Psoriasis Treatment

Although there is no cure for psoriasis, there are a variety of effective treatment options that can clear the skin lesions caused by psoriasis.

Your doctor will recommend one or more psoriasis treatments depending on the following factors:

  • Type of psoriasis (plaque psoriasis, or other types)
  • Location of psoriasis lesions (scalp, trunk, hands feet, etc.)
  • Psoriasis severity (mild, moderate or severe)
  • Results of previous psoriasis treatments
  • Ease or convenience of a treatment
  • Possible side effects

Since some psoriasis treatments work better for some patients than others, be prepared to try more than one treatment.

Topical psoriasis medications: Non-prescription (over-the-counter)
For mild to moderate psoriasis, many people may find sufficient relief from one or more of the following creams or ointments applied to the skin.

  • Moisturizers—While moisturizers won’t actually heal psoriasis lesions, they can reduce the itching and scaling. For psoriasis, the greasier moisturizers provide more relief, so choose ointments over lighter creams and lotions. 
  • Coal tar—One of the oldest known treatments for psoriasis, coal tar is available without a prescription as a shampoo, gel, and cream. Coal tar reduces inflammation, slows the growth of skin cells, and relieves itching and irritation. It can be messy to apply and has a strong odor.
  • Salicylic acid—This medication is available in shampoos, creams, lotions, pads, paste, and soap. It works as a peeling agent, removing scales from the skin, and it’s often combined with other topical treatments.

Topical psoriasis medications: Prescription

  • Anthralin (Micanol) - An established, safe treatment for psoriasis (especially of the scalp), anthralin slows down skin cell growth and reduces inflammation. The medication may stain clothing and nearby unaffected skin. 
  • Calcipotriene (Dovonex, Taclonex) - This synthetic form of vitamin D slows skin cell growth, flattens psoriasis lesions, and removes scales. It doesn't control inflammation, but most patients notice a reduction of skin redness.
  • Calcitriol (Vectical) - Vectical contains calcitriol, the naturally occurring and active form of vitamin D3. This topical psoriasis treatment slows down the over-production of skin cells that occurs with psoriasis, and it is thought to help decrease the excessive immune response on the skin of patients with psoriatic lesions. Vectial is well tolerated, and may be used on skin folds.
  • Corticosteroids (“topical steroids”) - Corticosteroids slow skin cell growth and relieve itching by suppressing the immune system. They work quickly and are easy to use. Corticosteroid may be used alone for mild psoriasis or combined with other therapies for severe lesions. Side effects include thinning of the skin, stretch marks, and reduced immune function, so prolonged use of corticosteroids should be avoided.
  • Topical retinoids (Tazorac) - Retinoids are a class of medications derived from vitamin A that are used for a variety of skin conditions, including acne and psoriasis. Some retinoids have been formulated for use on the skin. Tazorac is a topical retinoid that has been approved by the FDA for the treatment of psoriasis.
  • Calcineurin inhibitors (Elidel, Protopic) - These medications, typically used for atopic dermatitis (eczema), may be prescribed in some cases of psoriasis.

Oral psoriasis medications: Prescription

Oral medications may be prescribed for people with moderate to severe psoriasis whose psoriasis lesions do not respond sufficiently to topical medications or phototherapy. Because these medications are taken by mouth and absorbed into the blood, they reach the deeper layers of skin throughout the body.

These psoriasis medications can be very effective, but also have serious potential side effects to consider. Oral psoriasis treatments include:

  • Cyclosporine for psoriasis (Neoral)—By suppressing the immune system, cyclosporine slows the overgrowth of skin cells and is particularly effective against plaque and nail psoriasis. Because of cyclosporine’s significant side effects, people taking this medication are monitored closely.
  • Methotrexate for psoriasis—Like cyclosporine, this medication suppresses the immune system and is sometimes prescribed for the treatment of erythrodermic and pustular psoriasis, as well as psoriatic arthritis. Because of methotrexate’s significant side effects, people taking this medication are monitored closely.
  • Soriatane (acitretin)—“Retinoids” refers to a class of medications derived from vitamin A that are used for a variety of skin conditions. Soriatane is retinoid that is FDA approved specifically for the treatment of multiple types of psoriasis. It is often combined with other treatments, including calcipotriene (Dovonex, Taclonex) and phototherapy. Soriatane is particularly useful for severe psoriasis, but it has significant side effects, including chapped lips and dry skin. Because Soriatane can cause serious birth defects, women who might become pregnant must have two negative pregnancy tests before starting treatment, use two forms of birth control during treatment, and continue birth control for three years after stopping the medication.

Other oral treatments for psoriasis that might be considered include isotretinoin (Accutane, Sotret), hydroxyurea, mycophenolate (Cellcept), and sulfasalazine.

Phototherapy
As the name implies, phototherapy involves the use of light to treat psoriasis.

Phototherapy may use UVA or UVB rays. Although excessive exposure to UV radiation increases a person's risk of developing skin cancer, it has been shown that UV light can suppress T cell activity within the immune system and slow down the uncontrolled growth of skin cell. This leads to a reduction in the scaly plaques of psoriasis.

Before trying a sunlight or phototherapy regimen, seek the guidance of your doctor to make sure you don’t overexpose your skin to UV radiation and aggravate your symptoms. 

There are three main types of phototherapy:

  • UVB—During this therapy, the skin is exposed to controlled amounts of UVB light. The UVB light may be administered in a doctor's office or delivered via a home unit obtained by prescription.
  • PUVA (“psoralen UVA”) - PUVA treatment combines UVA light exposure with a light-sensitizing medication called a "psoralen" (PUVA = psoralen + UVA ). PUVA can provide long-term symptom relief by slowing skin cell growth.
  • Lasers for psoriasis - Select type of lasers can deliver intense beams of UV light directly to the affected skin to treat scaling and inflammation, leaving surrounding skin intact. Because it is so targeted, lasers can often provide satisfactory results after a few sessions.

Combination therapy
Some cases of psoriasis require the combination of different treatments to achieved desired results. For instance, Tazorac may be combined with a topical corticosteroid, or Soriatane may be combined with phototherapy. Your doctor may recommend different combinations at different times.

Rotating therapies
Long-term use of some medications, such a cyclosporine or methotrexate, can lead to an increased risk of side effects. In addition, the benefits of some medications can diminish over time. In such cases, doctors may recommend rotating medications, using one medication for several months followed by a different medication. For example, coal tar may be rotated with cyclosporine.

Biologics
Biologics (also called “disease-modifying therapy” or “immunomodulators”) are a relatively new treatment option for people with moderate to severe psoriasis. They are given this name because they are derived from human or animal proteins instead of chemicals like most other medications.

Biologics work by targeting specific parts of the immune system, such as T cells or TNF (tumor necrosis factor), a chemical used to transmit messages between immune cells. This focused approach reduces the likelihood of side effects seen with medications that affect the entire immune system.

Biologics must be administered by injection, either into the skin (subcutaneously), into the muscle (intramuscular or IM), or by intravenous infusion (IV). Subcutaneous injections are similar to the insulin shots used by someone with diabetes and can be administered by the person with psoriasis or a caregiver.

Some biologics may require long-term use to keep psoriasis under control. Stopping treatment can lead to a premature return of symptoms.

There are currently five biologic medications that are FDA approved for the treatment of psoriasis.

Raptiva (efalizumab) was withdrawn from the market in 2009.

More Information

The following resources provide additional information on psoriasis treatment:

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© 2010 Vivacare. Last updated July 26, 2010.

This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

Additional Resources

Treatment Summary
Psoriasis Treatment Guide
Alternative & Complementary Treatments
Alternative Topical Products for Psoriasis
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