Psoriasis

Although there is no cure for psoriasis, we offer new and innovative treatments that can help you control your overactive symptoms. Treatments depend on the severity and extent of the condition and the locations of the affected skin. A treatment must be practical and work within an individual’s daily routine.

1. Topical Treatments for Mild to Moderate Psoriasis Cases

Topical treatments are the first line of treatment for mild cases of psoriasis. These medications are applied directly to the skin and help to reduce inflammation, slow down skin cell production, and relieve itching, redness, and flaking. Common topical treatments include:

• Topical Corticosteroids: These medications are most frequently prescribed for psoriasis. Corticosteroids reduce inflammation, swelling, and redness. When used consistently for longer than 3 weeks, corticosteroids can cause side effects such as skin thinning, easier bruising, and color changes.
• Calcineurin Inhibitors: These reduce inflammation and itchiness for plaque psoriasis on sensitive areas like the face and genitals and inverse psoriasis on the face, groin, skin under the breasts, and underarms. Possible side effects include burning and itching where the medication is applied but lasts short-term.
• Vitamin D Derivatives: Vitamin D deficiencies are linked to psoriasis. Taking vitamin D derivatives helps manage psoriasis by slowing down skin cell production, reducing inflammation, and can reduce its severity.
• Coal Tar Preparations: Patients have been using coal tar for more than 100 years to treat psoriasis. Coal tar can safely be used long-term and can be purchased as shampoos, ointments, foams, and as a bath solution. It can reduce swelling, itchiness, redness, redness, and scale of psoriasis.
• Salicylic Acid: This medication is a common and effective treatment for psoriasis that causes the outer layer of skin to shed, thus removing scales and softening the skin. It is generally safe and gentle for most skin types and can be purchased as lotions, creams, foams, gels, soaps, shampoos, liquids, cloth pads, and patches.
• Moisturizers: Though not technically considered a treatment, keeping the skin well-moisturized is vital to manage psoriasis symptoms. Thick creams and ointments help prevent the skin from drying out.

2. Phototherapy for Moderate to Severe Psoriasis

When topical treatments aren’t doing the trick, phototherapy, or light therapy, may be the next recommended step. This treatment exposes the skin to ultraviolet light which reduces skin cell growth and inflammation. The most common types of phototherapy include:

• Narrowband UVB Therapy: Ultraviolet light B (UVB) treatment can be used for localized areas, such as the hands and feet, the whole body, or in hand-held units. It is typically used for patients with moderate psoriasis and can be very effective after several treatments.
• Excimer Laser: This FDA-approved treatment effectively treats chronic, localized plaque psoriasis by emitting a high-intensity beam of ultraviolet light B (UVB). This treatment is particularly effective on scalp psoriasis.
• PUVA: When light-sensitizing agents called psoralens are combined with ultraviolet light A (UVA), you get PUVA. PUVA works best on stable plaque psoriasis, guttate psoriasis, and psoriasis of the palms and soles of the feet. This treatment is typically reserved for more severe cases of psoriasis as there is an increased risk of side effects such as burning and skin damage.

3. Prescription Medications for Severe Psoriasis

With moderate to severe psoriasis, or where the joints have been damaged (psoriatic arthritis), first-line treatments are not practical. If topical treatments and phototherapy are not effective, it may be time for prescription systemic medications, which affect the entire body and are taken orally or through injection. Some examples of prescription systemic medications include:

• Methotrexate: Methotrexate works by suppressing the immune system and reducing inflammation. It is mainly used for severe, erythrodermic, and nail psoriasis, as well as psoriatic arthritis.
• Cyclosporine: This medication also suppresses the immune system and is often used for severe or disabling psoriasis. Once the psoriasis is controlled, your provider may switch you to another treatment.
• Acitretin: Acitretin does not suppress the immune system, so it is often used for patients with other conditions that weaken the immune system, such as HIV. This medication can effectively treat guttate, plaque, pustular, and erythrodermic psoriasis.
• Biologics: Biologics are a newer breakthrough medication specifically targeting the part of the immune system that is overactive because of psoriasis. This protects the other organs, such as the liver and kidneys, that process and remove other medications from the body. Biologics can be life-altering for some patients and make nearly all psoriasis areas dormant. Common biologics include:
  • Humira
  • Enbrel
  • Stelara
  • Tremfya
  • Cosentyx
  • Otezla

Deciding which medication is best depends on many variables, including where and what type of psoriasis a patient has, if someone has psoriatic arthritis or other medical conditions that may be impacted by certain biologics, ultimately requiring a thorough conversation with your dermatologist.