Treatments for psoriasis

Treatments for psoriasis can be divided into topical and systemic. Topical products are generally used to manage mild to moderate psoriasis and systemic therapies the more severe end of the disease spectrum. Topical therapies may be used to treat more severe disease in combination with systemic regimes especially where in-patient or day-care treatment is available, for example coal tar or short-contact dithranol in combination with UV light therapy. There have been relatively few recent breakthroughs for psoriasis therapy, particularly for the treatment of mild to moderate disease. The 21st century has, however, seen major developments in the field of immunologic treatments for severe disease. Camisa (2004a) details a timeline of breakthroughs in psoriasis therapy (p. 3).

Patients seem to have variable results with topical treatments in particular. It does seem to be the case that what will work for one person does not work for another, even though their disease severity and motivation seem to be equivalent. It is true, however, that some people do not have good results from topical therapies because they do not concord. It is vital, therefore, that patients with psoriasis receive support and encouragement when using topical therapies and that their expectations of level of clearance and timescales are realistic. Further information on helping patients to concord with treatment can be found in Helping patients make the most of their treatment. There is also a subset of people that, despite their best efforts with a topical product, do not see any positive result. This group should be referred to a Dermatology Department. Further information about referral guidelines is given at the end of this section.