How Plaque Psoriasis Is Treated

Newer biologic drugs offer hope to chronic sufferers

Smooth and moist without the hint of a blemish!
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While there is no cure for chronic plaque psoriasis, there are a variety of treatments that can help remove scales and prevent skin cells from growing so quickly. Options include topical ointments, light therapy, and prescription drugs taken either orally or by injection.

Drugs are not only tools at your disposal. Proper skin care and lifestyle choices can help you gain control over a disorder that continues to affect as many as 7.5 million Americans, according to American Academy of Dermatology.

Home Remedies

The primary aim of home therapies is to alleviate the itchiness, burning, and discomfort of plaques while gently removing accumulated skin cells without bleeding. Among some of the effective options:

  • Therapeutic baths made with Epsom salt, mineral oil, milk, or olive oil can soothe the skin while gently lifting scales from the outer layer of skin (epidermis). Use only lukewarm water; hot water can quickly strip away body oils and leave the skin drier than ever.
  • Fragrance-free moisturizers, such as petroleum jelly, aloe vera gel, or mineral oils, can aid in the shedding of cells while trapping moisture in the skin. These emollient-rich lotions should be applied after a bath to counteract the moisture loss.
  • Natural sunlight can slow the overproduction of skin cells but needs to be limited to no more than 10 minutes of direct exposure per day. You can gradually increase the exposure time but always do so with a minimum SPF30 sunscreen protection.

    A holistic approach to psoriasis treatment should always involve exercise, stress reduction, a low-fat diet rich in omega-3 fatty acids, and the avoidance of alcohol and cigarettes.

    Over-the-Counter Remedies

    There are a number of over-the-counter (OTC) products available to treat psoriasis. As some can work better than others (and some may be too harsh), it is important to speak with your dermatologist before using any non-prescription treatment.

    Among some of the more popular options:

    • Coal tar has been used to treat psoriasis for more than 100 years, and there are some who still swear by it. Coal tar is available without a prescription and can be found in a variety of preparations, including shampoos, ointments, lotions, creams, and foams. While soothing, some of the products can be messy and even a little smelly.
    • Salicylic acid is a peeling agent that can help soften and remove flaking scales. It is contained in a variety of moisturizing creams, lotions, and topical ointments. Avoid combining with other salicylic-containing products, and do not use on more than 20 percent of the body is this can lead to excessive topical absorption and toxicity. Do no use on children.

    Topical Corticosteroids

    Topical corticosteroids, also known as steroids, are considered the most effective means of treating mild plaque psoriasis. They can be used alongside other drugs for persons with moderate to severe psoriasis.

    When prescribing a topical steroid, the dermatologist will consider the location and severity of the plaques. For those on the face or genitals, a lower-strength, 1.0% preparation may be prescribed, while a medium- to high-potency steroid can be used on other parts of the body.

    Topical steroids are available over the counter and by prescription in a variety of lotions, creams, ointments, shampoos, foams, and sprays. While effective, prolonged use or overuse can lead to skin atrophy (thinning of the skin), a condition which is often irreversible.

    Prescription Drugs

    As a chronic autoimmune disorder, plaque psoriasis may require more than just topical steroids. In some cases, the autoimmune response will need to be tempered to prevent the body from causing further self-harm. To this end, doctors often turn to drugs that target the immune response, either systemically (as a whole) or in part.

    Non-Biologic Drugs

    Non-biologic drugs are those that have been synthesized in the lab. There are three non-biologics commonly used to treat plaque psoriasis:

    • Methotrexate is an immune suppressive drug that has been around for more than 50 years and works by dampening the immune response as a whole. It is typically used in the first-line treatment of moderate to severe plaque psoriasis. By suppressing the immune system as a whole, methotrexate can cause side effects ranging from liver toxicity to bone marrow suppression. Periodic blood tests are needed to avoid treatment complications.
    • Cyclosporine is another immune suppressive drug similar to methotrexate. It is used when psoriasis is either extensive or has not responded to at least one other systemic drug. While cyclosporine works quickly on the immune system, it also requires the frequent monitoring of side effect, including high blood pressure, liver toxicity, and kidney impairment.
    • Otezla (apremilast) was approved in 2014 to treat psoriasis and psoriatic arthritis, a form of rheumatoid arthritis closely related to psoriasis. Otezla works by blocking an enzyme, known as phosphodiesterase 4, which regulates cellular inflammation. While Otelza is well-tolerated, it may cause diarrhea, nausea, or headaches when first started. Less commonly, people may experience weight loss or symptoms of depression.

    Biologic Drugs

    Biologic drugs are those made from human or animal proteins. An increasing number of biologics have been approved for the treatment of moderate to severe plaque psoriasis. Unlike methotrexate, biologics target a specific component of the immune response rather than the immune system as a whole.

    Biologics are delivered either by injection or intravenously (through a vein). They are usually prescribed for people with moderate to severe psoriasis who have not responded to other treatments. The currently approved agents target one of three components of the immune response:

    As biologic drugs can increase the risk of infection, any cut, sore, or sign of infection be should be treated by a doctor. Common side effects include injection site pain, respiratory infections, and flu-like symptoms. In rare cases, certain cancers and neurologic symptoms (such as seizures and multiple sclerosis) may develop.

    Light Therapy

    While sunlight can be effective in alleviating plaque psoriasis, prolonged exposure can lead to sunburns and a worsening of symptoms. To this end, UV light therapy, also known as phototherapy, has become a safe option for those who fail to respond to medications alone.

    Ultraviolet B (UVB) radiation, in particular, is able to penetrate the skin and slow the hyperproduction of skin cells without harm.Treatments can be performed in a doctor's office or with a home unit. In either case, the procedure should be directed by a dermatologist experienced in phototherapy. While the skin may initially get worse before it gets better, consistency usually ensures the best results.

    Another form of light therapy, known as psoralen + UVA (PUVA), combines UVA radiation with a light-sensitizing drug known as psoralen), taken either orally or topically. PUVA is most effective for stable plaque psoriasis rather than for acute flares.

    Supportive Medications

    There are a number of prescription drugs commonly used to support the primary treatment of psoriasis:

    • Calcipotriol (calcipotriene) is a synthetic vitamin D3 analog first introduced in the 1990s to treat chronic plaque psoriasis. It is believed to improve symptoms by tempering the overproduction of keratinocytes in the skin. Other vitamin D3 analogs include calcitriol and tacalcitol.
    • Tazorac (tazarotene) is a topical retinoid derived from vitamin A which can slow skin cell production and reduce inflammation. It is also marketed under the brand names Avage and Fabior. Side effects include skin irritation and sun sensitivity.
    • Soriatane (acitretin) is an oral retinoid that is sometimes combined with UV light therapy. Side effects include lip inflammation, hair loss, and the drying of the eyes, nose, and mouth.

    Tazorac and Soriatane are both classified as a pregnancy category X drugs and cannot be used during pregnancy due to the risk of birth defects.


    American Academy of Dermatology (AAD) Work Group, et al. "Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions." J Am Acad Dermatol. 2011 Jul;65(1):137-74. DOI: 10.1016/j.jaad.2010.11.055.

    National Psoriasis Foundation. "Moderate to Severe Psoriasis and Psoriatic Arthritis: Biologic Drugs." Portland, Oregon.