There’s no cure for psoriasis. But treatment can help you feel better. You may need topical, oral, or body-wide (systemic) treatments. Even if you have severe psoriasis, there are good ways to manage your flare-ups. You may be able to get rid of your symptoms completely.
Topical Treatments for Psoriasis
These are drugs you rub directly on your skin. Along with a good moisturizer, they’re usually the first thing your doctor will suggest, especially for mild to moderate psoriasis. There are over-the-counter (OTC) and prescription options.
Topical treatments for psoriasis come as ointments, creams, solutions, or foam and include:
Steroid creams. These slow down immune cells in your skin. They can ease swelling and redness. Mild steroid creams are available over the counter. You’ll need a prescription from your doctor for something stronger. Steroids come with side effects and should be used with caution on sensitive areas like your face or genitals. They can burn or thin the skin. Use them exactly the way your doctor tells you.
Salicylic acid. This can soften and thin scaly skin. But it can also irritate your skin if you leave it on too long. It might weaken your hair follicles and cause temporary hair loss, too. The body can absorb salicylic acid if you put it on large patches of skin.
Calcipotriol (Calcipotriene). This is a strong form of synthetic vitamin D. It’s known to control overactive skin cells. Your doctor might pair it with a steroid cream.
Roflumilast (Zoryve) is a newly approved steroid-free cream that can be used once daily to give relief from plaques. A PDE-4 inhibitor, it can block an enzyme that causes inflammation.
Tapinarof (Vtama) is a new steroid-free topical cream that is an aryl hydrocarbon receptor agonist, approved to treat plaque psoriasis in adults. Applied once a day, it can be used on sensitive areas of the body and is safe for long-term use.
Tazorac (Tazarotene) is available in gel, cream, or foam and is applied once or twice daily. It is not recommended for those who are pregnant or breast-feeding or intending to become pregnant.
Immunomodulators. These aren’t steroids, but they change how your immune cells work. Options include pimecrolimus and tacrolimus. Your doctor might give you these to use on sensitive areas such as your face, groin, or skin folds.
Coal tar ointment and shampoo. Coal tar is known to ease psoriasis-related inflammation, itching, and scales. But it can cause side effects such as skin redness and dryness. It can also make your skin more sensitive to UV light. These are not recommended for pregnant and breastfeeding women. Ask your doctor how to use it.
Prescription retinoid. These are ointments made with synthetic vitamin A. Your doctor might want you to use a steroid at the same time. That can lower your odds of skin irritation caused by the retinoid.
Phototherapy for Psoriasis
Sunlight has been used to treat skin conditions for thousands of years. Now doctors use machines to shine ultraviolet (UV) rays directly on your skin.
Light therapy can slow down fast-growing skin cells in people who have psoriasis. It’s usually something a dermatologist will do in their office a few times a week. But there are some at-home kits you can use. Ask your doctor about them.
Different types of phototherapy for psoriasis include:
Narrowband UVB therapy. This is a targeted form of UV light. You’ll stand in a light box or your doctor will pass a brush or comb over the affected areas. It’s safe for children, people who are pregnant or breastfeeding, and those with a weakened immune system or ongoing illness.
Broadband UVB therapy. This sends out a wider range of UVB light. It’s not used as much as narrowband UVB therapy because it's not as effective.
Excimer Laser therapy (XTRAC laser). Excimer laser therapy helps get rid of the red patches by exposing them to targeted ultraviolet B (UVB) rays.
Psoralen + UVA (PUVA). This mixes a drug called psoralen with ultraviolet A, or UVA, light. You can take psoralen by mouth or sit in a bath. It makes your skin more sensitive to light, which boosts the amount of UVA light your skin can absorb. This combo is really effective for psoriasis. But it’s an older treatment that’s not used as much as narrowband UVB therapy.
Phototherapy can cause short and long-term side effects. It may make you feel like you have sunburn and raise your risk of getting skin cancer. It’s not recommended if:
- You’ve had skin cancer
- You have a medical condition that raises your chances of getting skin cancer
- You have a medical condition or take medicine that makes you more sensitive to UV light
Immunosuppressants. If other treatments don’t work or you have moderate to severe psoriasis, your doctor might give you drugs to slow down your entire immune system. You’ll take them by mouth or get them though a shot in your arm. They can make it harder to fight off infections and cause other unwanted side effects.
Some immunosuppressants used to treat psoriasis include:
Methotrexate. This is only for people with serious symptoms. It can raise your odds of liver disease and lung or kidney problems. Your doctor will give you lab tests every so often to make sure your organs are healthy.
Cyclosporine. This is used most for serious psoriasis. It can cause high blood pressure or kidney problems. You may notice some skin sensitivity or muscle and joint pain.
Enzyme inhibitor. A newer drug called apremilast can target and slow down inflammation in certain immune cells. It’s a pill you take twice a day. It’s generally considered safe. But tell your doctor if you have any mood changes. It can raise your chance of depression or suicidal thoughts.
Oral retinoids. Acitretin is a synthetic form of vitamin A. You take it by mouth. Experts aren’t sure why it helps with psoriasis. They think it’s because retinoids affect how fast skin cells grow.
Oral retinoids are often used to treat pustular psoriasis. But they can cause unwanted side effects, including hair loss and liver or bone problems. Your doctor may lower your dose once your symptoms get better.
It’s not safe to take acitretin if you’re allergic to retinoids. Oral retinoids can also lead to birth defects. Don’t take these drugs if:
- You’re pregnant, want to get pregnant, or are breastfeeding.
- You have serious liver or kidney disease.
- You have high triglycerides.
Systemic Biologic Treatments
These are newer drugs made from living material. Biologics are divided into groups: tumor necrosis factor (TNF) inhibitors, interleukin (IL)-23 inhibitors, IL-17 inhibitors, and IL-12/23 inhibitors. Each type targets specific immune cells or proteins that cause psoriasis. Unlike immunosuppressants, they don’t affect your whole immune system.
You’ll likely get this treatment through a shot or IV infusion.
Biologics work best for moderate to serious psoriasis and psoriatic arthritis. But they can be expensive. These drugs are generally considered safe. But more research is needed on their long-term effects. Your doctor will help you decide if they’re right for you.
Biologics used to treat psoriasis include:
- Golimumab and Abatacept (for psoriatic arthritis)
- Tofacitinib (oral)
Natural Psoriasis Treatments
Lots of people try herbs, vitamins, or other at-home remedies to ease symptoms. Just remember what works for someone else might not work for you. It’s best to talk to your doctor before you change or add something to your treatment plan. They’ll let you know what’s safe.
Here are some commonly used natural psoriasis treatments:
Salt bath. This might lift some of your scales and help you itch less. Add Dead Sea or Epsom salts to warm water. Soak for 15 minutes. Apply moisturizer after your bath so your skin doesn’t get too dry.
Colloidal oatmeal. Some people say their skin is less red and itchy when they soak in an oatmeal bath or apply a paste to their skin. There’s not much evidence to show it treats psoriasis.
Aloe vera. A cream with 0.5% aloe might lessen your scales and ease redness for a short time. You can use it up to three times a day.
Apple cider vinegar. This is sometimes used to ease itching from scalp psoriasis. You can use it a few times a week. Make sure you mix more parts water than vinegar. Otherwise, the vinegar can burn your skin. Avoid any open wounds.
Healthy diet. There’s no meal plan specifically for psoriasis. But if you’re overweight or obese, your symptoms might get better if you lose excess weight. Experts think that’s because certain cells, such as the ones in your belly, worsen inflammation. That makes it harder for the immune cells in your skin and body to work the right way.
Keep your doctor in the loop about your condition. They may need to update your care plan over time. That might mean switching to a different topical drug or trying a mix of psoriasis treatments.