Moderate psoriasis is often treated with a mix of topical therapies, phototherapy, and, if needed, systemic or biologic medications.
Experts commonly categorize psoriasis into three general stages: mild, moderate, and severe. The extent of skin involvement and the severity of symptoms determine the stage, which helps guide the choice of treatment.
Moderate psoriasis affects about
Topical treatments
Topical treatments, especially a combination of corticosteroids and vitamin D analogs, are typically the
- Corticosteroids: Doctors often treat moderate psoriasis with prescription corticosteroids, such as triamcinolone acetonide 0.1% or fluocinolone acetonide 0.025%. These reduce inflammation and slow the rapid growth of skin cells.
- Vitamin D analogs: Vitamin D analogs, such as calcipotriene, help treat moderate psoriasis by slowing skin cell growth and reducing inflammation.
- Combination products: Products that combine corticosteroids and vitamin D analogs, such as betamethasone dipropionate and calcipotriene, help reduce inflammation and slow skin cell growth.
- Coal tar: Coal tar — a thick, dark liquid derived from coal — helps reduce itching, scaling, and inflammation by slowing down skin cell growth. It’s available over the counter in various forms, such as shampoos, creams, and ointments.
- Retinoids: Retinoids, like tazarotene, are vitamin A derivatives used to treat moderate psoriasis by slowing skin cell growth and reducing inflammation.
Phototherapy (light therapy)
Phototherapy involves using ultraviolet (UV) light to treat psoriasis. This treatment works by slowing down the rapid growth of skin cells and reducing inflammation.
- UVB phototherapy: UVB therapy penetrates the skin’s outer layers to slow the rapid growth of skin cells and reduce inflammation.
- PUVA (psoralen and UVA): PUVA combines a light-sensitizing medication called psoralen with UVA light exposure, providing a more intensive treatment for stubborn or widespread psoriasis.
- Excimer laser: The Excimer laser delivers concentrated UVB light to specific areas of the skin, targeting psoriasis patches while sparing the surrounding healthy skin.
Systemic treatments
Systemic medications affect the entire body, working through the bloodstream to treat specific conditions.
For psoriasis, these medications target the immune system or skin cell production, providing more comprehensive control than topical treatments, which only address surface symptoms.
- Oral medications: Medications, such as methotrexate (immunosuppressant) and acitretin (retinoid), help slow down the overactive immune response and reduce inflammation.
- Oral small molecules: Drugs like apremilast (Otezla), which is a PDE4 inhibitor, work by inhibiting specific enzymes that contribute to inflammation in psoriasis.
- Biologic drugs: These newer drugs, known as biologics, target specific parts of the immune system, including TNF-alpha inhibitors (e.g., etanercept, infliximab) and IL-17 inhibitors (e.g., secukinumab). Healthcare professionals administer these drugs by injection or infusion. There is no set sequence for starting or switching biologics. A
2023 study found that the drugs infliximab, bimekizumab, ixekizumab, and risankizumab are the most effective.
Combination therapies
Combination therapies for moderate psoriasis use multiple treatments together to improve results and better manage symptoms. These treatments typically target various aspects of psoriasis, such as inflammation, skin cell proliferation, and immune response.
- PUVA and vitamin D derivatives: Combines PUVA therapy with topical or systemic vitamin D derivatives (e.g., calcipotriene) to enhance effectiveness and safety by targeting both skin cell growth and inflammation.
- PUVA and topical steroids: Uses PUVA therapy alongside topical corticosteroids to reduce inflammation and improve the effectiveness of light treatment.
- PUVA and UVB: Involves alternating or integrating both types of phototherapy. PUVA focuses on UVA light with a photosensitizing agent, while UVB therapy uses a different wavelength of ultraviolet light.
- UVB and topical steroids: Combines UVB therapy with topical corticosteroids to address inflammation and enhance the effects of UVB light on psoriasis plaques.
- UVB and vitamin D derivatives: Uses UVB therapy with vitamin D derivatives (e.g., calcipotriene) to improve treatment outcomes by targeting skin cell proliferation and inflammation.
- Biologics and topical therapies: Combines biologic drugs with topical treatments to provide a multi-faceted approach to managing moderate to severe psoriasis.
A
All combination therapies were more effective than UV monotherapy, with no significant differences in safety.
If you’re undergoing treatment for moderate psoriasis, here are some signs that the treatment may be working:
- reduced discoloration and inflammation
- less scaling
- smaller plaque size
- decreased itching and discomfort
- improvement in skin texture
- fewer flare-ups
- overall skin appearance
- improvement in quality of life
If you have moderate psoriasis and notice certain changes or worsening symptoms, it’s important to discuss them with your doctor.
Here are signs that your symptoms may be becoming more severe:
- increased discoloration and swelling
- expansion of plaques
- thicker, more scaly plaques
- severe itching, burning, or pain
- cracking or bleeding skin
- nail changes
- joint pain or swelling
- fever or malaise
- frequent or prolonged flare-ups
- emotional or psychological distress
For moderate psoriasis, a combination of treatments often works best. Topical therapies, such as corticosteroids and vitamin D derivatives, are commonly used alongside phototherapy options like PUVA or UVB. Systemic treatments and biologics can be added if needed.
If you have moderate psoriasis, it’s important to work with a healthcare professional to develop a personalized treatment plan and regularly review your progress to achieve the best results.