The Best Medications for the Treatment of Psoriasis

There are many approaches to treating psoriasis. Skin care methods and at-home remedies are used by many, but they may not work for everyone. Sometimes medical or pharmaceutical treatment is needed. These can include over-the-counter products, prescription medications, or biologics.

This article reviews the different medications for psoriasis treatment.

Types of Psoriasis Medication

Treatments for autoimmune conditions focus on reducing or controlling the immune system response in your body. Sometimes, localized psoriasis treatments are used to treat a small patch of affected skin. Other times, systemic therapies are required to manage psoriasis.

Systemic treatments are those that work throughout the body, reaching all areas by traveling through the bloodstream. Systemic psoriasis drugs can be grouped into two categories: biologics and pharmaceuticals. Your healthcare team will consider your situation and discuss different treatment options.

Generally, psoriasis medications decrease the symptoms of active psoriasis and help reduce the risk of long-term comorbidities (health conditions that occur with psoriasis). Comorbidities include:

• Psoriatic arthritis
• Diabetes
• Obesity
• Heart disease

Biologics for Psoriasis

Biologics, sometimes called biopharmaceuticals, are made using living organisms like human cells, animal cells, or small microorganisms like bacteria or viruses. Vaccines are biologics that have been around for hundreds of years.

There are several classes of biologics available to treat psoriasis. Each type of drug affects a different part of the immune system.

Tumor Necrosis Factor-Alpha (TNF-alpha) Inhibitors

Tumor necrosis factor-alpha (TNF-alpha) inhibitors work by inhibiting, or blocking, the TNF-alpha cytokine. Cytokines are signal proteins that produce inflammation in the body. Too much TNF-alpha is present in some people, which leads to inflammation, joint damage, and psoriasis symptoms.

TNF-alpha inhibitor drugs reduce the inflammatory response by preventing the cytokines from reaching the receptors. This can help decrease symptoms of psoriasis in some people. TNF-alpha inhibitors for psoriasis include:

• Enbrel (etanercept)
• Humira (adalimumab)
• Remicade (infliximab)

Interleukin Inhibitors

Interleukin (IL) is another cytokine protein produced in leukocytes, a type of white blood cell, and in other cells in the body. These signal proteins regulate the immune response. Interleukins are named using numbers and specific proteins that are associated with the inflammation that occurs with psoriasis. Blocking these proteins can help improve the symptoms of psoriasis.

Some interleukin inhibitors used are:

• Stelara (ustekinumab) - IL 12 and 23 inhibitor
• Cosentyx (secukinumab) - IL 17 inhibitor
• Tremfya (guselkumab) - IL 23 inhibitor
  

Treatments are being studied, and new biologics are being developed. Speak with your healthcare provider to see what is recommended for your specific condition.

Pharmaceuticals for Psoriasis

Pharmaceuticals are created from chemicals in a lab or manufacturing plant. They can be over-the-counter (OTC) medications or may require a prescription from a healthcare provider.

Several pharmaceutical treatments are available for psoriasis. All have different methods of effectiveness and vary in their side effects. Some pharmaceutical psoriasis treatments may include:

• Trexall (methotrexate)
• Sandimmune (cyclosporine)
• Soriatane (acitretin)

Some second-tier medications have been used to treat psoriasis. They are less effective and less commonly used than the drugs listed.

Other Treatment Options

Different combinations of psoriasis treatments are being evaluated. Be sure your healthcare team knows about your medications, including OTC medicines or creams.

Your medical team will evaluate the location and severity of your psoriasis and make recommendations about what treatments to start with. Most systemic biologic and pharmaceutical treatments are given by infusion (intravenously) or injection.

For mild or moderate psoriasis, your healthcare provider may recommend topical treatments, phototherapy (light therapy), or a combination of different therapies for your treatment.

Topical Treatments

Topical treatments are applied directly to psoriasis plaques on the skin to treat the affected areas. Many of these treatments help reduce the inflammation at the site of the psoriasis flare. Some may be purchased without a prescription, while others will require one.

Topical medications for psoriasis may include:

• Corticosteroids: Steroid medications reduce the inflammatory response and can help reduce and heal psoriasis plaques.
• Vitamin D analogs: Vitamin D helps lessens psoriasis plaques by reducing how fast skin cells grow. Vectical (calcitriol) is a naturally occurring substance, and Dovonex (calcipotriene) is a chemically created (synthetic) type. Both are used topically to treat psoriasis.
• Retinol: Tazorec (tazarotene) is a vitamin A retinoid. It also lowers the rate of skin cell growth and helps to minimize psoriasis plaques.
• Calcineurin inhibitors: Protopic (tacrolimus ointment) and Elidel (1.0% pimecrolimus cream) have been used off-label to treat psoriasis. They also help lessen inflammation and slow skin cell growth.
  

Phototherapy

Phototherapy is a treatment that uses ultraviolet (UV) light on patches of skin affected by psoriasis. Phototherapy requires the skin to be exposed to light for a specific amount of time regularly. Treatment can be performed at the provider's office or home. A prescription is required for the equipment used at home.

Depending on your healthcare provider's recommendations, phototherapy can be combined with other therapies, including topical or systemic treatments.

Summary

Psoriasis is an incurable autoimmune condition that primarily affects the skin. It can cause discomfort or unwanted cosmetic appearance changes. Systemic treatments are available, including pharmaceuticals and biologics. Each treatment has potential side effects. The treatment approach should be decided in conversation with your healthcare team, considering your lifestyle, preferences, and other health conditions you may have.

A Word From Verywell

Psoriasis can flare up during stressful times. Many different treatments can help control the immune system and help heal the plaques that come from rapid skin cell growth. You may benefit from a combination of lifestyle modifications and different treatments to best manage your psoriasis.