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Psoriasis
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Psoriasis

Diseases & Conditions A-Z

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WOMEN'S HEALTH

Hair/Nails/Skin

Psoriasis is a common skin condition characterized by a rapid buildup of rough, dry, dead skin cells forming thick scales. The inflammation can be frustrating if you have it, causing unsightly patches of skin, discomfort and even pain.

Normally, it takes about a month for new skin cells to move from the lowest layer of your skin, where they first form, to the outermost layer, where they die and scale off in flakes. In psoriasis, the life cycle of skin cells speeds up, resulting in a multitude of dead cells on the outermost layer of your skin.

Psoriasis is a persistent, chronic disease that tends to flare periodically and may go into remission, but usually remains active for years. Psoriasis can occur at any age, but the onset is usually gradual and the diagnosis is commonly made between the ages of 15 and 35.

Treatment

One of the things that make psoriasis so difficult to control is its wide variation in type, severity and response to treatment. Because each case of psoriasis is unique, your doctor will tailor a treatment to you. The goal of treatment is to suppress the growth of your skin cells. Among the treatment approaches:

  • Creams and ointments. Calcipotriene (Dovonex) is an ointment available by prescription that contains a derivative of vitamin D. Calcipotriene controls the overproduction of skin cells. It's a useful treatment for mild to moderate psoriasis. Steroid creams, coal tar, anthralin and a topical form of retinoic acid are other topical treatments. 

  • Oral medications. Retinoids are a group of drugs related to vitamin A. Retinoids reduce the proliferation of skin cells in cases of severe psoriasis. They can produce side effects such as eye and lip inflammation, bone spurs and hair loss, as well as birth defects if taken during pregnancy. Other oral medications include methotrexate, an anticancer drug that blocks the growth of skin cells in psoriasis, and cyclosporine (Gengraf, Neoral), which suppresses your immune system. Though these drugs are effective in treating severe psoriasis, they may also cause side effects, including liver and kidney toxicities.

  • Phototherapy. Psoralen plus ultraviolet A (PUVA), a combination of light-sensitizing medications (psoralens) and ultraviolet A light, is effective in suppressing the growth of skin cells in severe psoriasis. However, long-term — 250 treatments or more — use of PUVA may increase your risk of skin cancer and possibly melanoma, a deadly form of skin cancer. The higher risk begins about 15 years after the first PUVA treatment. Exposure to moderate sunlight — being careful to avoid sunburn — as well as the topical application of coal tar combined with ultraviolet radiation also are effective treatments. A form of phototherapy treatment called narrow-band ultraviolet B (UVB) has emerged in the past decade. This treatment may be as effective as PUVA but doesn't require that you take oral medications before each treatment. It's not thought to carry as high a potential for skin cancer as PUVA does. Some doctors also give UVB treatment in conjunction with coal tar in a method called Goeckerman treatment. Using the two approaches together is more effective than using either alone. Doctors don't know exactly how the dual approach works, but using the coal tar seems to make the skin more receptive to the UVB light.

  • Immune-modulating drugs (biologics). The Food and Drug Administration has approved several immune-modulating drugs for the treatment of moderate to severe cases of psoriasis. They include alefacept (Amevive), efalizumab (Raptiva) and etanercept (Enbrel). These drugs are given by intravenous infusion or intramuscular injection, and are usually used for people who have failed to respond to traditional therapy or for people with associated arthritis.

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