Plaque psoriasis is the most common type of psoriasis. It causes rapid skin cell growth that leads to inflamed, scaly patches on your skin. While there’s no cure, different treatments can help manage symptoms.
Psoriasis is a chronic autoimmune disease that affects your skin. An autoimmune disease is a condition in which your immune system mistakenly attacks your body.
Plaque psoriasis is the most common type of psoriasis. It causes rapid skin cell growth, leading to inflamed, scaly plaques on your skin.
On lighter skin tones, the plaques are pink to red with silvery-white scales. On darker skin tones, the plaques may be purple, gray, or dark brown.
There’s no cure for psoriasis, so treatment requires lifelong symptom management. This may be done using therapies that relieve symptoms or regulate your immune response.
Plaque psoriasis treatments fall under the following categories:
- topical
- phototherapy
- systemic
- biologic
The best option depends on the type and severity of your specific symptoms. You may also need a combination of different therapies.
This article takes a closer look at the types of plaque psoriasis treatments and how each one works.
The first way doctors usually diagnose plaque psoriasis is by visual examination. Your primary care physician can identify plaque psoriasis by its symmetrical, scaly skin lesions with clearly defined borders.
A dermatologist may follow up with a skin biopsy, where a sample of your skin is examined with a microscope to determine whether you have a skin condition in addition to or other than plaque psoriasis.
Topical treatments can include creams, ointments, gels, foams, or other formulations you spread on your skin or scalp. They can be available either over the counter (OTC) or with a prescription from a doctor or other qualified healthcare professional.
Topical steroids
The most common treatment for plaque psoriasis is topical steroids, which contain drugs called corticosteroids. They have anti-inflammatory properties that can help control itching and irritation.
You can get mild topical steroids at drugstores without a prescription. Stronger versions require a prescription.
Possible side effects of topical steroids include:
- acne
- purpura (purple-colored spots)
- striae (streaks on your skin)
- skin discoloration
- skin thinning
- delayed wound healing
- enlarged skin blood vessels
Topical nonsteroids
If you have a skin infection or open sores, you need to avoid topical steroids. This is also true if you have a fungal skin infection. Their anti-inflammatory effect can conceal the symptoms of the infection, potentially delaying treatment.
Steroids actually make fungal infections worse and can cause a condition called Majocchi granuloma. They must be avoided if there’s any suspicion of a fungal infection.
Instead, topical nonsteroids can help, which include OTC and prescription options.
OTC topical nonsteroids
For milder symptoms, a doctor might suggest OTC nonsteroid topicals. These may include products with active ingredients such as:
- Salicylic acid: Salicylic acid is a beta-hydroxy acid that helps lift scaly flakes and reduce itching. Applying too much can dry out your skin, so it’s important to use it as directed.
- Coal tar: Coal tar is considered to be an effective treatment for plaque psoriasis. However, it has an unpleasant smell and may irritate the skin.
- Aloe vera: Aloe vera is a soothing, natural treatment that may help reduce itchiness.
- Zinc pyrithione: Zinc pyrithione is often found in shampoo, which might ease plaque psoriasis on your scalp. It can sting your eyes, so use caution.
- Jojoba oil: The moisturizing and anti-inflammatory properties of jojoba oil may help reduce symptoms.
Prescription nonsteroid treatment
If OTC treatments are unable to relieve your symptoms, a doctor might prescribe the following topical treatments:
- Anthralin: Anthralin is the synthetic version of a substance naturally found in the araroba tree. It controls plaque formation by slowing skin cell growth.
- Calcipotriene: Calcipotriene, or synthetic vitamin D3, helps lift scales and reduce skin cell growth. Common side effects include irritation and burning.
- Calcitriol: Calcitriol is the natural form of vitamin D3. It helps reduce skin cell growth. Possible side effects include irritation and itching.
- Tazarotene: Tazarotene is a form of vitamin A, which is a topical retinoid. It prevents skin cells from building up, but it can increase your risk of sunburn.
- Tapinarof: This topical agent works against certain proteins in your immune system. If it causes side effects, they may include raised bumps, swelling, and skin rash.
- Roflumilast: Roflumilast helps psoriasis symptoms by targeting inflammatory enzymes. It’s a potent treatment and may cause side effects such as headache, nausea, or pain.
Phototherapy, also known as light therapy, involves exposing your skin to ultraviolet light. It might be used in combination with other treatments. But it’s different from sunbathing. It should only be done under medical supervision.
Phototherapy is typically used for mild to moderate psoriasis. Options include:
Ultraviolet light B (UVB)
UVB slows excessive skin cell growth. It can be used in the following forms:
- UVB phototherapy: This involves a phototherapy device. It can be done at a doctor’s office or at home.
- Excimer laser: An excimer laser targets specific plaques using a high intensity beam of UVB.
Ultraviolet light A (UVA) and psoralens
On its own, UVA is ineffective for psoriasis. It needs to be combined with psoralens, a light-sensitizing cream. Together, these treatments can help reduce the growth of skin cells.
Sunlight
For some people, exposure to natural sunlight might help. However, it’s not as effective as prescription phototherapy.
This type of therapy isn’t recommended for everyone. Some topical medications might increase the risk of sunburn. A doctor can help determine whether natural sunlight is a safe option for you.
For severe plaque psoriasis, a doctor might recommend systemic treatments. These treatments are most effective for moderate to severe psoriasis.
Traditional systemic drugs
The most common drug options include:
- Acitretin: Acitretin is a synthetic form of vitamin A taken by mouth. It’s thought to help by reducing excessive cell growth.
- Cyclosporine: Cyclosporine suppresses your immune system, which may help control the immune response seen in psoriasis. It’s taken by mouth as a liquid or capsule.
- Methotrexate: Methotrexate inhibits an enzyme involved in excessive skin cell growth. It’s taken by mouth as a tablet or by injection.
- Apremilast: Apremilast is a phosphodiesterase 4 (PDE4) inhibitor you take by mouth. It’s an enzyme that can contribute to inflammation in people with psoriasis. Originally used for psoriatic arthritis, apremilast is
now also used for plaque psoriasis. - Sotyktu: Sotyktu is prescribed to adults who are candidates for treatment with phototherapy or systemic therapy. It targets tyrosine kinase 2 (TYK2), a member of the Janus kinase (JAK) family, which is involved in the immune reactions associated with plaque psoriasis.
Off-label systemic drugs
In some cases, a doctor might want to try an off-label systemic drug. “Off-label” means the drug is approved as a treatment for a different condition and isn’t approved by the Food and Drug Administration (FDA) for treating psoriasis.
Options include:
- hydroxyurea
- isotretinoin
- mycophenolate mofetil
sulfasalazine - 6-thioguanine
- tacrolimus
- leflunomide
Biologics are drugs that contain proteins from living cells. They work by lowering inflammation or blocking certain immune cells.
Like systemic treatments, biologics are used for moderate to severe psoriasis. A doctor might recommend them if other treatments haven’t worked.
These drugs are given by injection or intravenous infusion. Options include:
- adalimumab
- etanercept
- infliximab
- certolizumab pegol
- ustekinumab
- secukinumab
- ixekizumab
- brodalumab
- tildrakizumab
- guselkumab
- risankizumab
- golimumab
Biologics may increase your risk of infection and tuberculosis. If you’re interested in biologics, speak with a doctor or dermatologist about the risks and benefits.
Alternative self-care therapies may also help plaque psoriasis. None offer long-term results, but they might provide some relief.
Self-care therapies include the following:
- Reduce shower time: Prolonged exposure to water can worsen itchiness. Hot showers can also have the same effect.
- Moisturize: Apply moisturizing creams to your skin after washing your hands or bathing. This can help hydrate your skin and reduce itchiness.
- Apply a cold compress: Place a cold compress on the irritated areas of your skin to reduce irritation.
- Avoid triggers: Certain factors can cause psoriasis flare-ups, such as stress, tobacco, or alcohol.
- Eat a balanced diet: Focus on vegetables, fruits, and anti-inflammatory foods. Avoid your food triggers for psoriasis, which may include alcohol, ultra-processed foods, or nightshade vegetables.
In 2022, the FDA approved tapinarof and deucravacitinib for plaque psoriasis.
Tapinarof is a nonsteroid topical drug. This cream can be used in areas that steroid medications can’t treat. Deucravacitinib is a TYK2 inhibitor that targets specific immune cells involved in inflammation.
If you’re interested in joining clinical trials for new plaque psoriasis treatments, visit ClinicalTrials.gov, where you can search for studies recruiting for different conditions.
Plaque psoriasis is the most common type of psoriasis. While there’s no cure, various treatments can help you manage your symptoms.
Topical medications or phototherapy can typically treat mild to moderate psoriasis. Systemic or biologic therapies can treat moderate to severe psoriasis.
Depending on your symptoms, you might need a combination of different therapies. A doctor can determine the best options for your situation.