Your health care provider will ask questions about your health and examine your skin, scalp and nails. Your health care provider then might take a small sample of skin (biopsy) for examination under a microscope. This helps determine the type of psoriasis and rule out other disorders.
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.
Treatment Of Psoriasis
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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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Coping with psoriasis can be a challenge, especially if the affected skin covers a large area of your body or is visible to other people. It can cause discomfort and embarrassment. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden.
If you have psoriasis, your dermatologist will create a treatment plan that meets your individual needs. An individualized treatment plan has many benefits. It can relieve symptoms like itching. It can help you see clearer (or clear) skin. It can also prevent psoriasis from worsening.
Topical (applied to the skin) medication may also be part of a treatment plan for patients with more extensive psoriasis. For these patients, a topical medication may be used along with light therapy or medication that works throughout the body like methotrexate or a biologic.
Many patients use this medication to treat psoriasis. A corticosteroid works quickly and is available in many strengths, which makes it beneficial for treating all types of psoriasis from the very mild to thick plaques.
While many medications applied to the skin can treat plaque psoriasis, roflumilast can also effectively treat a type of psoriasis called inverse (aka intertriginous) psoriasis, which affects the body folds.
In the studies that led the FDA to approve roflumilast, the cream worked quickly to reduce the itch and clear psoriasis. This cream should be applied once a day to the skin with psoriasis and can be used for as long as needed.
Medication that works throughout the body: Some people need strong medication to treat their psoriasis, especially if the psoriasis also affects their joints. For these people, medication that works throughout the body may be the best option.
For many people, taking a biologic is life-changing because it helps control psoriasis, psoriatic arthritis, or both when other treatments fail. A biologic may be prescribed alone or along with another psoriasis treatment. To learn more about biologics, go to Psoriasis treatment: Biologics.
A biosimilar is a medication that is very similar to a biologic, but may cost less than the original biologic. For more information about biosimilars, read Biosimilars: 14 questions patients ask their dermatologist.
Used for more than 40 years to treat psoriasis, this medication is prescribed to treat severe, disabling psoriasis. If this medication is part of your treatment plan, you should not drink alcohol while on methotrexate.
Finding the right treatment can be challenging. Sometimes, a medication used to treat another condition works best for treating severe psoriasis. To learn more about these medications, go to Psoriasis treatment: Off-label medications that work throughout the body.
Salicylic acid. This can soften and thin scaly skin. But it can also irritate your skin if you leave it on too long. It might weaken your hair follicles and cause temporary hair loss, too. The body can absorb salicylic acid if you put it on large patches of skin.
Coal tar ointment and shampoo. Coal tar is known to ease psoriasis-related inflammation, itching, and scales. But it can cause side effects such as skin redness and dryness. It can also make your skin more sensitive to UV light. These are not recommended for pregnant and breastfeeding women. Ask your doctor how to use it.
Prescription retinoid. These are ointments made with synthetic vitamin A. Your doctor might want you to use a steroid at the same time. That can lower your odds of skin irritation caused by the retinoid.
Methotrexate. This is only for people with serious symptoms. It can raise your odds of liver disease and lung or kidney problems. Your doctor will give you lab tests every so often to make sure your organs are healthy.
Oral retinoids are often used to treat pustular psoriasis. But they can cause unwanted side effects, including hair loss and liver or bone problems. Your doctor may lower your dose once your symptoms get better.
Apple cider vinegar. This is sometimes used to ease itching from scalp psoriasis. You can use it a few times a week. Make sure you mix more parts water than vinegar. Otherwise, the vinegar can burn your skin. Avoid any open wounds.
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Importance: Approximately 125 million people worldwide have psoriasis. Patients with psoriasis experience substantial morbidity and increased rates of inflammatory arthritis, cardiometabolic diseases, and mental health disorders.
Observations: Plaque psoriasis is the most common variant of psoriasis. The most rapid advancements addressing plaque psoriasis have been in its pathogenesis, genetics, comorbidities, and biologic treatments. Plaque psoriasis is associated with a number of comorbidities including psoriatic arthritis, cardiometabolic diseases, and depression. For patients with mild psoriasis, topical agents remain the mainstay of treatment, and they include topical corticosteroids, vitamin D analogues, calcineurin inhibitors, and keratolytics. The American Academy of Dermatology-National Psoriasis Foundation guidelines recommend biologics as an option for first-line treatment of moderate to severe plaque psoriasis because of their efficacy in treating it and acceptable safety profiles. Specifically, inhibitors to tumor necrosis factor (TNF-) include etanercept, adalimumab, certolizumab, and infliximab. Other biologics inhibit cytokines such as the p40 subunit of the cytokines IL-12 and IL-13 (ustekinumab), IL-17 (secukinumab, ixekizumab, bimekizumab, and brodalumab), and the p19 subunit of IL-23 (guselkumab, tildrakizumab, risankizumab, and mirikizumab). Biologics that inhibit TNF-, p40IL-12/23, and IL-17 are also approved for the treatment of psoriatic arthritis. Oral treatments include traditional agents such as methotrexate, acitretin, cyclosporine, and the advanced small molecule apremilast, which is a phosphodiesterase 4 inhibitor. The most commonly prescribed light therapy used to treat plaque psoriasis is narrowband UV-B phototherapy. 152ee80cbc
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