Ultraviolet light has powerful anti-inflammatory properties that can clear psoriasis from the skin.  Phototherapy treatments are performed three times per week, and most patients become clear after 8-9 weeks.  In order to accommodate our patients' busy schedules, treatment sessions are available as early as 6am, as late as 7pm, and during weekends.  Treatments are administered by two full-time nurses.  The cost is covered by Medicare and most insurance plans.

Several forms of phototherapy are available.  The type selected is determined by the severity and location of the patient's psoriasis as well as the patient's medical history.  Treatment types available include:

• Narrowband UVB:  This treatment is safe, highly effective, and drug-free.  The patient stands in a specially designed cabinet containing UVB light tubes.  The affected areas of the body are exposed to the UVB for a short time (seconds to minutes). The effects generally become noticeable after seven to ten treatments.
   
• PUVA:  Prior to treatment, patients ingest a photosensitizer tablet.  One hour later, the patient stands in a specially designed cabinet containing UVA bulbs, and the affected areas of the body are exposed to the UVA for a short time.
   
• Hand/foot PUVA:  Prior to treatment, patients soak the hands and/or feet in a photosensitizer solution.  These areas are then exposed to UVA light in a targeted manner that spares unaffected parts of the body.

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Biologic agents for psoriasis treatment

The past few years have seen promising advances in the treatment of psoriasis.  New types of medication — called biologics because they are made from living organisms — may offer hope to people who haven't had success with other approaches or were uncomfortable with the potential side effects of older medications.

Biologic agents are administered by injection.  They treat psoriasis by reducing inflammation in the skin and elsewhere in the body.  These medicines are intended to treat patients with moderate to severe psoriasis, patients with psoriatic arthritis, or patients who have failed to respond to other forms of treatment.  Selection of a specific agent is based on the patient's medical history, the presence or absence of psoriatic arthritis, and other factors.  Biologic agents which we prescribe include:

• Amevive:  The medicine is administered in the office as a brief injection from a nurse.  Treatments are given for three months, and most people experience a significant improvement that persists for several months after discontinuation.  Compared with other injectable therapies, Amevive offers the greatest potential for sustained clearance after the drug is discontinued.  Eventually, the psoriasis begins to return, and patients would then return to repeat the treatment course.  Because it is administered in the office, Amevive is paid for as part of the medical benefit of health insurance plans.  This may be a useful option for patients with high co-pays for prescription drugs.
   
• Enbrel:  Enbrel is self-injected by patients in the convenience of their home. It is intended for long-term, continuous use by persons with moderate to severe psoriatic skin disease or persons with psoriatic arthritis.
   
• Humira:  Humira is self-injected by patients in the convenience of their home. It is intended for long-term, continuous use by persons with moderate to severe psoriatic skin disease or persons with psoriatic arthritis.
   
• Raptiva:  Raptiva is self-injected by patients at home.  It is intended for long-term, continuous use by persons with moderate to severe psoriasis.
   
• Remicade:  This medication is given via intravenous infusion. This is administered over a 3-hour period in a specialized infusion center. It is extremely effective for cutaneous psoriasis and psoriatic arthritis.  It is paid for as part of the medical benefit of health insurance plans, and may be a useful option for patients with high co-pays for prescription drugs.

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Older oral medications

Additional agents we offer for the treatment of psoriasis include:

• Soriatane:  This oral agent is a modified form of vitamin A.  Taken daily, it reduces the thickness of psoriatic plaques.  It may be used alone, but usually works best when combined with phototherapy or topical therapy.
   
• Methotrexate:  This oral medication is taken once weekly and highly effective for the treatment of psoriasis.  Today it is used less often due to its potential to cause undesirable side effects and the availability of safer alternatives.  Nevertheless, we offer Methotrexate treatment in limited circumstances.
   
• Neoral (cyclosporine):  This is a fast-acting, highly potent medication originally created to prevent the body from rejecting transplanted organs.  Despite its efficacy, it is used less commonly today for psoriasis due to its potential to cause undesirable side effects and the availability of safer alternatives.  Nevertheless, we offer Neoral treatment in limited circumstances.

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