Psoriasis treatment reduces the symptoms through the combination of different therapies.
Psoriasis treatment is symptomatic and depends on the clinical situation of each patient.
As there is no definitive, there are different treatments that keep the disease under control and in some cases decrease the symptoms:
The different treatments for psoriasis are:
- Local therapies
- Phototherapy and chemotherapy photo
- Oral systemic medications
- Biological therapies
These are the starting treatments used for the majority of psoriasis.
They consist of the application of creams and lotions externally and localized on the cutaneous lesions.
Among the most commonly used drugs for psoriasis treatment we find:
- Vitamin D analogues
- Local corticosteroids
- Local retinoids
Vitamin D analogues: calcitriol, calcipotriol or tacalcitol
The most effective is calcipotriol . The clinical response of these analogues is slower than that of very potent corticosteroids, but as they have a better safety profile, this makes them very useful for long-term treatment .
Despite their obvious value, vitamin D analogs have a rather strong adverse effect: the possibility of irritations on the area of the injured skin, which is why we must avoid sun exposure after its application.
This group of drugs work primarily by brightening the plaques and reducing inflammation .
Low power ones are used for delicate areas (face and folds) and more powerful ones for the scalp, areas with larger plates, hands and feet.
The recommendation is to use the most potent at the beginning, then continue with the weaker ones, or even combine them with other therapies like vitamin D analogues.
We must be careful with corticosteroids because they have adverse effects both locally and systemically .
Among the premises we find:
- Decrease in the size of the epidermis
- Lightening of the skin by inhibition of melanocytes
- Rosacea-shaped dermatitis
The systemic effects are infrequent but serious, among them we find the inhibition of the hypothalamus-pituitary axis and Cushing’s syndrome.
Systemic effects such as inhibition of the hypothalamic-pituitary axis and Cushing’s syndrome are uncommon but serious.
To avoid them, we recommend a maximum of application per day, taking into account that they have a rebound effect if we stop the treatment of a stroke.
Keratolytics: acetylsalicylic acid (aspirin)
The use of acetylsalicylic acid is limited to eliminating squamous plaques, to promote the renovation of the tissue and enhance the effectiveness of associated drugs to facilitate their absorption, which is why it is a complementary treatment.
These are analogues of vitamin A.
Tazarotene is the only one available for psoriasis treatment and is used in combination with corticosteroids .
They produce skin irritation (avoid its use on the face or skin folds), and like all vitamin A analogues, it is photosensitive and teratogenic, which is why it is contraindicated in pregnant women.
It is the oldest treatment for psoriasis. They are prepared with pitch and coal.
Tars are used intermittently on skin folds , although they are sometimes hated because of their smell and their ability to stain clothes.
They are also photosensitive, so avoid sun exposure after application .
Phototherapy and chemotherapy photo
These treatments are used when the patient does not respond well to local therapies or the plaques are very large.
- Phototherapy : these are the UVB rays (those with narrow band are the most effective and which produce the least burns). They are used in combination with tazarotene, vitamin D analogues or systemic treatments.
- Photo chemotherapy : also called PUVA . It consists of the combination of UVA radiation after the local or oral administration of a psoralen that acts as a sensitizing photo . It is used alternately in patients for whom UVB has no effect, as PUVA is more effective and longer-lasting, but is associated with basiloma (basal cell carcinoma) and melanoma .
Oral systemic medications
Doctors indicates systemic treatment in cases where other therapies do not work . This treatment is based on the administration of:
Among these drugs, the most used is methotrexate , especially for long-term treatments.
The patient must be under monitor because of its serious adverse effects. We must also avoid pregnancies up to 3 months after treatment with this medication, both for women and men.
Another immunosuppressive drug used is oral cyclosporine , which has a similar or superior efficacy to methotrexate, but is nephrotoxic and produces hypertension , which is why it requires patient monotoring. The recommendation is for intermittent and short-term treatments.
The acitretin , analogue of vitamin A, can be considered as an alternative in-patient are suffering from pustular psoriasis and immuno-es who can not use immunosuppressive drugs.
UVB and PUVA can be combined, but it is less effective than cyclosporine and maintains teratogenesis up to 2 years after treatment.
Biological therapies for psoriasis
They are reserved for patients with contraindications or intolerances to PUVA and systemic oral treatments .
The Ustekinumab is a biologic medicine whose only indication is psoriasis. It requires a monitor to control its adverse effects because we do not know its safety in the long term.