eMedicine Specialties > Ophthalmology > Dermatologic Disorders

Psoriasis: Treatment & Medication

Author: Robert Arffa, MD, Clinical Assistant Professor, University of Pittsburgh School of Medicine
Contributor Information and Disclosures

Updated: May 15, 2009

Treatment

Medical Care

  • Management of the skin disease
    • The simplest treatment of psoriasis is daily sun exposure, sea bathing, topical moisturizers, and relaxation.
    • Topical therapy
      • Moisturizers, such as petrolatum jelly, are helpful.
      • Anthralin, coal or wood tar, corticosteroids, salicylic acid, phenolic compounds, and calcipotriene (a vitamin D analog) also may be effective.
      • Various ultraviolet light treatments are used; most commonly, PUVA therapy is used. Psoralen is a photosensitizer that is ingested prior to light exposure.
    • Systemic therapy
      • In severe cases, retinoids, methotrexate, cyclosporine, infliximab, and hydroxyurea may be used.
      • Systemic corticosteroids are generally ineffective, and they can exacerbate the disease.
  • Management of the ocular complications
    • Ocular lubricants and punctal occlusion can be used to treat keratoconjunctivitis sicca.
    • Trichiasis and cicatricial ectropion usually require surgical treatment.
    • Topical corticosteroids are useful in treating the conjunctival, corneal, and anterior chamber inflammation. Nonsteroidal anti-inflammatory agents or oral corticosteroids are occasionally necessary.
    • Whether systemic immunosuppression is effective for ocular disease is not clear.
    • Corneal complications include the following:
      • Corneal melting, inflammation, and vascularization can be difficult to treat.
      • A bandage contact lens may retard the melting.
      • Topical corticosteroids can control the infiltration and delay the vascularization.
      • In some cases, progression can occur in spite of these treatments and can lead to the need for lamellar or penetrating keratoplasty.

Medication

Artificial tears and topical corticosteroids may be helpful.

Topical corticosteroids

Have anti-inflammatory properties and cause profound and varied metabolic effects. Modify the body's immune response to diverse stimuli. Used to treat conjunctivitis, corneal infiltration, melting, or vascularization, and iritis.


Prednisolone acetate 1% (Pred Forte)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
In cases of bacterial infections, concomitant use of anti-infective agents is mandatory; if signs and symptoms do not improve after 2 days, reevaluate patient. Dosing may be reduced, but advise patients not to discontinue therapy prematurely.

Adult

1 gtt qid; frequency is determined by severity of disease

Pediatric

Not established

Documented hypersensitivity; viral, fungal, or tubercular infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in hypertension; known to cause cataract formation with chronic use; fungal invasion should be suspected in any persistent corneal ulceration where a corticosteroid has been used or is in use (fungal cultures should be taken when appropriate)


Dexamethasone 0.1% (Ocu-Dex, AK-Dex, Alba-Dex)

For various allergic and inflammatory diseases. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Adult

1 gtt qid; frequency is determined by severity of the disease

Pediatric

Not established

Documented hypersensitivity; active bacterial, viral, or fungal infection

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Prolonged use may increase hazard of secondary ocular infection; fungal invasion should be suspected in any persistent corneal ulceration where a corticosteroid has been used or is in use (fungal cultures should be taken when appropriate)

Artificial tears

Used to treat dry eye irritation. Many types of artificial tears are available over the counter. In mild cases, preserved tears can be used. In severe cases, only nonpreserved tears should be used. Preserved tears include GenTeal, Refresh Tears, and Tears Naturale II. Nonpreserved tears include Refresh, Refresh Plus, OcuCoat, Bion, and Hypo Tears PF.


Artificial tears

Contains equivalent of 0.9% NaCl and are used to maintain ocular tonicity. Acts to stabilize and thicken precorneal tear film and prolong tear film breakup time, which occurs with dry eye states.

Adult

Starting dose: 1 gtt q2h; adjust dose prn by the symptoms and punctate keratopathy

Pediatric

Not established

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

Hyperemia, photophobia, stickiness of eyelashes, ocular discomfort or irritation may occur

More on Psoriasis

Overview: Psoriasis
Differential Diagnoses & Workup: Psoriasis
Treatment & Medication: Psoriasis
Follow-up: Psoriasis
References
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References

  1. Christophers E, Sterry W. Psoriasis. In: Fitzpatrick TB, Eisen AZ, Wolff K, eds. Dermatology in General Medicine. New York: McGraw Hill; 1993:489-511.

  2. Farber EM, Cox AJ, eds. Psoriasis: Proceedings of the Third International Symposium Yorke Medical, New York. 1981.

  3. Gulliver W. Long-term prognosis in patients with psoriasis. Br J Dermatol. Aug 2008;159 Suppl 2:2-9. [Medline].

  4. Karabulut AA, Yalvac IS, Vahaboglu H, et al. Conjunctival impression cytology and tear-film changes in patients with psoriasis. Cornea. Sep 1999;18(5):544-8. [Medline].

  5. Pietrzak AT, Zalewska A, Chodorowska G, et al. Cytokines and anticytokines in psoriasis. Clin Chim Acta. Aug 2008;394(1-2):7-21. [Medline].

  6. Catsarou-Catsari A, Katambus A, Theodorpoylos P. Ophthalmological manifestations in patients with psoriasis. Acta Derm Venereol (Stock). 1984;64:557-559.

  7. Huynh N, Cervantes-Castaneda RA, Bhat P, et al. Biologic response modifier therapy for psoriatic ocular inflammatory disease. Ocul Immunol Inflamm. May-Jun 2008;16(3):89-93. [Medline].

  8. Moadel K, Perry HD, Donnenfeld ED, et al. Psoriatic corneal abscess. Am J Ophthalmol. Jun 1995;119(6):800-1. [Medline].

  9. Durrani K, Foster CS. Psoriatic Uveitis: A Distinct Clinical Entity?. Am J Ophthalmol. 2005;139:106-11. [Medline].

  10. Takahashi H, Sugita S, Shimizu N, et al. A high viral load of Epstein-Barr virus DNA in ocular fluids in an HLA-B27-negative acute anterior uveitis patient with psoriasis. Jpn J Ophthalmol. Mar-Apr 2008;52(2):136-8. [Medline].

  11. Lerman S. Ocular side effects of accutane therapy. Lens Eye Toxic Res. 1992;9(3-4):429-38. [Medline].

  12. Brelsford M, Beute TC. Preventing and managing the side effects of isotretinoin. Semin Cutan Med Surg. Sep 2008;27(3):197-206. [Medline].

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Further Reading

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Keywords

psoriasis, psoriatic skin disease, conjunctivitis, blepharitis, psoriatic arthritis, anterior uveitis

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Contributor Information and Disclosures

Author

Robert Arffa, MD, Clinical Assistant Professor, University of Pittsburgh School of Medicine
Robert Arffa, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine
Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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