paradigm shift with the development of new treatment options over the past 15 years." This makes it easier to control your skin symptoms and also to head off potential damage to your joints, cardiovascular system, heart, and liver.

Many Options Exist

Most people start off with topical psoriasis remedies (cream and ointments) and if this isn't enough, they then progress to more aggressive options such as light therapy and systemic medications, Kraffert explains. Sometimes therapies are combined to increase effectiveness.

Since psoriasis is cyclical and tends to flare up and go into remission, it can be helpful to keep a diary of when your condition worsens. Over time you may be able to see a pattern and suspected triggers may emerge such as a drastic climate change or a health condition—an infection like strep throat. Depending on the type of psoriasis you have and the severity of the condition, it can take up to a few months to get the full results so you may need to exercise patience while you wait for the therapy to take effect.

In addition to the traditional medical approach, many patients report getting relief from uncomfortable symptoms by making dietary changes (avoiding diary or gluten, for example), taking supplements (such as fish oil) and herbs, and from alternative medicine. Although the link between nutrition and psoriasis isn't fully understood, as long as you are eating a nutritious diet, there's no harm in exploring foods that may improve your condition. If you're considering going the alternative therapy route, be sure to discuss it with your doctor first. Many approaches are generally regarded as safe but some may interfere with medications or cause other unwanted side effects.

Here is Kraffert's overview of the main types of psoriasis treatments available today:

Topical OTC Treatments

For mild cases of psoriasis, topical OTC treatments may do the trick. Look for ones that contain alpha or beta hydroxyl acid, since these can help your skin to shed the scaling that typically occurs with psoriasis and can also provide more moisture to the affected areas. Some people find using a product with coal tar (which is messy and not as common today as in the past) can also help calm their irritated skin.

Prescription Therapies

The majority of people with psoriasis will need to take a more aggressive approach to treating the condition. In this case, you'll probably require one or more of the prescription therapies available. Most of these treatments, which work by suppressing the immune system response, can be broken down into the following four basic types:

1. Topical therapy. Prescription treatment for small areas of psoriasis are typically topical gels, lotions, sprays, liquids, and foams that contain corticosteroids to suppress the immune system response locally. Some people may also benefit from ointments that contain vitamin D or vitamin A analogs.

2. Ultraviolet light therapy. This is one of the most effective ways to suppress the immune system to treat the symptoms of psoriasis. It can be performed through tanning beds, UV booths, UVB lasers, and flash lamp devices, as well as using natural sunlight. These options can be used for the entire body or can target specific areas more intensely.

3. Oral medications. There are several types of oral medications currently approved to treat psoriasis and several more are on the horizon. Depending on the type your doctor prescribes, they will either work as an immunosuppressant or will affect epidermal cell growth regulation. The downside to these approaches is that they come with significant side effects and risks.

4. Biologic injectable medications. For more moderate to severe psoriasis, your doctor may prescribe biologic injectable medications, which are able to very effectively target the immune system response on the specific area affected without having an impact on the rest of the body. This makes them a very safe and appealing option for many patients. New and improved biologic options are also continually becoming available.

Finding the Best Approach

Often people will need a combination of approaches to get the best results. "Now, however, some of the biologic agents are so effective that complete—or nearly complete control—commonly occurs with only one agent," Kraffert explains. He points out that your best bet is to see a dermatologist who specializes in treating psoriasis, since he or she will be up on the latest options and will be able to recommend the best treatment approach for your specific situation. Kraffert also suggests visiting the National Psoriasis Organization's website to access a wealth of resources, including a directory of physicians around the country.

Craig Kraffert, MD, reviewed this article.



Sources:

Craig Kraffert, MD, Dermatologist, Redding Derm, email interview 12 December 2013.
http://www.reddingderm.com

Mayo Clinic. "Psoriasis. Alternative Medicine." Web. Accessed 17 January 2014. http://www.mayoclinic.org/diseases-conditions/psoriasis/basics/alternative-medicine/con-20030838