There's no cure for psoriasis. But treatment can stop your skin cells from growing so quickly, which reduces the patches of dry, raised rash. These patches also are called plaques. Treatment also can remove scales and smooth your skin.

Your health care provider can recommend a treatment plan based on your symptoms and where you have psoriasis patches on your body.

Having a basic understanding of treatment options can help you have a better conversation with your health care provider. Here's an overview of psoriasis treatment options.

Psoriasis can be treated with medicine applied to the skin, light exposure, pills and injections.

Creams, ointments and other products for the skin

Your health care provider might recommend medicated creams, ointments, gels, called topical therapy. These are applied to the skin to help ease the symptoms of mild psoriasis. For more-moderate psoriasis, these products might be used with other treatments. Options include:

• Corticosteroids. Low-potency versions are used on sensitive areas, such as the face. Stronger versions are used for thick plaques on the hands or 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 remove dead skin cells.
• Coal tar. Coal tar has been a staple of treatment for many decades. Coal tar is a byproduct of making coal products. It reduces scaling, itching and inflammation. Tar products come in shampoo, cream and other forms. They can be messy. Salicylic acid might be used with coal tar to remove dead skin cells.
• Anthralin. Anthralin, another tar product, removes scales. It can irritate the skin and stain anything it touches.
• Vitamin D analogues. These treatments are used for mild to moderate psoriasis. Calcipotriene (Dovonex) and calcitriol (Vectical) are synthetic forms of vitamin D available as cream ointments. They might irritate the skin and shouldn't be used on the face or groin area. Combining a vitamin D analogue with a corticosteroid ointment or cream may work better than either treatment alone.
• Retinoids. These treatments, such as tazarotene (Tazorac, Avage), are vitamin A derivatives. They might irritate the skin and increase sensitivity to sunlight. Tazarotene isn't recommended for people who are pregnant. If you're breastfeeding, talk to your health care provider.
• Calcineurin inhibitors. These medicines, such as tacrolimus (Protopic) and pimecrolimus (Elidel), are sometimes effective in treating psoriasis in selected cases. They can reduce inflammation and plaque buildup. They may be most useful on skin where a more potent corticosteroid can't be used. But they aren't recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma.

Light therapy

Light therapy involves exposing your skin to ultraviolet (UV) rays, which can reduce scaling and inflammation. This method also is called phototherapy. Options include:

• Sunlight. Brief, daily exposure to small amounts of sunlight might improve psoriasis. But 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 doesn't improve with topical treatments. It is often combined with topical treatments. Short-term side effects might include rash, itching and dry skin.

  Narrow band UVB therapy might work better than UVB phototherapy, requiring fewer treatments to get good responses. But narrow band UVB therapy might cause more-severe and longer lasting burns.

  Excimer laser therapy focuses a controlled beam of UVB light onto areas of mild to moderate psoriasis. This treatment helps control scaling and inflammation. Side effects can include rash and blistering.

• Artificial UVA light. UVA light penetrates deeper into the skin than does UVB light. Psoralen plus ultraviolet A (PUVA), also called photochemotherapy, involves taking a light-sensitizing medicine before exposure to UVA light. The medicine, called 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, rash, blistering, burning, itching and sensitivity to sunlight. Long-term side effects include dry and wrinkled skin, freckles, and increased risk of skin cancer.

Pills and injections

If you have moderate to severe psoriasis, or if other treatments don't work, your health care provider might prescribe pills or injections. Because of severe side effects, some medicines are used for only brief periods and are alternated with other treatments. Options include:

• Retinoids. These pills, such as acitretin, might reduce the production of skin cells if you have severe psoriasis that doesn't improve with other treatments. Symptoms usually return once therapy is discontinued. Side effects might include lip inflammation and hair loss. Acitretin isn't recommended for people who are pregnant, breastfeeding or might become pregnant within three years.
• Methotrexate. This medicine can be taken by mouth or injected. It suppresses inflammation. Methotrexate might cause upset stomach, loss of appetite and fatigue. When used for long periods, it can cause severe liver damage and lower levels of red and white blood cells and platelets. It's important to avoid alcohol while taking methotrexate. People need to stop taking methotrexate at least three months before attempting to conceive. This medicine is not recommended for those who are pregnant or breastfeeding.
• Cyclosporine. This medicine — usually taken by mouth for psoriasis treatment — suppresses inflammation. It's similar to methotrexate in effectiveness. It also increases the risk of infection and other health problems, including cancer, kidney problems and high blood pressure. These medicines aren't recommended for those who are pregnant, intend to become pregnant or are breastfeeding.

• Biologics. Several biologics are used to treat moderate to severe psoriasis. Options include infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), certolizumab (Cimzia), ustekinumab (Stelara), risankizumab-rzaa (Skyrizi), tildrakizumab (Ilumya) and ixekizumab (Taltz).

  Biologic medicines are injected, either by you or by a health care provider. They are for people who don't respond to traditional therapy. Because these medicines have strong effects on the immune system, they might increase your risk of life-threatening infections, such as tuberculosis.

Psoriasis treatment choices are complicated. As with any medicine, side effects may occur. Talk with your health care provider to determine which treatment is right for you.

Feb. 15, 2023

Original article: https://www.mayoclinic.org/diseases-conditions/psoriasis/in-depth/psoriasis-treatment-options/art-20300893