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Psoriasis treatment options

There are many psoriasis treatments that can be used alone or in combination. They include topical treatments, phototherapy ( ultraviolet light therapy), and oral and injected medications.

Deciding on the best treatment approach is something that involves a discussion with your GP or dermatologist ( skin specialist). Phototherapy and oral or injected medications are usually the province of the dermatologist. The decision will be based on a number of things: the severity of your psoriasis, any treatments that you've used before, whether you have other medical conditions, and finally, your own opinion about what sounds right to you.

Doctors tend to use a step-wise approach to treating psoriasis. You start with topical creams and ointments. If they aren't enough, you might move on to phototherapy. If your psoriasis still isn't under control, you then might try systemic or biologic medications. However, this incremental approach is only a rule of thumb. Your doctor may suggest a different strategy in your case. Here's a brief outline of the main approaches to treatment.

Topical treatments

Using topical treatments, such as creams and ointments, is often the first step in treating psoriasis. A few are available over-the-counter but most require a prescription from your doctor. Salicylic acid in a cream or ointment helps to remove scales. The most commonly used drugs are steroid creams and ointments. Others include vitamin D analogues, calineurin inhibitors, dithranol, and coal tar. For psoriasis that covers more than 10% to 20% of the skin, topical treatment usually won't work, at least, not on its own.

Phototherapy

Psoriasis responds to phototherapy. Regular exposure to the sun or artificial ultraviolet lights can cause the symptoms to subside. Approaches include UVB (exposure to ultraviolet B light) and PUVA (exposure to UVA combined with the drug psoralen, which increases the light sensitivity of the skin). It is not a question of using a sun bed - these treatments should only be used under the supervision of a specialist. A newer technique is to use lasers to give a highly concentrated UVB light exposure to a small area, but this is not generally available on the NHS.

Systemic treatments

For psoriasis that doesn't respond to other treatments, medications such as methotrexate, ciclosporin, and acitretin (a synthetic form of vitamin A) may help. However, many of these drugs have potentially severe side effects and are usually reserved for moderate to severe psoriasis. You'll need to be monitored closely when using them.

Biological drugs

Biological drugs target the immune system response that causes the symptoms of psoriasis. The evidence suggests that these new drugs have significantly fewer side-effects than traditional systemic therapy. Biological drugs currently used to treat psoriasis include etanercept, ustekinumab, infliximab and adalimumab.

What about alternative medicine for psoriasis?

If you've looked round a book shop or searched for psoriasis on the Internet, you may already have discovered some of the countless alternative methods for treating the condition. Almost every herb or pill or therapy has some supporters - you'll find people who swear by vitamins, enemas, acupuncture, shark cartilage, or emu oil. There are even special spas in Turkey where people with psoriasis go to relax in a hot pool, breathe in the steam, and have the psoriatic plaques eaten off their skin by hungry little fish.

Seek medical advice before trying an alternative therapy, including herbal treatments, as these may interfere with other medication.

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