After a psoriasis diagnosis, you probably have many questions. These answers will help you understand what to expect and how to better manage your condition.
Q. What are topical medications?
A. Topical medications are products you apply directly to your skin to improve its condition. They come in ointment, cream, and lotion formulas and can be in prescription or over-the-counter (OTC) strengths.
Q. What are the main types of topical medications?
A. There are many types of topical medications. The most common ones are corticosteroid drugs, synthetic types of vitamin A and vitamin D3, anthralin, salicylic acid, and coal tar.
Q. How do topical medications work?
A. Creams and ointments containing corticosteroids reduce inflammation. Medications containing synthetic vitamin A or D3 slow skin cell turnover. Coal tar and anthralin slow the increase in skin cells and inflammation. Products with salicylic acid reduce scaling.
Q. What type of psoriasis are topical medications used for?
A. If you have mild psoriasis, your doctor will probably prescribe topical medications. If you have moderate or severe psoriasis, your doctor may prescribe topical medications in combination with other forms of therapy.
Q. What are systemic medications?
A. Systemic medications are prescription drugs that work throughout the entire body. You take them internally, in pill or liquid form, or by injection. Systemic medications include acitretin (Soriatane), cyclosporine (Gengraf, Neoral, Sandimmune, SangCya), methotrexate (Rheumatrex, Trexall), 6-thioguanine, and hydroxyurea (Droxia).
Q. What types of psoriasis are systemic medications used for?
A. Your doctor may prescribe systemic medications if you have moderate to severe psoriasis or if for some reason you are unable to use topical medications.
Q. What is an “off-label” systemic medication?
A. When a medication that has been approved by the U.S. Food and Drug Administration to treat one illness is used for another condition without separate approval, that usage is called off-label. A number of systemic medications not specifically approved for the treatment of psoriasis may be beneficial for psoriasis patients. Prescribing medications off-label is a common medical practice.
Q. What are biologic response modifiers?
A. Biologic drugs are a relatively new treatment for moderate to severe psoriasis. Your doctor may prescribe biologics if your psoriasis has not responded to the more conventional systemic treatments, or if you had a bad reaction to them.
Q. How do biologics work?
A. Unlike systemic medications that target the whole body, biologics target specific parts of the immune system. They work by blocking certain cells and proteins that directly contribute to the development of psoriasis.
Q. How are biologics given?
A. Biologics are given by injection or through an IV.
Q. Who should not use biologics?
A. Because biologics dampen the immune system, they are not for everyone. If you have a significantly compromised immune system or an active infection, you should not take biologics. They are also usually not prescribed for pregnant women, women who may become pregnant, or women who are nursing. If you are prescribed biologics, your doctor will monitor you carefully.
Q. Are antibiotics ever used to treat psoriasis?
A. Not unless a psoriasis flare-up is caused by bacteria.
Q. Is more than one treatment ever prescribed for psoriasis?
A. Absolutely. Medications are often used in combination. What might work for you won’t necessarily work for someone else with psoriasis; so doctors often use a trial-and-error approach, trying different combinations of drugs to give you the best results.
1. Questions and Answers About Psoriasis, NationalInstitute of Arthritis and Musculoskeletal and Skin Diseases, NIH.
2. Topical Treatments, National Psoriasis Foundation.