Since there is no cure for psoriasis, treatment is focused on reducing the inflammation and slowing down the rapid skin growth responsible for the psoriatic patches as well as removing the patches.
Treatments for psoriasis depend on many factors, such as the type of psoriasis and its severity, the patient’s age, overall health, the disease progression and response to medications, and preferred medications and therapies.
Treatments for psoriasis usually includes topical therapy (corticosteroids, Vitamin D analogues, retinoids, calcineurin inhibitors, salicylic acid, coal tar, Goeckerman therapy, and anthralin), light therapy, other oral or injected medications, biologics, and alternative medications and therapies.
Treatments for psoriasis usually begin with topical and light therapies, and then progress to systemic therapies.
Topical therapy – Topical therapy for psoriasis includes corticosteroids, Vitamin D analogues, retinoids, calcineurin inhibitors, salicylic acid, coal tar, Goeckerman therapy, and anthralin.
Corticosteroids – Corticosteroids can help reduce the inflammation of psoriasis and can be administered as a cream, ointment, gel, or foam and include the medications, triamcinolone (Acetonide, Trianex) and clobestasol (Temovate).
Vitamin D analogues – Vitamin D analogues (calcipotriene and calcitriol) are synthetic forms of Vitamin D that help decrease the rate of skin growth in psoriasis and may be combined with corticosteroids ointments or creams.
Retinoids – Retinoids (Tazarotend gel or cream) are derived from Vitamin A and can improve skin conditions in psoriasis.
Calcineurin inhibitors – Calcineurin inhibitors (Tacrolims and pimecrolimus ) help to reduce inflammation and plaque formation in psoriasis.
Salicylic acid – Salicylic acid can be administered via shampoos and scalp solutions to treat scalp psoriasis.
Coal tar – Coal tar helps to reduce the inflammation, itching, and scaling associated with psoriasis and can be administered via shampoo, cream, or oil.
Goeckerman therapy – Goeckerman therapy is a combination therapy of coal tar combined with light therapy that is more effective for psoriasis than either treatment alone.
Anthralin – Anthralin is a tar cream that can help to decrease the skin growth in psoriasis as well as remove the scales.
Light therapy – Light therapy is commonly the first line of treatment for moderate-to-severe psoriasis and can be used in combination with other treatments. Several types of light therapy can be used in the treatment of psoriasis, including sunlight, UVB broadband, UVB narrowband, Psoralen plus ultraviolet A (PUVA), and excimer laser therapy.
Sunlight – Daily exposure to sunlight (heliotherapy) may improve psoriasis.
UVB broadband – UVB broadband light therapy can be administered in controlled doses to treat psoriasis patches, body-wide psoriasis, or psoriasis that has not improved with topical therapy.
UVB narrowband – UVB narrowband may work better than UVB broadband and can be used two or three times a week to improve skin in psoriasis.
Psoralen plus ultraviolet A (PUVA) – This therapy for psoriasis uses both light therapy and medication to make the skin more receptive to treatment.
Excimer laser – This light therapy uses more powerful UVB light directed at only the affected skin in psoriasis.
Other oral or injected drugs – If psoriasis does not respond to topical or light therapies or is severe, other oral or injected drugs may be administered, and include methotrexate (Trexall) for psoriatic arthritis, the immunosuppressant, cyclosporine (Neoral), biologics (etanercept , infliximab , adalimumab , ustekinumab , secukinumab , and ixekizumab , which use the body’s immune system to improve psoriasis, and medications that are given when other drugs cannot be used, such as thioguanine (Tabloid), hydroxyurea (Droxia, Hydrea), and apremilast (Otezla).
Alternative medicine – Alternative therapies for psoriasis are focused on helping to ease the symptoms and may include dietary supplements, special diets, herbs, and creams and include aloe extract cream (reduces inflammation, redness, itching, and scaling), fish oil supplements (may reduce amount of psoriasis or scaling when combined with UVB therapy), Oregon grape (barberry; may reduce psoriasis severity), and essential oils to reduce stress and anxiety. However, it is always important to speak with your doctor first before using any alternative therapies.
As some patients may become resistant to some treatments for psoriasis, their doctor may periodically switch treatments.