Psoriasis

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Psoriasis on the knuckles

Plaque psoriasis

Treatment is focused on control of the symptoms and prevention of secondary infections. It varies with the extent and severity of the disorder. Severe or resistant cases may require intensive treatment.

Psoriasis that covers all or most of the body is an emergency that requires hospitalization. The disorder is very rare. It may be painful. The body loses vast quantities of fluid and is susceptible to severe secondary infections that can become systemic, involve internal organs and even progress to septic shock and death. Treatment includes analgesics, sedation, intravenous fluids, and antibiotics.

Mild cases are usually treated at home. Topical medications (applied to the skin) include:

• Corticosteroid creams or ointments
• Prescription creams or ointments containing substances that are related to vitamin D (calcipotriol) or vitamin A (retinoids)
• Prescription or nonprescription dandruff shampoos
• Shampoos or ointments that contain coal tar
• Ointments or creams that contain anthralin
• Moisturizers
• Creams to remove the scaling (usually salicylic acid or lactic acid)
• Antibiotics, where infection with strep is suspected

Oral medications, such as retinoids or drugs that suppress inflammation (immunosuppressants such as methotrexate or cyclosporine), may be given. These are usually prescribed in more severe cases, when a large amount of body surface area is affected, or when topical treatment has not succeeded. They are also prescribed when the psoriasis is accompanied by arthritis. Women of childbearing age may not be treated with some of these medications.Other treatments may include short, controlled exposures to ultraviolet light (phototherapy). In some cases, the skin is first sensitized (made sensitive) to the ultraviolet light by the application of coal tar ointment, or by taking oral psoralens (special medicine with plant material in it). These treatments are performed in a lightbox in the doctor's office and usually require 2 to 3 visits per week.