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.
Having a basic understanding of available treatments can help you have a better conversation with your doctor. Here's an overview of psoriasis treatment options.
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 for thick, persistent 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 slough off dead skin cells.
- Coal tar. This treatment, a byproduct of the manufacturing of coal products, 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. However, it can irritate skin and stain anything it touches.
- Vitamin D analogues. These treatments are used for mild to moderate psoriasis. Cream versions, including calcipotriene (Dovonex) and calcitriol (Vectical), are synthetic forms of vitamin D. 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.
- Topical 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 women who are pregnant. If you're breast-feeding, talk to your doctor.
- Calcineurin inhibitors. These medications, such as tacrolimus (Protopic) and pimecrolimus (Elidel), are sometimes effective in treating psoriasis. They can reduce inflammation and plaque buildup. But they 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 doesn't improve with topical treatments. Short-term side effects might include redness, itching and dry skin.
Narrow band UVB therapy might work better than UVB phototherapy. 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 redness 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 medication before exposure to UVA light. The medication (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.
Pills and injections
If you have severe psoriasis, or if other treatments don't work, your doctor might prescribe pills or injections. 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 improve with other treatments. 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. This medication can be taken by mouth or injected. It 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 lower levels of red and white blood cells and platelets. It's important to avoid alcohol while taking methotrexate.
- Cyclosporine. This drug — usually taken by mouth for psoriasis treatment — suppresses inflammation. It's similar to methotrexate in effectiveness. It also increases your risk of infection and other health problems, including cancer, kidney problems and high blood pressure.
- Biologics. Several biologics are used to treat moderate to severe psoriasis, including ixekizumab (Taltz), secukinumab (Cosentyx), 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 increase your risk of life-threatening infections, such as tuberculosis.
- Hydroxyurea (Droxia, Hydrea, Siklos). This medicine is used when other drugs can't be given. Side effects include hoarseness, fever or chills, and lower back or side pain.
Psoriasis treatment choices are complicated. As with any medication, side effects may occur. Talk to your doctor to determine which treatment is right for you.
Jan. 08, 2019
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- Coal tar and coal pitch. National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/coal-tar. Accessed Dec. 20, 2018.
- Over-the-counter (OTC) topicals. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/treatments/topicals/over-the-counter. Accessed Dec. 20, 2018.
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- Phototherapy. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/treatments/phototherapy. Accessed Dec. 20, 2018.
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