Introduction

Quality care for psoriasis is essential. Especially given that this autoimmune disease, which causes thick, scaly patches of skin, has been linked with an increased risk of heart disease.

Yet in 2013, the National Psoriasis Foundation found that 28 percent of over 5,000 people surveyed gave up on their psoriasis treatment. The reasons given were varied, including cost and inconvenience, but highlighted a need for improved psoriasis care.

If you have psoriasis, it’s important to work with your doctor to treat it. Here’s what you need to know about the many treatments available today for psoriasis.

Topical treatments

Topical treatments are drugs you apply to your skin. Usually, they’re the first line of treatment for psoriasis. They’re often used in combination with oral drugs or biologics. Topical drugs are given to people with mild to severe psoriasis.

Topical treatments for psoriasis are available as prescription and over-the-counter (OTC) drugs.

Prescription topicals

A range of prescription topical treatments are available. Some of the most commonly used topicals include steroids. These drugs work by reducing inflammation and redness.

Topical retinoids are derived from vitamin A. They also help reduce inflammation. While they’re less powerful than steroids, they cause fewer side effects.

Two prescription topicals contain a combination of drugs. Taclonex and Enstilar both contain:

Taclonex comes as an ointment and a topical suspension, and Enstilar comes as a foam.

OTC topicals

OTC topical treatments are called emollients and help relieve symptoms such as itching and scaling. They contain ingredients that help keep your skin moisturized. Emollients include:

  • aloe vera
  • jojoba
  • zinc

Other OTC treatments to ask your doctor about include coal tar cream or ointment, capsaicin, and salicylic acid. Some mild steroids are also available over the counter as creams, lotions, or ointments.

Oral treatment

Several oral drugs are available to treat psoriasis. They’re typically used only for severe psoriasis.

Three older psoriasis drugs come in oral forms:

  • methotrexate (Trexall) comes as an oral tablet
  • cyclosporine (Gengraf, Neoral, Sandimmune) comes as an oral capsule and an oral solution
  • acitretin (Soriatane) comes as an oral capsule

Methotrexate and cyclosporine also come in injectable forms.

In addition to these drugs, a newer oral treatment was approved by the U.S. Food and Drug Administration (FDA) in 2014. This drug is called apremilast (Otezla). It’s prescribed to treat moderate to severe plaque psoriasis.

Apremilast, which comes as an oral tablet, works by blocking the immune response that causes inflammation. This relieves joint pain and swelling for people with psoriatic arthritis. It also reduces redness and scaling. Apremilast can be taken in combination with other treatments.

Biologics

Biologics are protein-based drugs made from living cells. They’re given by injection or intravenous (IV) infusion. Biologics work by blocking some functions of the immune system. The immune system plays a major role in how psoriasis and psoriatic arthritis develop.

New biologics

The FDA has approved several biologics for treating psoriasis in the past decade. These drugs include:

Newer biologic drugs that target the protein interleukin-17A (IL-17A) have shown impressive results. Ixekizumab was approved in March 2016. It was especially promising in clinical trials. According to the National Psoriasis Foundation, one-third of people had clear skin after just three months of using the drug. Other recently approved drugs, such as brodalumab and secukinumab, also target IL-17.

Doctors prescribe biologics to people with moderate to severe psoriasis. They’re used in people who haven’t responded to other treatments or who can’t use other treatments because of side effects. Biologics aren’t recommended for people with a weak immune system or an infection. Your doctor will test you for tuberculosis and other infections before you start a biologic drug.

New biosimilars

Other recently approved biologics include biosimilars. A biosimilar is similar to a brand-name biologic drug, but it’s not an exact copy. (On the other hand, a generic drug is an exact copy of a drug made from chemicals.)

Your doctor may prescribe a biosimilar to treat some or all of the conditions the brand-name drug treats. It’s expected to have the same effects as the original drug. Inflectra, approved in 2016, and Renflexis, approved in 2017, are biosimilar versions of Remicade (infliximab). Erelzi, approved in 2016, is a biosimilar version of Enbrel (etanercept).

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Light therapy

Light therapy (also called phototherapy) involves controlled exposure to natural or artificial ultraviolet light. This can be done alone or in combination with other medications. Light therapy reduces inflammation and slows the immune response that causes psoriasis symptoms.

Light therapies include:

  • UVB phototherapy
  • narrowband UVB therapy
  • psoralen plus ultraviolet A (PUVA) therapy
  • excimer laser therapy

Light therapy requires that you see a dermatologist in addition to your regular doctor.

Talk to your doctor

The broad range of treatments available for psoriasis gives you many options. If one of these doesn’t work well, you can try another. Keep in mind that most people with psoriasis benefit from using a combination of treatments.

Talk with your doctor about your options. Together, you can find the best course of treatment for you.