What is the treatment for psoriasis?

Self-care action plan

There are several common-sense ways to help minimize psoriasis flare-ups:

• Where possible, avoid anything known to trigger the condition, especially stress.
• Do not scratch or pick at the skin: it may bleed and become infected, and psoriasis may then develop in that area.
• Avoid soap, which can be drying, and instead wash with aqueous cream or an emollient wash (eg E45).
• After washing, pat the skin dry, don't irritate it by rubbing vigorously.
• Use plenty of moisturizing cream to soothe and soften the skin. This is especially effective after washing.
• Sunlight helps some people with psoriasis. However, avoid the sun if it causes pain and avoid getting burnt.
• Wear cotton clothes next to the skin and avoid rough, synthetic materials.

Medicines and light treatments

There are many treatments available for psoriasis. Creams and ointments are usually the first tried, followed by tablets and treatment with ultraviolet light. The main treatments are as follows:

• Steroid creams - this is the most widely used treatment, and can reduce inflammation and plaques. The creams may thin the skin, and symptoms may increase when the treatment is stopped.
• Tar compounds - which are especially useful for psoriasis of the scalp. They are messy to use.
• Ointments containing vitamin D derivatives - recently developed for treating moderate psoriasis. However their effect may not last long.
• Light therapy, with ultraviolet A or B - this is available at specialist hospital clinics or lamps that can be used at home. Care must be taken not to burn the skin.
• Psoralen and ultraviolet A light treatment (also called PUVA). This involves combining a medicine which sensitizes the skin to sunlight (psoralen) with a controlled dose of ultraviolet light. It can reduce symptoms in moderate psoriasis.
• Vitamin A derivatives, which are available in tablet form and as ointment/cream (eg tazarotene). Not suitable for women who are, or who may become, pregnant.
• Medicines that suppress the immune system if the psoriasis is severe. eg methotrexate and ciclosporin.

Complementary therapy

It is unusual for conventional medicine to cure psoriasis, or to relieve the symptoms completely. For this reason, many people turn to complementary therapies such as homeopathy, acupuncture and herbal remedies. Whether they are of any benefit is unclear, partly because people often use steroid creams at the same time as the complementary therapies, and also because of the way psoriasis naturally comes and goes.

Relaxation methods such as meditation, yoga and the Alexander Technique may well be beneficial because they reduce stress, a trigger for psoriasis.

Physiotherapy/occupational therapy

This type of treatment is important for the minority of people for whom psoriasis is associated with severe arthritis.

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