What Are the Treatments for Psoriasis?
Rutledge Forney, M.D. Medical, Surgical, and Cosmetic Dermatologist
Topical Treatments for Psoriasis
Topical treatments are rubbed directly into the affected skin to bring local relief without the system-wide side effects of medicines taken by mouth or a shot. Topical treatments for psoriasis include:
Salicylic acid . Some doctors recommend salicylic acid ointment, which smoothes the skin by promoting the shedding of psoriatic scales. Using salicylic acid over large areas of skin, however, may cause the body to absorb too much of the medication, leading to side effects. Salicylic acid may also cause skin irritation and weaken hair shafts, which can cause breakage and temporary hair loss. The effectiveness of these preparations are modest at best.
Steroid-based creams. The mainstay of psoriasis treatment, steroid creams decrease inflammation, relieve itching, and block the production of cells that are overproduced in psoriasis. Stronger preparations, which are more effective than milder ones, can cause side effects that include burning, dryness, irritation, and thinning of the skin. Be especially careful to follow your doctor's instructions on their use.
Calcipotriene or calcitriol (Vectical) containing topical ointment. Calcipotriene (Dovonex), which is vitamin D, has proven to be effective for treating psoriasis, especially when combined with a topical corticosteroid cream. It's best to use only limited amounts to avoid side effects.
Coal-tar ointments and shampoos. These products can help slow the rapid growth of skin cells and alleviate symptoms, but some people are vulnerable to the side effects, especially folliculitis, a pimple-like rash affecting the hair follicles. These medicines should be used only under a doctor's supervision.
Prescription retinoids. These topical preparations containing a synthetic form of vitamin A can help improve psoriasis. These preparations don't work as quickly as steroids. Topical retinoids can sometimes cause dryness and irritation of the skin.
Light Therapy for Psoriasis
Even regular doses of sunlight -- not enough to produce sunburn -- can help psoriasis lesions in many people. For persistent, difficult-to-treat cases of psoriasis, many doctors recommend light therapy. One of the most effective treatments is PUVA (the drug psoralen combined with ultraviolet A, or UVA, light). However, this form of therapy is used far less often today, because it has been shown to increase the risk of developing skin cancer -- even decades after stopping this therapy.
Some doctors may prescribe ultraviolet B light (UVB) treatment using a light box alone or with other therapies such as coal tar. A more targeted ultraviolet light treatment, called narrow-band UVB therapy, is less carcinogenic than PUVA and almost as effective.
Oral and Injectiable Medications for Psoriasis
When other treatments fail, some doctors prescribe oral or injectable drugs to treat psoriasis. Some of these medications affect the immune system. One such medication, methotrexate (also used as a chemotherapy drug for cancer and for various forms of arthritis), can produce dramatic clearing of the psoriasis lesions. However, it can cause side effects, so the prescribing doctor should perform regular blood tests. Another medication of this type is cyclosporine.
Oral retinoids, compounds with vitamin-A-like properties, can be mildly helpful to people with severe psoriasis. Women of childbearing age need to use birth control with this medication and for three years afterwards, because it is associated with an increased risk for birth defects.
Biologics that control the body’s immune response are routinely used to treat severe psoriasis and psoriatic arthritis. These drugs, which are made from human or animal proteins, are quite effective but extremely expensive. They include adalimumab (Humira), brodalumab (Siliq) etanercept (Enbrel), guselkumab (Tremfya) ixekizumab (Taltz), secukinumab (Cosentyx), and ustekinumab (Stelara).
Natural Psoriasis Treatments
If medications fail to relieve the symptoms of psoriasis or cause unwanted side effects, people may try natural remedies, such as herbs and vitamins, for relief. Some people with psoriasis find natural sunlight and ocean water helpful. Some seaside resorts offer special programs for people with psoriasis.
If you are considering natural remedies for psoriasis, here's what you should know about some of the more commonly used remedies:
Aloe vera. Preliminary research suggests that topical cream from the aloe vera plant may improve symptoms of psoriasis. One study showed that topical aloe vera was more effective than placebo. This product is of only minimal benefit, at best.
Fish oil . Fish oil may be helpful for psoriasis when taken orally. Research has suggested that taking daily oral fish oil supplements containing 1.8 to 3.6 grams of eicosapentaenoic acid (EPA) may bring some improvement by reducing inflammation. A survey of more than 1,200 psoriasis patients found that many reported symptom improvement by taking fish oil supplements. Others reported they were helped by vitamin D supplements.
Dead Sea salts. Bath solutions, such as Dead Sea salts, oil, oilated oatmeal, or Epsom salts can help psoriasis by removing scales and easing itching. To try Dead Sea salts and other bath solutions, mix them in the bath as directed, then soak in the tub for about 15 minutes. As soon as you get out of the tub, apply a moisturizer to the skin. Don't expect a lot of improvement, however.
Cayenne. Cayenne peppers have been used medicinally for thousands of years. Capsaicin, the ingredient in peppers that gives them their heat, is also the active ingredient in many pain-relieving gels and creams. In one study, applying capsaicin cream to the skin relieved itching and skin lesions in people with psoriasis. Capsaicin can cause a burning sensation to the skin, which improves the longer you use it. It's important to wash your hands immediately after rubbing in capsaicin and not touch your eyes or mouth while you have capsaicin on your hands.
Diet. Obese psoriasis patients who lose weight report significant improvement in their symptoms, research has shown. Eliminating gluten also seems to alleviate joint pain and skin symptoms in the 25% of psoriasis patients who are sensitive to the protein, which is found in bread, pasta, crackers, soy sauce, lunch meats, and many other food products. Many of the patients surveyed in the 2014-15 study reported the same, and some said adopting vegan, Paleolithic and the Pagano diet (alcohol-, carb, and red meat-free) also helped reduce their symptoms.