April 24, 2014
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Psoriasis


Psoriasis treatment options

Although there is no cure for psoriasis, it can be effectively managed with proper treatment. Your treatment options for psoriasis include:

Your doctor may also recommend a combination of therapies.

The treatment your doctor recommends depends on many individual factors, including:

  • the type of psoriasis
  • psoriasis severity (mild, moderate, or severe)
  • which treatment you are comfortable with based on the risks and benefits and how it's given
  • how well you respond to a given treatment

Whatever the severity or type of psoriasis you have, there is a treatment option to help control psoriasis.

Also keep in mind that what works for one person won't necessarily work for another. It may take a few tries to find the right treatment for your psoriasis and see real improvements. Don't give up!

Topical medications

Topical medications are creams, ointments, and lotions applied to the skin. Topical medications should be applied as directed by your doctor or pharmacist.

Topical treatments can be prescription or non-prescription medications and include:

  • corticosteroids
    • Topical corticosteroids work by decreasing inflammation, redness, and itchiness.
    • They are usually applied sparingly to psoriasis lesions once or twice a day. Different strengths and formulations are used for different parts of the body. Usually, less potent corticosteroids are used for thin-skinned or sensitive areas (e.g., face, skin folds, groin, breasts). Stronger corticosteroids are used for thicker skin (e.g., palms, soles).
    • There are many topical corticosteroids. Some of these include: amcinonide (Cyclocort® and generics), betamethasone dipropionate (Diprosone®, Diprolene®, and generics), betamethasone valerate (Betaderm®, Valisone®, and generics), clobetasol propionate (Dermovate® and generics), desoximetasone (Topicort® and generics), hydrocortisone (Emo Cort® and generics), and prednicarbate (Dermatop®).
       
  • vitamin A derivatives
    • vitamin A derivatives, or retinoids, such as tazarotene (Tazorac®), are believed to work by slowing down skin cell growth.
    • A thin layer is applied once a day to the affected areas. Tazarotene is used on the body (not the face or skin folds).
       
  • vitamin D derivatives
    • Vitamin D derivatives work by controlling the abnormal growth of cells to help flatten lesions and remove scales.
    • They are usually applied twice a day to the affected areas of the body (not the face or skin folds). When used with a topical corticosteroid, calcipotriol (a vitamin D derivative) and the corticosteroid should be applied once daily, at different times of the day (e.g., one in the morning and the other in the evening).
    • Vitamin D derivatives include calcipotriol (Dovonex®), which is a synthetic form of vitamin D, and calcitriol (Silkis™), a naturally occurring active form of vitamin D. These are not the same as the vitamin D you find in vitamin supplements taken by mouth. Calcipotriol is also available in combination with betamethasone as an ointment (Dovobet®) or a scalp gel (Xamiol®).
       
  • anthralin
    • Anthralin, also known as dithranol, works by slowing the growth of skin cells that cause psoriasis lesions.
    • It is usually applied one a day and can be applied to the body and scalp. It can be prepared into a compounded mixture by a pharmacist.
       
  • salicylic acid
    • Salicylic acid is a peeling agent that works by shedding the outer layers of the skin, helping to soften and remove psoriasis scales.
    • It is usually applied once or twice a day to the body or once or twice a week to the scalp.
    • It is available without a prescription combined with other topical medications such as coal tar (e.g., Targel SA, Polytar AF®) and corticosteroids (e.g., Diprosalic®, Nerisalic®), or it can be prepared into a compounded mixture by a pharmacist.
       
  • coal tar
    • Coal tar (e.g., Targel, Doak Oil™) works by helping to slow the growth of skin cells and reducing inflammation, itching, and scaling.
    • It is usually applied once a day to the affected areas of the body for 2 hours or scalp for 5 to 10 minutes (not in skin folds). Some formulations can also be added to bath water.
    • It is available without a prescription, or it can be prepared into a compounded mixture by a pharmacist.

Like other medications, topical psoriasis medications may have side effects. To learn more, see "Topical medications for psorasis" or speak to your pharmacist or doctor.

This is not a complete list of all side effects, warnings and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

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Systemic treatments for psoriasis

Oral treatment

Oral therapy is medication that is ingested into the body by swallowing a pill. These medications are used to treat moderate to severe psoriasis.

Oral treatment options for psoriasis include:

  • acitretin
    • Acitretin (Soriatane®) belongs to the group of medications known as retinoids, which are synthetic forms of vitamin A. It is believed to work by reducing the speed of skin cell growth, which is very rapid in psoriasis.
    • Acitretin is taken by mouth once a day with food.
       
  • cyclosporine
    • Cyclosporine (Neoral® and generics) belongs to the group of medications known as immunosuppressants. It works by controlling the skin cell overgrowth seen in psoriasis by decreasing the activity of the immune system.
    • Cyclosporine is taken by mouth twice a day.
       
  • methotrexate
    • Methotrexate (Methotrexate® and generics) belongs to a class of medications called cytotoxic agents or anti-metabolites. It works by blocking the function of a particular enzyme. Blocking this enzyme interferes with the growth of some cells. In psoriasis, this helps to slow down the rapid overgrowth of skin cells.
    • It can be taken by mouth, usually once a week. It can also be given as an injection into a muscle or vein by a health care provider once a week.

Like other medications, oral psoriasis medications may have side effects. To learn more, see "Systemic treatments for psoriasis" or speak to your pharmacist or doctor.

This is not a complete list of all side effects, warnings and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

Biologic treatments for psoriasis

Biologics (or biological response modifiers) work by decreasing the activity of the immune cells that become overactive in psoriasis. This helps control skin cell overgrowth and inflammation. Biologics are used to treat moderate to severe psoriasis.

The biologics available in Canada to treat psoriasis include:

  • ustekinumab (Stelara®)
    • Ustekinumab (Stelara®) works by blocking the action of two proteins in the body called interleukin 12 and interleukin 23. These proteins are thought to be involved in causing the immune system to become overactive.
    • Ustekinumab is given by subcutaneous (under the skin) injection at week 4 following the first dose, then every 12 weeks thereafter.
       
  • infliximab (Remicade®)
    • In psoriasis, tumour necrosis factor alpha (TNF alpha) is one of the substances in the immune system that is overproduced, causing too much inflammation in the body. Infliximab (Remicade®) works by blocking the action of TNF alpha.
    • Infliximab is given as an intravenous infusion (injected into the vein over 2 hours) at 2 and 6 weeks following the first dose, then every 8 weeks thereafter. Infusions are given under the supervision of health care professionals such as nurses and doctors.
       
  • etanercept (Enbrel®)
    • In psoriasis, tumour necrosis factor alpha (TNF alpha) is one of the substances in the immune system that is overproduced, causing too much inflammation in the body. Etanercept (Enbrel®) works by blocking TNF alpha in the body to help reduce psoriasis lesions.
    • Etanercept is given twice a week by subcutaneous injection. After the first 3 months of treatment, it may be given once weekly.
       
  • alefacept (Amevive®)
    • In psoriasis, certain cells in the immune system called T cells are triggered and become overactive. Alefacept (Amevive®) works by helping prevent T cells from becoming overactive and by reducing the number of overactive T cells in the body.
    • Alefacept is given once a week by intramuscular (into a muscle) injection or by intravenous injection. The usual treatment period is 12 weeks.
       
  • adalimumb (Humira®)
    • In psoriasis, tumour necrosis factor alpha (TNF alpha) is one of the substances in the immune system that is overproduced, causing too much inflammation in the body. Adalimumab (Humira®) works by blocking TNF alpha in the body to help reduce psoriasis lesions.
    • Adalimumab is given by subcutaneous injection every 2 weeks starting 1 week after the first dose.

Like other medications, injectable psoriasis medications may have side effects. To learn more, see "Biologic treatments for psoriasis" or speak to your pharmacist or doctor.

This is not a complete list of all side effects, warnings and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

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Light therapy

Light therapy, also called phototherapy, involves exposing skin to natural and artificial ultraviolet (UV) light under the guidance of a health care professional. Light therapy is usually done in a doctor's office, but some people may use a phototherapy unit at home. It is used to treat moderate to severe psoriasis.

There are several types of light therapy:

  • PUVA treatment
    • PUVA is the short form for psoralen plus UVA (ultraviolet A light). PUVA works to slow down the overgrowth of skin cells to help clear psoriasis lesions. Psoralen is a light-sensitizing medication that is taken by mouth or applied directly on the skin at a specific time before UVA exposure to help make the light therapy work better. After taking or applying psoralen, you expose the affected areas to a light booth with UVA lamps.
    • PUVA therapy is usually given 1 to 4 times a week.
       
  • UVB treatment
    • UVB stands for ultraviolet B light. UVB light therapy involves using a UV lamp that emits a wavelength of UV light that penetrates the outmost layer of skin.This slows down the fast overgrowth of skin cells to help clear psoriasis.UVB therapy includes two types: narrowband and broadband. The main difference between the two is that narrowband UVB light lamps emit a smaller range of UVB light.
    • UVB therapy is usually given 1 to 4 times a week.

Like other medications, light therapy may have side effects. To learn more, see "Light therapy for psoriasis" or speak to your pharmacist or doctor.

Talk to your doctor about the most appropriate psoriasis treatment for you. With effective treatment and management, psoriasis lesions can be cleared.

Remember that whatever the severity or type of psoriasis you have, there is a treatment option to help control psoriasis.

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