How Psoriasis Is Treated

Psoriasis is a chronic autoimmune disorder that cannot be cured but can be effectively treated, usually with a combination of self-care interventions, medications, and ultraviolet (UV) light therapy.

Despite many treatment options, managing the inflamed, scaly skin patches that come with this condition can be tricky. It requires an individualized approach based on the type, location, and severity of psoriasis you have.

Not all people will respond to psoriasis interventions equally. Patience and persistence may be needed to find the combination of therapies that works best for you.

This article explores over-the-counter (OTC) and prescription medications commonly used to treat psoriasis, different light therapy options, and skincare and lifestyle strategies that can be helpful.

Types of Psoriasis

Verywell / Emily Roberts

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Home Remedies and Lifestyle

Self-care strategies that aim to mitigate the dryness, itching, and flaking of skin plaques may be enough to help manage symptoms and flares in those with mild psoriasis. In more severe cases, they can be helpful complements to other treatments.

Skin Care

Establishing a daily bathing and moisturizing routine can help minimize scaling and relieve persistent itching.

Overheating the skin promotes inflammation and the risk of flares; over-soaking the skin increases skin dryness. So use water warm rather than hot. Also, limit showers to five minutes and baths to 15 minutes, and avoid vigorous scrubbing.

A washcloth is usually all you need to slough off loose scales. Daily shampooing is a good way to gently buff plaques from the scalp.

After showering or bathing, pat the skin dry and moisturize immediately with a fragrance-free emollient-rich lotion, which is heavily moisturizing and offers a protective barrier for the skin.

To intensify the effects of a moisturizer, cover the moisturized skin with a non-absorbent wrap (such as cling wrap or plastic gloves) for several hours or even overnight.

Itch Relief

Pruritis (itchiness) is an especially irritating aspect of psoriasis. Itching can further inflame the skin.

One way to help ease the itch is to apply an ice pack or cold compress to the affected skin. Nerves that send itch signals to the brain don't work as well when they are cold.

Cover the ice pack with a thin cloth and move it around in circular motions (rather than letting it settle in one place). Limit treatments to no more than 15 to 20 minutes.

Storing moisturizer in the refrigerator is a good way to tap the soothing benefits of cold as well.

Oatmeal baths can also reduce itching by gently softening and exfoliating the skin, or removing dead skin cells from the outer layer of skin. You can purchase oatmeal bath products at the drugstore or make your own by whirring breakfast oatmeal in a food processor until powdery. Add enough to warm water to create a milky bath.

Epsom salt may also sometimes help. Add some to a warm bath and soak for up to 15 minutes.

Injury Avoidance

Almost any kind of skin trauma can trigger a flare in people with psoriasis. Known as the Koebner effect, it can occur as a result of a cut, burn, scrape, or anything that causes intense friction or inflammation.

Examples include:

  • Vigorous scratching
  • Shaving with a dull blade or too little shaving gel
  • Wearing a tight belt with rough fabric
  • Suntanning
  • Insect bites
  • Skin allergic reactions

While some skin injuries just happen, others can be avoided by taking the necessary precautions, such as using sunscreen or insect repellent, wearing gentle fabrics, or changing your razor regularly.

Recap

Bathing in warm instead of hot water and moisturizing daily is often helpful. Try to avoid skin injuries and overheating or oversoaking your skin whenever possible.

Over-the-Counter Therapies

OTC medications may provide ample relief for mild psoriasis or be used in combination with prescription medications for more severe cases.

Even though you can purchase OTC products on your own, you should avoid self-treating without a proper diagnosis.

Psoriasis can mimic other diseases and vice versa. Without a proper diagnosis, you may incorrectly treat a skin condition or, worse yet, miss a more serious disease in need of immediate medical attention.

Hydrocortisone Cream

An OTC 1% hydrocortisone cream is a key player in the first-line treatment of mild psoriasis. It works by blocking inflammatory proteins called cytokines, thereby reducing skin redness, swelling, and itch.

Side effects include burning or stinging at the application site, acne, changes in skin color, and a temporary increase in itching.

Hydrocortisone cream should not be used on the face or genitals unless so directed by your healthcare provider. Prolonged use can cause irreversible skin thinning called skin atrophy.

Numbing Creams

Some anti-itch creams work by temporary numbing nerve receptors in the skin. These include products made with menthol or camphor, or topical (applied to the skin) pain relievers containing benzocaine.

Antihistamines

Oral antihistamines work by blocking chemicals, called histamines, that trigger allergy symptoms. In doing so, they may help reduce itchiness.

Some, like Benadryl (diphenhydramine), have a sedative effect, which may be useful if the itching is keeping you up at night.

Salicylic Acid Products

Salicylic acid is classified as a keratolytic, a type of drug that helps remove excess skin. It works by dissolving scales so that they can be washed or brushed away easily. This makes it easier for medications applied to the skin to be absorbed.

Salicylic acid is available in a variety of OTC products, including creams, shampoos, soaps, and lotions.

Salicylic acid can sometimes cause irritation and may lead to temporary hair loss in the area where it's applied.

Coal Tar Products

Coal tar has been used for more than a century to treat psoriasis and other skin conditions. It works by relieving inflammation and slowing skin cell growth. When used as prescribed, coal tar can achieve visible improvement in psoriasis plaques within around eight weeks.

The U.S. Food and Drug Administration (FDA) has stated that products containing 0.5% to 5% coal tar are safe and effective for treating psoriasis.

You can find coal tar in a variety of lotions, creams, bath solutions, and scalp treatments. Depending on the product, the coal tar is usually left on the skin for an hour or two and then rinsed off. 

Side effects of coal tar are minimal and may include skin irritation and redness. Coal tar has a pungent, resiny odor and can permanently stain fabrics if splashed or splattered.

Medicated Shampoo 

Scalp psoriasis can be especially difficult to treat as hair can get in the way of topical medicines. Medicated shampoos (containing salicylic acid, tar, or both) are commonly used, either on their own or to support topical treatment.

To get the optimal benefit of a medicated shampoo, massage it into the scalp and let it sit for five to 10 minutes before gently combing the hair and rinsing. This can help loosen plaques without pain or bleeding.

Recap

OTC medications, such as 1% hydrocortisone, may be enough to effectively treat mild psoriasis flare-ups. If you haven't already been diagnosed with psoriasis, see a healthcare provider in order to rule out other serious conditions.

Prescriptions

Topical prescription medications are considered the mainstay of moderate to severe psoriasis treatment. They may be used on their own or incorporated into combination therapies.

While topical options treat only the areas they are applied to, systemic options (taken by mouth or injected into the skin or a blood vessel) treat the whole body from the inside.

They are used when topical drugs are unable to control psoriasis on their own. Some suppress the entire immune system, while others target specific parts of the immune response.

Topical Corticosteroids

Topical corticosteroids can help reduce inflammation, aid in the shedding of skin cells, and promote the renewal of healthy skin. They come in a variety of formulations and are chosen based on the severity and location of the lesions.

Options include:

  • Ointments: Greasy, but potent
  • Creams: Best for the face, groin, or armpits
  • Oils: Used on the entire body or as an overnight scalp treatment
  • Gels and foams: Easy to apply to the scalp and hairy areas
  • Sprays: Generally high-potency
  • Infused tapes: For use on the knees or elbows

Topical corticosteroids can cause side effects if not used as directed.

For example, if they are used around the eyes, they can seep into tissues and affect vision by causing glaucoma or cataracts. On the face, a too-strong steroid can cause acne, rosacea, and telangiectasia (spider veins).

Skin thinning, stretch marks, and skin lightening (hypopigmentation) are common when corticosteroids are overused.

Vitamin D Analogs

Psoriasis medications derived from vitamin D, known as vitamin D analogs, work by decreasing the rate of skin cell growth. These topical medications do the job slowly, taking around four to six weeks to produce results. That said, they have none of the long-term side effects of topical steroids.

Dovonex (calcipotriene) is a commonly prescribed vitamin D analog that comes as a cream or scalp solution. Dovonex can be used continuously and can be combined with other treatments, including topical steroids and UV light therapy.

Calcineurin Inhibitors

Calcineurin inhibitors, also known as topical immune modulators, work by blocking a chemical needed to trigger the inflammatory response. These drugs are especially gentle and can even be applied to the face and groin.

Protopic (tacrolimus) and Elidel (pimecrolimus) are approved by the FDA for the treatment of eczema but are regularly used off-label to treat all forms of psoriasis. Side effects tend to be mild and may include itching, acne, redness, burning, stinging, cold/heat sensitivity, and folliculitis.

Despite proven benefits of Protopic and Elidel, the FDA issued a black box warning in 2005 suggesting that the drugs may be linked to skin cancer and lymphoma. However, the American Academy of Dermatology has adamantly stated that no causal link has been found and that the drugs are safe and effective when used as prescribed.

Topical Retinoids

Derived from vitamin A, retinoids can help slow the growth of skin cells that contributes to dry, itchy skin patches in those with psoriasis.

Tazorac (tazarotene) is the topical retinoid approved for the treatment of plaque psoriasis. It works best when combined with other psoriasis medications. It can also make the skin more sensitive to UV light in order to achieve better results with UV light therapy.

It can be used on most parts of the body, including the nails, but it is known to cause skin irritation. As such, it should only be used on the face or genitals under the direction of a dermatologist, a physician who specializes in skin conditions.

Tazorac should not be used during pregnancy since it can harm a fetus.

Tazorac is available as a cream, gel, or foam. Common side effects include application-site itchiness, redness, and burning. Applying a thin layer of moisturizer beforehand may help minimize these symptoms.

Psoriatec (Anthralin)

Anthralin has been around since the early 1900s and was once the gold standard of psoriasis treatment. Although it has been replaced by more effective (and less messy) medications, anthralin is still sometimes used as an alternate option if other medications fail to provide relief.

Psoriatec, a timed-release anthralin cream, is an updated version that can slow the hyperproduction of skin cells without the hassle of messy application, staining, or skin irritation. It is applied directly to the skin and left for 30 minutes before being washed off with cool or lukewarm water.

Psoriatec may cause redness and burning but doesn't damage the skin, even with long-term use. It is also less expensive than some of the newer psoriasis treatments. 

Aryl Hydrocarbon Receptor Agonists

Vtama (tapinarof) cream, 1% is an aryl hydrocarbon receptor agonist that is newly approved for the treatment of mild, moderate, and severe plaque psoriasis in adults. It works by activating aryl hydrocarbon receptors located in the skin to reduce inflammation.

The cream is applied once daily and has been shown to be effective and safe for use on multiple body sites—including sensitive skin areas. Common side effects include itching, folliculitis, skin rash, and headache.

It is the first and only FDA-approved non-steroidal topical medication in its class. 

DMARDS

Disease-modifying antirheumatic drugs (DMARDs) like methotrexate and cyclosporine work by dampening the immune system as a whole. When moderate to severe plaque psoriasis is being treated with oral drugs, these are typically the first ones that are used.

Methotrexate can cause side effects ranging from liver damage to bone marrow suppression, which causes reduced production of blood cells. Cyclosporine is known to cause high blood pressure, liver damage, and kidney impairment. Periodic blood tests are needed to avoid treatment complications.

Biologics

Biologic drugs are medications derived from living cells cultured in a lab.

Rather than affecting the entire immune system, biologics block either the white blood cells that incite the inflammatory response (called sT-cells) or specific cytokines (such as tumor necrosis factor-alpha, interleukin 17-A, or interleukins 12 and 23).

There are many types of biologics used to treat moderate to severe psoriasis and psoriatic arthritis, a type of arthritis linked to this skin condition. Most of the biologics are delivered by injection or IV infusion (given through a vein).

When prescribed a biologic, be aware that is can take anywhere from three to four months before visible results are seen. Prior to this, you may experience a temporary worsening of psoriasis symptoms.

Among the biologic drugs used for psoriasis are:

Immunosuppression, the reduced ability of your immune system to fight infections, is a common side effect. Due to this, testing for tuberculosis (TB) and other infectious diseases is often required before starting treatment.

Other side effects include injection site pain, chills, weakness, diarrhea, nausea, vomiting, and rash.

There are also a type of biologics called JAK inhibitors, such Xeljanz (tofacitinib), that are oral medications for psoriatic arthritis. Common side effects include headaches, diarrhea and upper respiratory infections.

Xeljanz and other JAK inhibitors have black box warnings that they can increase the risk of serious heart-related events such as heart attack or stroke, cancer, infections, blood clots, and death.

Oral Retinoids

An oral retinoid such as Soriatane (acitretin) is sometimes prescribed for people with moderate to severe psoriasis.

Soriatane is particularly useful for people with nail psoriasis, pustular psoriasis (includes pus-filled blisters), and erythrodermic psoriasis (a rare type that causes a widespread red rash).

Oral retinoids are also ideal for people with immunosuppression who aren't candidates for methotrexate or biologics.

Unlike other oral medications, Soriatane can be taken with biologic drugs. However, it should not be used with any other retinoid product as this may lead to vitamin A toxicity.

Soriatane should never be used during pregnancy due to the risk of birth defects. Women in their reproductive years should use two forms of birth control while on Soriatane and take a monthly pregnancy test as well.

PDE4 Inhibitors

Otezla (apremilast) is an oral medication classified as a PDE4 inhibitor. It is approved for the treatment of moderate to severe psoriasis, as well as active psoriatic arthritis.

Otezla works by blocking an enzyme known as phosphodiesterase 4 (PDE4), which promotes inflammation within cells. Side effects include diarrhea, headache, nausea, upper respiratory tract infections, vomiting, runny nose, abdominal pain, and fatigue.

Recap

Topical prescriptions, such as corticosteroids and vitamin D analogs, are the primary treatments for moderate to severe psoriasis. Oral or injectable medications are more invasive and carry risks of serious side effects, so they are typically only used if topicals aren't managing flare-ups of scaly, inflamed skin.

Specialist-Driven Procedures

Psoriasis is not treated surgically. However, the condition does respond to sunlight and can improve significantly when exposure is limited to about 10 minutes per day.

UV light therapy, also called phototherapy, uses the same principle. Controlled bursts of UV light can slow skin cell production and help achieve remission. Phototherapy is highly effective in treating psoriasis, either alone or in conjunction with topical or systemic drugs.

Phototherapy Types

Phototherapy has immunosuppressive and anti-inflammatory effects beneficial to people with psoriasis. It is especially useful when more than 30% of the body is affected and a case is moderate to severe.

The phototherapy systems deliver either stronger ultraviolet B (UVB) light or weaker ultraviolet A (UVA) light as follows:

  • Narrowband UVB (NB-UVB): This is most commonly used for psoriasis and involves using a smaller, more intense part of UVB. It can be used with or without topical coal tar, which makes the skin more sensitive to light. The approach with coal tar is known as Goeckerman therapy.
  • Psoralen plus UVA (PUVA): The skin is treated with a sensitizing agent called psoralen. This is considered essential since UVA is usually too weak to be beneficial on its own.
  • Excimer laser therapy: Excimer lasers, which generate focused beams of UVB light, are used to treat smaller areas of skin, such as the elbow or knee (where psoriasis can be especially stubborn).
  • Broadband UVB (BB-UVB): This uses a wider range of UVB and can also be used with coal tar. Broadband UVB is less effective than other types of phototherapy and is typically only used when NB-UVB isn't an option.

A typical course of phototherapy is three to five sessions per week for several weeks, followed by occasional maintenance sessions.

Potential side effects include burning, itching, redness, and sunburn (particularly in fair-skinned people).

The treatment also poses a slightly increased risk of skin cancer, particularly squamous cell carcinoma. This risk is highest for people who receive PUVA therapy over an extended period of time.

Phototherapy is not appropriate for people who are immunosuppressed (the immune system is not functioning as it should) or are taking medications that increase sensitivity to light.

It also should not be used by those who have a history of skin cancer (particularly melanoma), the autoimmune disease lupus, or light sensitivity disorders like erythropoietic protoporphyria.

Recap

Exposing skin to UV light under medical supervision is often an effective treatment for moderate to severe psoriasis. It may be used on its own or with some other treatments. However, this therapy is not appropriate for everyone.

Complementary and Alternative Medicine

People regularly turn to natural therapies to support standard medical treatments for psoriasis. However, very few of these—including aloe vera or turmeric—have been shown to be effective in clinical research.

The following are some exceptions. They are typically used in addition to other treatments.

Mind-Body Therapies

Stress is a major trigger of psoriatic flares. According to a 2018 review of studies in Disease Markers, it's estimated that anywhere from 40% to 80% of people with psoriasis cite stress as a contributing factor.

There are a number of stress-reduction techniques that may help if practiced on an ongoing basis and during acute flares. They include:

  • Meditation, or techniques focused on attention and awareness
  • Deep breathing exercises that involve slowly breathing in and out
  • Yoga, a practice that can include gentle movements and meditation
  • Guided imagery, which involves thinking about a calming scene and how it would engage all of your senses
  • Progressive muscle relaxation (PMR), which involves tensing then relaxing muscles
  • Biofeedback, which uses sensors to measure different physical functions so you can learn more about your individual stress responses and what may work best to manage them

Capsaicin

Capsaicin is a chemical derived from chili peppers that appears to block pain signals to the brain when applied to the skin. This may help alleviate itching and discomfort.

Capsaicin is sold as a topical cream or patch under various brand names.

Preliminary research suggests that topical creams containing 0.025% capsaicin may be helpful for the itching associated with psoriasis, but more research is needed.

Capsaicin should not be applied to broken skin.

Biotin

Biotin is a B vitamin sometimes used to support the treatment of nail psoriasis. It doesn't alter the disease mechanisms that cause nail crumbling, denting, or lifting, but rather promotes normal nail growth when used with topical therapies.

According to the National Institutes of Health (NIH), a biotin deficiency is one of the primary causes of brittle nails. The recommended daily intake is about 30 micrograms per day (mcg), but your healthcare provider may suggest a higher amount if deficiency is suspected.

Summary

Maintaining a gentle skincare routine, including daily bathing and moisturizing, can help manage mild psoriasis. Adding OTC medications can help during flares.

Moderate or severe psoriasis needs more and is typically treated with prescriptions topical medications and light therapy. If that's still not enough, oral or injectable medications to suppress or target parts of the immune system may be added.

Response to treatments varies widely from person to person. You may need to try different options under the advice of your healthcare provider to see what works best in your case.

Frequently Asked Questions

  • How do you treat mild psoriasis?

    Mild psoriasis can typically be treated with over-the-counter 1% hydrocortisone cream plus the use of emollient moisturizers to keep the skin moist. Moisturizers containing salicylic acid are especially useful in removing dry, flaking skin. Anti-itch creams can help relieve itch and reduce scratching.

  • How do you treat moderate to severe psoriasis?

    Topical medications like steroids and retinoids are typically used. They can be combined with oral medications like methotrexate, Enbrel (etanercept), and others for more severe cases.

  • How do you treat nail psoriasis?

    The same treatments that work for skin psoriasis also work for nail psoriasis. Severe cases may benefit from steroid injections into the nail bed or matrix (where the nail starts to grow). Nail removal may be needed to remove badly deformed nails so that new ones can grow.

  • How does phototherapy treat psoriasis?

    Exposure to ultraviolet (UV) radiation works by slowing the growth of affected skin cells. There are different types of phototherapy, each of which use specific bands of UV radiation to achieve this.

  • Are there natural treatments for psoriasis?

    One of the oldest remedies is cold tar, which promotes the shedding of skin cells. Available over the counter in lotions, creams, and shampoos, coal tar is considered safe and effective. However, it can cause dryness and irritation, staining, and make the skin extra sensitive to light.

  • Can you cure psoriasis?

    There is currently no cure for psoriasis, but long-term remission is possible with the appropriate treatment. If you aren't seeing improvements with over-the-counter medications and daily skincare, let your dermatologist know so that you can discuss other treatment options.

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