A Case of Statin-Induced Myopathy
What Are The Most Effective Psoriasis Therapy Options?
Medically reviewed by William Truswell, MD
Psoriasis is a chronic skin condition with many options to help manage your disease and reduce symptoms. The right psoriasis therapy for you depends on various factors, including disease severity, other co-occurring conditions, and your personal preferences.
A healthcare provider may recommend topical medications (those applied to the skin), oral medications, or newer biologic therapies via injection for psoriasis. Light therapy can help many people, as can working on the mind/body connection through various stress management techniques.
Finding the right combination of therapies may take some trial and error. This article covers some standard approaches to treating psoriasis.
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Choosing the Right Psoriasis Therapy for YouThere are many things to consider when deciding on psoriasis therapy. For example, some treatments are only appropriate for people with moderate or severe psoriasis but not for those with mild symptoms. Some treatments might work particularly well for specific, less common forms of psoriasis.
You might want to avoid a specific treatment because of your other health conditions or have personal preferences regarding the type of treatment and how often you are treated. Cost and availability are also important practical factors to consider.
Topical TherapyTopical therapies are relatively low-cost and usually the first approach in people with mild to moderate psoriasis, especially if symptoms are limited to a specific area of the body. Many people use them alongside other psoriasis treatments.
Topical therapies are often available in multiple formulations, such as creams, gels, lotions, shampoos, and sprays.
CorticosteroidsCorticosteroid topical therapies like Betnovate (betamethasone valerate) are one of the cornerstones of psoriasis treatment, and they are available in different strengths. They can effectively clear up psoriasis patches found on a limited region of your body, but symptoms usually come back after you stop using them.
Corticosteroids can have side effects, like thinned skin, and because of this, you shouldn't use them for long periods. They might also be inappropriate for people with certain medical conditions, like diabetes, and you shouldn't use them in certain sensitive areas of the body.
Vitamin DAnother option is compounds derived from vitamin D, such as Dovonex (calcipotriene). Some healthcare providers combine them with corticosteroids for the best effect, and together, the two may be more effective than either medication alone. They have fewer overall safety concerns than corticosteroids, and most people can use them long-term.
RetinoidsRetinoids, compounds related to vitamin A, are another topical option. Retinoids such as Tazorac (tazarotene) often work best when combined with other agents, such as corticosteroids and phototherapy. They are usually used only for a limited period.
Retinoids may be particularly helpful for people with palmar-plantar (palm and sole) and nail psoriasis, but some people find them irritating to the skin. They are also dangerous during pregnancy, so they aren't a good option if you are pregnant or planning to become pregnant soon.
MoisturizersNon-medicated moisturizers are also important to reduce itchy and scaling skin in psoriasis treatment. They are very safe and can be used with all other psoriasis therapies.
Light TherapyLight therapy, also known as phototherapy, is another broad treatment approach, particularly if you have moderate to severe psoriasis or if you can't get control of your symptoms with topical treatments alone. Light therapy uses exposure to different kinds of ultraviolet (UV) light to help reduce your symptoms.
Light therapy can be used alone, but it's typically used with other approaches. It is relatively low-cost, has few side effects, and can be used during pregnancy.
One drawback of light therapy is the time commitment. Healthcare providers recommend beginning treatment with 20 to 36 half-hour sessions three times a week, then switching to once weekly. Most versions are given in a clinic, so travel can also take time.
Ultraviolet B (UVB)The first type of phototherapy used was broadband UVB (BB-UVB), sometimes just called "UVB." It exposes the skin to specific wavelengths of light. Narrowband UVB (NB-UBV) was developed a little later and uses a limited wavelength spectrum within that larger range.
NB-UVB is the most common type of phototherapy. It tends to be more effective than BB-UVB and is easier to use than some other forms of phototherapy. Plus, it may have fewer side effects than other forms of light therapy.
Many people have in-home NB-UVB units. However, they may not be as safe or effective as getting it in a clinic.
Targeted UVBTargeted UVB approaches, such as excimer lasers, also utilize UVB energy. These methods apply higher doses of radiation to a smaller area of skin, so they are best suited to people with a small affected region of skin.
Psoralen Plus UVA (PUVA)Another approach to light therapy uses ultraviolet A, a range of the ultraviolet light spectrum with a little less energy than ultraviolet B. Because of that, it's used with a drug, psoralen, that helps sensitize your skin to light therapy. You might take psoralen orally, applied onto your skin, or by soaking in water containing the medication.
Psoralen plus UVA (PUVA) is the second most common form of light therapy. It seems more effective than BB-UVB and may work more in fewer sessions than NB-BB. It may be particularly helpful if your psoriasis is limited to a specific region, for example, for someone with the palmoplantar form of the disease.
ClimatotherapySome parts of the world have climates that improve psoriasis symptoms. They may have different levels of UVA and UVB natural radiation from the sun, allowing for safer exposure. They are often close to the sea, and the moist and salty air may be protective.
Climatotherapy is an approach to improving your skin by moving to a particular part of the world. For example, some people travel to the Dead Sea in Israel or to the Canary Islands as part of temporary treatment. It might particularly make sense for people who don't want to pursue other treatment options.
Pharmaceutical Systemic Therapy (Non-Biologic)People with moderate to severe psoriasis may want to explore oral drug therapies. These drugs are less expensive than newer biologic therapies, and some insurance companies may require that you try them before they cover a biologic treatment.
MethotrexateMethotrexate is often the first drug used in this category, as it is best overall in terms of safety and effectiveness. You can also take it as a shot once a week instead of via pill.
However, it's often not safe for people with liver disease. It's also not safe during pregnancy or breastfeeding.
RetinoidsVitamin A-based therapies like Soriatane (acitretin) are another approach. They may be a good option if you have an immune system problem, like HIV. Unlike other forms of non-biologic or biologic systemic therapies, it doesn't directly affect the immune system.
Soriatane might be a good choice for some less common kinds of psoriasis, like erythrodermic or palmar-plantar, but it can cause itching and burning skin and hair loss at high doses. Like retinoids used topically, Soriatane should never be used during pregnancy.
CyclosporineCyclosporine can be a very effective and quick treatment for people with severe disease, or disease that has been hard to treat. However, because of the risk of serious side effects, it can't be taken long-term (unlike a drug like methotrexate). Your symptoms may come back after you stop taking the drug.
It's probably not a good choice for people with kidney disease, uncontrolled high blood pressure, or people who have had a lot of prior PUVA treatments (because of the potentially increased risk for cancer).
JAK InhibitorsSotyktu (deucravacitinib) is a new oral medication for moderate to severe psoriasis. It is a Janus kinase (JAK) inhibitor that inhibits an enzyme that promotes inflammation. It may work just as well as some biologics, but it's more expensive than older oral systemic drugs.
Biologic Systemic TherapyBiologic therapies are an option for some people with moderate or severe psoriasis. Biologic therapies are made from components of living things. They must be refrigerated and are given via an injection instead of orally. They target different components of the immune system to tone down its response.
These biologics suppress your immune system and may increase your risk for certain potentially serious infections. Although they share some slight differences in terms of potential side effects, they all can effectively treat moderate to severe disease.
Some important Food and Drug Administration (FDA)-approved biologics for psoriasis include:
Tumor necrosis factor (TNF) inhibitors like Humira (adalimumab), Remicade (infliximab), and Cimzia (certolizumab)
Interleukin (IL)-12/IL-23 inhibitors like Stelara (ustekinumab)
IL-17 inhibitors like Cosentyx (secukinumab) and Taltz (ixekizumab)
IL-23 inhibitors like Tremfya (guselkumab) and Ilumya (tildrakizumab)
Certain biologics may be a better choice if you have certain medical conditions. For example, Humira or Cosentyx might be good choices if you have psoriatic arthritis and psoriasis symptoms. Conversely, Humira might not be a good choice if you have inflammatory bowel disease.
Mental Health and Mind/Body TherapiesPeople with psoriasis are more prone to having problems like depression, anxiety, and low self-esteem, partly because of the way the disease affects their personal lives. Addressing some of these problems through mental health therapies can improve your mood and overall well-being.
Moreover, stress plays a role in exacerbating symptoms of psoriasis, perhaps through effects on the sympathetic nervous system and the release of certain hormones, like cortisol. So, complementary therapies that can help you deal better with stress may also help reduce your skin symptoms.
If you work with a professional in person, mental health and mind/body approaches may be difficult for some people to access. However, many more options are now available through phone apps, online resources, or remote support, which may make this approach more practical.
Depending on the setting, you may work with someone who blends one or more of these techniques or related techniques, such as hypnosis.
Psychological Counseling and Cognitive Behavioral Therapy (CBT)Various kinds of mental health counseling may be helpful for some people. It's a place where you can talk about your thoughts and feelings to a supportive person, which helps you find a better way to deal with them.
Some evidence indicates that a specific kind of talk therapy called cognitive behavioral therapy (CBT) may be particularly helpful for people with psoriasis. It helps you change some of your distorted thoughts and feelings, improving your emotional regulation as you develop coping strategies.
MeditationMeditation, a process of training one's attention over time, may also be helpful for psoriasis. Many different approaches are available, but you might focus your attention on an object, work to increase your feelings of kindness, or try to be mindful of the present moment without judging it.
BiofeedbackIn biofeedback, you are connected to a machine that monitors some aspect of psychological tension, like your heart rate or sweating.
You might get feedback through tones you hear or a special kind of video game. Over time, you learn to recognize when you are becoming stressed, and you learn how to relax more easily. One study combining CBT with biofeedback found positive results for people with psoriasis.
Relaxation TherapyRelaxation therapy might include a number of different approaches to help you decrease your stress response. Through techniques like guided imagery or progressive muscle relaxation, you learn how to let stress and anxiety move out of your mind and body more easily.
Related: Psoriasis Treatment: How Therapy Can Help
How to Combine Psoriasis Therapy OptionsAlthough some people use just one type of psoriasis therapy, many get improved results when combining one or more approaches. You may start with one but add another if you still have remaining symptoms.
For example, you might use one or more topical creams with phototherapy or oral medication like methotrexate. Or you might use both phototherapy and a systemic treatment like methotrexate, which might allow you to use lower doses of both, potentially reducing the risks of side effects.
Some people with severe disease might combine a non-biologic systemic treatment with a biologic treatment, potentially in addition to treatments from other categories.
Apart from topical creams and mental health approaches, you typically wouldn't use more than one treatment from the same category. For example, you wouldn't use more than one biologic or more than one type of phototherapy at the same time. But otherwise, most combinations are OK.
SummaryThere isn't one single ideal treatment for psoriasis. The best treatment or combination of treatments for you will depend on many factors, like the type and severity of your psoriasis, other medical conditions, cost considerations, availability in your area, and personal preferences.
Treatments applied to the skin are generally the starting point for psoriasis treatment, but people with moderate or severe disease often need additional approaches. These might include phototherapy, oral drug or biologic treatments, and mind/body approaches.
Some people do well with a single therapeutic approach. However, many people get the best results if they combine more than one category of psoriasis treatment. Your healthcare provider can help you decide on the best approach for you.
Read the original article on Verywell Health.
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How Does Psoriasis Affect Pregnancy?
Medically reviewed by Cordelia Nwankwo, MD
Pregnancy can significantly impact many chronic health conditions; however, psoriasis can improve with the hormonal changes that occur during pregnancy.
Psoriasis is a chronic skin condition where dry, flaky, and often painful plaques form across your body. There is no cure for this condition, but many treatments are available.
This article explores how pregnancy can affect psoriasis, safe and effective treatments during pregnancy, and how to protect your fetus from the adverse effects of treatments while pregnant or breastfeeding.
How Does Pregnancy Affect Psoriasis?More than half of the estimated 7 million adults affected by psoriasis in the United States are women—and most of them are in their childbearing years. This statistic suggests that many women with psoriasis may need to manage both their psoriasis and a healthy pregnancy.
Between 9,000 and 15,000 live births in the United States each year are to people who face moderate-to-severe psoriasis. Although autoimmune conditions like psoriasis are linked to problems during pregnancy, many people with psoriasis report an improvement in their psoriasis symptoms and overall condition during pregnancy.
One study estimates that 60% of people see improvement in their psoriasis during pregnancy, 20% report no change, and 20% see their condition worsen. There are a few reasons for this variation. In general, psoriasis is believed to affect more women because people assigned female at birth have immune systems that are more sensitive to hormonal stimulation.
Cytokines (small proteins that help signal cell activity) can positively affect autoimmune inflammation that psoriasis triggers. During pregnancy, cytokine levels fluctuate due to pregnancy hormones, contributing to a reduction in psoriasis symptoms in some people.
Can Pregnancy Cause Psoriasis?Most of the research describing psoriasis during pregnancy focuses on pre-existing cases of psoriasis, but this doesn't mean that it's impossible to develop a new autoimmune condition during pregnancy.
Several autoimmune conditions are known to be triggered by pregnancy, including:
Pregnancy doesn't typically trigger psoriasis, except for one specific form of the skin condition known as "pustular psoriasis of pregnancy."
Pustular Psoriasis of PregnancyPustular psoriasis of pregnancy (PPP) is a rare condition primarily affecting people in their third trimester. It's also known as impetigo herpetiformis and can cause inflamed, itchy, or crusted lesions to form on the skin—especially in skin folds.
If left untreated, this condition can lead to problems during pregnancy for the birthing parent and baby. It can develop in people with or without a family history of psoriasis. Although this form of psoriasis usually resolves within days of giving birth, severe cases may be treated during pregnancy with medications like steroids and antibiotics.
If you develop PPP with one pregnancy, you are more likely to have a recurrence with additional pregnancies.
Which Medicines Are Safe to Take for Psoriasis During PregnancyThere is limited information about the safety of some medications during pregnancy simply because testing the effects of new medicines on pregnant people and their developing fetuses is unethical.
The safety of medications during pregnancy is usually determined based on how easily the medication can be transferred from the pregnant person's system to the fetus through the placenta and the effect these medications can have on a developing fetus.
Medications, such as steroids and immunosuppressants, used to treat various conditions and have been around for a long time tend to have the most data. These medications are sometimes used during pregnancy but carry the risk of reduced fetal growth, and healthcare providers typically recommend the smallest possible dose.
Certain psoriasis medications can be used during pregnancy, though they can affect the fetus. The medications include the following:
Talk to your dermatologist and obstetrician about the efficacy and risks associated with psoriasis medications before using them during pregnancy or while breastfeeding.
Which Medicines Should You Avoid While Pregnant?While some of the medications above are used for severe cases of psoriasis under a healthcare provider's guidance, there remain several other psoriasis medications that are unstudied in pregnancy or are known to pose a significant risk of congenital abnormalities.
Biologics are a newer class of medications used to treat psoriasis and other autoimmune conditions. While effective in treating certain diseases, biologics have not been studied and proven safe during pregnancy. While research suggests that some biologics are likely safe to use during pregnancy without risk to the pregnant person or fetus, healthcare providers do not currently recommend these medications for use during pregnancy.
Other medications that are not recommended or strictly prohibited for use in pregnancy include:
This list is not exhaustive. These medications—and others—are proven to or highly likely to cause severe congenital abnormalities, premature birth, or even fetal death. If you take any of these medications and become pregnant or are planning to become pregnant, talk to a healthcare provider about when to stop taking them and when they are safe to resume after delivery.
Related: List of Medications You Can and Can't Take While Pregnant
Other Safe Treatment Options for Psoriasis During PregnancySeveral non-pharmaceutical or over-the-counter (OTC) treatments may help relieve psoriasis symptoms during pregnancy without putting you or the fetus at risk.
Reduce StressStress can trigger psoriasis and cause flare-ups. Reducing stress can help you control your psoriasis. Stress relief can take many forms, including meditation, massage, or acupuncture. Talk to a healthcare provider about other pregnancy-safe strategies for stress management. If you use massage or acupuncture, make sure your therapist is trained in treating pregnant people.
Take an Oatmeal or Dead Sea Salt BathBathing is an excellent way to deliver exfoliation and moisture to the body. Various bath products are created specifically to exfoliate and moisturize, but you don't need high-end products to achieve psoriasis relief with a bath.
Dead sea salts and colloidal oatmeal bath soaks help relieve psoriasis symptoms such as flaking and itching. They are considered safe during pregnancy and widely found in generic formulas.
Use Moisturizers After BathingMoisturizers can also help calm irritated or inflamed skin, even without additional medications. Many use topical creams and ointments containing ingredients like petroleum jelly, mineral oil, or oatmeal-based creams to help manage psoriasis.
These topical treatments can help at any time, but they may be particularly effective after showering or bathing because they help seal moisture into the skin.
Select Products With CareNot all baths and lotions are created equal when it comes to psoriasis. Too-hot water can irritate the skin, as can lotions or creams with added fragrance. Opt for warm water and fragrance-free products, especially during a psoriasis flare-up.
Will the Baby Have Psoriasis Too?Not every case of psoriasis is genetic, but it can be passed through families. If you or your partner have psoriasis, your baby is more likely to develop the condition at some point.
How to Protect Your BabyYou can't change your genetics, but you can help protect your growing fetus from the toxic effects of some psoriasis treatments. Talk to a dermatologist and obstetrician about the best treatment options for psoriasis during pregnancy.
If you don't already have psoriasis before pregnancy, discuss any new skin conditions with your obstetrician or primary care provider.
Learn More: What You Need to Know About Psoriasis and Family Planning
Psoriasis Flare-Ups Right After DeliveryIf you notice a change in your psoriasis during pregnancy—especially if your symptoms improve—it's very likely that these changes won't last long after delivery. Your psoriasis may return as your body returns to its baseline function after delivery.
If you developed psoriasis during your pregnancy and didn't have it before, there is a chance that your condition was PPP and will resolve after you have your baby.
Learn More: Postpartum Physical Therapy
SummaryPsoriasis is a chronic, autoimmune disease that causes flaky and sometimes painful patches on your skin. Many women report their psoriasis improves during pregnancy, but it won't go away completely.
If you use prescription medications to treat your psoriasis, you may need to talk to a healthcare provider about the safety of these medications during pregnancy. You may be able to continue some psoriasis medications throughout pregnancy, but others can be highly toxic or even fatal to a developing fetus.
Read the original article on Verywell Health.
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