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Topical Psoriasis Treatments info.

It is commonly agreed that there is no cure for Psoriasis.  The goal of most treatments is to alleviate symptoms and suffering.

Creams, ointments, gels, and more, by psoriasis.about.com

Most patients with psoriasis covering only a small portion of their bodies can usually get their condition under control with topical Psoriasis treatment -- creams, gels, or other medications applied directly to the skin. There are several different types of topical treatments available.

Corticosteroids

The most common drugs used in a topical preparation are corticosteroids. (These steroids are not to be confused with the type of steroids that make you grow muscles.) The mildest of these, hydrocortisone is available over-the-counter in a 1% strength. Psoriasis, however, is often too stubborn to treat with OTC hydrocortisone alone. Cortisone creams come in many strengths (classes), and higher strengths require a prescription. The stronger the cortisone, the lower the class. Class 1 steroids are exponentially stronger than class 7 steroids.

Strong steroid creams have side effects that are not to be underestimated. They can cause stretch marks to develop in closed areas, such as the armpits and groin, and tend to thin the skin over time. Covering large areas of the body with strong steroids can suppress the body's natural cortisol production, reducing your ability to cope with stresses like infection, injury or surgery. Always ask your doctor exactly where you are and are not supposed to apply any topical Psoriasis Treatment.

Non-Steroids

We can lump anything that's not a steroid into this group.

�                     Immune modulating Psoriasis Treatment drugs, such as Protopic (tacrolimus) and Elidel (pimecrolimus), reduce inflammation without the side effects of steroids.

�                     Vitamin D-derived Dovonex (calcipotriene) is a Psoriasis Treatment that normalizes cell growth.

�                     Tazorac (tazarotene) is a retinoid (vitamin-A like) Psoriasis Treatment drug which normalizes cell growth and maturation.

�                     Anthralin works by slowing down the rapid skin cell growth seen in psoriasis. The side effects of the non-steroid Psoriasis Treatments are typically less worrisome than their steroid cousins, but they are also usually slower acting or less potent. Recently, an ointment combining a steroid with Taclonex (calcipotriene) was introduced in order to get the benefits of both classes of Psoriasis Treatment drugs while minimizing the side effects.

General Recommendations for the Treatment of Psoriasis, by Guideline.gov

Topical Psoriasis treatments are appropriate for patients who are candidates for localized therapy but may not be practical as monotherapy for most patients who are candidates for systemic and/or phototherapy (Pariser et al., 2007), where traditional systemic Psoriasistreatments, including methotrexate, cyclosporine (CyA), narrowband (NB) and broadband ultraviolet light B (UVB), psoralen plus ultraviolet A (PUVA), oral retinoids, and the newer biologic agents are prescribed.

1. UVB is a safe, effective, and cost-effective Psoriasis treatment. NB UVB is more effective than broadband UVB. Up to 20 to 25 NB UVB treatments, given 2 to 3 times a week, are usually required for significant improvement. This Psoriasis Treatment can be offered in the office or at home; home UVB reduces the inconvenience of patients having to travel a long distance for treatment. Other forms of UV exposure, including sun exposure, may offer benefit in select patients.  
2. PUVA Psoriasis treatment therapy is very effective in the majority of patients, with potential for long remissions. However, long-term PUVA Psoriasis treatment in Caucasians is associated with an increased risk of squamous cell carcinoma and possibly malignant melanoma. PUVA induces photoaging and other skin changes including lentigines. Ingestion of psoralen may also produce nausea. Oral psoralen Psoriasis treatment is contraindicated in pregnancy. NB-UVB therapy avoids some of the adverse side effects of PUVA, while being slightly less effective than PUVA.
3. Methotrexate Psoriasis treatment, although effective in the majority of patients, has the potential for hepatotoxicity and is contraindicated in the following clinical scenarios: pregnancy; individuals with renal impairment, hepatitis, or cirrhosis; alcoholics; unreliable patients; and patients with leukemia or thrombocytopenia. In addition, drug interactions are common. Methotrexate Psoriasis treatment is an immunosuppressive agent. In patients treated with methotrexate, drug interactions are common with resultant bone-marrow suppression a concern. Methotrexate Psoriasis treatment may induce pneumonitis. Methotrexate is a teratogen, an abortifacient, and decreases sperm count. Prior guidelines suggest a liver biopsy after 1.5-g cumulative dose (Roenigk et al., 1988).
4. CyA, another immunosuppressive Psoriasis treatment medication, works rapidly and is effective in the majority of patients. However, impaired renal function, hypertension, concerns about lymphoma, and a potential increase in cutaneous malignancies are known adverse effects after long-term treatment with CyA. CyA as a Psoriasis treatment is thus best used interventionally in short-term courses of 3 to 4 months. There are also numerous potential drug interactions with CyA. Guidelines exist for reducing the CyA dose in patients who develop hypertension or elevations in creatinine.
5. Acitretin is an effective systemic agent for a Psoriasis treatment that is not immunosuppressive. Because it is teratogenic and should not be used in women who are pregnant, breast-feeding, or may become pregnant within 3 years of discontinuing acitretin, its use is substantially limited in female patients of childbearing potential. Mucocutaneous side effects are frequent. Dyslipidemia may also ensue and require dose reduction or treatment with lipid-lowering agents. Hepatotoxicity rarely arises during therapy. Acitretin is frequently used in combination therapy with UVB or PUVA.
6. Biologic agents are proteins that can be extracted from animal tissue or produced by recombinant deoxyribonucleic acid (DNA) technology and possess pharmacologic activity. Five biologic agents are currently Food and Drug Administration (FDA) approved for psoriasis treatment.
    

Biologic agents work by blocking the activation of a type of white blood cell called a T cell, thus weakening the immune system.  A weakened immune system can mean less Psoriasis, but can leave the body susceptible to infections.  

According to Psoriasis.org,

Common side effects for biologics include Respiratory infections, Flu-like symptoms, and Injection site reactions.  These side effects are generally mild and in most cases do not cause individuals to stop taking the medication.

Rare side effects for biologics include Serious nervous system disorders, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes have; Blood disorders; Certain types of cancer.  

Eczema, Other Skin Conditions