How do I know if I have Psoriasis?
Psoriasis typically appears on elbows, knees, and scalp, but can also surface on our upper buttocks, palms, soles, and genitals. If your skin is a little scalier than usual, especially on your elbows and knees, it may be psoriasis.

What treatments are available?
Topical treatments, such as tar and cortisone creams are typically used to treat mild to moderate forms of psoriasis. For more severe cases, dermatologists may use oral medications, light treatment, or a combination of both. As with any medication, these drugs can have serious side effects and their effectiveness varies among patients.

Psoriasis Treatments
As many as 6.4 million Americans have psoriasis, a chronic, noncontagious skin disorder. Most have a mild form with a few lesion often confined to the knees, elbows, or scalp. Other have moderate psoriasis, which ordinarily involves 10 – 20% of the skin. Severe psoriasis may affect large areas such as the back, chest, legs, or the entire body.

No matter what percentage of the skin involved, psoriasis may cause physical and emotional pain. The bad news is that no one can predict its severity or its course over time. The good news is that effective treatments, and combination of treatment, are available.

The majority of people with psoriasis have psoriasis vulgaris (vulgaris means common). The lesions are characterized by an inflamed or reddened base covered by a silvery white scale. The edges of the lesions are well defined. The less common form of psoriasis are guttate, pustular, inverse, and erythrodermic. Treatments vary with the type and severity of psoriasis

Treatments for Psoriasis can be divided into three basic categories:
I. Sunlight and Topical Agents (external therapies)
II. Phototherapy (artificial ultraviolet light or a combination of light and medication)
III. Systemic Medications (internal therapies)

STEP I: SUNLIGHT AND TOPICAL AGENTS
Topical Steroids
• Commonly prescribed for mild to moderate psoriasis
• Simple to apply and do not stain clothing or have an offensive odor
• Available in strengths ranging from most potent (Class I) to least potent (Class 7)
• Abuse or misuse of steroids, particularly the stronger ones, may lead to thinning of the skin, stretch marks, and skin atrophy (wasting away)
• High potency steroids are effective, but should only be used for short periods of time on limited areas of skin because they can produce a "rebound" (the psoriasis comes back the same or worse than before the treatment) and lead to serious side effects

Steroid Injections
• Steroids are sometimes injected into very small, persistent, psoriasis lesions or into the nail bed to treat psoriasis of the nails (known as intralesional injection)
• Steroids can be injected into the muscle which affect the whole body (systemic treatment)

Coal Tar
• Coal tar is applied directly to the lesion or used in a bath solution
• Tar preparations are most often applied at bedtime and washed off in the morning due to their unpleasant odor and ability to stain clothing
• Most often used for hospitalized patients or for those in day treatment programs
• Coal tar can be used in combination with ultraviolet light (UVB) phototherapy or sunlight; tar makes the skin more sensitive to ultraviolet light

Anthralin
• Very effective to mild in moderate psoriasis
• Anthralin can be irritating to unaffected skin, and it is similar to tar in that it can stain almost anything
• Anthralin cream rages from 0.1% to 1.0% in concentration; If a person fails to respond to 1% anthralin cream, specially compounded anthralins of up to 10% can be produced by a pharmacist
• The higher the concentration, the shorter period of time it may be used
• Micanol, a 1% anthralin cream, is a new formulation designed to limit the staining and irritation usually associated with anthralin. The medication is contained in microscopic capsules that melt only at skin temperature, so the active ingredient is released on the lesion, not on clothes, towels, etc.

Topical Vitamin D3 (Dovonex)
• Calcipotrience (Dovonex) was approved for mild to moderate psoriasis
• This Vitamin D3 derivative has few side effects if used as directed
• It is odorless and non-staining
• Usually applied to lesion twice a day; not normally used for the face or the genitals because it can be irritating or on children, or women during pregnancy

Salicylic Acid
• Used to help remove scales and is often combined with steroids, anthralin, or tar to enhance their effectiveness
• Available over-the-counter in many topical forms: cream, gel, lotion, ointment, pads, plaster, shampoo, soap, and solution
• Has the potential to irritate if left in contact with the skin for too long
• Aspirin based

Tazarotene (Tazorac)
• Available in an odorless, non-staining gel form in 0.05% or 0.1% concentrations
• Skin may appear bright red which may make it appear that the psoriasis is getting worse before its getting better
• A mid- to high-potency steroid in combination with the Tazorac will help reduce redness and irritation
• Not recommended for use in the groin area or around the eyes
• Not recommended for women who are pregnant, planning to become pregnant, or breast-feeding

Occlusion Therapy
• The process of covering the skin overnight with an airtight, waterproof wrapping (plastic wrap, tape, or other material) after an application of mild to moderate steroid or a moisturizer
• Used mostly for stubborn, localized lesions of psoriasis and for the scalp, but not for widespread psoriasis
• Occlusion suits are available to treat extensive areas of the skin

Moisturizers, Bath Solutions, and Nonprescription medications
• Keep the skin moist to help reduce inflammation and itching and promote flexibility
• Apply moisturizers daily and over time you may see significant results
• Heavy, greasy moisturizers work best such as Eucerin, Vaseline, Aquaphor, Neutrogena, Norwegian

Formula Hand Cream, and Bag Balm
• Cooking oils or shortening can be effective substitutes
• Soaking in water for 15 minutes and followed by application of a moisturizer will help soothe the skin
• Adding oil, coal tar solution, oilated oatmeal, Epsom salt, or Dead Sea salts to the water is beneficial and can help remove scale and soothe itching
• Substances such as aloe vera and jojoba are frequently used to moisturize and soothe lesions
• "Natural" agents such as Vitamin E oil can cause allergic reactions

Natural Sunlight
• The most effective wavelength, ultraviolet light B (UVB ) is found in natural sunlight
• Sunbathing on a regular schedule can help eliminate lesions or at least reduce them, but it is important to schedule a yearly skin exam with your physician
• Sunburns, however, can make psoriasis worse
• Cover unaffected areas to reduce the risk of skin cancers

STEP 2: PHOTOTHERAPY
Ultraviolet light B (UVB)
• Common treatment for moderate to severe psoriasis or localized areas of stubborn lesions
• Involves exposing the skin to a particular wavelength of ultraviolet light called UVB
• May be used alone or in combination with topical or systemic internal treatments
• UVB is administered with a light panel or with a light box that surrounds the patient
• Exposure time usually begins at a few seconds and gradually increases
• Treatments usually consist of 3 – 5 exposures per week for a period of 1 – 2 month
• Treatments that burn the skin can irritate psoriasis
• Side effects can include: freckling, premature skin aging, or long-term risk of skin cancer

PUVA
• Involves the use of a prescription medication called Psoralen and exposure to ultraviolet light A – PUVA
• Recommended only for moderate to severe psoriasis or disabling psoriasis
• Psoralen makes the skin more sensitive and responsive to the UVA
• Depending on the area being treated, Psoralen can be administered orally, topically, or in a water solution containing the medication; UVA light is administered immediately after any of these
• Topical Psoralen is more labor intensive, and poses a higher risk of burning, therefore it requires close supervision
• Orally Psoralen may produce such side effects as nausea, headaches, and dizziness
• Itching and redness may sometimes appear after as long as 48 hours
• The first 12 – 24 hours precaution should be taken because Psoralen stays in the body and make both the eyes and skin sensitive to UVA in natural sunlight

Day Treatment
• Available for people with widespread psoriasis who might otherwise require hospitalization
• Patients spend 4 – 8 hours a day at a special facility for 2 to 4 weeks
• Treatments at the facility consist of applications of tar or anthralin, and exposure to UVB light; most patients greatly improve within 3 weeks

STEP 3: SYSTEMIC INTERNAL MEDICATIONS
Your physician may prescribe medications in combination or rotational to other therapies as needed. This helps people avoid becoming resistant to certain treatments or being affected by the long-term risks of some treatments:
• Methotrexate
• Retinoids
• Isotretinoin
• Hydroxyurea (Hydrea)
• Sulfasalazine
• Cyclosporine (Neoral)