Psoriasis treatments

Psoriasis is a chronic immune condition that most frequently appears in adult life. It occurs when the immune system sends out an abnormal signal to speed up the growth cycle of skin cells. This in turn causes skin affected by psoriasis to thicken, redden and shed skin scales.

Psoriasis on the skin may resemble many forms. Most commonly psoriasis spots are dry, raised, red and scaly areas. They may be a few spots or there maybe many, and they can be found anywhere on the body. Most commonly, psoriasis occurs on the elbows, knees, and scalp.

Guttate form of psoriasis commonly occurs after a sore throat, and present as numerous small droplets on the body.

Psoriasis can also affect the nails, hands and feet.

(Modified from the Australasian College of Dermatologist Website)

There are many treatments available for people with psoriasis. Unfortunately, no one treatment helps everyone with psoriasis.Treatment recommendations usually vary depending on the severity and location of psoriasis, its impact on a person’s quality or way of life and other existing medical conditions.

It may be necessary to rotate through different treatments at different times, or to combine treatments for faster clearance of psoriasis, particularly in those with more severe or widespread disease.

If your psoriasis is getting you down or interfering with your enjoyment of life, you should tell your general practitioner or dermatologist about your feelings and how your psoriasis is impacting on your everyday activities.

Topical treatments

Several topical therapies are available without prescription. Over the counter products that can help those with psoriasis include: tar and oil baths, medicated shampoos and the regular use of a moisturiser. They may be all that is necessary in those with mild disease.

Cortisone, tar, anthralin (Dithranol) and vitamin D based (calcipotriol) creams and ointments remain the mainstay of treatment for most with psoriasis.

Cortisone (steroid) creams

These are the commonest treatment prescribed for psoriasis and are helpful in reducing inflammation and irritation. The main problems are that the skin can become accustomed to the steroid over a period of time and, with prolonged use of strong cortisone creams, thinning of the skin can occur. The choice of steroid varies depending on the severity of the lesions and their location (e.g. scalp, face or skin folds). You should check with your doctor and pharmacist about how often and for how long the steroid cream prescribed for you can be used on the same area. Also, by attending your doctor’s recommended follow-up appointments, your doctor can assess and tailor your ongoing management plan to minimise risk of both of these problems.

Tar

Tar has been used for over one hundred years and is usually effective in treating psoriasis. Unfortunately, it can be smelly and may stain clothing. Tars are made from the distillation of coal and wood. They can be used as creams and shampoos. Application is usually at night to minimise odour during the day. Tars may also make you more sensitive to the sun.

Calcipotriol

Calcipotriol is a medication related to vitamin D and can be effective in treating psoriasis. It is usually well tolerated. It can cause irritation, particularly when used on sensitive skin areas such as the face or groin. If it is making your psoriasis redder, angrier or more itchy and uncomfortable, you should stop its use and see your doctor. If too much is used (a greater amount than recommended, particularly in children), there is the possibility of increasing the level of calcium in the blood. The calcium level in the blood may be checked periodically if large quantities are required.

Anthralin (Dithranol)

Anthralin is extracted from tree bark. It can be used in a thick ointment that is left on overnight, sometimes under dressings, or more commonly applied at higher concentrations for 10-15 minutes before removal.

Anthralin is usually very effective in treating psoriasis. The main potential problems with anthralin are irritation of the skin, temporary skin discolouration and permanent staining of fabric.

Light treatment (Phototherapy)

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People with psoriasis often take advantage of natural sunlight’s beneficial effects. Sunlight is made up of visible light and a variety of invisible rays. These invisible rays include ultraviolet and infrared or heat rays. The ultraviolet wavelengths of sunlight have been shown to be most effective in improving psoriasis.

Light treatment is effective in most people with psoriasis. Light is mainly used for treating people with widespread psoriasis. There are two main types of ultraviolet (UV) light treatment used in Australia to treat psoriasis: Narrow Band UVB, and PUVA. A measured dose of the appropriate wavelength of light is delivered by a number of specially designed fluorescent tubes that line the walls of a special light cabinet.

Narrowband Phototherapy

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Narrow Band UVB can be likened to tuning a radio to a single band (around 311nm). The wavelength of light determines the quality or effects of different parts of the light spectrum such as warmth, colour and ability to burn the skin. This narrowband incorporates the sun’s most beneficial rays for treating psoriasis and leads to faster and more prolonged benefits compared to broadband phototherapy and natural sunlight. NB-UVB does not contain ultraviolet’s shorter, most sunburning and potentially dangerous wavelengths.

Because it is a powerful and potentially dangerous treatment, ultraviolet light should only be administered by Specialists. Disadvantages include the need for several treatments a week over several weeks.  Treatments with narrowband phototherapy have a proven safety record, providing treatments are kept below 300 illuminations.

Tablets - Oral (Internal) treatments


A number of tablet treatments are available, and these have proven very effective in most people living with psoriasis but, like all medications and therapies, can cause potentially serious side effects. These treatments include methotrexate, acitretin and cyclosporin. Careful choice of therapy and skilled monitoring reduce the potential risks of these therapies, which are generally very effective in controlling even severe cases of psoriasis. Methotrexate and cyclosporine work by largely modulating the immune system. Acitretin is a derivative of vitamin A. Acitretin helps program the skin cells back to normal and also has effects on the immune system.

Injections - New internal treatments

A number of new biological agents have been developed or are under development for treating psoriasis. These interfere with the immune mechanisms that lead to psoriasis, helping to rebalance or normalise the skin immune system. They work by targeting the abnormal immune cells or their chemical products involved in causing psoriasis.

At present, only a limited number of biological agents have been shown to be effective in treating psoriasis. These all need to be given by injection (into a vein or into muscle).

Patients who have psoriasis that responds poorly to treatments such as Narrowband light, creams and tablets can be considered for Psoriasis Biologic injection therapy.

Professor Peter Soyer currently supervises the Biologic clinic.

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People who smoke have a higher risk of developing psoriasis than non-smokers. Giving up smoking after the onset of psoriasis will not, unfortunately, lead to the clearance of psoriasis.

People with psoriasis often take advantage of natural sunlight’s beneficial effects. Light therapy delivered by Narrowband is, however, safer and more effective.

Any cream with moisturising properties can be beneficial in improving psoriasis and this is the probable basis for a number of non-prescription “miracle” treatments.

Diet has not been shown to be an important factor in controlling or treating psoriasis. However, obesity leading to large folds of skin can make psoriasis in these folds difficult to manage. Excessive alcohol consumption may worsen psoriasis.

Wearing light rather than dark coloured clothes can make shed skin flakes less obvious.

Vitamin A and vitamin D are beneficial in psoriasis, but the high doses required to help those with psoriasis are potentially toxic or dangerous. Thus, safer, less toxic vitamin analogues have been developed (calcipotriol & acetretin) which require a prescription from your doctor. Check with your doctor before taking a specific high dose vitamin A or vitamin D supplement.

Psychological distress can have profound effects on the immune system. Such distress is reported as a trigger factor by around two thirds of people with psoriasis, and the most stressed do least well in therapy. A psychologist may be able to teach you better ways of coping with the problem.

In summary


With appropriate treatment, psoriasis can be well controlled for the vast majority of sufferers and a normal lifestyle enjoyed. Unfortunately, not everyone responds to all therapies and, in some people, particularly those with more severe psoriasis, combination therapy may be required.

At this stage it is not possible to cure psoriasis.

Dermatologist are trained medial practitioners who specialise in skin disorders and treatments, including diagnosing and treating all forms of skin psoriasis. Our treatments range from creams, diet, prescribed medication and Narrowband phototherapy.

As Specialist, patients receive a Medicare rebate for their consultation. Many patients also qualify for medication at a rebate/ discounted rate.

Additionally, treatments such as Narrowband phototherapy are Bulk Billed, with no additional cost to the patient.

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Initial consultation: $195

Follow up consultation: $110

Narrowband Phototherapy:  Bulk Billed. No out of pocket expense to patients.

As we are a specialist group of doctors, a referral from your GP is advised for Medicare claims. Call us directly on (07) 3871 3437 to make a booking or enquire about the referral process.

"Narrowband Phototherapy has done wonders for my psoriasis. Only two treatments a week, less than 5 minutes a week and it’s under control. This has helped me decrease my steroid cream application to once a week." Gordon R. St Lucia