Trial and error

The options for treatment are complex and varied. It is a grab bag of choices, each of­fering their own pros and cons with varying degrees of success based on each individual’s experience. And new drugs are being researched and added to the list of options all the time. For example, three new drugs were approved by the FDA in 2008 (Taclonex Scalp, the Xtrac Velocity light-emitting device, and an oral medication called Humira with the active ingredient being adalimumab).

Of the various therapies available to treat psoriasis, it is generally best to start with those that have the least-serious side effects, such as topical steroids (cortisone creams), coal-tar creams or shampoos, or sulfur-based creams and shampoos, along with careful exposure to sunshine. If those methods are not successful, you can proceed to the more serious treat­ments involving oral medications. More often than not, successful treatment requires a combination of methods.

All of the treatments, both topical and oral, are often used in varying combinations for the best results. Frequently, several combination treatments are used in rotation to reduce the potentially harmful side effects of each one or the decrease in or lack of effectiveness.

Discovering whether any of these will work for you, alone or in combination, takes patience and a systematic, ongoing review and evaluation of how your skin and health are doing. Successful treatment, as is true with all chronic skin disorders, requires diligent adherence to the regimen and a realistic understanding of what you can and can’t expect.

It is also important to be aware of the consequences of the varying treatment levels. For example, continued long-term use of topical cortisone creams can cause skin thinning, stretch marks, and built-up resistance to the cortisone medication itself, so that it actu­ally becomes an ineffective treatment. Exposure to sunlight without adequate protection (particularly from UVA radiation) can cause skin cancer. Oral steroids can have serious withdrawal effects, including increased bouts of psoriasis. Accutane causes birth defects if a woman becomes pregnant while taking it. Several systemic psoriatic treatments can cause liver problems, nausea, and severe irritation. Each option has its own set of pros and cons that need to be researched and discussed at length with your physician.

For more information on the current status of available treatment, visit the Web site for the National Psoriasis Foundation (NPF) at www. psoriasis. org/.

Updated: September 23, 2015 — 8:50 pm