There are now more effective treatments for psoriasis than ever before. Some treatments are approved by the U.S. Food and Drug Administration (FDA) for the skin forms of psoriasis or plaque psoriasis only, while others are approved to treat psoriatic arthritis. Some medications can treat multiple types of psoriatic disease.
Guidelines for psoriasis treatment generally recommend trying the safest treatments first and moving to more intensive treatments with more serious potential side effects if the first-line treatments fail. Guidelines also take into account the severity and extent (how much skin is covered) of psoriasis symptoms.
Psoriasis treatments can be categorized by the way they are taken. Some treatments for skin psoriasis are topical — applied directly to the skin. Other treatments for psoriasis or psoriatic arthritis are taken:
Read on to learn more about six types of treatment for psoriasis and how they work to help symptoms.
The effects of topical treatments are limited mainly to the skin and won’t help psoriatic arthritis. Topical treatments for psoriasis can come in a variety of forms, including:
Different forms of topical medication are better for different parts of the body or different types of psoriasis. For instance, medicated shampoos work well for the scalp.
Some topical medications are available over the counter in pharmacies without a doctor's prescription. Coal tar and salicylic acid are two FDA-approved ingredients for treating psoriasis found in over-the-counter products.
Corticosteroids, or simply steroids, are among the most frequently used treatments for psoriasis. Corticosteroids are synthetic hormones that suppress immune system response.
Examples of corticosteroids include:
Scientists believe corticosteroids work by blocking inflammatory responses within the body. Hydrocortisone, a milder steroid, is an ingredient in some over-the-counter products at a lower strength.
Stronger steroids, such as betamethasone (Luxiq), triamcinolone acetonide (Kenalog), and mometasone (Elocon), are available by prescription only. Stronger steroids are reserved for more severe disease and can thin the skin over time.
Other prescription topical medications for psoriasis include immunosuppressants and synthetic forms of vitamin D. Calcipotriene (Dovonex), calcitriol, and tacalcitol are vitamin D derivatives which are believed to slow the growth of skin cells.
Topical immunosuppressants include tacrolimus (Protopic) and pimecrolimus (Elidel), which work similarly to steroid creams to suppress the inflammation in the skin. Tapinarof is a topical immunosuppressant approved for the treatment of plaque psoriasis in adults in 2022. Roflumilast is a phosphodiesterase 4 inhibitor that was also approved for the treatment of plaque psoriasis in 2022.
Some topical treatments are combinations of two different drugs that work together to fight psoriasis. Betamethasone/calcipotriene (Taclonex), which contains a steroid and a powerful form of vitamin D, is one example.
Side effects from topical psoriasis treatments are usually limited to the skin. Some cause skin discoloration, sensitivity to light, or other skin reactions — especially when treatment first begins. Some topical psoriasis medications and stronger corticosteroids should be used for limited periods of time to avoid side effects, such as stretch marks, changes in pigmentation, allergic reactions, and skin atrophy — which thins skin and may cause depressions or wrinkles.
Used over large areas of skin for long periods of time, powerful topical steroids can be absorbed into the bloodstream and cause systemic problems such as:
Oral medications are prescribed for psoriatic arthritis, for cases of plaque psoriasis that cover a significant percentage of the skin, or when topical drugs fail to control plaque psoriasis. Some oral drugs prescribed for psoriatic disease are types of immunosuppressants, such as cyclosporine and sulfasalazine.
Hydroxychloroquine (Plaquenil) is an antimalarial drug with anti-inflammatory effects. Apremilast (Otezla) and deucravacitinib (Sotyktu) are anti-inflammatory oral medications that may be used for psoriasis. Acitretin is an oral systemic retinoid used for severe psoriasis, and it may be used in combination with ultraviolet therapy. Oral corticosteroids may be given for short periods of time during flare-ups of psoriasis or psoriatic arthritis, but they may result in a rebound flare and should be used with caution.
Unlike topical medications, the effects of oral psoriasis medications are not limited to the skin. They have effects — and cause side effects — throughout the body. Some suppress the immune system and may require lab tests to monitor side effects on the kidneys and liver. Side effects such as Cushing’s syndrome are more likely to develop when taking steroids orally, especially over longer periods of time.
For moderate to severe psoriasis, injected medications may be prescribed. Steroids may be injected into joints or veins during flares. Similarly, methotrexate may be given intravenously during severe psoriatic disease flares.
Several injected medications are newer biologic drugs designed to suppress specific aspects of the immune system responsible for inflammation in psoriasis and psoriatic arthritis. Biologics are usually taken long-term as maintenance drugs to prevent disease flares. Infliximab (Remicade) is a biologic that’s administered as an intravenous infusion.
Biologics that can be self-administered as subcutaneous injections include:
Biologic drugs for psoriatic disease are usually injected once every few weeks or every few months. There are more than 10 commercially available biologics for psoriatic disease.
Like oral medications, injected medications can cause unwanted side effects on a systemic basis throughout the body. Since biologics suppress aspects of the immune system, many of these treatments can increase your risk for contracting infections and, in rare cases, developing certain types of cancer.
Each psoriasis treatment has specific side effects and different levels of risk. Your dermatologist can help you understand the benefits and risks of each psoriasis medication based on your medical history and individual condition.
Phototherapy, also called light therapy, involves the use of different types of light to treat plaque psoriasis. Types of phototherapy can include exposure to sunlight or medically supervised treatments with specialized ultraviolet light — ultraviolet B light (UVB) or ultraviolet A (UVA) light combined with Psoralen, called PUVA therapy.
Laser treatment is a type of phototherapy that uses special lasers to treat affected skin and improve psoriasis symptoms. Long-term light therapy may lead to an increased risk of certain types of skin cancer.
Making some lifestyle changes can help you get a better handle on your symptoms.
Using moisturizers, creams, and ointments can help soothe itching and dryness and prevent your psoriasis from getting worse. Moisturizers work by trapping water in the skin and maintaining the skin’s natural barrier. The regular application of moisturizers can promote healing in skin affected by psoriasis. Thicker and greasier ointments may be more effective, as they are more protective of the skin barrier.
There is no specific diet that helps everyone with psoriasis, but many physicians and researchers recommend a balanced diet with plenty of fresh fruit and vegetables, whole grains, and unsaturated fats.
People with psoriasis have a higher risk of developing health conditions such as diabetes, osteoporosis, and heart disease. A balanced, nutritious diet can help lower the risk. Some people with psoriatic disease report reduced symptoms after adopting a gluten-free diet or an anti-inflammatory diet, although there is no single diet that has been proven to slow or cure psoriasis.
People with psoriasis and psoriatic arthritis are less likely to exercise than those without psoriasis. Embarrassment, pain, stiffness, and swelling lead many people with psoriatic disease to give up on exercise and become increasingly sedentary. However, lack of physical activity can lead to increased stiffness and contribute to the development of other serious conditions, such as osteoporosis, heart disease, diabetes, and depression. Research has proven that regular exercise helps people with psoriatic disease keep joints flexible and reduce inflammation and stress.
Stress is a common trigger for psoriasis flares, and reducing stress may have benefits for people with psoriatic disease. Some ways to find stress relief include:
Some people with psoriasis have reported feeling better after trying various complementary or alternative therapies, such as acupuncture or acupressure. Natural treatments cannot replace clinically proven medications — no alternative treatments have been proven effective in studies to prevent relapses or delay disease progression.
Some natural treatments, such as nutritional or herbal supplements, can interfere with psoriasis medications or cause their own side effects. It’s important to talk to your doctor before trying alternative therapies.
Despite encouraging research, there is at present no cure for psoriasis. The good news is that while psoriasis is not yet curable, it is treatable. More recently developed medications can even lead to completely clear skin for some people. Talk to your doctor about the best treatment plan for you.
On MyPsoriasisTeam, the social network for people with psoriasis and their loved ones, more than 117,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.
Which psoriasis treatments have been helpful for you? Share your experience in the comments below, or start a conversation by posting on MyPsoriasisTeam.