Treatment of psoriasis

Psoriasis-on-backThe treatment of psoriasis depends on the severity of the psoriasis. Think of the treatment of psoriasis as a flight of stairs. Each step represents a treatment of greater potency, but with more potential side effects. The treatment of psoriasis always starts at the bottom step, i.e. the least potent treatment with the least potential side effects. If the treatment at this level does not work, the treatment can progress to the next level. This stepwise approach allows for control of the psoriasis with the least potent and safest medication possible.

The treatment levels for psoriasis are as follows:

LEVEL 1:

  • Moisturisers containing Urea or Salicylic Acid.  Moisturisers help to remove the white scaling of psoriasis lesions.
  • Sun exposure. Sun exposure should not be overdone, because a sun burn can also worsen psoriasis. The time spent in the sun should be just enough to feel you have been in the sun the day before.
  • Rest and relaxation

LEVEL 2:

  • Diluted corticosteroid creams.  Corticosteroid creams suppress the redness and inflammation of psoriasis lesions.

LEVEL 3:

  • Undiluted corticosteroid creams, corticosteroid ointments, corticosteroid lotions and corticosteroid shampoos. The most reliably effective ointment is Dovobet™ ointment. Dovobet™ is actually a combination of a topical corticosteroid and a Vitamin D derived ingredient.

LEVEL 4:Alternate Text

  • Vitamin D derived creams like Calcipotriol (Dovonex™)
  • Vitamin A derived creams like Tazarotene (Zorac™)
  • Anthralin or Dithranol containing ointments Level one to four treatments are often used in combination and additively. So, if you progress to a level 4 treatment it is very likely that you will be using all the treatments from level one to four.

LEVEL 5:

  • Ultraviolet light therapy. Narrow band Ultraviolet B treatment is the most effective of the ultraviolet treatment options. Ultraviolet treatments can be combined with level 1-4 treatments, but corticosteroid medications should be gradually stopped during Ultraviolet treatment.

LEVEL 6:

  • Methotrexate tablets
  • Acitretin containing tablets, like Neotigason™. Acitretin is derived from Vitamin A and is especially useful in Pustular Psoriasis

LEVEL 7:

  • Cyclosporin tablets (Sandimmun Neoral™)

LEVEL 8:

  • Various injections. These medications are also known as the Biologic Response Modifiers

50 thoughts on “Treatment of psoriasis

  1. Good morning

    I have been using zorac and locoid and it helps the condition of psoriasis however I have heard that they discontinued the zorac. Should I visit a dermatologist for another script for something else. If so please advise what the cost is of a consultation with yourself as well as a map and the next available appointment.

    Regards
    Roselyn

  2. Hi Dr Louw, I have genital psoriasis and I have been prescribed Dovobet, however, it does not really help in the pubic area because the ointment is too thick and difficult to apply there. Is there something else I can use?

    1. Dear Dorothy. Dovobet is not often used as a first line treatment for genital psoriasis. Was the diagnosis made by a dermatologist? There are many things to do, but the correct diagnosis is the first step.

  3. Hello Sir,
    is there any permanent cure for Psoriasis?
    my uncle badly suffering with psoriasis (17 years). he is in India, if any good permanent cure, we are happy to call for treatment.
    thank you

    1. Dear KK. No, there is no permenant cure, because the condition has a genetic basis. The goal of treatment is control to a level where the condition does not bother the patient.

  4. Hello Sir,
    is there any permanent cure for Psoriasis?
    my uncle badly suffering with psoriasis (17 years). he is in India, if any good permanent cure, we are happy to call for treatment.
    thank you

    1. Dear KK. No, there is no permenant cure, because the condition has a genetic basis. The goal of treatment is control to a level where the condition does not bother the patient.

  5. Hi i have i few questions
    Hi have noticed that i have mild scalp psoriosis, which seems to get worse with stress. Which shampoo’s or treatments can i use. And i have started getting it on the groin area, which gets itchy at some stages. unfortunately it runs in the family, my father has severe psoriosis, which he keeps at pay with cortisone creams. any advice will be apreciated, thank you

    1. Dear Tarien. The are very few OTC products that work well, but try Bioderma Node K shampoo. It will help to reduce scaling which is very important. After showering you can then apply a topical steroid lotion or gel that you will most likely already have. Try it for a few weeks. If is does not work well enough, come and show me.

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