Psoriasis is an autoimmune skin condition in which skin cells reproduce themselves too quickly and cause a buildup. If you have psoriasis, you may notice flaky patches on your skin that can form a scale-like appearance.
Our body typically replaces skin cells every 3–4 weeks, but in people with psoriasis, this usually happens in 3–7 days.
Treatment types
Psoriasis treatments aim to improve symptoms and discomfort. The recommended treatment depends on the severity of the condition and the area it affects.
Doctors divide psoriasis into treatment three categories:
- topical, such as creams and ointments
- systemic, including injections and oral medications
- phototherapy
Your doctor can recommend the most effective treatment plan for your condition.
Topical treatments and side effects
Doctors usually recommend topical therapy for mild psoriasis. Topical treatments may include:
| Name | Uses | Side effects |
|---|---|---|
| Anthralin | • raised, scaly skin patches, known as plaques | • skin irritation • skin staining |
| Coal tar | • plaque psoriasis • itch • difficult to treat palm and sole psoriasis • can use with dressings • doctors may use it alongside UVB light therapy | • skin staining • skin odor • irritation • contact dermatitis • stinging • folliculitis |
| Salicylic acid | • removes excess skin • increases hydration Doctors may also recommend using salicylic acid after phototherapy as it blocks UV light. | • systemic intoxication • headaches • nausea • vomiting • tinnitus • burning sensation in mouth |
| Topical retinoids such as tazarotene | • plaque psoriasis • nail psoriasis You should not use topical products such as tazarotene on sensitive areas like the face or genitals. | • localized irritation Doctors advise against using tazarotene during pregnancy. |
| Topical corticosteroids | • psoriasis management at all stages The recommended strength depends on which area needs treatment and the severity. | • blood vessel dilation and rupture near the skin’s surface • stretch marks • hyperglycemia (long-term use only) |
| Vitamin D analogs (calcipotriene, calcitriol, tacalcitol) | • nail psoriasis • plaque psoriasis • chronic plaque psoriasis | • localized irritation • high calcium levels in blood (hypercalcemia) • high calcium levels in urine (hypercalciuria) • irregular calcium levels (parathyroid hormone suppression) |
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Oral medications and side effects
If you have moderate or severe psoriasis, you may need additional or other medications. Oral medications include:
| Name | Typical use | Side effects |
|---|---|---|
| methotrexate (Rheumatrex, Trexall) | • typical starting dose 2.5 milligrams (mg) to 10 mg once per week • slow increase up to 30 mg possible | • nausea • gastrointestinal problems • increased risk for infections • liver symptoms with prolonged use |
| cyclosporine (Neoral, Gengraf, Cyclosporin Pro, or Sandimmune) | • one capsule, taken at the same time each day • doses can increase or decrease • doctors may recommend only taking in the short term | • unusual skin sensations, including tingling, numbness, or needles • headaches • joint pain • raised blood pressure • muscle twitching • unsuitable for people with kidney failure or during pregnancy |
| acitretin (Soriatane) | • initial daily tablets of 25–50 mg • could reduce to 10 mg once symptoms improve | • dry mouth, skin, and lips • eyelid inflammation (you should not wear contact lenses while treated with acitretin) • light sensitivity • hair loss • may make birth control pills less effective • may cause fetal developmental issues if taken while pregnant |
| apremilast (Otezla) | • 30-mg dose, twice each day, 12 hours apart • if no improvement after 24 weeks, doctors may try another treatment | • nausea • vomiting • diarrhea • stomach pain • headache • fever • sore throat |
Injectables and side effects
If topical, light, and oral medications do not help your symptoms, doctors may consider injectable medications. These are biological drugs that suppress the immune system. Because of this, they come with some risk of infection, typically in the urinary and respiratory systems.
Doctors do not typically recommend biological drugs for those with:
- cancer
- liver or kidney failure
- multiple sclerosis
- hepatitis
- heart infection
- tuberculosis
The table below shows the drugs available and how they’re used.
| Name | Use |
|---|---|
| adalimumab (Humira) | • initial 80-mg dose injected under the skin • every other injection will contain 40 mg • 1 dose per week for the first 2 weeks, then 1 dose every 2 weeks |
| etanercept | • initial 50-mg dose, twice weekly, injected under the skin for 3 months • then 50-mg doses once per week |
| infliximab | • initial dose of 5-mg per kilogram (kg) of body weight, administered intravenously • second dose is 2 weeks later • third dose 4 weeks later • after that, doses are every 8 weeks |
| secukinumab (Cosentyx) | • initial 300-mg injections once per week for the first 4 weeks • then 300-mg doses once each month |
| ustekinumab (Stelara) | body weight 100 kg or less: • initial 45-mg injection • 45-mg injection 4 weeks later body weight greater than 100 kg: • initial 90-mg injection • 90-mg injection 4 weeks later • 90-mg injection every 12 weeks |
Light therapy and other therapies (including any side effects)
Light therapy (phototherapy) is widely used to treat psoriasis.
Types of light used for phototherapy can include:
| Name | Use |
|---|---|
| Ultraviolet B (UVB) | It can only reach the upper levels of your skin, and it is typically used to treat stable plaque psoriasis. |
| Ultraviolet A (PUVA) | It can penetrate deep into your skin, and it can be recommended for treating refractory psoriatic plaques, palmoplantar pustular psoriasis, and stable plaque psoriasis. |
| Pulsed dye laser (PDL) | It is commonly used for nail psoriasis. |
| Photodynamic therapy (PDT) | This type of light is mainly used to treat nail psoriasis, but it may also be effective for chronic plaque psoriasis. |
| Intense pulsed light (IPL) | It can be used alongside PDL to treat nail psoriasis. |
Light therapy has some side effects, including:
- a stinging sensation
- a mild sunburn
- blisters
- dark skin patches (often more noticeable in dark skin tones)
- premature skin aging
- an increased risk for skin cancer
Natural treatments
According to a 2018 study, around 86% of people with mild or moderate psoriasis responded well to ointment medications containing a mixture of bee propolis and aloe vera.
However, more research is necessary to confirm the effects of these ingredients on psoriasis.
Summary
There are various types of psoriasis treatment. Doctors typically recommend topical medications for mild cases, but often recommend oral medications, injections, or light therapy for moderate and severe psoriasis forms.
Your doctor or healthcare team can recommend the most effective treatment for you. However, it may take a few weeks to notice an improvement.
There may be some side effects along the way, but your doctors can help you manage those, too.
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