Moderate to Severe Psoriasis

People with more severe forms of psoriasis (or psoriasis that does not respond to topical medications) should be encouraged by the many treatments available, including a number of new ones. Treatments include:

• Phototherapy – There are a number of phototherapy treatments, all of which involve exposing the skin to a form of light, which can help clear up the condition. The treatment typically is done in a dermatologist’s office. The different types of phototherapy include:
  • The excimer laser
  • Psoralen and ultraviolet A (PUVA)
  • Broadband ultraviolet B (UVB) light
  • Narrowband UVB light
    
  Some may be used in combination with topical treatments to increase the effectiveness of the therapy. Side effects vary, but may include darkening of the skin and scarring (laser) and skin cancer (PUVA and UVB).
  
• Systemic medications – A number of medications that have been FDA-approved for psoriasis are taken orally, or by injection or infusion. They include:
  • Acitretin – a retinoid, or vitamin A derivative
  • Cyclosporine – an immunosuppressant
  • Methotrexate – a chemotherapy drug
    
  They can work well, but come with potentially serious side effects, ranging from liver and kidney damage to increased risk of cancer. Women who are pregnant or plan to become pregnant must not use acitretin or methotrexate because of the risk of birth defects.
  
• Biologics – A revolutionary new treatment for moderate to severe psoriasis, biologics target different parts of the immune system that are overactive in people with psoriasis. Biologics that have received FDA approval to treat psoriasis include:
  
  
  • Etanercept
  • Ustekinumab
  • Adalimumab
  • Alefacept
  • Infliximab
    
    
  The last three may be beneficial for people with psoriatic arthritis. Side effects, which vary according to the biologic, can include increased risk for infection as well as risk of developing cancer.
  
• Other systemic medications – There are a number of oral medications that are not FDA approved for psoriasis, but are approved for other conditions, and show promise for people with psoriasis. Talk to your dermatologist to learn more.
  
• Topical medications (See Mild to Moderate Psoriasis)

For more detailed information about psoriasis, visit PsoriasisNet.

 

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