Management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures

Patient Guideline Summary

Publication Date: July 1, 2020

Objective

Objective

This patient summary means to discuss key recommendations from the American Academy of Dermatology (AAD) for the management and treatment of psoriasis with topical therapy and alternative medicine modalities. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • Psoriasis is an immune-related skin disease associated with a type of arthritis.
  • There is no known cause of psoriasis.
  • Symptoms include a variety of disfiguring skin rashes that itch, burn, bleed and pit fingernails and toenails.
  • This patient summary focuses on topical and alternative medicine treatments.

Diagnosis

Diagnosis

  • There are many different appearances of psoriasis with names like vulgaris, plaque, guttate, erythrodermic, pustular, palmoplantar, inverse, and nail.

Treatment

Treatment

  • There is a dizzying variety of available therapies that can be used alone or in combination, leading to a near infinite treatment arsenal.
    • Topical agents:
      • 47 topical steroids in 5 strength classes
      • 2 calcineurin inhibitors
      • 4 vitamin D analogues
      • Tazarotene
      • Anthralin (dithranol)
      • Salicylic acid
      • Coal tar/liquor carbonis detergens (LCD)
      • Moisturizers: creams, ointments, lotions, gels, emollients, etc.
    • Ultraviolet A and B light (UVA & UVB)
    • Oral medications
      • methotrexate
      • cyclosporine
      • acitretin (vitamin A derivative)
    • Injectable targeted agent
      • Adalimumab
    • Alternative medicine
      • Chinese medicine, Aloe vera, St John’s wort, fish oil, vitamin D, turmeric (curcumin), zinc, hypnosis, gluten-free diet, meditation, and stress reduction
Note: each treatment has its benefits and its risks. Your doctor will discuss each recommended treatment so that together you can plan the regimen that suits you best.

Abbreviations

  • AAD: American Academy Of Dermatology
  • LCD: Liquor Carbonis Detergens
  • UVA: Ultraviolet A Light
  • UVB: Ultraviolet B Light

Source Citation

Elmets CA, Korman NJ, Prater EF, Wong EB, Rupani RN, Kivelevitch D, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Siegel M, Stoff B, Strober B, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol. 2021 Feb;84(2):432-470. doi: 10.1016/j.jaad.2020.07.087. Epub 2020 Jul 30. PMID: 32738429.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.