1. Topical (surface) treatments
There are several types of creams and ointments that are useful and many of the preparations are available as bath additives, scalp applications or shampoos. The problem that people with psoriasis have is the time it takes to apply the treatment and the fact that it may take up to six weeks to know whether an individual treatment will work. No wonder so many give up on the treatments. The more old-fashioned treatments, although they were effective, were smelly and messy, but fortunately newer drugs have been developed to overcome these problems.

Emollients, or skin softeners, are used to reduce irritation and soften plaques of psoriasis, helping remove scale. You can use these on their own, in the bath water or as a soap substitute.

Preparations containing salicylic acid are used to soften and remove scale.

Coal tar is more effective than salicylic acid, reducing inflammation and scale formation.

Dithranol is very effective when applied for short periods of time on a daily basis, then removed.

Vitamin D derivatives calcipotriol and tacalcitol are widely used for plaque psoriasis and can be very effective. They are also much easier to use than coal tar creams.

Topical steroids have a limited place in treating psoriasis. If strong steroids are used for a prolonged period of time skin thinning and other abnormalities may occur. The other problem is that the psoriasis may come back with a vengeance if you stop the steroids.

Tazarotene is a retinoid (vitamin A derivative) preparation licensed for small areas of plaque psoriasis.

2. Ultraviolet light
If your psoriasis does not respond to the topical treatments mentioned above you may be referred to the dermatologist to consider other forms of treatment. Many people have noticed that exposure to the sun has cleared their psoriasis in the past. This is utilised in the hospital setting with narrowband UVB light exposure in gradually increasing periods of time. This form of treatment is time-consuming but very effective in most cases. Occasionally, people find their skin gets worse in the sun. The other problem is the increased risk of skin cancer with long periods of UV exposure, so the number of treatments have to be limited.

3. Oral treatments
If you have severe psoriasis that will not respond to the above treatments you will be offered treatment with oral drugs such as retinoids, methotrexate and cyclosporin. These are all drugs with potential serious side effects and cannot be taken if you are pregnant or considering pregnancy. You will need regular blood tests while you are on these drugs. Severe generalised pustular psoriasis, and arthritis associated with psoriasis are usually treated with one of the above drugs.

Useful address:

Psoriasis Association
Milton House
7 Milton Street
Northampton NN2 7JG
Tel:01604 711129
Fax: 01604 792894

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