Treatment options for psoriasis range from topical ointments or light therapy to address skin symptoms to medications that work inside the body to stop psoriasis at the source. The right approach or combination of treatments can vary based on factors like psoriasis severity and personal preferences.
The right psoriasis treatment approach depends on the following factors:
- the severity of your psoriasis
- how much of your body is affected
- your type of psoriasis
- how well your skin responds to initial treatments
- your overall health
- your personal preferences
It may also take some trial and error to find the right treatment or combination of treatments that work best for you. Here are some of the options you may try for treating psoriasis.
Treatments applied directly to the skin are called topical treatments. They include:
They’re usually the first line of treatment for people with mild to moderate psoriasis. In some cases, they’re used in combination with another type of treatment.
Corticosteroid-containing creams and ointments are the most common treatments for psoriasis. These low-dose steroid treatments work to control the excessive production of skin cells and soothe the skin. However, some corticosteroids include stronger steroids that may actually make your symptoms worse.
Your doctor will know the correct strength to reduce your symptoms, rather than increase them.
Topical retinoids are a different type of topical treatment derived from vitamin A. They work to normalize growth activity in skin cells. This slows the inflammation process.
Although not as fast acting as corticosteroid ointments, topical retinoids have fewer side effects. People who are pregnant or may become pregnant shouldn’t use these due to a risk of birth irregularities.
Vitamin D3 analogues
These topical treatments are synthetic forms of vitamin D that slow down skin cell growth. Your doctor may prescribe them alone or with other treatments to treat mild to moderate psoriasis. They include:
- calcipotriene (Dovonex)
- calcitriol (Rocaltrol)
Coal tar creams or ointments
Coal tar is the oldest treatment for psoriasis. It’s made from the byproducts of petroleum manufacturing. Coal tar products reduce scaling, itching, and inflammation.
Some types of coal tar can be found over the counter (OTC). Higher concentrations are available by prescription only.
These topicals have some downsides, however. Coal tar is messy, and it can stain clothing and bedding. It can also have a strong and unpleasant odor.
Medicated and prescription-strength shampoos are also available from your doctor to treat scalp psoriasis.
This treatment promotes sloughing of dead skin cells, which reduces scaling. It’s available in OTC and prescription formulas. This topical option can also be used in combination with other treatments.
Phototherapy is a procedure in which skin is carefully exposed to natural or artificial ultraviolet (UV) light.
It’s important to discuss phototherapy with your dermatologist before exposing your skin to high doses of UV light. Long-term phototherapy is associated with increased incidences of skin cancer, particularly melanoma. 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. This 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 topical coal tar treatment makes the two therapies more effective than either therapy alone. Coal tar makes skin more receptive to UVB light. The Goeckerman therapy is used for mild to moderate cases.
Laser therapy is a treatment option for mild to moderate psoriasis. Lasers can target concentrated beams of UVB light on psoriatic patches without affecting the surrounding skin. However, it may only be useful in treating small patches of psoriasis skin, since the laser cannot cover larger 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. You 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 those with moderate to severe cases of psoriasis.
Pulsed dye laser
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.
Prescription medications can help combat the spread of psoriasis by addressing inflammation in the body that leads to psoriasis plaques.
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 may be recommended.
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 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 prescribe this to people with moderate to severe psoriasis. It’s one of the most effective treatments for people with erythrodermic psoriasis or pustular psoriasis. This medication can be used to treat psoriatic arthritis as well.
Side effects include:
- loss of appetite
- upset stomach
- liver disease
Because serious liver disease may occur as a potential side effect of methotrexate, regular blood tests are
Cyclosporine is a highly effective drug designed to suppress the immune system. Doctors usually prescribe this drug only to people with severe cases of psoriasis because it weakens the immune system.
Most doctors also only prescribe this drug for short lengths of time because of a risk for high blood pressure. If you take this medication, you’ll need regular blood tests and blood pressure checks to monitor for potential problems.
Only one oral drug, called apremilast (Otezla), is currently available in this class of drugs for psoriasis. It isn’t fully understood how apremilast works to treat psoriasis. It’s thought to work by decreasing your body’s response to inflammation.
Potential side effects of apremilast
These oral vitamin A derivatives treat moderate to severe psoriasis by reducing the production of skin cells. Your doctor may suggest that you use oral retinoids 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. People who are pregnant or wish to become pregnant shouldn’t take this medication.
The only FDA-approved oral retinoid for the treatment of psoriasis is acitretin (Soriatane).
Biologics are a newer class of drugs that target your body’s immune response. These drugs are given by injection or intravenous infusion (IV). Doctors often prescribe them to people with moderate to severe psoriasis who haven’t responded to traditional therapies.
The biologics approved for the treatment of psoriasis are:
- adalimumab (Humira)
- etanercept (Enbrel)
- certolizumab (Cimzia)
- golimumab (Simponi Aria)
- infliximab (Remicade)
- ustekinumab (Stelara)
- secukinumab (Cosentyx)
- ixekizumab (Taltz)
- brodalumab (Siliq)
- guselkumab (Tremfya)
- tildrakizumab (Ilumya)
- risankizumab (Skyrizi)
Biosimilars are also newly available, which are similar to brand-name biologic drugs, but not an exact copy. They’re expected to have the same effects as the regular drug. There are currently biosimilars for adalimumab, etanercept, and infliximab.
In September 2022, the FDA approved the first Janus kinase (JAK) inhibitor for treating moderate to severe plaque psoriasis. This oral drug, called deucravacitinib (Sotyktu), is a specific type of JAK inhibitor called a tyrosine kinase 2 (TYK2) inhibitor. It works in a very targeted way to block immune system activity that otherwise leads to psoriasis.
Certain drugs may be prescribed off-label to treat psoriasis. This may occur if treatments indicated for psoriasis stop working or aren’t compatible with other health conditions. Off-label drugs may also be used to reduce the risk of potential side effects.
Medications sometimes prescribed off-label for psoriasis include:
- fumaric acid esters
- mycophenolate mofetil
However, these drugs do come with their own risks and side effects. For example, people who are trying to conceive, are pregnant, or breastfeeding should avoid most of these drugs due to risks like birth irregularities or miscarriage.
Your doctor should be aware of all medications you take, both prescription and OTC, before you start taking any drugs off-label in order to prevent serious side effects.
Off-label drug use
Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that hasn’t been approved. However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.
While there’s no cure for psoriasis, a variety of options are available to treat it.
Work with your doctor to discuss which treatment or combination of approaches will work best for your individual circumstances. Also schedule regular checkups with your doctor to monitor how well your treatment is working and make adjustments as needed.