Dr. Lebwohl, could you describe the topical treatments for psoriasis?
MARK LEBWOHL, MD: There are dozens, if not hundreds of topical medications, but they fall into a small number of categories. Until recently, the most commonly prescribed treatment for psoriasis was topical corticosteroids, and there are at least 100 of these available worldwide. They range in strength from very weak to very strong. They come in lotions, solutions, creams, emollient creams, and ointments. As a rough rule, the messier they are, the more effective they are, so that ointments are more effective than creams.
There are a number of other agents that were more recently developed - such as vitamin D analogs, like calcipotriene, and retinoids, such as tazarotene. There are some old-fashioned treatments as well, which are derived from tar. Tars themselves that are used are anthralin, which is a rather messy treatment that is available for psoriasis.
Do you need a prescription for these topical treatments?
KENNETH GORDON, MD: You are required to have prescriptions for all the topical medication except the weakest topical corticosteroid - which is the hydrocortisone you're able to get over the counter.
But as a patient's psoriasis gets more severe, having to apply these creams day in and day out becomes a little bit overwhelming. They're not able to use them consistently, and patients can't comply with the medications. So the use of topical therapy for psoriasis, though effective in many cases, is limited a little bit in patients who have severe cases.
What is phototherapy?
MARK LEBWOHL, MD: There are three forms of phototherapy -- and actually, if you count lasers, now a fourth form. Old-fashioned ultraviolet B has been around for more than 80 years, and is quite effective in a number of psoriasis patients. Usually patients who respond to sunlight will get better with old-fashioned UVB.
