Treating psoriasis typically requires several different approaches. This may include lifestyle changes, nutrition, phototherapy, and medications. Treatment depends on the severity of your symptoms, your age, your overall health, and other factors.
There’s no cure for psoriasis, so doctors will often try several methods before finding the right treatment for you.
Treatment options for psoriasis depend 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
Many common treatments are meant to treat the symptoms of the disease. They try to soothe the itching and flaking skin and reduce flare-ups. Regular use of over-the-counter (OTC) moisturizers after baths and showers can help keep moisture in the skin to prevent flaking. But it won’t treat the underlying inflammation.
Dermatologists also recommend that people with psoriasis use perfume-free and dye-free soaps, detergents, and moisturizers to keep irritation of the skin to a minimum.
Here, we’ll describe the common treatments for psoriasis, from first-line treatments like topical creams to a new class of drugs called biologics.
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. Women who are pregnant or may become pregnant shouldn’t use these due to a risk of birth defects.
Vitamin D analogues
These 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. High concentrations are available by prescription.
These creams 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 dandruff shampoos are available from your doctor to treat psoriasis on your scalp.
Salicylic acid and lactic acid
Both of these acids promote sloughing of dead skin cells, which reduces scaling. They can also be used in combination with other treatments. They’re available in OTC and prescription formulas.
Prescription medications can help combat the spread of psoriasis by addressing inflammation.
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 can be used.
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. Recently, doctors have begun prescribing it as a treatment for psoriatic arthritis as well.
Side effects include:
- loss of appetite
- upset stomach
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 new 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.
Retinoids are made from vitamin A derivatives. They treat moderate to severe psoriasis by reducing the production of skin cells. Your doctor may suggest that you use these 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. Women 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).
Hydroxyurea belongs to a class of drugs called antimetabolites. It’s thought to work by inhibiting DNA replication. It can be used with phototherapy, but it isn’t as effective as cyclosporine and methotrexate.
Possible side effects include red blood cell levels that are too low (anemia) and a decrease in white blood cells and platelets. Women who are pregnant or plan to become pregnant shouldn’t take hydroxyurea due to a risk of birth defects and miscarriage.
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)
- 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 infliximab and etanercept.
Thioguanine is used off-label to treat psoriasis. While not as effective as methotrexate or cyclosporine, thioguanine has fewer side effects. This makes it a more attractive treatment option. However, it still may cause birth defects. Women who are pregnant or plan to become pregnant should avoid taking it.
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.
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 yourself 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 coal tar treatment makes the two therapies more effective than either therapy alone. Coal tar makes skin more receptive to UVB light. This therapy is used for mild to moderate cases.
Laser therapy is a promising development in the treatment of mild to moderate psoriasis. Lasers can target concentrated beams of UVB light on psoriatic patches without affecting the surrounding skin. But it may only be useful in treating small patches since the laser cannot cover large 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. Patients 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 patients 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.