Your Answer to Smoother, Clearer Skin—Found!

After a few months of giving a new medication a try, Regina called her dermatologist. Her plaque psoriasis had partially cleared, but there were still some scales left—just enough to make her feel self-conscious and put a damper on her daily life. On the job, she kept a low profile. Socially, she spent too many weekends at home, finding excuses for not joining her friends on fun outings. “This medication isn’t helping,” she told her doctor. “I want to find the treatment that’s going to clear my skin.”

Regina’s doctor prescribed a new treatment. She was skeptical, she admits. “But hopeful, too. And I was super determined. I knew there was some treatment that would work—and my doctor agreed.” Fortunately, the new strategy did work. And she was happy she’d been frank with her doctor.

As Regina learned, being willing to try new treatments and working with your dermatologist can yield the desired results. When picking your treatment strategy, your dermatologist will consider two factors: (1) How much of your skin is covered by psoriasis and (2) how severe your symptoms are—and that includes how psoriasis affects you day in and day out. After all, how you feel about your psoriasis is unique to you: For some people, large patches of psoriasis may not be a problem, while others may feel embarrassed about just a few small patches. So don’t be shy about telling your doctor if you want a more aggressive regimen.

Your plan of attack may include any of the following methods.

1. Applying a cream

Just found out you have psoriasis? Or simply dealing with a mild problem? Then it’s likely your dermatologist will start you on a topical treatment (applied to the skin), such as a medicated lotion, ointment, cream, gel or shampoo. Some are available over the counter, but most will require a prescription. 

Topical treatments
 

Medication

How it works

What you should know

Anthralin
(Synthetic chrysarobin, from araroba tree bark)

Thought to normalize DNA activity in skin cells; reduces rapid buildup of skin cells.

Can be irritating to skin; can stain skin and clothing.

Calcipotriene
(Multiple brands) and calcitriol (Vectical) (Vitamin D and derivatives)

Slows the growth of skin cells.

Can cause mild stinging or burning.

Coal tar
(Thick liquid obtained from the distillation of coal)

Helps slow the rapid growth of skin cells; reduces scaling, itching and inflammation.

Has a strong odor; can stain skin and clothing.

Corticosteroid
(Anti-inflammatory agent)

Suppresses the immune system, reducing itching and inflammation; slows turnover of skin cells.

Long-term use can cause thinning of skin and loss of response to treatment.

Retinoid
(Synthetic vitamin A)

Normalizes DNA activity in the cells.

Can be irritating to skin; increases sensitivity to the sun.

Salicylic acid
(A keratolytic, or peeling agent)

Causes the outer layer of skin to shed.

Can be irritating to skin; can lead to temporary hair loss.

 

2. Exposing your skin to light

When topical treatments aren’t enough, your dermatologist may suggest phototherapy—the use of ultraviolet light to treat your skin. Getting a phototherapy treatment involves exposing your skin to a lamp in your doctor’s office or to a special (prescription) lamp at home. These lamps range in size from a handheld wand to a full-body bed or booth. Light treatments typically happen a few times a week for a month or longer. Phototherapy can also be used with medications.

Phototherapy Treatments
 

Treatment

How it works

What you should know

Ultraviolet B (UVB)
Skin is exposed to UVB rays generated from a special lamp or laser.

Causes reactions in skin cells that decrease overproduction; helps clear up plaques.

• Broadband UVB is effective but requires frequent treatments at a doctor’s office.
• Narrowband UVB emits a more specific range of UV light and may clear psoriasis more quickly.

Psoralen + Ultraviolet A (PUVA)
You’ll either ingest, apply topically or bathe in a drug called psoralen, then undergo UVA exposure.

Psoralen makes the skin more sensitive to UVA light, which penetrates deeper into the skin than UVB rays. The combination slows skin cell growth and kills T cells in plaque and guttate psoriasis.

Often used to treat psoriasis on the palms of the hands or soles of the feet.

Excimer laser
A controlled beam of UVB light targets only affected areas.

Reduces inflammation and fast-growing skin cells.

Therapy requires fewer sessions, but is practical only for people with very mild, localized psoriasis.

 

3. Exploring your medication options

For moderate or severe psoriasis, or for cases that don’t respond to other therapies, medications that work throughout the body may be the answer. These drugs fall into two broad categories:

  1. Systemics work with your immune system to control skin cell production.
  2. Biologics (one type of disease-modifying antirheumatic drug, or DMARD) block the actions of certain immune system cells to slow skin production and possibly reduce inflammation.
Body-Wide Medications
 

Medication Brand (Generic)

How it works

How it’s given

SYSTEMICS

Cyclosporine
Immunosuppressant

Slows the growth of skin cells by suppressing the immune system.

Taken orally twice a day.

Methotrexate
Antimetabolite

Inhibits an enzyme involved in rapid cell growth.

Taken orally or by injection.

Soriatane (Acitretin)
Retinoid, vitamin A derivative

Slows the growth of skin cells.

Taken orally once a day.

BIOLOGIC DMARDs

Enbrel (Etanercept)
TNF-alpha inhibitor

Reduces inflammation and slows the overproduction of skin cells.

Self-injected once or
twice a week.

Humira (Adalimumab)
TNF-alpha inhibitor

Reduces inflammation and slows the overproduction of skin cells.

Self-injected every other week.

Remicade (Infliximab)
TNF-alpha inhibitor

Reduces inflammation and slows the overproduction of skin cells.

Given by three IV infusions during the first six weeks and then once every two months.

Stelara (Ustekinumab)
Cytokine inhibitor

Blocks the action of two proteins that contribute to the overproduction of skin cells.

Given by injection in a doctor’s office about four times a year.

Published September 2013

Basics
Overview
Causes & Risk Factors
Symptoms
Diagnosis
Your Healthcare Team
Questions to Ask
    Your Doctor

Quiz: How Severe
    is Your Psoriasis?


Treatments
Never Tried a Biologic?
What Your Dermatologist
    Needs to Know

Topical Treatments
Phototherapy Treatments

Body-Wide Medications
When Your Treatment is Denied
    by Your Insurance Company


Features
Look Your Best With Psoriasis!
Feel Your Best With Psoriasis
Your Answer to Smoother, Clearer Skin—Found!
Take Charge of Your Psoriasis and Protect
    Your Whole Body!

Try These Simple Skin-Care Tips
Quiz: Test Your Psoriasis Smarts
Simple Ways to Better Your Life
Ask the Experts: Dating Tips and More
Let Summer Soothe Your Psoriasis
Lifestyle Adjustments to Help Ease Psoriasis

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