Psoriasis Management, Medications, and Treatment Options

If you’re living with itchy, dry plaques, rashes, or other uncomfortable psoriasis symptoms, you may be wondering what your treatment options are. While you can’t permanently cure psoriasis, there are several options available to help clear your skin and relieve your symptoms.1 Some treatment options used for psoriasis also work at relieving psoriatic arthritis (PsA) symptoms, including joint pain, swelling, and stiffness.

In this article, we’ll discuss the different types of psoriasis treatments, how they’re used, and what their common side effects are. To learn more about any of these therapies, talk to your primary care doctor or dermatologist.

Corticosteroids for Psoriasis

Corticosteroids are synthetic (laboratory-made) hormones used to help treat inflammation. Topical corticosteroids are one of the most common psoriasis treatments. They’re applied directly to the skin over plaques, scales, or rashes to help relieve intense itching, burning, and discomfort. They also help slow down skin cell growth, preventing the formation of new plaques in people with plaque psoriasis.2

Corticosteroids are available as creams, ointments, shampoos, sprays, or foams to help treat psoriasis. Your doctor or dermatologist will prescribe specific formulations depending on what areas of your skin are affected. For example, you may need a foam, shampoo, or spray to treat psoriasis symptoms on your scalp. Over-the-counter corticosteroids like hydrocortisone 1% are available as creams or ointments to use on the sensitive skin on your face and in skin folds that rub together.

Prescription-strength topical corticosteroids you may be prescribed by your dermatologist include:1

  • Betamethasone dipropionate
  • Clobetasol propionate
  • Fluocinonide
  • Triamcinolone

When using a topical corticosteroid, be sure to use the recommended amount and apply it only to skin that’s affected by psoriasis.3 Follow your dermatologist’s instructions closely — don’t use a corticosteroid for longer than recommended because this can cause skin thinning, bruising, and discoloration. Don’t stop using your topical corticosteroid without talking to your dermatologist first. Stopping suddenly can cause your psoriasis symptoms to flare worse than they were before.

Vitamin D Analogs for Psoriasis

Synthetic forms of vitamin D — known as analogs — have been used for decades to treat psoriasis. These medications slow skin cell growth and stop plaques from forming. After using a vitamin D analog, your plaques may shed off, leaving smooth skin underneath. According to the American Academy of Dermatology Association, vitamin D analogs can improve your symptoms after two weeks of treatment.4

Examples of vitamin D analogs approved by the U.S. Food & Drug Administration (FDA) include calcitriol (Vectical®) and calcipotriene (Dovonex®). Along with treating symptoms in commonly affected areas such as the knees, elbows, and lower back, calcipotriene can also be used to treat psoriasis on the fingernails and scalp.5

The most common side effects of vitamin D analogs include:4

  • Skin irritation
  • Dryness
  • Itching
  • Burning
  • Peeling
  • Redness
  • Swelling

These side effects typically go away on their own as your skin gets used to the medication. If they continue for more than a few weeks or if your psoriasis symptoms haven’t improved, talk to your doctor or dermatologist.

Tazarotene for Psoriasis

A form of vitamin A — known as a retinoid — can help slow skin cell growth in psoriasis.5 Tazarotene (Tazorac®) is a topical cream or gel prescribed by dermatologists to treat plaque psoriasis and nail psoriasis. It helps treat thick plaques while also relieving redness and swelling. If you have nail psoriasis, tazarotene helps reduce thickness and strengthens your nails to prevent crumbling.

While tazarotene can be used on its own, many dermatologists also prescribe a corticosteroid or use phototherapy (light therapy) for better results. If you’re using a combination of treatments, you may need to take extra precautions to avoid irritating your skin too much.

The most common side effect of tazarotene is skin irritation that causes itching or burning sensations, dryness, or peeling. It’s also normal for your plaques to become extremely red during treatment before they clear up. To avoid irritating your healthy skin, apply some petroleum jelly (such as Vaseline®) around your plaques. Try to apply a thin layer of tazarotene only to your psoriasis.5

Topical Calcineurin Inhibitors for Psoriasis

Some topical treatments — like corticosteroids — may be too harsh on areas with delicate skin. Topical calcineurin inhibitors (TCIs) are an option for treating plaque psoriasis on the face and genitals. They’re also useful for treating inverse psoriasis or a red, painful rash that affects areas of skin that rub together (armpits, groin, or under the breasts).6

The FDA has approved tacrolimus (Protopic®) and pimecrolimus (Elidel®) for treating eczema, another inflammatory skin condition. Dermatologists can prescribe these medications “off-label” or outside of their approved use for treating psoriasis.6 Studies show they’re both safe and effective for treating psoriasis on the face and genitals. TCIs are typically prescribed along with corticosteroids for extra symptom relief.7

The most common side effects people experience when they first start using a TCI are skin itching and burning.6 As your skin gets used to the medication and begins to clear up, these symptoms will go away. If you start to notice signs of an allergic reaction like redness, intense itchiness, or hives, stop using the TCI and talk to your dermatologist.

It’s also important to note that the FDA put a warning on tacrolimus and pimecrolimus about an increased risk of cancer. In animal studies, they found that TCIs may cause skin cancer or lymphoma, a type of blood cancer.8 If your dermatologist prescribes you one of these medications, they’ll discuss the risks and watch you closely during treatment.

Traditional Systemic Therapies for Psoriasis

While topical therapies only work where you apply them, systemic therapies work throughout your body to help control inflammation. Before doctors and researchers developed treatments to target specific parts of the immune system, traditional therapies were used to broadly block the immune system. Examples still used today include methotrexate and cyclosporine.9,10

Methotrexate is a powerful medication used to treat severe, disabling psoriasis that can’t be controlled with other medications. Your dermatologist may prescribe you methotrexate if you have severe PsA, palmoplantar psoriasis (on your hands or feet), or erythrodermic psoriasis (intense red rashes).9 Your symptoms should start improving within 4 to 6 weeks, but it may take up to six months to completely clear your skin.

The most common side effects of methotrexate include:

  • Fatigue
  • Mouth sores
  • Nausea
  • Vomiting
  • Loss of appetite
  • Infections

Cyclosporine is another powerful medication used to treat severe cases of:10

  • Plaque psoriasis
  • Generalized pustular psoriasis (creates painful, pus-filled blisters)
  • Palmoplantar psoriasis
  • Erythrodermic psoriasis
  • Guttate psoriasis (create small round or tear-drop-shaped spots)

It works quickly to treat symptoms, and it can be used in both children and adults. If your dermatologist prescribes you cyclosporine, you’ll need to be closely monitored throughout treatment. You’ll have regular testing done to check your blood pressure and kidney function to make sure the medication hasn’t caused any complications.

Acitretin (Soriatane®) is a retinoid made from vitamin A that is used to treat severe cases of:11

  • Plaque psoriasis
  • Guttate psoriasis
  • Erythrodermic psoriasis
  • Palmoplantar pustular psoriasis
  • Pustular psoriasis affecting large areas of skin
  • Psoriasis caused by infection with human immunodeficiency virus (HIV)

Most people start seeing their symptoms improve after two weeks of acitretin treatment. It can take up to three months to see the full effects. Common side effects of acitretin include dry or cracked lips and skin, brittle nails, dry nose, eyes, and mouth, and skin burning. Be sure to take your acitretin dose with food and a glass of milk — fat helps your body to absorb the medication.11

Biologics for Psoriasis

Biologics are laboratory-made proteins that work by blocking specific parts of the immune system. In psoriasis, inflammation is created by chemical messengers. They cause your skin cells to grow and divide quickly, creating plaques. People with PsA have too many of these messengers in their joints, causing inflammation, pain, and swelling.12

By blocking these messengers, biologics help reduce excess inflammation in the skin and joints. This helps relieve your psoriasis and psoriatic arthritis symptoms. Below are lists of all the biologics approved by the FDA that are categorized by the chemical messenger they block.12

Approved tumor necrosis factor-alpha (TNF-alpha) inhibitors include:

  • Etanercept (Enbrel®)
  • Adalimumab (Humira®)
  • Infliximab (Remicade®)
  • Certolizumab pegol (Cimzia®)
  • Golimumab (Simponi®) — approved for PsA only

Approved interleukin (IL)-17 inhibitors include:

  • Ixekizumab (Taltz®)
  • Secukinumab (Cosentyx®)
  • Bimekizumab (Bimzelx® )
  • Brodalumab (Siliq™) — approved for psoriasis only

Approved IL-23 inhibitors include:

  • Ustekinumab (Stelara®)
  • Guselkumab (Tremfya™)
  • Risankizumab-rzaa (Skyrizi™) — approved for psoriasis only
  • Tildrakizumab (Ilumya™) — approved for psoriasis only

Approved T cell activation Inhibitors include:

  • Abatacept (Orencia®)

Because biologics are made with proteins, they need to be injected into your body rather than taken as a pill.13 This is because your stomach would break them down before they have a chance to start working. Some biologics are injected just underneath your skin (subcutaneously) using a pre-filled pen or syringe. Others are infused intravenously (IV) at your doctor’s office or an infusion clinic.

Every biologic comes with its own set of potential side effects. Because they work by blocking your immune system, biologics increase your risk of serious infections. Other common side effects you may experience include:12

  • Redness, pain, or swelling where you inject the medication
  • Increased risk of urinary tract infections or upper respiratory tract infections
  • Headache
  • Flu-like symptoms

PDE4 Inhibitors for Psoriasis

Phosphodiesterase 4 (PDE4) is an enzyme used by your immune cells to create inflammation. Blocking it with a PDE4 inhibitor helps treat skin inflammation in psoriasis. Apremilast (Otezla®) and roflumilast (Zoryve®) are two PDE4 inhibitors approved by the FDA for treating psoriasis.14,15

Apremilast is a pill taken by mouth twice a day that helps treat body-wide inflammation affecting both your skin and joints. Your dermatologist may prescribe you apremilast if you have plaque psoriasis, scalp psoriasis, nail psoriasis, and/or PsA.14 The most common side effects seen during clinical trials were:

  • Headache
  • Nausea
  • Vomiting
  • Diarrhea
  • Infections

The FDA warns that apremilast may cause new or worsening depression or an increase in suicidal thoughts. Talk to your doctor if you’re experiencing any signs of depression for at least two weeks.

Roflumilast, a topical cream, was approved in July 2022 for treating inverse psoriasis in sensitive skin folds.5,15 In clinical trials, around half of the participants had nearly or completely clear skin after eight weeks of treatment. The most common side effects reported in studies include:

  • Headache
  • Nausea
  • Diarrhea
  • Insomnia
  • Urinary tract infection
  • Upper respiratory tract infection

Phototherapy for Psoriasis

Phototherapy or light therapy uses controlled ultraviolet (UV) light on areas of your skin affected by psoriasis. Specifically, UVB light is able to reach deep into your skin and slow down cell growth. It also helps reduce inflammation to relieve skin burning and itching.16

Your dermatologist may use narrow-band UVB treatments to clear your skin over the long term. It’s especially helpful for treating thick scales from plaque psoriasis, scalp psoriasis, nail psoriasis, and palmoplantar psoriasis. If you’ve previously had skin cancer or have another health condition that makes you sensitive to UV light, phototherapy isn’t recommended for you.17

Phototherapy treatments can be done in your dermatologist’s office or a clinic. At-home treatments can also be done once your psoriasis is under control to keep your skin clear or treat any new flares. The FDA has also approved the excimer laser to target specific areas of psoriasis with intense UV light.17

The most common side effects of phototherapy include mild skin redness, pain, stinging (similar to a sunburn), itching, or new dark spots (more common in darker skin tones).17

Managing Psoriasis Symptoms

Along with using treatments prescribed by your dermatologist, you can take extra steps to protect your skin and avoid triggering a flare. Below is a list of recommendations to help you manage your symptoms.18

Use sunscreen: Many psoriasis treatments make your skin extra sensitive to the sun, so be sure to wear sunscreen and cover up when spending time outdoors.

Avoid your triggers: If you know what triggers your psoriasis flares, try to avoid them as much as possible. Sunlight, allergies, certain medications, and smoking can all make your symptoms worse.

Shower or take a bath every day: Lock moisture into your skin with a daily shower or bath; try not to scrub your skin because this can irritate it. Soaking in a bath with colloidal oatmeal or Epsom salts can help relieve dryness and itching.

Moisturize after washing: After showering or bathing, apply moisturizer to your skin to keep it hydrated. Use an oil-based cream or ointment for especially dry skin. This helps you avoid scratching your skin, which can irritate it more and trigger a flare.

Stay cool in hot weather: Sweat and irritating clothing can make your skin itchy, so be sure to wear light clothing and keep ice packs around in the summer.

The Future of Psoriasis Treatments

Doctors and researchers are always looking for new and better ways to treat psoriasis. Clinical trials in psoriasis are currently studying several new treatments for clearing away symptoms and providing relief.