Combination Therapy as a Psoriasis Treatment

If you have psoriasis and you haven’t been able to achieve clear skin as often as you’d like, it may be time double down on treatments. Combination therapy consists of using two different psoriasis treatments at the same time. This form of therapy can work very well in moderate to severe cases.

Psoriasis treatment options

If your psoriasis covers more than 10% of your body, your doctor could consider this severe. It’s also important to consider how much psoriasis affects your quality of life. If your symptoms hold you back from socializing or doing everyday activities, your case could also be considered severe.

Topical medications

These are creams and ointments you put on your skin. The most common ones are corticosteroids. Others include vitamin D compounds, retinoids, salicylic acid, and coal tar.

Phototherapy

This uses several forms of light, including sunlight, ultraviolet B, and photochemotherapy (PUVA), which uses deeper-piercing ultraviolet A rays. The rays penetrate the skin, much like a tanning booth.

Whole body medications

These are medications that you take by mouth, with a shot, or through an IV. This class of drugs is called systemic because they work throughout your entire body, not just on your skin. Another option is biologics, drugs made from living cells that target specific proteins that can set off psoriasis.

What are the advantages of combination therapy?

Combining two treatments at once can have several benefits, including fewer side effects. Many psoriasis medications can cause problems like headaches, diarrhea, or higher chances of infections. Combining two therapies can let you take each in lower doses, lessening the side effects and possible harms.

You would have a customized treatment which pairs different drugs giving your doctor more flexibility and options to design your treatment plan. Combination therapy may also work quicker and better than one treatment alone.

Also, some drugs can boost the power of another drug. Salicylic acid, for instance, helps corticosteroids better seep into your skin. Longer relief is also another benefit. Combining two treatments may allow you to stick with it longer. It also may keep your disease in remission for longer stretches after you seize treatment.

Is combination therapy right for you?

Although double the treatment may mean double the result, it also means that you will have to follow two different guidelines and schedules. It also may cost more than a single treatment or require more medical visits. Combination therapy isn’t for everyone, and two people can respond differently to the same treatment.

You might be a good candidate if you tried and failed with a single therapy, can’t tolerate certain treatments at full dose, need long-term treatment for psoriasis that comes back, or need a therapy that can be tailored to a specific medical or health problem.

Where do I start?

Not all psoriasis treatments are useful or even safe to combine. You shouldn’t use salicylic acid on your skin in combination with UVB phototherapy because it makes the UVB less effective. Also, cyclosporine, in combination with psoralen plus ultraviolet A can make you more likely to get cancer.

These combinations have a track record of working well:

Topicals + topicals

• Corticosteroids and salicylic acid
• Corticosteroids and vitamin D compounds
• Corticosteroids and tazarotene cream

Phototherapy + topical therapies

• UVB plus topical calcipotriene (Dovonex).
• UVB plus anthralin and topical coal tar products (Ingram regimen)

Phototherapy + phototherapy

• UVB plus PUVA

Phototherapy + systemic

• UVB plus methotrexate
• PUVA plus retinoids

Systemics + topical medication

• Acitretin plus topical calcipotriene
• Cyclosporine plus topical calcipotriene

Phototherapy + biologics

• Narrow-band UVB plus biologics

If your current treatment doesn’t give you enough relief, talk to your doctor about trying a new approach. Always consult your doctor before making any changes in your skincare or treatment regimen.