Because the symptoms of psoriasis are caused by an overproduction of skin cells, many psoriasis treatments work by slowing down skin cell reproduction. Some treatments help to remove scale while others help soothe itchy or uncomfortable skin.
Different people respond differently to medications, so a treatment that worked great for your friend may or may not work for you. It might take a little experimenting to find the treatment or combination of treatments that work best on your skin.
There are three basic categories of psoriasis treatment:
- Topical treatments like creams and ointments are used on the areas of skin that have psoriasis plaques.
- Light therapy (ultraviolet light A and B or UVA and UVB) works by exposing the skin to light waves, sometimes over the whole body and sometimes only on affected areas, like hands and feet.
- Systemic medications are medications taken by mouth or injected into the muscle.
How Do They Work?
Moisturizers help repair and strengthen the skin’s barrier, which oftentimes is compromised in skin conditions like psoriasis. They soften hardened skin and plaques, while controlling itchy skin and reducing scaling. Keeping your skin moisturized will also help to reduce cracking of your skin, which can lead to infections.
When Should I Use a Moisturizer?
For mild cases of psoriasis or between flare-ups, a good moisturizer may be all that some patients need. All patients, even if on a prescription treatment, should be using a moisturizer on a daily basis, prior to the prescription topical treatment, to ensure that their skin is healthy and supple.
After a bath/shower, you should apply the moisturizer to your entire body while it is still damp to allow for better absorption. Give the moisturizer 20-30 minutes to penetrate before applying your prescription topical treatment.
Topical Treatments (medications applied to the skin)
These topicals are usually the first type of treatment your doctor will recommend. Patients with psoriasis are thought to have an immune dysfunction that results in skin cells dividing too quickly and accumulate in layers on the skin, causing plaques and scales.
What topical treatments do is halt or slow down the rapid skin cell division and the inflammation associated with psoriasis.
Types of Topical Treatments:
How Are Steroids Used?
Steroids come in an array of different formulations, such as ointments, gels, creams, lotions, shampoos and foam, depending on what part of the skin it’s being used for and how severe your psoriasis is. It’s important to use the steroid exactly as your doctor recommends. They are usually applied once to twice a day, 20-30 minutes after applying a moisturizer (see above).
What are Some Types of Steroids?
Dermatopp, Propaderm, Aristocort R, Aristocort C, Topicort are some brands of effective steroids that your doctor may have prescribed to you.
Combination Steroid Medications
Steroids are often prescribed in combination with other topical treatments, like Vitamin D-based topical medications that work by slowing the rate of skin cell division. Dovonex® cream and ointment (calcipotriol) is an example of a Vitamin D-based treatment.
What Are the Side effects from Steroids?
The stronger the steroid is, the higher the potential side effects from using them. If strong steroids are used in the wrong areas (groin, skin folds, face) or you’re using too much of your topical steroid for too long, your skin may become thin, change colour (hypo or hyper-pigmentation), develop stretch marks and easily bruise.
How can I help reduce the side effects?
Use your topical steroid exactly as prescribed by your physician. Pulse- dosing is often a technique used to help minimize the long-term effects of steroids. In this method, a topical steroid is applied once to twice a day during active flare ups. Once the lesions have cleared, the frequency of application is reduced. Your doctor will be able to guide you on whether this method will work for you.
Coal tar : This is one of the oldest therapies for psoriasis. It can irritate unaffected skin, but this irritation is usually temporary and mild. It is not generally recommended for delicate areas. Coal tar works by reducing the turnover of skin cells and they have also been found to have some anti-scaling properties and reduce inflammation as well.
Coal tar is suitable for plaques that are widespread across the body.
- Drawbacks to coal tar: odour and the fact that it can stain clothing. To avoid this, be sure to let the medication air dry before dressing.
- Sunlight Daily: Regular short doses of sunlight, but not sunburn, can help improve or even clear up psoriasis by reducing inflammation and slowing the overproduction of skin cells that causes scaling.
- Warning!: The ultraviolet radiation (UV) given off by the sun can also cause suntans, sunburns, skin cancer and the signs of premature aging such as wrinkles, so be careful about how much sunlight you are getting. Your doctor can recommend an appropriate sunbathing schedule for you.
- Ultraviolet Phototherapy (UV): UV is a controlled form of artificial light that uses special wavelengths of ultraviolet lights, either in the form of ultraviolet A (UVA) or ultraviolet B (UVB). This treatment is usually administered in a doctor’s office or a psoriasis day clinic.
- UVB: With this treatment the skin is exposed to short-wave ultraviolet light B (UVB). This can be an effective treatment for moderate to severe psoriasis but, like any light therapy, should only be used under the supervision of a dermatologist.
STELARA® blocks the action of two proteins in your body called interleukin 12 (IL-12) and interleukin 23 (IL-23). In people with psoriasis, psoriatic arthritis or Crohn’s disease, their immune system may attack parts of their body and that attack uses IL-12 and IL –23. Ustekinumab can block the IL-12 and IL-23 from causing the immune system to attack the skin, nails, joints or the digestive tract.
Stelara® is indicated for:
Pediatric Plaque Psoriasis
STELARA® is indicated for the treatment of chronic moderate to severe plaque psoriasis in adolescent patients from 12 to 17 years of age, who are inadequately controlled by, or are intolerant to, other systemic therapies or phototherapies.
STELARA® should be used only by physicians who have sufficient knowledge of plaque psoriasis and who have fully familiarized themselves with the efficacy/safety profile of the drug.
Choosing a treatment
You and your doctor will chose a treatment according to the type and severity of the psoriasis, the areas of your skin affected, your age and past medical history. Some of the treatments available for adults are used less often for teenagers because of the possibility of long-term or delayed side effects, including long term effects on your ability to have a child if you are female.
Your role in treatment
The whole point of therapy is to gain control over your psoriasis and learn to manage it. This is going to need a group effort. You, your parents/guardian and doctor should all work together to choose a therapy that will suit your needs and your lifestyle. You will need to understand exactly how to follow the treatment direction so that you can use your therapy correctly to give the medication a fair chance to work.
The more you know about your treatment and the bigger the role you play in managing your treatment, the better prepared you are know what to expect and to use your medications correctly.