Because all types of psoriasis have the same underlying cause, all psoriasis treatments will work to some extent for most types of psoriasis. There are, how-ever, a few treatment approaches that can maximize the effectiveness of therapies in different types of psoriasis.
Plaque psoriasis: All prescription psoriasis treatments have been proven to treat this most common type of psoriasis. Because most treatments are effective, people may consider rotating different medicines and trying different formulas to find the right one for them.
Palmar-plantar psoriasis: Although topical medicines are effective, they may need more time or more frequent use to penetrate through the thick skin of hands and feet. Ointments, frequent application, or use under occlusion at night (using plastic wrap or cotton socks and gloves) can maximize the effectiveness of topical medications. Systemic treatments aren’t always indicated for palmar-plantar psoriasis, but when overall disease is severe and disabling, some people experience good improvement with more aggressive treatment such as topical PUVA or systemic medications. Retinoids such as acitretin are often used in this scenario.
Scalp psoriasis: Medications in solution or foam formulations penetrate scalp skin well, while leaving the least amount of medication on the hair. In addition to using psoriasis medicines, specific treatments to loosen scale can be very effective. In particular, keratolytics (compounds that break up scale), anti-dandruff shampoos, and oils are effective for many people.
Inverse and genital psoriasis: Although the same topical treatments are effective, thin skin in the skin folds (under the arm pits, around the groin, and under a woman’s breasts) and on the genitals requires special attention. In particular, this thin and some-times sensitive skin absorbs medication very rapidly and is more susceptible to both the therapeutic effects and unwanted side effects of topical medications. For this reason, milder steroids (Class V or below) should be used in these areas. Certain topical immunomodulators, called tacrolimus and pimecrolimus, can be effective on the skin folds and genitals as well. These medications show modest benefit for “regular” plaque psoriasis but are more effective (and with minimal side effects) in sensitive skin areas.
Nail psoriasis: The nail changes of psoriasis are particularly challenging to treat for two reasons. First, it is very difficult to get medication to reach the nail bed where new, healthy nail is growing. Second, nails grow slowly, so any treatment takes a long time to take effect. Choices include topical therapies that penetrate well (strong steroids under occlusion, for example), steroid injections into the base of the nail behind the cuticle, and systemic treatments for those who have more severe overall disease.