Psoriasis Treatment – An Overview

Psoriasis is a chronic autoimmune disease that causes the rapid buildup of skin cells. This buildup of cells leads to the formation of thick, red patches of skin covered with silvery scales. Psoriasis can occur anywhere on the body, but it most commonly affects the scalp, elbows, knees, and lower back.

While there is no known cure for psoriasis, there are various treatment options available that can effectively manage and control its symptoms. The choice of treatment depends on the severity of the condition, the extent of the affected area, and the patient’s individual preferences.

The most common symptoms of psoriasis include:

• Red, scaly patches of skin
• Thickened skin
• Itching
• Pain
• Burning
• Dry skin

The exact cause of psoriasis is unknown, but it is thought to be an autoimmune disorder. This means that the body’s immune system mistakenly attacks healthy cells. In the case of psoriasis, the immune system attacks skin cells, causing them to grow too quickly.

Psoriasis Treatment

There is no cure for psoriasis, but there are a variety of treatments that can help to control the symptoms. The type of treatment that is best for you will depend on the severity of your psoriasis.

Some common treatments for psoriasis include:

1. Topical Treatments:
   • Corticosteroids: These anti-inflammatory medications help reduce itching, redness, and inflammation associated with psoriasis. They are available in different strengths and formulations.
   • Vitamin D analogues: These synthetic forms of vitamin D slow down the growth of skin cells, helping to reduce scaling and plaque formation.
   • Retinoids: These derivatives of vitamin A are available as gels or creams and can help to decrease inflammation and normalize skin cell growth.
   • Calcineurin inhibitors: These medications reduce inflammation and help to suppress the immune system response.
   • Salicylic acid: It helps to remove the scales and is often used in combination with other topical treatments.
   • Coal tar: It has been used for many years and helps to reduce inflammation, itching, and scaling.
2. Phototherapy:
   • UVB Phototherapy: Exposure to UVB light slows down the growth of affected skin cells and reduces inflammation. It can be done using a light panel or in a full-body lightbox.
   • PUVA: Psoralen combined with UVA light therapy is used in cases where UVB phototherapy alone is not effective. Psoralen, a medication that sensitizes the skin to light, is either applied topically or taken orally before UVA exposure.
3. Systemic Medications:
   • Methotrexate: This medication helps to slow down the rapid growth of skin cells and suppresses the immune system response.
   • Cyclosporine: It is an immunosuppressant that works by inhibiting the immune system to reduce inflammation and skin cell overgrowth.
   • Acitretin: It is a retinoid taken orally that reduces scaling and inflammation associated with psoriasis.
   • Biologic agents: These are newer medications that target specific components of the immune system involved in psoriasis. Biologics are administered through injections or intravenous infusions and include drugs like adalimumab, etanercept, infliximab, ustekinumab, and secukinumab.
4. Oral Medications:
   • Apremilast: It is a phosphodiesterase-4 inhibitor that helps to reduce inflammation and control the immune response.
   • Oral corticosteroids: They are sometimes used for short-term relief in severe cases but are generally not recommended for long-term use due to their potential side effects.

It is important to note that the choice of treatment should be made in consultation with a dermatologist or healthcare professional who can assess the individual’s condition and determine the most appropriate course of action.

Additionally, treatment effectiveness can vary among individuals, and it may require a trial-and-error approach to find the most suitable treatment or combination of treatments for each person.

Regular follow-up and communication with a healthcare provider are crucial to monitoring the response to treatment and making any necessary adjustments.

Limitations of Psoriasis Treatment

While there are several treatment options available for psoriasis, it is important to acknowledge that each treatment modality has its limitations. Here are some limitations commonly associated with psoriasis treatment:

1. No cure: There is no cure for psoriasis, so treatments are only able to control the symptoms.
2. Effectiveness – Treatment may not be 100% effective: Psoriasis treatments may not work equally well for everyone. The effectiveness of a particular treatment can vary from person to person, and what works for one individual may not work for another. It often requires a trial-and-error approach to find the most suitable treatment or combination of treatments for each patient.
3. Side Effects: Many psoriasis treatments, especially systemic medications,, and biologics, can have potential side effects. These side effects range from mild to severe and may include nausea, headache, fatigue, increased risk of infections, liver toxicity, and suppression of the immune system. The risk and severity of side effects can vary depending on the specific medication used.
4. Long-term Use: Some treatments, such as oral corticosteroids, are not recommended for long-term use due to their potential side effects and risks. Prolonged use of certain systemic medications and biologics may also raise concerns about their long-term safety and tolerability.
5. Cost: Certain psoriasis treatments, particularly biologics, can be expensive. The cost of these medications may pose a significant financial burden, especially for individuals without adequate insurance coverage. Access to newer and more expensive treatments may be limited in some healthcare systems or regions.
6. Time Commitment: Some treatment modalities, such as phototherapy, require regular and consistent sessions, which can be time-consuming and may not be convenient for everyone. It can be challenging for individuals with busy schedules or those living in remote areas to adhere to the recommended treatment regimen.
7. Maintenance Therapy: Psoriasis is a chronic condition, and many treatments provide symptomatic relief rather than a cure. Continuous or maintenance therapy is often required to manage symptoms and prevent flare-ups. Discontinuing treatment without medical supervision may lead to the return of symptoms.
8. Individual Variations: Psoriasis is a heterogeneous condition, and the response to treatment can vary based on the subtype of psoriasis, the severity of the disease, and individual factors. What works for one person may not work for another, and finding the most effective treatment approach for each individual can be challenging.
9. Treatment may not be suitable for everyone: Some psoriasis treatments are not suitable for everyone, due to factors such as age, pregnancy, or other medical conditions. It is important to talk to your doctor about the risks and benefits of any treatment before starting it.

It is important for individuals with psoriasis to have open and ongoing communication with their healthcare providers to discuss treatment options, manage expectations, and address any concerns or limitations associated with the chosen treatment plan. Regular follow-up visits and evaluations are crucial to monitor the response to treatment and make any necessary adjustments.

References:

1. https://www.aad.org/public/diseases/psoriasis/treatment/treatment
2. https://www.psoriasis.org/about-psoriasis/
3. https://www.uptodate.com/contents/treatment-of-psoriasis-in-adults