Treating psoriasis should be a team effort, the team members varying according to the needs of the person concerned. Treatments need to be acceptable to the individual as well as being effective, so it is important that health-care professionals understand your view of the disease. The cost of treatment in terms of both time and money has to be taken into account, and the chore of applying creams once or twice a day can dampen one’s motivation to treat the skin over a prolonged period.
It is, therefore, very important to avoid looking at the psoriasis on its own because treatment is much more likely to succeed if it is firmly grounded in the context of your life, beliefs and needs for treatment. Expectations, especially unrealistic ones, must be explored and discussed.
‘First-line treatments’ are the initial treatments that your doctor or nurse will suggest to manage your psoriasis. These are topical, i.e. applied directly to the skin.
For mild-to-moderate psoriasis, they are usually all that are required to control it successfully. If your psoriasis is severe and/or does not respond to first-line treatments, your doctor may recommend a move to second-line treatments.
Overall, some 75% of people with psoriasis need no more than these topical treatments, and one of the main reasons for failure seems to be a lack of ability or willingness to continue with the treatment according to the instructions.
First-line treatments generally involve applying creams and ointments to the skin (topical treatment); when used properly, they have minimal side (unwanted) effects. There are lots of different treatments on the market, often with a bewildering variety of names, and many manufacturers make extravagant claims about their success.
Whatever treatment you use, moisturisers will be the mainstay. Moisturisers are substances used to moisturise the skin, either by being rubbed in or by being put in the bath or shower. They are also good to use instead of soap as the detergents in soap can have a very drying effect on the skin. There is a huge range available, and every individual should be able to find an acceptable one. More descriptions of and explanations for the use of moisturisers are given on this site – Read the part on moisturisers. Moisturisers are sometimes known as emollients – in effect they are two words used to describe the same thing.
Tar is a useful substance to treat psoriasis, although it tends to have a strong smell and can be very messy. Tar-based products range from weak substances (e.g. in Exorex) to much stronger ones (e.g. coal tar and salicylic acid, which tends to be prepared and used in hospital departments). Although there is no conclusive evidence linking the use of coal tar with cancer, there have been concerns about the risk in people who use it extensively over long periods of time. Tar can be used on small or large plaques of psoriasis, and although it can irritate unaffected skin, this is only transient and mild, and makes tar suitable for psoriasis that does not have a definite edge and/or is widespread across the body. Tar is not generally recommended for delicate areas of skin (e.g. skin folds or the face), but it can be very useful for pustular psoriasis on the hands and feet.
Dithranol, now manufactured chemically, was originally produced as an extract from a special tree bark. Its value in psoriasis was discovered by accident when a patient with psoriasis and arthritis was given a powder produced from the tree to treat the arthritis. His psoriasis cleared even though the arthritis did not. Dithranol is now used to treat well-defined plaques of psoriasis. It can irritate quite seriously if it is allowed to get on to skin with no psoriasis on it, so it needs to be applied carefully. It is usually applied for a short period of time before being washed off. Dithranol does not smell, but it does tend to stain clothes and surrounding furniture a distinctive purple colour.
Vitamin D derivatives, for example Dovonex (calcipotriol), Curatoderm (tacalcitol) and Silkis (calcitriol), are newer treatments for psoriasis and have the advantage of being relatively clean and non-smelly. They are easy to apply, and although some people have experienced a degree of irritation, this is usually fairly mild and only temporary. Calcipotriol is now available combined with a potent topical steroid in a formulation called Dovobet; this is particularly useful for treating inflamed psoriasis but should not be used for more than 4 weeks without being reviewed by a doctor. Vitamin A derivatives, for example Zorac (tazarotene), are also relatively new to the list of available topical treatments. They are applied only once a day and can be used for up to 12 weeks. Zorac comes in gel form and is relatively clean and non-smelly, but it can cause irritation on the face and in skin folds.
Get a free trial of Dermasis psoriasis cream. and Read the Quick Action Plan to cure psoriasisTopical steroids are not routinely used for treating chronic plaque psoriasis because, although potent or very potent steroids can have a very spectacular positive effect, the psoriasis often comes back (rebounds) as badly if not worse than before once they have been stopped. The short-term use of steroids can, however, be very helpful, especially when psoriasis is inflamed or when it exists in delicate areas of the skin (e.g. the skin folds or face). They are also used in combination with other treatments, and one preparation (Dovobet; see above) contains calcipotriol and a potent steroid – this is licensed for use of up to 6 weeks, although it should ideally be reviewed at 4 weeks.
It is called Protopic (tacrolimus) and is an immunomodulator that was designed for the treatment of atopic eczema. It has proved promising for treating psoriasis where the plaques are quite thin and without scale – such as in those delicate and sensitive areas mentioned above.
Topical treatments often take 4–8 weeks to have any effect, which can be quite demoralising. They can, however, work very well, and the best strategy is to choose treatments that fit best into your lifestyle. It is very important that you use the correct amount of any cream or ointment: some treatments need to be applied sparingly, whereas others are put on more thickly. Many people notice that if one of two plaques start to fade with the treatment, others do so of their own accord. If treating all the psoriasis seems too much trouble, it is worth tackling the bits that are most bothersome and seeing whether the others fade by themselves. We would always recommend that you put moisturiser on all over your body as this really does help to soothe and smooth.
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