A Beginner's Guide to Psoriasis Treatments

4 of the most common types of psoriasis treatments available today

Common Psoriasis Treatments

Psoriasis is a lifelong disease and while currently there is no cure, fortunately there are effective treatments. Treatments are aimed at controlling the symptoms and preventing long-term damage to the joints in those people who have associated arthritis.

Treatment is also very individualized. Factors that may affect your treatment options could include:

  • your age
  • pregnancy or plans for pregnancy
  • other health conditions (for example diabetes, Hepatitis C, or tuberculosis)
  • other medications you take

All medications have potential side effects, so you should discuss with your doctor how you would like to balance the risks of side effects with the potential benefits to your psoriasis. It is important to find a dermatologist and/or rheumatologist who is experienced treating psoriasis to help tailor a plan to your specific needs.

Although numerous different approaches have been used throughout history, there are four common categories of psoriasis treatment in the modern arsenal. These treatments are covered only in a general sense in this article, so it is very important to review all of the potential risks, benefits, and possible interactions of any treatment with your doctor and/or pharmacist before proceeding.

Topical Treatments

Topical treatments include anything you apply to the skin, such as creams, ointments, sprays, foams, or medicated tapes. Many people with psoriasis have a drawer full of old tubes and pots of topical treatments they have used over the years. Most common are topical steroids, which decrease the inflammation in the skin and come in many strengths and forms. Vitamin D creams are also common although usually not as strong as steroids.

Older options which are still sometimes used today include tar creams and shampoos, anthralin, and Vitamin A derivatives.

Best used for

  • People with small amounts of psoriasis

  • Those where more aggressive medications might be dangerous

  • In addition to more aggressive treatments to spot treat resistant areas


  • Some options are inexpensive

  • Can be used as needed and applied in private at home

  • Low risk of side effects when used appropriately

  • Can target specific problem areas while leaving normal skin alone

  • Can be tailored for use in different parts of the body (drops or foam for the scalp, for example)


  • Difficult and time consuming to apply to large areas

  • Often not potent enough to completely clear thick or large plaques

  • Large amounts may be needed if psoriasis is severe, leading to more expense and risk of side effects

  • Does not help joints in people with psoriatic arthritis

Ultraviolet Light Treatments

Although dermatologists often tell people to avoid too much sun to prevent skin cancer, ultraviolet light can help improve psoriasis.

For centuries people with psoriasis have used natural sunlight and trips to sunny places (like the Dead Sea) to help control their skin. Artificial ultraviolet light treatment can be very helpful and safe when used correctly.

The most common forms used today are narrowband-UVB (which treats the whole body at once) and excimer laser (which targets specific areas).

An older form called psoralen-UVA (PUVA) is rarely used anymore since it required taking medication that caused nausea and sun sensitivity. These are generally administered in a dermatologist’s office although narrow band-UVB machines can be purchased for home use with a prescription.

Best used for

  • Thin plaques that cover a large area of the body

  • Patients with health problems (like tuberculosis or diabetes) that can make other medications riskier

  • Children who want to avoid the potential long-term risks of other medications

  • Pregnant women


  • Relatively safe (sunburning and a long-term increased risk of skin cancer are possible, eye protection must be worn during treatments)

  • Relatively inexpensive (which can depend on your insurance since they cost of the treatment and the cost to the patient are often not the same thing)

  • Can be used in special populations like children and pregnant women where other options may have more risk

  • Few systemic side effects


  • Treatments generally begin with sessions three times weekly for 2-3 months, which can be difficult if you live far from the doctor’s office or travel frequently

  • Does not help joints in people with psoriatic arthritis

  • Certain medications and other health conditions can make you sensitive to ultraviolet light

    Oral Medications

    Oral medications (pills) for psoriasis have been used for decades and newer options are also available in this category. Pills offer convenience, but some require careful monitoring for side effects. Older options include methotrexate, cyclosporine, acitretin (Soriatane), and hydroxyurea. Each is quite different both in terms of whom it helps and its side effects. There is also a recently approved oral option called apremilast (Otezla).

    Best used for

    • Targeting specific situations. For example, acitretin (Soriatane) is often helpful for severe disease on the hands or feet and works especially well in combination with ultraviolet light therapy. Methotrexate and acitretin (Soriatane) can sometimes be used in people who have previously had cancer, where other options might be dangerous.

    • For patients who are afraid of needles and cannot tolerate injections


    • Oral medications are quite diverse and offer different positives and negatives

    • Cyclosporine works especially quickly to clear the skin but does not help the joints and requires careful monitoring as it can cause dangerous side effects (like high blood pressure and kidney problems). It is generally not used for more than one year because of these. It is sometimes used for pregnant women when other options fail.

    • Methotrexate has been used for decades to treat psoriasis and can help with both skin psoriasis and joint pain (although it may not stop damage to the joints, just help with the pain). It also has many potentially dangerous side effects (such as liver damage) and requires careful monitoring. It is very dangerous to pregnant women.

    • Acitretin (Soriatane) is a derivative of Vitamin A that can help the skin but not the joints. It also has potentially serious side effects, although they seem to be less common than with methotrexate or cyclosporin, and requires monitoring of blood tests to check the liver and cholesterol levels. It is generally not used in women who might one day become pregnant as it is very dangerous to the fetus and these effects can last up to three years after the medicine is stopped.

    • Apremilast (Otezla) is the newest oral agent. It is approved by the FDA to treat both skin disease and psoriatic arthritis. Although not the most powerful of the newer treatments, it does not require routine blood tests and its side effects have, so far, appeared to be milder than some other treatments.

    Injectable Medications

    Most of the newest options to treat psoriasis are injections given to yourself at home or in the doctor’s office. These medications attempt to target some of the chemicals in the body that stimulate the inflammation which causes psoriasis and psoriatic arthritis. Their goal is to treat the disease while leaving most of the immune system intact to do its job. These include etanercept (Enbrel), adalimumab (Humira), ustekinumab (Stelara), and secukinumab (Cosentyx).

    Two medications in this family were previously available in the United States but are not any longer, efalizumab (Raptiva) and alefacept (Amevive). New medications are also being developed and studied now in this family.

    Although they are grouped together in this category, these medications are all different both in terms of benefits and side effect risk. You should discuss which choice is right for you with your doctor.

    Best used for

    • Patients with moderate or severe psoriasis, especially when other options have not been successful

    • Patients with psoriatic arthritis. Etanercept (Enbrel) and adalimumab (Humira) seem to be able to halt the progression of damage to the joints as well as reducing pain


    • Powerful treatment that can often improve even severe psoriasis and psoriatic arthritis

    • Injections are convenient to administer at home, between twice weekly and quarterly depending on the medication

    • Some of these medications may be able to halt the joint destruction seen in psoriatic arthritis, which may prevent permanent joint damage


    • These medications alter the immune system and may decrease your ability to fight infections, especially unusual fungal infections or tuberculosis

    • Altering the immune system may also increase the risk of certain cancers, like leukemia and lymphoma. These injections are generally not used in someone who has previously had cancer (except for certain common skin cancers)

    • Expense. Although insurance coverage and out-of-pocket cost varies greatly, the cost of these medications can reach $30,000 a year or more. Programs are often available, depending on your insurance and income, to help limit these costs

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