Psoriasis cannot be eliminated. It is a chronic medical condition, just like high blood pressure, diabetes, and high cholesterol. As a dermatologist, the focus I have is more on management and control of a chronic medical condition.
Psoriasis is an inflammatory skin condition that affects 3-5% of all people. It causes red, itching plaques with scales that most commonly occur on the elbows, knees, and scalp but can occur anywhere on the body. The spectrum of psoriasis severity varies from very, very mild with one or two small rough patches where patients don't even know they have psoriasis to severe red, scaling plaques that cover almost an entire body.
The one important thing to note about psoriasis is that approximately 33% of all psoriasis patients will develop an associated psoriatic arthritis. Because this tends to be both progressive and degenerative, it is important to intervene early with appropriate medications to spare joints.
When I look at managing psoriasis, there are different levels of treatment based on the patient's severity.
Initially, you can use gentle topical moisturizers and topical antiinflammatory agents such as nonsteroidal antiinflammatory creams and ointments and topical steroid creams and ointments. In fact, we have patented a brand new spray called CutiCort spray that is the most effective topical treatment for psoriasis known today.
Additionally, creams containing vitamin D have been effective and, to a lesser extent, creams containing vitamin A.
Another modality to treatment, is phototherapy. In our clinic, we have successfully used narrow-band ultraviolet B light treatments with tremendous success in treating psoriasis.
Another line of treatments would be systemic medications. These include medicines such has methotrexate, cyclosporine, and oral retinoids. These medicines work very well, but they have a higher side-effect profile and risks and benefits must be weighed carefully by a skilled dermatologist when administering them. When used properly, the results can be exceptional.
Last but not least, there is a new class of medications called biologic agents. These medications are derived from antibodies, which are proteins that can actually bind to other proteins that drive the psoriasis process. By essentially acting like little sponges or mops, they soak up the proteins that normally land on skin cells and cause them to grow very fast (this is the problem with psoriasis--skin grows way too fast and piles up upon itself), and as a result, the psoriasis state is controlled. Some can also help with inflammation, which will also treat psoriatic arthritis in the joints.
In my clinic, I tend to use a combination of all modalities. I rarely use monotherapy because I think when you combine proven methods to treat psoriasis, you get much better control, and they tend to work synergistically, so I often will use a combination of topical agents, systemic agents, phototherapeutic agents, and some of the new biologic agents, with great success. In my opinion, psoriasis can be managed very, very well with what is available today in medicine.