Currently there is no cure for psoriasis. But many types of treatment are available, including products applied to the skin, phototherapy, and oral medicines, which can help control psoriasis. Most cases are mild and can be treated with skin products. In some cases, psoriasis can be hard to treat if it is severe and widespread. Most psoriasis returns, even mild forms.
The purpose of treatment is to slow the rapid growth of skin cells that causes psoriasis and to reduce inflammation. Treatment is based on the type of psoriasis you have, its location, its severity, and your age and overall health. It also depends on how much you are affected by the condition, either physically (because of factors such as joint pain) or emotionally (because of embarrassment or frustration from a skin rash that may cover a large or visible area of the body).
Medicines applied to the skin (topical treatments)
Treatment for mild psoriasis, characterized by a few isolated raised patches, begins with skin care, which includes keeping your skin moist. Basic treatment often involves combining treatments and products that you can get without a prescription, including:
- Creams, ointments, and lotions to moisturize the skin.
- Shampoos, oils, and sprays to treat psoriasis of the scalp.
- Some exposure to sunlight.
It is also important to avoid what can trigger a flare-up of psoriasis or make the condition worse. Stress, skin injury, infection, and use of alcohol can all contribute to symptom flare-ups. Streptococcal infections, which usually affect the upper respiratory tract, are associated with guttate psoriasis.
Effective treatment will improve your overall well-being and reduce your physical symptoms.
You may try prescription medicines if your psoriasis is not helped by products you can get without a prescription. Topical medicines for psoriasis treatment include:
- Vitamin D compounds, such as calcipotriene.
- Topical corticosteroids, such as betamethasone.
- Anthralin and tars.
- Retinoids, such as tazarotene.
A treatment called occlusion therapy may be effective for some people. This involves first applying skin products, such as moisturizers, medicated creams, or gels, then wrapping the skin with tape, fabric, or plastic. Occlusion helps keep the area moist and increases the effectiveness of medicated creams. Talk to your doctor before using occlusion therapy, to make sure that you do it safely.
Treatment using more than one topical medicine is often done. This can help prevent side effects from some of the stronger medicines. For example, you may use one medicine during the week but another on the weekend.
Creams, ointments, lotions, and other medicines spread on the skin work better for some people than for others. If one medicine does not clear up your psoriasis, your doctor will likely advise you to try another medicine or combination of treatments.
Creams and ointments may be used in combination with sunlight orultraviolet light (phototherapy) for moderate psoriasis that affects less than 20% of the skin surface (about equal to having both arms completely covered).
If you use phototherapy (brief exposures to ultraviolet light such as ultraviolet B light, also known as UVB), follow your doctor's instructions carefully to avoid serious skin damage.
- UVB light therapy often improves psoriasis. UVB treatment is usually done 3 times a week. Treatment of psoriasis with UVB and with medicines spread on the skin, such as tar or calcipotriene, is safe and effective.6
- Psoralen and UVA light therapy (PUVA) combines a medicine and ultraviolet A light (UVA) for psoriasis treatment. First, you use a medicine, called a psoralen. You may take it as a pill, spread it on your skin as a lotion, or use it as bath salts. The medicine makes the skin more sensitive to UVA light. Then you walk into a chamber where your skin is exposed to UVA light. PUVA treatment usually is done for weeks before the psoriasis symptoms go away.
Treatment with UVB appears to be safer than PUVA, but it is less effective.7
Medicines taken by mouth (oral)
If you have moderate to severe psoriasis, your doctor may recommend a medicine you take by mouth (oral medicine), such asmethotrexate, some retinoids, andcyclosporine. Oral medicines also may be used if topical medicines and phototherapy are not controlling your psoriasis well enough.
- For many people, methotrexate works well to control psoriasis that has not improved after other treatments. Methotrexate also is used to treat psoriatic arthritis. Methotrexate cannot be used for women who arepregnant or are planning to become pregnant within 3 months. Men whose partners are planning to become pregnant should also avoid using methotrexate.7
- Retinoids are medicines related to vitamin A. Acitretin is the most common oral retinoid used to treat psoriasis. Because retinoids do not weaken the immune system, they are sometimes used for children and for people who have psoriasis along with other conditions such as HIV infection.7 Retinoids cannot be used for women who are pregnant or who are planning to become pregnant.
- Cyclosporine may be used as a short-term treatment for moderate to severe psoriasis. But this medicine weakens the immune system and so is often rotated with other medicines to treat psoriasis.
These oral medicines are usually used along with medicated products you spread on your skin (topical treatments). They also may be used along with exposure to ultraviolet light.
Oral treatment for children is reserved for severe psoriasis, because the safety of these medicines in children has not been well tested.
In rare cases, medicine may be injected into a skin sore or patch (plaque).
Biologics are medicines similar to or the same as proteins made by the body. These medicines, such as alefacept and etanercept, block the harmful response of the body's immune system that causes the symptoms of psoriasis.
Biologics are used mainly for people who cannot use other treatments or whose psoriasis did not improve with other types of therapy. Although biologics may not be more effective than other treatments for psoriasis, they may be safer for organs, such as the liver or kidneys, that some oral medicines can damage. But the long-term safety of biologics is not known.
What To Think About
You may need to try different treatments before you find one that works well for you. It is important to discuss your treatment and progress with your doctor.
One study found that education, stress reduction, and muscle relaxation training can help many people who have psoriasis. Adding these elements to a treatment plan can reduce disability, anxiety, and stress related to dealing with psoriasis.8
Treatments for psoriasis have potential side effects. People with moderate or severe psoriasis may need treatment for the rest of their lives. Many doctors will recommend that treatments be changed or rotated after a certain period of time to make treatment more effective and to reduce side effects.