Toronto Psoriasis Centre
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Types of Treatment


Steroids (Cortisone)

– Cortisone (steroid) is a medication that reduces inflammation and has been around for more than 60 years. Cortisone creams, ointments, lotions, sprays, foams, gels and shampoos help clear the skin temporarily and control the condition in many patients. Combination products such as Dovobet® gel or ointment or Enstilar® foam are particularly effective and commonly used.

Weaker preparations should be used on more sensitive areas of the body such as the genitals and face. Stronger preparations will usually be needed to control lesions on the scalp, elbows, knees, palms, soles, and parts of the torso. Side effects of the stronger cortisone preparations (if misused) include thinning of the skin, dilated blood vessels, bruising, and skin color changes.

Stopping these medications suddenly may result in a flare-up of the disease. Occasionally, the psoriasis may become resistant to the steroid preparations. Your dermatologist may inject cortisone in difficult-to-treat spots (a treatment called “intralesional kenalog”).

Non-steroid anti-inflammatory creams such as Protopic® (tacrolimus) and Elidel® (pimecrolimus), as well as the synthetic vitamin-D analogues Silkis® and Dovonex® can be quite helpful in sensitive/thin-skinned areas such as the groin, armpits, and face.

Light Therapy

- Sunlight and ultraviolet light slow the rapid growth of skin cells in psoriasis. Toronto Dermatology Centre offers full-body narrow-band phototherapy and hand & foot phototherapy units for its patients. Although ultraviolet light or sunlight can cause skin wrinkling, eye damage, and skin cancer, light treatment ("phototherapy") using narrow-band UVB is safe and effective under a dermatologist's care.

Methotrexate

- This is an oral anti-cancer drug that can produce dramatic clearing of psoriasis when other treatments have failed; it is also useful in psoriatic arthritis. Because it can cause side effects, particularly liver disease, regular blood tests are performed and periodic visits to your dermatologist are required.

Other side effects include upset stomach, nausea, fatigue and dizziness. Methotrexate should not be used by pregnant women, or by men and women who are trying to conceive a child. Alcohol should not be consumed if using methotrexate.

Retinoids

- Prescription oral vitamin A-related drugs (e.g. Soriatane®) may be prescribed alone or in combination with ultraviolet light for severe cases of psoriasis. Side effects include dryness of the skin, lips, and eyes, as well as elevation of fat levels in the blood (cholesterol and triglycerides). Oral retinoids are rarely used in women of child-bearing age as pregnancy avoidance is critical while on these medications. Occasional blood tests are required and periodic visits with your dermatologist as well.

Biologic Agents

- Adalimumab (Humira®), Etanercept (Enbrel®), Infliximab (Remicade®), Ustekinumab (Stelara®), ixekizumab (Taltz®), and secukinumab (Cosentyx®) are very effective agents for psoriasis and psoriatic arthritis, and are either administered by self-injection (e.g. Humira®, Enbrel®, Stelara®, Taltz®, Cosentyx®) or intravenously (e.g. Remicade®) for people considered to have moderate to severe psoriasis. Some of these agents are administered once or twice a week, while others are administered every 1-3 months. The vast majority of patients find these medications very convenient and the discomfort of the injection/infusion to be quite minimal. A new oral option called apremilast (Otezla®) appears to be a very safe and effective option as well for more moderate to severe psoriasis.

These agents have been safely and effectively used in millions of people now for other inflammatory conditions as well, including: rheumatoid arthritis, Crohn's disease, ulcerative colitis and ankylosing spondylitis.

When topical (cream/ointment) therapy is not practical or not effective enough, and the psoriasis too widespread, and/or in the presence of psoriatic arthritis, biologic agents should be strongly considered; they are typically prescribed by a dermatologist rather than by a family physician/general practitioner.
 These agents have revolutionized the treatment of moderate-severe plaque psoriasis therapy as these treatments are considered both safe and highly effective; although there are potential side effects to these medications like all medications, with proper counseling and periodic blood tests and periodic visits to the dermatologist, these therapies can be an excellent treatment option for many patients struggling with psoriasis and/or psoriatic arthritis. Toronto Dermatology Centre is dedicated to minimizing the physical and psychosocial impact of psoriasis through a variety of treatment options and counseling.



The main drawback to the psoriasis biologics is their high-cost, and fortunately most third party (e.g. work) insurance will pay for these medications. There are also instances of coverage under ODB/social assistance and for seniors.

In cases where a biologic medication is indicated for psoriasis but the cost is not covered for the medication by a drug or government plan, at the Toronto Dermatology Centre we offer clinical research trials in psoriasis which allows many patients to obtain psoriasis medications for free. Speak with one of our dermatologists to decide the best treatment plan for your psoriasis.