Treating psoriasis typically requires several different approaches. These may include lifestyle changes, nutrition, and medication. Treatment depends on the severity of the symptoms, your age, overall health, and other factors. Doctors will often try several methods before finding the right one for a patient since there is no one cure for psoriasis.
Treatment options for psoriasis depend on the following factors:
- severity of the psoriasis
- how much of the body is affected
- type of psoriasis
- how well skin responds to initial treatments
Many common treatments are meant to treat the symptoms of the disease. They try to soothe the itching and flaking skin and reduce flare-ups. Regular use of over-the-counter moisturizers after baths and showers can help keep moisture in the skin to prevent flaking, but won’t address the underlying inflammation.
Dermatologists also recommend that people with psoriasis use perfume- and dye-free soaps, detergents, and moisturizers to keep irritation of the skin to a minimum.
Treatments applied directly to the skin are called topical treatments. They include:
They’re usually the first line of treatment for patients with mild to moderate psoriasis. In some cases, they’re used in combination with another type of treatment.
Cortisone creams and ointments are the most common treatments for psoriasis. These low-dose steroid treatments work to control the excessive production of skin cells, soothe skin, and help symptoms. However, some corticosteroids include stronger steroids and may actually make symptoms worse. Your doctor will know the correct strength to reduce symptoms, rather than increase them.
Topical retinoids are derived from vitamin A and work to normalize growth activity in skin cells. This slows the inflammation process. Alhough not as fast acting as corticosteroid ointments, topical retinoids have fewer side effects. Women who are pregnant or may become pregnant should not use these due to a risk of birth defects. Common forms of these are Tazorac and Avage.
Vitamin D Analogues
Your doctor may prescribe these alone or with other treatments to treat mild to moderate psoriasis. They include calcipotriene (Dovonex) and calcitriol (Rocaltrol). These are both synthetic forms of vitamin D that slow down skin cell growth.
Anthralin, or Dritho-Scalp
This cream works to normalize growth activity in your skin cells and remove scales. Doctors use these with phototherapy. It’s recommended that this cream stay on your skin for only a brief time since it can cause staining and irritate skin if left too long.
Coal Tar Creams or Ointments
This is the oldest treatment for psoriasis. It’s made from the byproducts of petroleum manufacturing. Coal tar products reduce scaling, itching, and inflammation. High concentrations are available by prescription. These creams have some downsides, however. Coal tar is messy, and it can stain clothing and bedding. It sometimes has a strong and unpleasant odor.
Medicated and prescription-strength dandruff shampoo are available from your doctor to treat psoriasis. You wash your hair with these and massage the affected areas of the scalp.
Salicylic Acid and Lactic Acid
These are available in over-the-counter and prescription formulas. Both acids promote sloughing of dead skin cells, which reduces scaling. Both can be used in combination with other treatments.
Prescription medications help combat the spread of the disease by addressing inflammation.
Doctors usually prefer to use the lowest level of treatment needed to stop symptoms. They begin with a topical treatment in many cases. As the skin becomes resistant and no longer responds to one treatment, a stronger treatment can be used.
Your doctor may prescribe oral or injectable drugs if your psoriasis is more severe or doesn’t respond to topical options. Many of these drugs have serious side effects, so doctors limit their use to only difficult or persistent cases.
Methotrexate decreases the production of skin cells and suppresses immune response. Doctors often prescribed this to people with moderate to severe psoriasis. It’s one of the most effective treatments for people with erythrodermic psoriasis or pustular psoriasis. Recently, doctors have begun prescribing it as a treatment for psoriatic arthritis as well.
Side effects include:
- loss of appetite
- upset stomach
Pregnant women or those who may become pregnant should not take methotrexate due to a risk of ectopic pregnancy and miscarriage. Any man who is using (or has recently used) this drug should avoid getting a woman pregnant. According to the National Psoriasis Foundation, long-term use may cause liver damage and decreased production of red and white blood cells and platelets.
Cyclosporine is a highly effective drug designed to suppress the immune system. Doctors usually only prescribe this drug to people with severe cases of psoriasis because it weakens the immune system. Most doctors only prescribe this drug for short lengths of time because of a risk for high blood pressure. You may take it for three to six months. Patients on this medicine require regular blood tests and blood pressure checks to monitor for potential problems.
Retinoids are made from vitamin A derivatives and may treat moderate to severe psoriasis by reducing the production of skin cells. Your doctor may suggest that you use these with light therapy.
As with other systemic medications, these have some potential major side effects. Your doctor may order regular blood tests to check for high cholesterol, which is a common problem for people on this medicine. Retinoids can also cause birth defects. Women who are pregnant or wish to become pregnant should not take this medicine. Doctors recommend that women stop taking retinoids at least three years before trying to become pregnant.
The only FDA-approved oral retinoid for the treatment of psoriasis is acitretin (Soriatane).
Hydroxyurea can be used with phototherapy, but it isn’t as effective as cyclosporine and methotrexate. Possible side effects include red blood cells levels that are too low (anemia) and a decrease in white blood cells and platelets. Women who are pregnant or plan to become pregnant should not take hydroxyurea due to a risk of birth defects and miscarriage.
Biologics are a newer class of drugs that target your body’s immune response. These drugs are given by shot (injection) or IV (infusion). Doctors often prescribe them to people with moderate to severe psoriasis who haven’t responded to traditional therapies.
Biologics approved for the treatment of psoriasis include:
- adalimumab (Humira)
- alefacept (Amevive)
- etanercept (Enbrel)
- golimumab (Simponi)
- infliximab (Remicade)
- ustekinumab (Stelara)
While not as effective as methotrexate or cyclosporine, thioguanine has fewer side effects, making it a more attractive treatment option. However, it still may cause birth defects. Women who are pregnant or plan to become pregnant should avoid taking it.
Phototherapy is a procedure in which skin is carefully exposed to natural or artificial ultraviolet (UV) light. Long-term phototherapy is associated with increased incidences of skin cancer, particularly melanoma, the most deadly form of skin cancer. It’s important you discuss phototherapy with your dermatologist before exposing yourself to high doses of UV light. Never try to self-treat with a tanning bed or sunbathing.
The most natural source of UV light is the sun. It produces UVA rays. UV light reduces T-cell production and eventually kills any activated T-cells, which slows down the inflammatory response and skin cell turnover. Brief exposures to small amounts of sunlight may improve psoriasis. However, intense sun exposure or long-term sun exposure can worsen symptoms. It can also cause skin damage and may increase your chances of developing skin cancer.
For mild cases of psoriasis, artificial light treatments with UVB light may be used. Because UVB-emitting light boxes are used frequently for this type of treatment, single patches or smaller areas of skin can be treated, instead of exposing the whole body. Side effects include itchy, dry skin and redness in treated areas.
Combining UVB treatment with coal tar treatment makes the two therapies more effective than either therapy alone. Coal tar makes skin more receptive to UVB light. This therapy is used for mild to moderate cases.
A promising development in the treatment of mild to moderate psoriasis is laser therapy. Lasers can target concentrated beams of UVB light on psoriatic patches without affecting surrounding skin. It may only be useful in treating small patches since the laser cannot cover large areas.
Photochemotherapy, or Psoralen Plus Ultraviolet A (PUVA)
Psoralen is a light-sensitizing medication that may be combined with UVA light therapy as a treatment for psoriasis. Patients take the medicine or apply a cream version to the skin and enter a UVA light box. This treatment is more aggressive and is often only used in patients with moderate to severe cases of psoriasis.
Your doctor may recommend pulsed dye laser if other treatments have limited success. This process destroys tiny blood vessels in areas around psoriasis plaques, cutting off blood flow and reducing cell growth in that area.