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- Plaque—inflamed patches of skin topped with silvery, white scales (most common type)
- Guttate—small dot-like lesions
- Pustular—weeping lesions and intense scaling
- Inverse (intertriginous)—inflamed patches of skin in body folds (armpits, groin, under breasts)
- Erythrodermic—intense sloughing and inflammation of nearly the entire skin
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- Family history of psoriasis
- Cold climates
- Suppression of the immune system, including AIDS
- Certain bacterial infections
- Certain medications, such as beta blockers, tumor necrosis factor-alpha inhibitors, and lithium
- Silvery white scales
- Pitted or dented fingernails and/or toenails
- Red lesion in folds of skin
- Joint pain suggesting arthritis
- The severity of the disease
- The extent and location of the areas involved
- Responsiveness to the treatment
- Corticosteroid creams and ointments (most common treatment)
- Synthetic forms of vitamin D and retinoids ( calcipotriene ointment)
- Retinoids (tazarotene gel 0.05 and 0.1%)
- Coal tar preparations
- Bath solutions and moisturizers
- Tacrolimus and pimecrolimus (especially for inverse psoriasis)
Photo (Light) Therapy
- Methotrexate—a type of systemic medicine that affects the whole immune system; should not be taken by pregnant women, women planning to become pregnant, or by their male partners
- Cyclosporine—another type of systemic medicine that suppresses the immune system to slow the turnover of skin cells; should not be taken by pregnant or breastfeeding women
- Hydroxyurea—less toxic than methotrexate or cyclosporine, but may be less effective
- Systemic retinoids—Compounds with vitamin A-like properties taken internally may be prescribed in severe cases. Retinoids can cause birth defects, and women must diligently protect themselves from pregnancy for several years after completing treatment. Systemic retinoids are often combined with phototherapy for increased effectiveness and for their property of being protective against squamous skin cancer.
Newer medicines include biologic agents, which affect a part of the body's immune response by targeting certain cells in the immune system that cause inflammation, including:
National Institutes of Health http://www.nih.gov/
National Psoriasis Foundation http://www.psoriasis.org/
Canadian Dermatology Association http://www.dermatology.ca/
Psoriasis Society of Canada http://www.psoriasissociety.org/
de Prost Y. New topical immunological treatments for psoriasis. J Eur Acad Dermatol Venereol. 2006;20(suppl 2):80-82.
Kasper DL, Braunwald E, Fauci A, Hauser S, Longo D, Jameson JL. Harrison's Principles of Internal Medicine . 16th ed. McGraw-Hill; 2000.
Lebwohl M. Psoriasis. American Academy of Dermatology website. Available at: http://www.aad.org/education/students/psoriasis.htm . Accessed July 15, 2009.
Moderate to severe psoriasis: biologic drugs. National Psoriasis Foundation website. Available at: http://www.psoriasis.org/netcommunity/sublearn03%5Fsevere%5Fbiologics . Accessed October 2, 2009.
Moderate to severe psoriasis: systemic medications—methotrexate. National Psoriasis Foundation website. Available at: http://www.psoriasis.org/netcommunity/sublearn03%5Fsevere%5Fmetho. Accessed October 2, 2009.
Psoriasis vulgaris. DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated August 27, 2009. Accessed September 18, 2009.
Tierney LM, McPhee SJ, Papadakis MA. Current Medical Diagnosis and Treatment. 44th ed. McGraw Hill/Appleton & Lange; 2005.
Varani J, Bhagavathula N, Ellis CN, Pershadsingh HA. Thiazolidinediones: potential as therapeutics for psoriasis and perhaps other hyperproliferative skin disease. Expert Opin Investig Drugs. 2006;15:1453-1468.
10/2/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: FDA approves new drug to treat psoriasis. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm183851.htm. Published September 25, 2009. Accessed October 2, 2009.
- Reviewer: Purvee S. Shah, MD
- Review Date: 09/2012
- Update Date: 02/25/2013