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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 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 broken down into categories by the way in which they are taken. Some treatments for skin psoriasis are topical — applied directly to the skin. Other treatments for psoriasis or psoriatic arthritis are taken orally or injected into the skin (subcutaneous), veins (intravenous), or joints.
The effects of topical treatments are limited mainly to the skin and will not help with psoriatic arthritis. Topical treatments for psoriasis can come in a variety of forms, including ointment, cream, spray, foam, shampoo, and lotion. Different forms of topical medication are better for different parts of the body or different types of psoriasis. For instance, medicated shampoo and solutions work well for the scalp.
Some topical medications are available over the counter (OTC) in pharmacies without a doctor's prescription. Two ingredients approved by the FDA for treating psoriasis that may be found in OTC preparations are coal tar, sold under the brand name Psoriasin, and salicylic acid.
Corticosteroids, or simply steroids, are among the most frequently used treatments for psoriasis. Corticosteroids are synthetic hormones that suppress immune system response. Cortisone, Hydrocortisone, Beclomethasone, Prednisone, Prednisolone, and Methyl-prednisolone are examples of corticosteroids. Corticosteroids are believed to work by inhibiting or blocking inflammatory responses within the body. Hydrocortisone, a milder steroid, is an ingredient in some OTC products at a lower strength. Stronger steroids such as Luxiq (Betamethasone), Kenalog (Triamcinolone acetonide), and Elocon (Mometasone) as 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. Dovonex (Calcipotriene), a derivative of vitamin D, is believed to slow the growth of skin cells. Topical immunosuppressants include Protopic (Tacrolimus) and Elidel (Pimecrolimus), which work similarly to steroid creams to suppress the inflammation in the skin. Some topical treatments are combinations of two different drugs that work together to fight psoriasis. Taclonex (Betamethasone/Calcipotriene), 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 redness, 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 Cushing’s syndrome, a metabolic disorder that involves weight gain, muscle weakness, high blood pressure, and high blood sugar.
Oral medications are prescribed in cases of psoriatic arthritis, when plaque psoriasis covers 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, Sulfasalazine, and Methotrexate. Plaquenil (Hydroxychloroquine) is an antimalarial drug with anti-inflammatory effects. Otezla (Apremilast) is a newer anti-inflammatory medication. 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 — on a systemic basis 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.
In cases of psoriatic disease that is severe or difficult to control, injected medications may be prescribed. Steroids and Acthar gel, a drug closely related to 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. Remicade (Infliximab) and Simponi (Golimumab) are administered as intravenous infusions. Biologics including Enbrel (Etanercept), Cosentyx (Secukinumab), Stelara (Ustekinumab), and Cimzia (Certolizumab pegol) can be self-administered as subcutaneous injections. Biologic drugs for psoriatic disease are generally indicated to be injected once every few weeks to 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 psoriasis 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 doctor 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, medically supervised treatments with specialized ultraviolet B light, or ultraviolet A light combined with Psoralen for 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.
Using moisturizers can help soothe itching, redness, 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 studying the effects of nutrition in people with psoriasis recommend a balanced diet with plenty of fresh fruit and vegetables, whole grains, and unsaturated fats. Maintaining a healthy weight can help reduce the severity of psoriasis and psoriatic arthritis symptoms. People with psoriasis have a higher risk of developing dangerous 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 anti-inflammatory diet.
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 obesity, osteoporosis, heart disease, diabetes, and depression. Research has proven that regular exercise helps people with psoriatic disease maintain a healthy weight, 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. Deep breathing, meditation, prayer, yoga or tai chi, connecting with family and friends, going to psychotherapy sessions, and taking an antidepressant medication are a few ways some people with psoriasis find relief from stress.
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 is 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 and more recently developed medications can lead to completely clear skin.
Which psoriasis treatments should I avoid?
Any medication can cause side effects. Each psoriasis treatment has specific potential side effects associated with it. This does not mean that anyone who takes that psoriasis medication will experience all, most, or any of the side effects it can potentially cause. Some side effects are very common, while some are extremely rare. Risk for side effects may depend on whether you have other conditions or are taking other medications, as well as your age and ethnicity. Your doctor can help you assess the risks and benefits of each psoriasis treatment as they relate to your family medical history and condition. Read more about side effects of specific treatments in Treatments A-Z.
Can I get assistance paying for psoriasis medications?
Most people with private or employer-sponsored health insurance are eligible for copay assistance programs through the manufacturers of biologic treatments. Some people with low income and no health insurance may qualify for free psoriasis medications through nonprofit organizations, medical foundations, or drug manufacturers.