People with very mild psoriasis may be able to get help from self-treatment with little more than a skin moisturizer, an antidandruff shampoo, and some sunlight. But most patients require medically supervised therapy. Although no treatment will cure psoriasis, many medications can control the disease.
Topical therapy. These ointments, gels, and lotions are the mainstay of treatment, especially for mild-to-moderate disease. In the past, coal tar and anthralin were widely recommended; because they stain skin and clothing, they have been replaced by topical treatments that are more convenient and more effective. Many corticosteroid preparations are available; they vary in potency, but all can reduce inflammation and control itching. Corticosteroids act rapidly, but long-term use of strong steroids can produce skin thinning and damage. Newer topical therapies that are proving very effective include two forms of vitamin D, calcipotriene (Dovonex) and calcitriol (Vectical), and the vitamin A relative tazarotene (Tazorac); all are prescription drugs.
Phototherapy. At one time, it involved two to four weeks of sunbathing or, for those who could afford it, "climatotherapy" with naturally filtered sunlight at the Dead Sea. Now, though, doctors use carefully controlled exposure to ultraviolet (UV) radiation to treat moderate to severe psoriasis. UVB can be administered alone or in combination with tar or other topical agents; some patients can use UVB at home. UVA is usually reserved for extensive psoriasis that has not improved with other treatments. It is used with a photosensitizing drug in the so-called PUVA regimen.
Systemic therapy. The toughest cases of psoriasis call for the toughest treatments. Options include the oral vitamin A–like drug acitretin, the antimetabolite methotrexate, and the immunosuppressant drug cyclosporine. Biologic agents that target specific steps in the immune system include alefacept, etanercept, and infliximab. All of these systemic therapies can produce serious side effects, and all require careful monitoring by experienced physicians. Still, systemic therapies offer new hope to patients who are disfigured and disabled by severe psoriasis. It demonstrates how modern science has made inroads against a disease that has plagued man for thousands of years.