There isn’t a cure for psoriasis yet. But if you have the condition, there are lots of treatment options available. The trick is to find one that works for you.
Different people respond to different treatments, says Ashley Jenkins, MD, a dermatologist and adjunct professor of dermatology at the University of Missouri in Columbia. In some cases, a medication may be effective for a while and then stop working. That’s when it’s time to try something new.
If you have psoriasis, here’s what you need to know about your treatment plan.
What Should Treatment Do?
The goal of psoriasis treatment is to have plaques on no more than 1% of your body. If you have symptoms in other areas of your body, such as pitted nails or inflamed joints, treatment should decrease those, too.
“It can take up to 12 weeks for a medication to work completely,” says Dendy Engelman, MD, a dermatologist at the Shafer Clinic in New York City. “If your symptoms aren’t [mostly cleared] in that time, let your dermatologist know.”
Most doctors start treatment with topical medications, like corticosteroids, that you put directly onto your skin. “They have fewer side effects and can be effective, especially if you have mild to moderate psoriasis,” Jenkins says.
But if you have a lot of scaling on your skin, joint pain, or don’t get relief from topicals, your doctor may recommend another treatment. That could include light therapy or “systemic treatments.” These are oral or injected medications that treat inflammation throughout your body. You can pair systemic medications with topical treatments or use them on their own. They should start working within several weeks.
No matter what your treatment, your doctor will examine your skin to determine whether it’s working, says Joshua Zeichner, MD, a dermatologist and director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City.
If you have psoriatic arthritis, “your doctor may also recommend tests like X-rays to see if you have joint damage,” Zeichner says.
Biologic medications, a type of treatment that suppresses your immune system, can help. Your doctor may put you on them for a few months to get your inflammation under control, Zeichner says, then switch to a different treatment, like light therapy and topical medications.
What Happens if Treatment Doesn’t Work?
Touch base with your doctor right away,” Zeichner says, if you notice your psoriasis is getting worse, or you’re having a side effect linked to your treatment. These are signs it may be time to try a new type of medication. Sometimes combining treatments, like a biologic and a topical ointment or cream, will give you better results.
“You want to have a conversation with your dermatologist or doctor about what results you want and how aggressive you’re willing to be with treatment,” Jenkins says. There are dozens of different options, so don’t be afraid to speak up if you don’t like the plan your doctor suggests for you.
Having psoriasis means seeing your dermatologist or another member of your health care team regularly, especially when your symptoms flare up. Make sure your doctor is looking at all aspects of your health, not just your skin.
“Psoriasis is a sign of inflammation in your body. That inflammation throws off your body's ability to regulate your immune system,” Engelman says. The impact on your immune system can cause or contribute to many other health problems, including joint damage. Tests to measure your blood sugar, blood pressure, and weight can help your doctor spot and treat psoriasis-related health problems before they cause serious problems.
Effectiveness isn’t the only reason you may want to change medications. If you don’t like or can’t live with the side effects, or find a medication too hard to use, you may want to switch. Depending on your health insurance, cost may also be an issue. Know that it’s OK to stop using a medication, even if it’s working.
“It’s important to be your own advocate,” Engelman says. The key is to be willing to try something else.
“Left untreated, psoriasis can have a major impact on your health and day-to-day life,” Jenkins says. “It’s important to team up with your doctor and keep trying new approaches until you find a solution that works for you.”
Ashley Jenkins, MD, dermatologist; adjunct professor of dermatology; University of Missouri, Columbia, MO.
Dendy Engelman, MD, dermatologist, the Shafer Clinic, New York, NY.
National Psoriasis Foundation: “What’s Next?” “When It Comes to Your Treatment, One Size Does Not Fit All.”
UptoDate: “Treatment of Psoriasis in Adults.”
Mayo Clinic: “Psoriasis.”
Anca D. Askanase, MD, MPH, rheumatologist, ColumbiaDoctors; associate professor of medicine and director, rheumatology clinical trials, Columbia University Medical Center, New York, NY.
Joshua Zeichner, MD, dermatologist; director of cosmetic and clinical research in dermatology; Mount Sinai Hospital, New York City.