For people with mild psoriasis, one type of treatment is usually enough. But people with moderate or severe psoriasis often benefit from a combination of treatments. The best combinations are those in which the two therapies have complementary effects, so they can work together to create improved results. And since such combinations have better results, lowers doses of each treatment can be given, reducing the overall side effects.
A number of different regimens of pills, light therapy and topical agents can be used for combination therapy.
Here are the most common combinations:
Acriten plus light therapy: One popular regimen is acitretin, a retinoid taken as a pill, in combination with light therapy. While retinoids are only moderately effective on their own, they help light therapy work faster. So, skin clears with shorter treatments and fewer sessions, minimizing side effects from prolonged use of ultraviolet light. Adding light therapy also permits lower doses of acitretin to be used. Instead of taking 50 mg a day or more, people using combination therapy usually need only 10 or 25 mg a day. Researchers also suspect that acitretin may reduce the risk of skin cancer from light therapy, although this theory has yet to be proven.
Acitretin with ultraviolet B (UVB) is called reUVB, while acitretin with psoralen plus ultraviolet A (PUVA) is called rePUVA. The regimen requires the patient to begin taking acitretin about two weeks before adding light therapy.
Acitretin is relatively safe, but should not be taken by pregnant women because it can cause birth defects. Possible side effects include hair loss, cracking of the lips and high blood cholesterol.
UVB is also relatively safe; the most common side effects are burns. PUVA is more effective than UVB, but can lead to skin cancer if used too often. Cyclosporine and PUVA should not be combined because of the potential for cancer.
Methotrexate with UVB: Methotrexate pills and UVB is also a popular treatment combination. Methotrexate is very effective, but it has the potential to damage the liver and bone marrow. Combining this drug with UVB allows for lower, safer doses of methotrexate to be used. It also reduces the number and length of UVB treatments needed.
The combination usually involves several weeks of treatment with methotrexate before adding UVB treatments. The methotrexate dose is tapered and discontinued after the skin clears, and a maintenance regimen of UVB continues. The disadvantage of the regimen is that psoriasis may return after methotrexate is discontinued.
PUVA with UVB: A combination of PUVA and UVB appears to clear up skin more quickly than using either treatment alone. Another benefit to this combination is that overall exposure to ultraviolet radiation is reduced. The main drawback of this relatively new combination is that the long-term effects are unknown.
Methotrexate with cyclosporine: Methotrexate with cyclosporine, which is one of the most successful combinations used to treat psoriatic arthritis, also works well for psoriasis itself. It is especially effective in people who have pustules on their body. Low doses of methotrexate combined with low doses of cyclosporine clear skin better than either treatment alone and with fewer side effects. Cyclosporine is very effective against psoriasis, but it can cause kidney damage and elevated blood pressure.
Questions to ask your doctor:
Do you think I would benefit from combination therapy?
What type of combination therapy might be best for me?
What special precautions do I need to take with this treatment regimen?
Supported through an educational grant from Biogen Idec. For more information on psoriasis from Biogen Idec please click here.
