Psoriasis Care - Steroid Treatments

Psoriasis typically appears as well defined, raised, red, scaly plaques or areas of abnormal skin. It can range from a single plaque no bigger than the size of a small coin to almost total body involvement. More information about the different types of Psoriasis can be found our Information section.

Unfortunately there is no cure for psoriasis but there is every reason for optimism. There are many treatments which are effective in controlling the disease and although these require daily effort the benefits usually far outweigh the disadvantages. The treatments can be divided into topical (ie creams, ointments that can be applied to the skin) and systemic (ie medicines taken into the system by mouth or injection). Manufacturers are continually updating formulations of products to improve their acceptability.

i) Topical Treatments are most suitable for mild to moderate disease. Because they are rubbed into the skin very little of the active drug is absorbed into the circulation.

Topical treatments include moisturisers, coal tar, dithranol, corticosteroids, and vitamin D analogues. These are usually formulated as creams or ointments to be rubbed into affected areas every day.

Moisturisers help to relieve the dryness of psoriatic skin. Coal tar and dithranol are effective but tend to be smelly and can stain the skin which understandably makes them unpopular. Steroids and Vitamin D analogues are the two most effective topical treatments. Both are well tolerated if used correctly.

A novel form of steroid treatment called Betesil is an adhesive plaster which contains a potent steroid. Recent studies show this is particularly suitable for individual stubborn or difficult to treat plaques of psoriasis such as those which can occur on the knees, shins and elbows. The medicated plaster is placed over the plaque, left for 24 hours and then renewed. The occlusive effect of the plaster improves moisturisation and assists the effect of the steroid giving localised improved benefit.  A second, less potent version with a less potent steroid is Haelan.

ii) Systemic Treatments are reserved for more severe and extensive disease. They include, methotrexate, retinoids, cyclosporin and hydroxyurea. UV light may be given alone (UVB) or in combination with a photoactive compound known as a psoralen (PUVA). Methotrexate, cyclosporin and hydroxyurea are effective and powerful drugs that affect the immune system and need careful monitoring because they can be associated with serious side effects.

Recently a new class of drugs which affect the immune system has been developed for use in psoriasis. These are usually given by injection and are reserved for more severe forms of the disease that have not responded to other first-line treatments.

Psoriasis is a complex disease and there are many treatment options. No single treatment is best for everyone. The correct treatment for each individual has to be chosen to fit that person’s unique circumstances and the process of choosing requires knowledge, experience and a degree of trial and error. With perseverance by patient and doctor it should be possible to keep psoriasis under control in the large majority of cases.

Information provided as part of a project partly sponsored by Genus Pharmaceuticals