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How Your Psoriasis Treatment Plan Is Personalized for You
- By Jennifer Acosta Scott
- Reviewed by Niya Jones, MD, MPH
Psoriasis treatment varies by the severity of your condition, your preferences, and other health issues. Find out how your doctor can design a regimen just for you.
Medical treatments for just about every health condition have improved over the past few decades, and that’s especially true when it comes to psoriasis. Today, doctors have much more information about the processes that happen in the body to cause psoriasis. As a result, better treatments have been developed, says David Pariser, MD, a dermatologist in Norfolk, Va., and past president of the American Academy of Dermatology.
“In the past, psoriasis was considered as just a disorder involving an overgrowth of skin cells,” Dr. Pariser says. “Now we know it’s a systemic, immunological disease — an abnormal immune response to the skin itself.”
The History of Psoriasis Treatment
In years past, most people with psoriasis were treated with the Goeckerman regimen, a one-size-fits-all combination therapy that involved exposure to ultraviolet (UV) light and daily application of coal tar, according to the American Academy of Dermatology. The routine was thought to slow down the excessive cell growth that caused the thick, inflamed, scaly skin that’s typical of psoriasis. The treatment was messy and smelly, and it didn’t always work, Pariser says.
As doctors began to realize that psoriasis was caused by an immune system reaction, they started to use immune-suppressing medications, like cyclosporine and methotrexate, with better results. Most recently, the list of effective drugs for psoriasis has grown to include biologics — drugs that target specific parts of the immune system. With all of the psoriasis treatment options now available, doctors have more flexibility to create a plan that’s specific to each person’s needs.
In addition to using more effective medications, doctors have also changed psoriasis treatment from a one-size-fits-all approach to a plan that takes individual needs into account. “I don’t think there are any two people with psoriasis that are treated exactly the same,” Pariser says. “We try to use a combination of therapies that are effective, while minimizing side effects.”
Personalizing Psoriasis Treatment
An individualized psoriasis treatment plan should depend on many factors, including:
Severity and location. People with only small patches of psoriasis may be prescribed less-aggressive treatments than those who have a large amount of skin involved. Mild cases may only need a corticosteroid cream or another topical ointment , while more extensive psoriasis might call for treatment with a body-wide (systemic) medication. The location of the affected skin can also be an important factor.
“A person who has a very small amount of psoriasis, but on a sensitive spot like the hands, might need an oral medication earlier than someone with it on their thigh, for example,” says Abby Van Voorhees, MD, associate professor of dermatology and director of the Psoriasis and Phototherapy Treatment Center at the Hospital of the University of Pennsylvania in Philadelphia.
Other medical conditions. Any other illnesses you have may play a role in determining your psoriasis treatment. For example, if you also have psoriatic arthritis, you’ll likely be treated with oral medications from the start. On the other hand, if your immune system is weak from another condition like cancer, immune-suppressing medications could be too risky, Pariser says.
Your preferences and finances. Most doctors will take your psoriasis symptoms as well as your personal concerns into account when developing a psoriasis treatment plan. Concerned about the risks of an oral medication? Your doctor may try a topical ointment first. In addition, if your finances or your insurance coverage are limited, your doctor may avoid prescribing more expensive drugs.
The type of psoriasis you have. Certain forms of psoriasis must be treated much more aggressively than others. For example, erythrodermic psoriasis, a severe form that causes the skin to fall off in sheets, can cause heart failure and even death if not treated promptly. “In this case, a medication that works very quickly must be used,” Dr. Van Voorhees says.
The Future of Psoriasis Treatment
Doctors currently use a trial-and-error approach when treating psoriasis , Van Voorhees says. If one medication doesn’t work, another will be tried to see if it produces better results. In the future, doctors may be able to use specialized tests to determine each person’s disease pathway to choose the best psoriasis treatment.
“Hopefully, when we understand more about the genetics of psoriasis, “we’ll be able to prescreen people and know how they might best be treated,” Van Voorhees says.
Last Updated: 10/27/2014
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