Although there is no cure for
psoriasis, a variety of treatments are available to reduce the severity of symptoms and lessen their impact on the patient's quality of life. For patients with less than 20% body surface involvement, topical
therapy is the most appropriate choice for initial treatment. Commonly used topical
therapies include
corticosteroids;
calcipotriene, a
vitamin D analogue;
tazarotene, the first
retinoid to be approved for the treatment of
psoriasis; and
anthralin. Each of these treatments is effective in mild to moderate
psoriasis, but each is also associated with varying degrees of safety and tolerability concerns. For patients with more severe, recalcitrant, or extensive
psoriasis,
phototherapy and systemic
therapies are available. These
therapies are more effective than topical
therapy, but are also associated with significant cutaneous and systemic adverse effects.
Phototherapy, alone or in combination with
coal tar or
psoralen, is very effective in the treatment of moderate to severe
psoriasis, but can lead to
erythema and
pruritus acutely, and long-term problems such as wrinkling, solar elastosis, and an increased risk of
skin cancer. Systemic
therapies such as
acitretin,
methotrexate,
cyclosporine,
hydroxyurea, and
thioguanine are also very effective in the treatment of moderate to severe
psoriasis, but are all associated with significant systemic toxicity, which requires that patients be monitored carefully. Ultimately, treatment selection for each patient must take into account both the patient's disease severity and expectations for improvement, as well as the risk-benefit ratio associated with each potential
therapy.