Topical Treatment

Treatments applied directly to the skin (creams, ointments, lotions, and gels), or topical treatments, are usually the first line of treatment for most patients with mild to moderate psoriasis. In many cases, they’re also used in combination with another type of treatment.

Topical treatments include:

Cortisone Creams and Ointments

The most frequently prescribed medications for treating mild to moderate psoriasis, these low-dose steroid treatments work to control the excessive production of skin cells, soothe skin, and improve symptoms. However, some corticosteroids are made with stronger steroids and may actually make symptoms worse.

Topical Retinoids

Retinoids (including Tazorac and Avage) are derived from vitamin A and work to normalize DNA activity in skin cells and slow the inflammation process. Though not as fast-acting as corticosteroid ointments, they have less side effects. Women who are pregnant or may become pregnant should not use retinoids due to a risk of birth defects.

Vitamin D Analogues

These drugs may be used alone or in combination with other treatments to treat mild to moderate psoriasis, and include calcipotriene (Dovonex) and calcitriol (Rocaltrol), synthetic forms of vitamin D that slow down skin cell growth.

Anthralin, or Dritho-Scalp

This cream works to normalize DNA activity in your skin cells and remove scales, and is sometimes used in combination with phototherapy. Doctors recommend that this cream stay on your skin for a brief time since it can irritate skin if left too long, and cause staining. 

Coal Tar Creams or Ointments

The oldest treatment for psoriasis, made from the byproducts of petroleum manufacturing, coal tar products reduce scaling, itching, and inflammation. High concentrations are available by prescription. These creams have some downsides, however: coal tar is messy, stains clothing and bedding, and has a strong, sometimes unpleasant odor.

Dandruff Shampoos

Used to treat scalp psoriasis, medicated and prescription-strength versions are available from your doctor.

Salicylic Acid and Lactic Acid

Available in over-the-counter and prescription formulas, both acids promote sloughing of dead skin cells, which reduces scaling. Both acids can be used in combination with other treatments.

Systemic Treatment

For more severe forms of psoriasis, or cases that are resistant to other treatments, traditional oral or injectable medicines or drugs may be used. Because many of these drugs have serious side effects, doctors limit their use to only difficult or persistent cases.

Systemic medicines include:

Methotrexate

Methotrexate decreases the production of skin cells and suppresses immune response. This drug is often prescribed to people with moderate to severe psoriasis, and it is one of the most effective treatments for people with erythrodermic psoriasis or pustular psoriasis. Recently, doctors have begun prescribing it as a treatment for psoriatic arthritis as well.

Side effects include: 

  • loss of appetite
  • fatigue
  • upset stomach

Pregnant women or those who may become pregnant should not take methotrexate due to a risk of ectopic pregnancy and miscarriage. (Men should also avoid getting a woman pregnant if he is using or has recently used this drug.) Long-term use may cause liver damage and decreased production of red and white blood cells and platelets.

Cyclosporine

Cyclosporine is a highly-effective immunosuppressant drug. However, because it weakens the immune system, it is only prescribed to people with severe cases of psoriasis. Most doctors only prescribe cyclosporine for short lengths of time, usually three to six months because of a risk for increased blood pressure. Patients on cyclosporine require regular blood tests and blood pressure checks to monitor for potential problems.

Retinoids

Retinoids, which are made from vitamin A derivatives, may treat moderate to severe psoriasis by reducing the production of skin cells. Retinoids are also sometimes used in combination with light therapy.

As with other systemic medications, retinoids have some potential major side effects. Your doctor may order regular blood tests to check for high cholesterol, a common problem for people on this medicine. Retinoids can also cause birth defects, so women who are pregnant or wish to become pregnant should not take this medicine; they should also stop taking retinoids at least three years before trying to become pregnant.

The only FDA-approved oral retinoid for the treatment of psoriasis is acitretin (Soriatane). 

Hydroxyurea

Unlike cyclosporine or methotrexate, hydroxyurea can be combined with phototherapy, but it isn’t as effective as cyclosporine and methotrexate. Possible side effects include anemia (too-low red blood cells) and a decrease in white blood cells and platelets. Women who are pregnant or plan to become pregnant should not take hydroxyurea due to a risk of birth defects and miscarriage.

Immunomodulator Drugs (biologics)

Biologics are a newer class of drugs that target your body’s immune response. They work by blocking interactions between immune system cells and inflammatory pathways. These drugs, which are given by injection (shot) or infusion (IV), are often prescribed to people with moderate to severe psoriasis who have not responded to traditional therapies.

A few biologics have been approved to treat psoriatic arthritis, as well. Research shows these biologics may slow or stop joint damage altogether—a significant medical advance as, previously, patients with psoriatic arthritis could only take medications to temporarily alleviate pain and swelling associated with the arthritis.

Biologics approved for the treatment of psoriasis include: 

  • adalimumab (Humira)
  • alefacept (Amevive)
  • etanercept (Enbrel)
  • golimumab (Simponi)
  • infliximab (Remicade)
  • ustekinumab (Stelara) 

Thioguanine

While not as effective as methotrexate or cyclosporine, thioguanine has fewer side effects, making it a more attractive treatment option. However, it still may cause birth defects, so women who are pregnant or plan to become pregnant should avoid taking it.