Psoriasis treatment options
While there's no cure for psoriasis, treatment can stop your skin cells from growing so quickly, which reduces inflammation and the formation of patches of dry, raised, red skin (plaques). Treatment can also remove scales and smooth your skin.
Your doctor will recommend a treatment plan based on the severity of your psoriasis and its location on your body.
For a better conversation with your doctor, it can help to have a basic understanding of available treatments. Here's an overview of psoriasis treatment options.
Types of treatments
Psoriasis can be treated with creams and ointments, light exposure, pills and injections.
Creams and ointments (topical therapy)
Your doctor might recommend this therapy for mild psoriasis or for more severe psoriasis in combination with other treatments. Options include:
- Topical corticosteroids. Low-potency versions are used on sensitive areas, such as the face. Stronger versions are used on small areas, persistent plaques on the hands and feet, and when other treatment fails. Long-term use or overuse of strong corticosteroids can thin the skin. Salicylic acid might be used with this therapy to help slough off dead skin cells.
- Coal tar. This treatment, a byproduct of the manufacturing of coal products, reduces scaling, itching and inflammation. However, it can be messy. Salicylic acid might be used with coal tar to remove dead skin cells.
- Vitamin D analogues. These treatments, such as calcipotriene (Dovonex) and calcitriol (Vectical), are synthetic forms of vitamin D. They treat mild to moderate psoriasis. They might irritate the skin.
- Topical retinoids. These treatments, such as tazarotene (Tazorac, Avage), are vitamin A derivatives. They might irritate the skin increase sensitivity to sunlight. Tazarotene isn't recommended for women who are pregnant. If you’re breast-feeding, talk to your doctor.
- Anthralin. Anthralin (Dritho-Scalp) removes scales. However, it can irritate skin and stain anything it touches.
- Calcineurin inhibitors. These medications, such as tacrolimus (Prograf) and pimecrolimus (Elidel), are sometimes effective in treating psoriasis. They can reduce inflammation and plaque buildup. But calcineurin inhibitors aren't recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma.
Light therapy (phototherapy)
Light therapy involves exposing your skin to ultraviolet (UV) rays, which can reduce scaling and inflammation. Options include:
- Sunlight. Brief, daily exposure to small amounts of sunlight might improve psoriasis. However, intense sun exposure can worsen symptoms and damage skin.
Artificial UVB light. Controlled doses of UVB light from an artificial light source might improve mild to moderate psoriasis symptoms.
UVB phototherapy can treat single patches, widespread psoriasis and psoriasis that resists topical treatments. Short-term side effects might include redness, itching and dry skin.
Narrow band UVB therapy might be more effective than UVB phototherapy. But narrow band UVB therapy might cause more severe and longer-lasting burns.
UVB treatment and coal tar treatment combined is known as the Goeckerman treatment. Coal tar makes skin more receptive to UVB light.
The excimer laser, used for mild to moderate psoriasis, treats only involved skin. A controlled beam of UVB light is directed at the psoriasis plaques to control scaling and inflammation. Side effects can include redness and blistering.
- Artificial UVA light. Photochemotherapy or psoralen plus ultraviolet A (PUVA) involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure. This treatment consistently improves skin and is used for more-severe cases of psoriasis. Short-term side effects include nausea, headache, burning, itching and sensitivity to sunlight. Long-term side effects include dry and wrinkled skin, freckles and increased risk of skin cancer.
Oral and injected medications
If you have severe psoriasis or it's resistant to other treatments, your doctor might prescribe oral or injected drugs. However, because of severe side effects some medications are used for only brief periods and are alternated with other treatments. Options include:
- Retinoids. These drugs, such as acitretin (Soriatane), might reduce the production of skin cells if you have severe psoriasis that doesn't respond to other therapies. Signs and symptoms usually return once therapy is discontinued. Side effects might include lip inflammation and hair loss. Acitretin isn't recommended for women who are pregnant, breast-feeding or might become pregnant within 3 years.
- Methotrexate. Taken orally, methotrexate decreases the production of skin cells and suppresses inflammation. Methotrexate might cause upset stomach, loss of appetite and fatigue. When used for long periods, it can cause severe liver damage and decreased production of red and white blood cells and platelets. It's important to avoid alcohol while taking methotrexate.
- Cyclosporine. This drug suppresses the immune system and is similar to methotrexate in effectiveness. It also increases your risk of infection and other health problems, including cancer, kidney problems and high blood pressure.
- Drugs that alter the immune system (biologics). Several biologics can be used to treat moderate to severe psoriasis, including etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira) and ustekinumab (Stelara). These drugs are injected, either by you or a doctor, and are for people who don’t respond to traditional therapy. Because these drugs have strong effects on the immune system, they might permit life-threatening infections, such as tuberculosis.
- Thioguanine and hydroxyurea (Droxia, Hydrea) are used when other drugs can't be given. Various side effects can occur, including hoarseness, fever or chills and lower back or side pain.
Psoriasis treatment choices are complicated and can cause side effects. Talk to your doctor to determine which treatment is right for you.
Jan. 05, 2017
- Feldman SR. Treatment of psoriasis. www.uptodate.com/home. Accessed Nov. 21, 2016.
- Questions and answers about psoriasis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/health_info/psoriasis/. Accessed Nov. 21, 2016.
- Papadakis MA, et al., eds. Dermatologic disorders. In: Current Medical Diagnosis & Treatment 2017. 56th ed. New York, N.Y.: The McGraw-Hill Companies; 2016. http://www.accessmedicine.com. Accessed Nov. 22, 2016.
- Coal tar and coal pitch. National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/coal-tar. Accessed Dec. 1, 2016.
- Over-the-counter (OTC) topicals. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/treatments/topicals/over-the-counter. Accessed Dec. 1, 2016.
- Mild psoriasis: Non-steroidal prescription topical treatments. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/treatments/topicals/non-steroid. Dec. 1, 2016.
- Phototherapy. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/treatments/phototherapy. Accessed Dec. 1, 2016.
- Gibson LE (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 6, 2016.
- Tazorac (prescribing information). Irvine, Calif.: Allergan, Inc.; 2013. http://www.allergan.com/assets/pdf/tazorac_cream_pi. Accessed Dec. 7, 2016.
- Soriatane (prescribing information). Research Triangle Park, N.C.: Stiefel Laboratories Inc.; 2015. http://www.soriatane.com/. Accessed Dec. 7, 2016.