Psoriasis, a chronic autoimmune condition, causes inflammation in the skin, most often leading to thick, scaly areas called plaques. An overactive immune system speeds up skin cell development, causing these dry, scaly patches. There are several types of psoriasis , but plaque psoriasis is the most common.e60dc2a1-f33c-4a05-9b50-8e3e8e59762994fba90a-644c-4303-92ed-81b83d2112ac Most psoriasis therapies aim to slow down the overproduction of cells, remove scales, and reduce inflammation. Treatment options include topicals (such as creams and ointments), light therapy (also called phototherapy) , and oral or injected drugs (systemic therapy).e60dc2a1-f33c-4a05-9b50-8e3e8e597629b8daae63-d861-4e99-9fe7-8b53ba24121b The treatment plan for psoriasis depends on many factors, including severity, plaque locations, medications with the best response, and personal preference. Getting it right often takes trial and error, and a combination of approaches. Treating psoriasis can not only improve symptoms, but it can also lower the risk of developing other related health conditions , including heart disease , obesity , diabetes , depression , and psoriatic arthritis .e60dc2a1-f33c-4a05-9b50-8e3e8e597629564b9d82-1d17-46ec-9ea2-b3733b45e13c Even with successful treatment, psoriasis often returns, but proper management will reduce the number and severity of flares. Some treatments have side effects or should not be used along with other medications, or when breastfeeding or pregnant. Make sure you discuss any therapies you are considering, even so-called natural ones, with your healthcare provider.
Medications Medications A variety of medications, from over-the-counter topical solutions to oral or injected drugs that act in a systemic way, are used to treat psoriasis. Topical Psoriasis Treatments Topical treatments are applied directly to the skin and include lotions, ointments, creams, foams, solutions, sprays, and shampoos. These are usually the first option for treating mild to moderate psoriasis.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c92280bc-3a48-43cf-ae8b-3d067eb0df82 Topical Corticosteroids These anti-inflammatory medicines, generally referred to as steroids, are often used to treat psoriasis. Topical steroids are derived from the natural corticosteroid hormones produced by the adrenal glands and come in various brands and strengths. e60dc2a1-f33c-4a05-9b50-8e3e8e597629a462c746-572c-4dec-aabe-eedee8299688 Steroids can help control inflammatory responses in the body and reduce symptoms such as swelling, redness, and itchiness. There are seven classes of steroids, with the first being the highest strength and the seventh being the lowest strength. Medications in each class include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976299461994e-846f-44b8-b790-82b3b3f2ab73 Class 1 Clobetasol propionate 0.05 percent lotion (Temovate) or shampoo (Clobex) Class 2 Mometasone furoate 0.1 percent ointment (Asmanex) Class 3 Betamenasone valerate 0.1 percent ointment Class 4 Fluocinolone acetonide 0.025 percent ointment (Synalar) Class 5 Betamenasone valerate 0.1 percent cream or lotion Class 6 Desonide 0.05 percent ointment, gel, cream or lotion (DesOwen) Class 7 Hydrocortisone 0.5 percent to 2.5 percent ointment, gel, cream, or lotion Long-term use of powerful steroids can come with side effects such as skin thinning, changes in pigmentation, easy bruising, stretch marks, and dilated surface blood vessels.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296da44968-412f-4e9a-aa17-8509380de501 Vitamin D Analogues These medications help psoriasis by slowing skin-cell growth. Different types include calcipotriene (Dovonex) and calcitriol (Vectical). Calcipotriene combined with the topical steroid betamethasone is available under the brand name Taclonex.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f4d15820-183a-4db7-89a5-5429fe94a241 Topical Calcineurin Inhibitors (TCIs) Tacrolimus (Protopic) and pimecrolimus (Elidel) are used to treat psoriasis, especially in sensitive parts of the body such as the face or groin.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299461994e-846f-44b8-b790-82b3b3f2ab73 These medications aren’t specifically approved by the U.S. Food and Drug Administration (FDA) to treat psoriasis but can improve psoriasis rash and reduce scaly buildup.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298f42cf8d-956e-41a6-8d0b-736c415547dbe60dc2a1-f33c-4a05-9b50-8e3e8e597629324be3c9-1a2e-48a2-9c97-6b84ffd83196 Tapinarof (Vtama) Cream 1 Percent This topical steroid alternative is an aryl hydrocarbon (AHR) receptor agonist; AHR is a protein that has a role in regulating metabolism and the immune system. Tapinarof can be used in sensitive areas, such as the face, skin folds, or genitals.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f4d15820-183a-4db7-89a5-5429fe94a241 Roflumilast (Zoryve) Cream 0.3 Percent This medication is another topical steroid alternative. A topical phosphodiesterase-4 (PDE4) inhibitor, it works by targeting the PDE4, an enzyme involved with inflammation. Roflumilast has been shown to be effective in treating inverse psoriasis , a type of psoriasis that appears in skin folds. e60dc2a1-f33c-4a05-9b50-8e3e8e597629f4d15820-183a-4db7-89a5-5429fe94a241 Retinoids A retinoid is a synthetic form of vitamin A; the type that’s used as a topical treatment for psoriasis is called tazarotene (Tazorac). Retinoids can slow the growth of skin cells, reduce thick psoriasis plaques, lessen discoloration and swelling, and treat nail psoriasis . People who are pregnant or plan to become pregnant should not use these drugs.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f65f02c7-3a96-4e26-ae1d-b1544ec475d2 Salicylic Acid Often sold over the counter, this medication is a keratolytic (peeling agent) that causes shedding of the outer layer of your skin. In psoriasis, it helps soften and remove scales.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a1397b82-7cf6-4404-8e2e-989d3f0f4219 Coal Tar Coal tar topicals come in various formulations and are one of the oldest psoriasis treatments. These topicals contain actual tar that comes from coal and pine wood. Like salicylic acid, coal tar medication belongs to a class of drugs called keratolytics or keratoplastics. By slowing the rapid growth of skin cells, tar can restore the skin’s smooth appearance and help with symptoms like inflammation and itchiness.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a1397b82-7cf6-4404-8e2e-989d3f0f4219 Anthralin (Dritho-Scalp, Drithocreme, Micanol) This medication works to slow skin cell reproduction. It is approved to treat stable scalp psoriasis in people 12 and older.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f4d15820-183a-4db7-89a5-5429fe94a241 Systemic Therapies for Psoriasis These treatments target processes inside the body that are causing the psoriasis. Therapies are either oral (by mouth), injected, or intravenous (through an IV), depending on the drug. Systemic psoriasis therapies are usually reserved for people with moderate to severe disease and include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629744c437b-d987-414f-b123-108c8c01da26 Corticosteroids In some cases of severe psoriasis, a dermatologist may prescribe systemic steroids to reduce inflammation. But there is a risk that steroid withdrawal can lead to a pustular flare .e60dc2a1-f33c-4a05-9b50-8e3e8e597629cf4d6dd8-825f-4ef0-9045-fa3889523014 Biologic Medications These drugs are immunomodulators and protein-based medicines that are derived from living cells cultured in a laboratory. Biologics work by blocking (inhibiting) the action of a specific type of immune cell and proteins in the part of the immune system that is overactive. Typically, doctors reserve these medications for people with moderate to severe psoriasis, sometimes prescribing them in conjunction with another medication, such as a topical steroid. Biologics are generally administered either by an injection into the skin or via intravenous (IV) infusion.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d96a30a7-466a-41a7-b923-ba8f7cc4d92a Because biologics work by modulating the immune response, people who take certain biologics have an increased risk of developing a serious infection.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290e4b3903-6423-46e3-b9e4-6e72de37a6fd Researchers have linked numerous biological pathways to psoriasis, and different biologics target different pathways. Biologics for psoriasis can be grouped according to the inflammatory pathway they inhibit. Biologic medications include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976290e4b3903-6423-46e3-b9e4-6e72de37a6fde60dc2a1-f33c-4a05-9b50-8e3e8e597629ee36eed7-0c44-4cd1-b964-e245268b9294
Other Immunomodulators These medications suppress or regulate the part of the immune system that causes the overproduction of skin cells.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e2a9f939-eeba-4994-9e7f-45f65ca35520 They include: apremilast (Otezla) deucravacitinib (Sotyktu) Other Medicines Some other medicines approved by the FDA to treat psoriasis include: acitretin (Soriatane), an oral retinoid that works by decreasing the rate of skin cell proliferatione60dc2a1-f33c-4a05-9b50-8e3e8e59762928b6561d-3066-447e-9b1b-afe150df12c5 cyclosporine (Gengraf, Neoral, SandIMMUNE), an immunosuppressant approved for adults with severe psoriasise60dc2a1-f33c-4a05-9b50-8e3e8e5976294f78abb0-c7be-4671-8971-57e8015b8095 methotrexate, an immunosuppressant approved to treat severe psoriasis in adultse60dc2a1-f33c-4a05-9b50-8e3e8e5976293cc87271-c9fb-4039-ae29-9d631a1d664f Off-Label Medicines Sometimes doctors prescribe drugs off-label for psoriasis, which means the FDA didn’t specifically approve the drug for this purpose. Examples include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976294daf23a1-05f0-401e-9879-8a2d608fb780 hydroxyurea (Hydrea) isotretinoin (Accutane)e60dc2a1-f33c-4a05-9b50-8e3e8e59762928b6561d-3066-447e-9b1b-afe150df12c5 mycophenolate mofetil (CellCept) sulfasalazine (Azulfidine) 6-thioguanine
Light Therapy for Psoriasis Light Therapy Light therapy, also known as phototherapy, exposes skin to specific types of light. The treatment requires some dedication: A typical course of treatment is two to three times a week or more for several weeks.e60dc2a1-f33c-4a05-9b50-8e3e8e59762952c44f32-430f-465c-8c40-16171ff1d2bc Your doctor may suggest one or more of the following phototherapy or combination therapy approaches.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298d997647-1984-4038-973f-b1ce2ac73a82 Ultraviolet B (UVB) This treatment can be delivered as either broadband UVB (BB-UVB) or narrowband UVB (NB-UVB). PUVA (Psoralen and Ultraviolet A) A doctor might recommend combining ultraviolet A light with psoralen, a light-sensitizing medication that is most commonly administered orally. Taken shortly before light treatment, psoralen seems to boost the therapeutic effect of light on the immune system. Stable plaque psoriasis, guttate psoriasis , and psoriasis on the palms and soles seem to benefit most from PUVA therapy. Light therapy is administered in a psoriasis treatment center or hospital, or at home with a phototherapy unit. The FDA regulates medical devices used in the application of phototherapy. One phototherapy device, an excimer laser, can administer highly targeted beams of ultraviolet light to treat select areas of affected skin.e60dc2a1-f33c-4a05-9b50-8e3e8e597629dcd01547-cba0-415b-80a3-4308682068ab Before starting phototherapy, tell your doctor about any new drugs you are taking. Light therapy may not be recommended for people with certain medical conditions, such as lupus and porphyria, that require avoiding exposure to sunlight. Minor side effects of phototherapy can include sunburn-like reactions, mild stinging or burning, itching, or dark spots on the skin (most commonly in patients with darker skin tones). Patients and doctors should monitor skin closely for suspicious lesions and any other early signs of cancer .e60dc2a1-f33c-4a05-9b50-8e3e8e59762952c44f32-430f-465c-8c40-16171ff1d2bc Sunlight Exposure Short periods of exposure to natural sunlight, also called solar therapy or heliotherapy, may help improve psoriasis. To avoid the risk of sun damage, talk to your doctor about how much sunlight exposure is safe for your situation. It’s also recommended that you apply sunscreen with an SPF of 30 or higher to all areas of skin unaffected by psoriasis.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f08bb17d-13e5-4978-b22e-05f3a6339979
Complementary Treatments for Psoriasis Complementary Complementary therapies can sometimes improve symptoms of psoriasis . Although most of these approaches are safe, you should talk to your doctor before trying any new treatment or technique. Here are some examples of complementary methods commonly used to treat psoriasis. Diet and Nutrition There is no evidence that eating one particular diet can help manage or prevent psoriasis flares. But after a systematic review of scientific studies on psoriasis and diet , the medical board of the National Psoriasis Foundation published dietary recommendations. The authors found strong evidence that adults with overweight or obesity can improve their psoriasis by reducing their caloric intake to support weight loss. They also recommended a gluten-free diet for people with psoriasis who have confirmed celiac disease. For people who test positive for blood markers of gluten sensitivity, the board suggested a three-month trial of a gluten-free diet in addition to standard medical therapy.e60dc2a1-f33c-4a05-9b50-8e3e8e59762927ff006b-4aad-433b-b205-7f666462487b Healing Baths A quick soak in mineral water baths may help hydrate and soften psoriatic skin. Adding oatmeal, oil, Epsom salts, or Dead Sea salts to bathwater may help calm inflamed skin.e60dc2a1-f33c-4a05-9b50-8e3e8e597629041fb98b-eeae-41d2-8bac-75e04181cbc6 But stay away from hot water and harsh soaps, which can worsen symptoms. Over-the-Counter Topicals Products that contain aloe vera , jojoba, urea, zinc pyrithione, and capsaicin may help relieve itching, moisturize and soothe irritated skin, and remove scales. Be aware that even ingredients billed as natural may cause side effects or reactions.e60dc2a1-f33c-4a05-9b50-8e3e8e597629041fb98b-eeae-41d2-8bac-75e04181cbc6 Mindfulness Mindfulness is the practice of being fully present in the moment and accepting “what is” without judgment; it’s been shown to be effective in managing stress. There is evidence that regularly practicing mindfulness meditation can help manage psoriasis and improve quality of life, according to a systematic review.e60dc2a1-f33c-4a05-9b50-8e3e8e59762982d77725-5f7d-4bed-9c1c-60da63b96b7b Physical Activity A joint guideline review by the American Academy of Dermatology and the National Psoriasis Foundation recommended that dermatologists counsel their patients on lifestyle changes that include regular exercise in order to reduce the risk of associated comorbidities (diseases that often occur in people with psoriasis) such as metabolic syndrome.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292a8b15b5-abbc-443d-8bf5-d7be63d30798 Adults should get 150 minutes of moderate-intensity physical activity per week along with two days of muscle-strengthening exercises, according to the current Physical Activity Guidelines for Americans.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b1b2de48-944d-4bc8-8113-6c52b9a5ba85 Acupuncture This ancient Chinese practice may relieve psoriasis symptoms. An overview of systematic reviews concluded that acupuncture could be considered as a complementary part of a treatment plan, but that more rigorous studies are still needed.e60dc2a1-f33c-4a05-9b50-8e3e8e59762927dd61a5-35af-48dd-888d-e621538de480
Mental Health Mental Health Living with psoriasis can negatively affect your emotional health. Research has found that people with psoriasis are 1.5 times more likely to have depressive symptoms than people without the condition.e60dc2a1-f33c-4a05-9b50-8e3e8e597629de5190a3-03aa-41e7-beea-1afde672790b While emotional factors play a role, as psoriasis can affect your self-esteem or lead to social withdrawal, research suggests that depression associated with psoriasis may be due to the systemic inflammation that happens with the condition.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d464a3a3-624f-467b-bf20-d7d6bcb52275 Getting your psoriasis under control may help your mental health. Talk with your doctor, too, about medications to treat depression and anxiety, such as antidepressants including selective serotonin reuptake inhibitors (SSRIs).e60dc2a1-f33c-4a05-9b50-8e3e8e597629b5a37f2d-817a-416e-8503-3b1cbcbdea1f If you’re struggling with mental health issues, it’s also worth considering psychotherapy, stress reduction techniques, and finding a support group .
The Takeaway While there’s no cure for psoriasis, medical treatments can help you manage the symptoms. Treatments include topicals, phototherapy, and systemic drugs such as biologics. Regular exercise, stress reduction, and a healthy lifestyle can support overall well-being and potentially alleviate the condition’s severity. There are different types of psoriasis, and the severity of symptoms can vary; consult your doctor to come up with a treatment plan that works best for you.
Resources We Trust Mayo Clinic: Psoriasis Cleveland Clinic: Psoriasis American Academy of Dermatology: Psoriasis: Diagnosis and Treatment National Psoriasis Foundation: Treatment & Care National Institute of Arthritis and Musculoskeletal and Skin Diseases: Psoriasis
Additional reporting by Deborah Shapiro .
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