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A Combination Treatment Plan for Severe Psoriasis

Medically reviewed by Darren Hein, PharmD on June 21, 2016Written by Adrienne Santos-Longhurst on December 5, 2014

Natasha Nettles is a strong woman. She’s a mom, a makeup artist, and she also happens to have psoriasis. But she doesn’t let this one part of her life take her down. She doesn’t let it control who she is, what she does, or how she describes herself. She is much more than her autoimmune disease. Go inside Natasha’s life, and watch how open and comfortable she is in her own skin in this documentary-style video.

Severe psoriasis causes multiple symptoms and side effects. Treatment results can also differ from person to person. This is why most doctors prefer to treat psoriasis with a combination treatment plan.

The Benefits of a combination treatment plan

Some psoriasis treatments work well on their own, but using a combination of treatments may have added benefit. An article published in the Archives of Dermatology in 2011 suggests that combination therapies are more effective and better tolerated.

Using a combination of treatments allows for smaller doses. This can decrease the risk of side effects and may end up being cheaper for you. Combining therapies has also been shown to relieve symptoms more quickly and efficiently. Some combination therapies may even lower the risk of skin cancers.

Another important benefit of combining treatments is that it offers numerous possible combinations. Having a potentially large supply of treatment combinations is valuable because there’s no known cure for psoriasis.

Combining treatments

Combination treatments are given in different stages or steps. The first step is known as “the quick fix” to clear skin lesions during an outbreak. This is often done using a strong topical steroid or an oral immunosuppressant for cases of severe psoriasis.

The next step is the “transitional phase.” This involves gradually introducing a maintenance drug. For severe cases, this includes a rotational therapy that involves alternating a combination of treatments. The goal is to keep the disease under control and to decrease the risk of side effects and resistance to the drugs.

The third step is the “maintenance phase.” The treatment dose generally can be decreased as symptoms diminish.

Treatment types

Below is a list of treatments available for psoriasis, not including those for any related conditions.

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Topical medications

Topical medications include:

  • creams
  • ointments
  • shampoos
  • other forms of medication that are applied to the skin’s surface

The most commonly used topical treatments for psoriasis contain steroids. Potencies range from low to very high. They’re used to decrease inflammation, relieve itching, and block cell production.

Topical treatments are often used in combination with other, more potent treatments because they aren’t enough to treat the symptoms of severe psoriasis. Other topical medications that may be used as a part of your combination therapy include:

  • vitamin D3
  • coal tar
  • salicylic acid

Systemic medications

These medicines affect the entire body as opposed to just the skin. They can be taken orally or by injection. Cyclosporine, methotrexate, and oral retinoids are among the most commonly used systemic medications.

Systemic medications are often effective even when used to treat severe psoriasis on their own. However, they’re associated with side effects that range from mild to severe. Using them in combination with other treatments allows for a lower dose and potency, which makes side effects less likely.


Also known as “biological response modifiers,” biologics are protein-based drugs. They’re derived from living cells cultured in a laboratory and are given by injection or IV infusion. Unlike systemic medications that affect the entire body, biologics target specific parts of your immune system. They also block specific immune cells or proteins that are part of the development of psoriatic disease.

Biologics are often effective on their own, but can be very effective and better tolerated when given in a lower dose with other treatments.


This type of light therapy involves consistent use of ultraviolet light on the skin. It’s performed either under medical supervision or at home using a phototherapy technique that a certified dermatologist recommends.

Phototherapy is almost always used as a secondary treatment in combination with another therapy. It can clear up the skin completely or at least improve it. Phototherapy is usually given in small doses that are gradually increased to avoid burning the skin.

Contrary to some popular beliefs, the type of light provided by most indoor tanning beds can’t treat psoriasis. The World Health Organization and American Academy of Dermatology have reported that use of an indoor tanning bed significantly raises the risk of melanoma.

Using a combination of treatments may be the solution for managing your severe psoriasis because two is oftentimes better than one.

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