Walgreens Specialty Pharmacy > Conditions and therapies > Psoriasis
Psoriasis
PrintPsoriasis is a chronic, or long-term skin disease that causes skin irritation and skin outbreaks that may sometimes look like a rash. The outbreaks can appear anywhere on the body, but most often appear on the elbows, knees, legs, scalp, lower back, face, palms, and soles of the feet.
The disease also can affect the fingernails, toenails, and the soft tissues of the genitals and inside the mouth. Although there is no cure for the condition, it can be managed through a combination of treatments.
Who develops psoriasis?
What causes psoriasis?
What are the symptoms of psoriasis?
How is psoriasis diagnosed?
How is psoriasis treated?
What are topical treatments for psoriasis?
How is psoriasis treated with light?
What is systemic treatment for psoriasis?
What is combination therapy for psoriasis?
How does psychological support help people with psoriasis?
How can Walgreens Specialty Pharmacy help?
Where can I find more information about psoriasis?
Who develops psoriasis?
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, psoriasis affects between 5.8 and 7.5 million people in the United States. Although it occurs in all age groups, it primarily affects adults, appearing about equally in men and women. Research suggests that genes are a factor. About one-third of people with psoriasis have a family history of the condition.
What causes psoriasis?
Psoriasis occurs when skin cells rise from below the surface of the skin and accumulate on the surface before they have a chance to mature. The movement of skin cells, called turnover, usually takes about one month. In psoriasis, however, turnover may occur in only a few days.
Psoriasis is caused by a problem in the immune system that involves a type of white blood cell called a T-cell. Normally, T-cells help protect the body against infection and disease. In psoriasis, T-cells are mistakenly put into action and become so active that they trigger inflammation, or swelling, and rapid turnover of skin cells.
What are the symptoms of psoriasis?
One type of psoriasis, called plaque psoriasis, causes painful and itchy patches of thick, red skin covered with silvery scales. Other types of psoriasis can also produce other types of skin outbreaks that may look like a rash. Sometimes the affected skin around joints can crack. Approximately 1 million people with psoriasis also experience joint inflammation, a condition called psoriatic arthritis.
People with psoriasis may notice that there are times when their skin symptoms get worse, sometimes referred to as "flare-ups." These times are usually followed by periods when skin symptoms improve. Conditions that may cause flare-ups include infections, stress, and changes in climate that dry the skin. Certain medications may also trigger an outbreak or make symptoms worse. It’s important to ask a doctor or pharmacist about medications that may make psoriasis symptoms worse.
People with psoriasis may experience significant physical discomfort and some disability. Itching and pain can make it difficult to handle everyday tasks including self-care, walking, and sleeping. Plaques on hands and feet might prevent people with psoriasis from working particular jobs, participating in certain sports, and caring for family members or a household. Frequent medical care can become costly and can interfere with a person’s daily schedule. People with moderate to severe psoriasis may also feel self-conscious about their appearance. Some people with psoriasis might find themselves avoiding social situations, which could lead to feelings of isolation or depression.
How is psoriasis diagnosed?
Occasionally, doctors may find it difficult to diagnose psoriasis because it often looks like other skin diseases. It may be necessary to confirm a diagnosis by examining a small skin sample under a microscope. There are several forms of psoriasis:
- Plaque psoriasis: Affected areas are red at the base and covered by silvery scales.
- Guttate psoriasis: Small, drop-shaped spots appear on the trunk, limbs, and scalp. Guttate psoriasis is most often triggered by upper respiratory infections, such as a sore throat caused by streptococcal bacteria.
- Pustular psoriasis: Blisters of noninfectious pus appear on the skin. Attacks of pustular psoriasis may be triggered by some medications, infections, stress, or exposure to certain chemicals.
- Inverse psoriasis: Smooth, red patches occur in the folds of the skin near the genitals, under the breasts, or in the armpits. The symptoms may be worsened by friction and sweating.
- Erythrodermic psoriasis: Widespread reddening and scaling of the skin is often accompanied by intense itching and sometimes pain. This condition can result from poorly controlled psoriasis.
How is psoriasis treated?
Doctors generally treat psoriasis based on the severity of the disease, locations affected, size of the areas involved, type of psoriasis, and the person’s response to treatments. Psoriasis therapy follows what is sometimes called the "1-2-3" approach.
In step 1, medication is applied to the skin as topical treatment. Step 2 includes treating the skin with ultraviolet light, a process called phototherapy. Step 3 is systemic therapy, which involves oral or injectable medications that treat the whole immune system.
Over time, affected skin can become resistant to treatment, especially when topical corticosteroids are used. Because a treatment that works for one person may have little benefit for another, doctors often need to try several types of treatment before finding one that works. It may also be necessary to try a different treatment if one does not work or if bothersome side effects occur.
What are topical treatments for psoriasis?
When applied directly to the skin, certain medications may improve psoriasis. Some people respond well to ointment or cream forms of corticosteroids, vitamin D3, retinoids, coal tar, or anthralin. Bath solutions and moisturizers may soothe the skin, but they often must be combined with stronger remedies and are usually not strong enough to improve the condition of the skin.
- Corticosteroids: These medications reduce inflammation and slow the turnover of skin cells. They also suppress the chemicals in the immune system responsible for triggering psoriasis. Short-term treatment can improve, but not eliminate, psoriasis. Long-term use or overuse of corticosteroids can cause thinning of the skin, other side effects, and resistance to the medication.
- Calcipotriene: This drug is a synthetic (man-made) form of vitamin D3 that can be applied to the skin. Applying calcipotriene (for example, Dovonex®) as directed controls the speed of skin cell turnover. Because calcipotriene can irritate the skin, however, it is not recommended for use on the face or genitals.
- Retinoids: Topical retinoids are synthetic forms of vitamin A. The retinoid tazarotene (Tazorac®) is available as a gel or cream that is applied to the skin. If used alone, tazarotene does not act as quickly as topical corticosteroids. It also does not cause thinning of the skin or other side effects associated with corticosteroids. However, it can irritate the skin, particularly in skin folds and the normal skin surrounding a patch of psoriasis. Because of the risk of birth defects, women of childbearing age must protect against pregnancy while using tazarotene.
- Coal tar: Gels and ointments containing coal tar may be applied directly to the skin, added to the bath as a liquid, or used on the scalp as a shampoo. Coal tar products are available in different strengths, and many are available over the counter. Coal tar is less effective than other treatments and, therefore, sometimes is combined with ultraviolet B (UVB) phototherapy, a type of light therapy, for a better result. Coal tar can irritate the skin. It also has a strong odor, can be messy, and may stain the skin or clothing.
- Anthralin: This medication slows the production of new skin cells and reduces inflammation. This treatment often fails to adequately improve the skin, and it stains skin, bathtubs, sinks, and clothing brown or purple. In addition, the risk of skin irritation makes anthralin unsuitable for acute or actively inflamed psoriasis eruptions.
- Salicylic acid: This peeling agent is available in many forms, including ointments, creams, gels, and shampoos. It can be applied to reduce scaling of the skin or scalp. Often, it is more effective when combined with topical corticosteroids, anthralin, or coal tar.
- Bath solutions: Adding oil to a bath, then applying a moisturizer, can help soothe skin. It can also be easier to remove scales and reduce itching by soaking for 15 minutes in water containing a coal tar solution, oiled oatmeal, Epsom salts, or Dead Sea salts.
- Moisturizers: When applied regularly over a long period, moisturizers have a soothing effect. Preparations that are thick and greasy usually work best because they seal water into the skin, reducing scaling and itching. But moisturizers only relieve some of the skin irritation associated with psoriasis—they do not treat psoriasis.
How is psoriasis treated with light?
Natural ultraviolet light from the sun and controlled delivery of artificial ultraviolet light are used in treating psoriasis. This treatment is called phototherapy.
- Sunlight: Much of sunlight is composed of bands of different wavelengths of ultraviolet (UV) light. When absorbed into the skin, UV light suppresses the process that leads to psoriasis. This process reduces inflammation and slows the turnover of skin cells that cause scaling. Brief, nonburning daily exposure to sunlight clears or improves psoriasis in many people and is an initial treatment for the condition. It is important to avoid sunburns. Talk to your doctor before exposing affected skin to direct sunlight.
- Psoralen and ultraviolet A phototherapy (PUVA): This treatment combines oral or topical administration of a medication called psoralen with exposure to ultraviolet A (UVA) light. Psoralen makes the skin more sensitive to UVA. The treatment may be used when more than 10 percent of the skin is affected or when psoriasis interferes with a person’s lifestyle. Compared with broadband UVB treatment, PUVA treatment taken two to three times a week clears psoriasis more consistently and in fewer treatments. However, it is associated with more short-term side effects, including nausea, headache, fatigue, burning, and itching. It is important to avoid exposing the skin to sunlight after taking psoralen to avoid severe sunburns. The eyes must also be protected with UVA-absorbing glasses for one to two days after treatment. Long-term treatment is associated with an increased risk of some skin cancers.
- Ultraviolet B (UVB) phototherapy: Ultraviolet B (UVB) light has a short wavelength that is absorbed into the outermost layer of skin. An artificial source can be used to treat mild and moderate psoriasis. UVB phototherapy, called broadband UVB, can be used for a few small lesions, to treat widespread psoriasis, or for lesions that do not respond to topical treatment. This type of phototherapy usually is given in a doctor’s office using a light panel or light box. Some patients use UVB light boxes at home under a doctor’s guidance.
A newer type of UVB, called narrowband UVB, emits the part of the ultraviolet light spectrum band that is most helpful for psoriasis. Narrowband UVB therapy is gaining in popularity because it does help and is more convenient than PUVA. Several treatments may be required before benefit begins. Once the skin has shown improvement, a once-weekly maintenance treatment may be all that is necessary. However, narrowband UVB treatment can cause more severe and longer-lasting burns than UVB broadband treatment. Narrowband UVB treatment is more effective than broadband UVB, but less effective than PUVA.
- Light therapy combined with other therapies: Studies have shown that combining ultraviolet light treatment and a retinoid such as acitretin adds to the effectiveness of UV light therapy. If a person does not respond to light therapy, retinoids may be added. UVB phototherapy, for example, may be combined with retinoids and other treatments. One type of combined therapy, referred to as the Ingram regime, involves a coal tar bath, UVB phototherapy, and application of an anthralin-salicylic acid paste that is left on the skin for six to 24 hours. A similar regime, the Goeckerman treatment, combines coal tar ointment with UVB phototherapy. Also, PUVA can be combined with some oral medications (such as retinoids) to increase its effectiveness.
What is systemic treatment for psoriasis?
For more severe forms of psoriasis, doctors sometimes prescribe systemic treatment, or medications that are taken as pills or injections. Newer medications, called biologic response modifiers, can suppress immune system processes that are linked to psoriasis.
- Methotrexate: This is a disease-modifying antirheumatic drug (DMARD) that slows cell turnover by suppressing the immune system. People taking methotrexate must be closely monitored because it can cause liver damage and other serious side effects. It sometimes is combined with PUVA or UVB treatments. Methotrexate may cause birth defects and should not be used by pregnant women or by women who are planning to become pregnant.
- Retinoids: Oral retinoids, such as acitretin, have vitamin A-like properties and may be prescribed for severe cases of psoriasis that do not respond to other therapies. Because this treatment also may cause birth defects, women must protect themselves from pregnancy beginning one month before acitretin treatment until three years after treatment ends. Psoriasis often returns after treatment with retinoids stops.
- Cyclosporine: Cyclosporine acts by suppressing the immune system to slow the rapid turnover of skin cells. It may provide quick relief of symptoms, but the improvement stops when treatment is stopped. Cyclosporine treatment is best for those with severe psoriasis who have not responded to, or cannot tolerate, other systemic therapies. Cyclosporine acts quickly, and can help people avoid hospitalization when their psoriasis is rapidly progressing. People using cyclosporine must be monitored by a doctor, as the medication may affect kidney function or cause high blood pressure. Cyclosporine is not recommended for people who have a weak immune system or those who have had skin cancers as a result of previous PUVA treatments. Cyclosporine should not be given with phototherapy.
- Alefacept: This is the first biologic response modifier approved specifically to treat moderate to severe plaque psoriasis. Alefacept is given by injection in the doctor’s office, usually once a week for 12 weeks. The treatment is then stopped for a period of time so a doctor can observe changes in the skin and determine the need for further treatment. Because alefacept suppresses the immune system, the skin often improves, but there also is an increased risk of infection or other problems, including an increased risk of cancer. People taking alefacept should be monitored by a doctor and have a blood test every two weeks around the time of each injection to make sure the immune system is not overly suppressed.
- Etanercept, infliximab, and adalimumab: These biologic response modifiers are approved for the treatment of moderate to severe plaque psoriasis. These medications block interactions between certain cells in the immune system and limit the action of a specific protein that causes the scaling and inflammation in psoriasis. Individuals should not receive etanercept, infliximab, or adalimumab treatment if they have an active infection, a history of recurring infections, or an underlying condition, such as diabetes, that increases their risk of infection. Added caution is needed for people who have rheumatoid arthritis, who should follow the advice of a rheumatologist regarding this treatment.
What is combination therapy for psoriasis?
There are many approaches for treating psoriasis. Combining various topical, light, and systemic treatments often permits lower doses of each medication and can result in increased effectiveness. Therefore, doctors may suggest combination therapy at any time during treatment.
How does psychological support help people with psoriasis?
Some individuals with moderate to severe psoriasis may benefit from counseling or participation in a support group to reduce self-consciousness about their appearance or to relieve worry or anxiety about their condition. A number of organizations host support groups, including The National Psoriasis Foundation.
How can Walgreens Specialty Pharmacy help?
It is important to find a pharmacy that understands the medications and treatments for psoriasis. Our specially trained pharmacists join your treatment team, working together with your doctor and other healthcare providers, to support their services and help you get the most from your therapy.
To take advantage of Walgreens Specialty Pharmacy’s patient support services, call us toll free at 888-782-8443, or complete our online form.
Where can I find more information about psoriasis?
The more informed you are, the better you can manage your health. The sites listed below are considered highly reliable.
National Institute of Arthritis and Musculoskeletal and Skin Diseases
www.niams.nih.gov
American Academy of Dermatology
www.aad.org
National Psoriasis Foundation
www.psoriasis.org
Inclusion of resources on this list does not imply endorsement by Walgreen Co. or any of its subsidiaries or affiliates. These resources should be used for general information and educational purposes only. Information provided by these resources should not replace necessary medical consultations with a qualified health or medical professional.
Information provided here does not constitute professional medical advice. Although it is intended to be accurate, neither Walgreen Co., its subsidiaries or affiliates, nor any other party assumes liability for loss or damage due to reliance on this material. If you have a medical question, consult your medical professional.