Psoriasis treatments aim to stop skin cells from growing so quickly and to remove scales. Options include creams and ointments (topical therapy), light therapy (phototherapy), and oral or injected medications.

Which treatments you use depends on how severe the psoriasis is and how responsive it has been to previous treatment and self-care measures. You might need to try different drugs or a combination of treatments before you find an approach that works. Even with successful treatment, usually the disease returns.

Topical therapy

  • Corticosteroids. These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They are available as oils, ointments, creams, lotions, gels, foams, sprays and shampoos. Mild corticosteroid ointments (hydrocortisone) are usually recommended for sensitive areas, such as the face or skin folds, and for treating widespread patches. Topical corticosteroids might be applied once a day during flares, and on alternate days or weekends during remission.

    Your health care provider may prescribe a stronger corticosteroid cream or ointment — triamcinolone (Trianex) or clobetasol (Cormax, Temovate, others) — for smaller, less-sensitive or tougher-to-treat areas.

    Long-term use or overuse of strong corticosteroids can thin the skin. Over time, topical corticosteroids may stop working.

  • Vitamin D analogues. Synthetic forms of vitamin D — such as calcipotriene (Dovonex, Sorilux) and calcitriol (Vectical) — slow skin cell growth. This type of drug may be used alone or with topical corticosteroids. Calcitriol may cause less irritation in sensitive areas. Calcipotriene and calcitriol are usually more expensive than topical corticosteroids.
  • Retinoids. Tazarotene (Tazorac, Avage, others) is available as a gel or cream. It’s applied once or twice daily. The most common side effects are skin irritation and increased sensitivity to light.

    Tazarotene isn’t recommended when you’re pregnant or breastfeeding or if you intend to become pregnant.

  • Calcineurin inhibitors. Calcineurin inhibitors — such as tacrolimus (Protopic) and pimecrolimus (Elidel) — calm the rash and reduce scaly buildup. They can be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are irritating or harmful.

    Calcineurin inhibitors aren’t recommended when you’re pregnant or breastfeeding or if you intend to become pregnant. This drug is also not intended for long-term use because of a potential increased risk of skin cancer and lymphoma.

  • Salicylic acid. Salicylic acid shampoos and scalp solutions reduce the scaling of scalp psoriasis. They are available in nonprescription or prescription strengths. This type of product may be used alone or with other topical therapy, as it prepares the scalp to absorb the medication more easily.
  • Coal tar. Coal tar reduces scaling, itching and inflammation. It’s available in nonprescription and prescription strengths. It comes in various forms, such as shampoo, cream and oil. These products can irritate the skin. They’re also messy, stain clothing and bedding, and can have a strong odor.

    Coal tar treatment isn’t recommended when you’re pregnant or breastfeeding.

  • Anthralin. Anthralin is a tar cream that slows skin cell growth. It can also remove scales and make skin smoother. It’s not intended for use on the face or genitals. Anthralin can irritate skin, and it stains almost anything it touches. It’s usually applied for a short time and then washed off.

Light therapy

Light therapy is a first line treatment for moderate to severe psoriasis, either alone or in combination with medications. It involves exposing the skin to controlled amounts of natural or artificial light. Repeated treatments are necessary. Talk with your health care provider about whether home phototherapy is an option for you.

  • Sunlight. Brief, daily exposures to sunlight (heliotherapy) might improve psoriasis. Before beginning a sunlight regimen, ask your health care provider about the safest way to use natural light for psoriasis treatment.
  • Goeckerman therapy. An approach that combines coal tar treatment with light therapy is called the Goeckerman therapy. This can be more effective because coal tar makes skin more responsive to ultraviolet B (UVB) light.
  • UVB broadband. Controlled doses of UVB broadband light from an artificial light source can treat single psoriasis patches, widespread psoriasis and psoriasis that doesn’t improve with topical treatments. Short-term side effects might include inflamed, itchy, dry skin.
  • UVB narrowband. UVB narrowband light therapy might be more effective than UVB broadband treatment. In many places it has replaced broadband therapy. It’s usually administered two or three times a week until the skin improves and then less frequently for maintenance therapy. But narrowband UVB phototherapy may cause more-severe side effects than UVB broadband.
  • Psoralen plus ultraviolet A (PUVA). This treatment involves taking a light-sensitizing medication (psoralen) before exposing the affected skin 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 more aggressive treatment consistently improves skin and is often used for more-severe psoriasis. Short-term side effects might include nausea, headache, burning and itching. Possible long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma.

  • Excimer laser. With this form of light therapy, a strong UVB light targets only the affected skin. Excimer laser therapy requires fewer sessions than does traditional phototherapy because more-powerful UVB light is used. Side effects might include inflammation and blistering.

Oral or injected medications

If you have moderate to severe psoriasis, or if other treatments haven’t worked, your health care provider may prescribe oral or injected (systemic) drugs. Some of these drugs are used for only brief periods and might be alternated with other treatments because they have potential for severe side effects.

  • Steroids. If you have a few small, persistent psoriasis patches, your health care provider might suggest an injection of triamcinolone right into them.
  • Retinoids. Acitretin and other retinoids are pills used to reduce the production of skin cells. Side effects might include dry skin and muscle soreness. These drugs are not recommended when you’re pregnant or breastfeeding or if you intend to become pregnant.
  • Biologics. These drugs, usually administered by injection, alter the immune system in a way that disrupts the disease cycle and improves symptoms and signs of disease within weeks. Several of these drugs are approved for the treatment of moderate to severe psoriasis in people who haven’t responded to first line therapies. Options include apremilast (Otezla), etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), ustekinumab (Stelara), secukinumab (Cosentyx), ixekizumab (Taltz), guselkumab (Tremfya), tildrakizumab (Ilumya) and certolizumab (Cimzia). Three of them — etanercept, ixekizumab and ustekinumab — are approved for children. These types of drugs are expensive and may or may not be covered by health insurance plans.

    Biologics must be used with caution because they carry the risk of suppressing the immune system in ways that increase the risk of serious infections. People taking these treatments must be screened for tuberculosis.

  • Methotrexate. Usually administered weekly as a single oral dose, methotrexate (Trexall) decreases the production of skin cells and suppresses inflammation. It’s less effective than adalimumab and infliximab. It might cause upset stomach, loss of appetite and fatigue. People taking methotrexate long-term need ongoing testing to monitor their blood counts and liver function.

    People need to stop taking methotrexate at least three months before attempting to conceive. This drug is not recommended for those who are breastfeeding.

  • Cyclosporine. Taken orally for severe psoriasis, cyclosporine (Gengraf, Neoral, Sandimmune) suppresses the immune system. It’s similar to methotrexate in effectiveness but cannot be used continuously for more than a year. Like other immunosuppressant drugs, cyclosporine increases the risk of infection and other health problems, including cancer. People taking cyclosporine long-term need ongoing testing to monitor their blood pressure and kidney function.

    These drugs aren’t recommended when you’re pregnant or breastfeeding or if you intend to become pregnant.

  • Other medications. Thioguanine (Tabloid) and hydroxyurea (Droxia, Hydrea) are medications that can be used when you can’t take other drugs. Talk with your health care provider about possible side effects of these drugs.

Treatment considerations

You and your health care provider will choose a treatment approach based on your needs and the type and severity of your psoriasis. You’ll likely start with the mildest treatments — topical creams and ultraviolet light therapy (phototherapy). Then, if your condition doesn’t improve, you might move on to stronger treatments.

People with pustular or erythrodermic psoriasis usually need to start with stronger (systemic) medications.

In any situation, the goal is to find the most effective way to slow cell turnover with the fewest possible side effects.

Alternative medicine

Some studies claim that alternative therapies (integrative medicine) — products and practices not part of conventional medical care or that developed outside of traditional Western practice — ease the symptoms of psoriasis. Examples of alternative therapies used by people with psoriasis include special diets, vitamins, acupuncture and herbal products applied to the skin. None of these approaches is backed by strong evidence, but they are generally safe and might help reduce itching and scaling in people with mild to moderate psoriasis.

  • Aloe extract cream. Taken from the leaves of the aloe vera plant, aloe extract cream may reduce scaling, itching and inflammation. You might need to use the cream several times a day for a month or more to see any improvement in your skin.
  • Fish oil supplements. Oral fish oil therapy used in combination with UVB therapy might reduce the extent of the rash. Applying fish oil to the affected skin and covering it with a dressing for six hours a day for four weeks might improve scaling.
  • Oregon grape. Oregon grape — also known as barberry — is applied to the skin and may reduce the severity of psoriasis.

If you’re considering alternative medicine to ease the signs and symptoms of psoriasis, talk with your health care provider about the pros and cons of these approaches.

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