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Dry, itchy skin patches that appear as rashes can be frightening to live with. You may find yourself frustrated, uncomfortable, and worried about the social implications of having a visible rash caused by psoriasis.
There can be a variety of triggers for this skin disease as well as many different treatment options. Psoriasis treatment starts with educating yourself on the condition and what can be done to make living with it easier.
This article can serve as a good starting point for understanding your psoriasis. Let’s take a look at this condition and its treatments.
What is psoriasis?
A common skin condition, with more than 3 million cases yearly in the United States, psoriasis is related to an immune system response by the body. It is a chronic skin disease that is still without a cure.
There are five types of psoriasis that are characterized by the appearance and location of the rash. According to the National Psoriasis Foundation, the five types of psoriasis are plaque, guttate, inverse, erythrodermic, and pustular psoriasis. There is also a form of arthritis that can be caused by it and is called psoriatic arthritis.
Psoriasis symptoms can vary depending on the type but the most common is a rash on the skin. There are a variety of psoriasis treatments including self-care, medications, and medical procedures.
How is psoriasis diagnosed?
Since psoriasis is caused by an immune system response, it is easiest to diagnose when the rash is occurring. While the specific symptoms will vary by the type of psoriasis you have, the most commonly occurring symptoms are red, inflamed skin covered in patches of scaly, silver-colored skin. These patches will be itchy or painful and the scaly skin may even crack and bleed. The scales can occur anywhere. Sometimes they are even found on or near the scalp. Fingernail or toenail issues can also happen as a result of psoriasis, causing discoloration, crumbling, or complete detachment from the nail bed itself.
A primary care physician or dermatological specialist can perform an examination to diagnose psoriasis. Although there are not any blood tests or other tool-based tests for diagnosing psoriasis, a biopsy on the skin may be performed. Some cases of psoriasis can resemble other skin conditions like eczema, which can cause the doctor to biopsy the skin for further examination under a microscope.
Before the appointment with your dermatologist, you may want to look into your family’s history as one-third of people with psoriasis have a family member with the disease.
Psoriasis treatment options
Unfortunately, there is not a cure for psoriasis at this time and it is a chronic condition. The good news is there are a variety of treatments you will be able to explore. Because psoriasis is related to an immune system and skin cell response, many of the treatment options focus on those specific areas.
Medications available both by prescription or over-the-counter can help with psoriasis treatment. This includes the use of steroids, immunosuppressive drugs, and anti-inflammatory drugs. Many medications for psoriasis are in the form of topical ointments, but there are other medication forms available as well.
Medical phototherapy, called photodynamic therapy, is also an option for the treatment of psoriasis. Phototherapy will take place at home or at the doctor’s office and involves exposure to ultraviolet light.
Additionally, there are at-home or self-care based treatments as well that have become popular options for tackling psoriasis. These can include stress management and other non-pharmacological therapies. Some also find that preventative measures can help when dealing with psoriasis, such as avoiding immune system triggers like allergens or stress.
Psoriasis medications
A typical treatment plan for psoriasis will be focused on decreasing inflammation, clearing the skin, and slowing the growth of excess skin cells. Different medications will help reduce the severity of symptoms, but other therapies may be used to prevent psoriasis flares from occurring in the first place. Some of the most common medications used for psoriasis are topical corticosteroids, vitamin D analogs, calcineurin inhibitors, and biologics.
Topical corticosteroids
One of the most common medications used for psoriasis are steroids, specifically topical corticosteroids. These are used to mimic hormone responses, which results in reduced inflammation and a suppressed immune response. There are a few different strengths and types of steroid ointments that are available as either a prescription or over-the-counter.
A popular over-the-counter steroid ointment that is used for psoriasis treatment is hydrocortisone. Commonly prescribed steroids include triamcinolone acetonide, betamethasone, and desonide. Common side effects of using topical steroids are irritation and burning or pain at the application site.
Vitamin D analogs
Vitamin D analogs are commonly prescribed for psoriasis and can help reduce scaling and inflammation of the skin. These medications are topically applied and can be used alone as an alternative to topical steroids or in combination with them.
These medications include calcitriol and calcipotriene both of which are synthetic versions of vitamin D. They are often taken once or twice daily and have been shown to be quite effective against psoriasis. Side effects are minimal; although, some may experience irritation at the application site.
Retinoids (vitamin A derivatives)
Retinoids are chemically similar to vitamin A and are usually used in combination with other treatments. Studies have shown that retinoids can help slow skin cell growth and reduce inflammation during psoriasis flare-ups.
There are different forms of retinoids used when treating psoriasis including topical and oral retinoids, both of which are prescribed by a doctor. Acitretin is the oral retinoid that is continuously used for treating severe psoriasis and can be used with phototherapy for better skin clearance. Tazarotene is a commonly prescribed topical therapy and is often used with a topical corticosteroid to reduce irritation. Topical retinoids may cause burning, stinging, or itchiness at the application site.
Calcineurin inhibitors
Calcineurin inhibitors include topical tacrolimus and pimecrolimus, which are sometimes used to treat other skin conditions like eczema. They work by binding to certain proteins in skin cells to reduce inflammation. These medications are especially useful for sensitive areas like the face and behind the arms or legs. This is because tacrolimus and pimecrolimus have been shown to be effective at clearing the skin without causing severe side effects. However, some irritation is common after application on the skin.
Cyclosporine is an oral calcineurin inhibitor that is effective in those with severe psoriasis. It is given on a daily basis and clears the skin within four weeks. Because it may cause renal toxicity, those taking cyclosporine should be routinely monitored by their doctor.
Biologics
Because psoriasis is an immune response that causes skin cell overgrowth, it may become a priority for your doctor to treat it with immunosuppressant drugs like biologics. These medications are given by injection or intravenous infusion and are available only with a prescription.
Some of the biologic medications used to treat psoriasis include adalimumab and infliximab. Adalimumab has grown increasingly popular for treating psoriatic arthritis. It works by blocking the action of certain proteins known to contribute to inflammation. Common side effects for these medications can be headache, nausea, and dizziness.
Methotrexate
Methotrexate is an effective long-term therapy for psoriasis. Not only can it treat psoriasis, but it can also help treat psoriatic arthritis. It works by suppressing the action of immune cells involved with inflammation in psoriasis.
Administration of methotrexate is versatile as it can be given as an oral tablet, injection, or infusion. It can also be given on a weekly basis. Close monitoring is needed for this drug since it has a risk for live toxicity when used long term.
Anthralin
Anthralin is one of the oldest topical treatments for psoriasis and is still used today. It has been shown to be effective in reducing inflammation and slowing down skin cell growth. Side effects for anthralin can include discoloration of the fingernails after application as well as redness or irritation at the application site. Its use has declined in recent years due to temporary staining of the skin and permanent staining of clothes if not applied carefully.
Other Medications
There are several options available to treat psoriasis as an alternative to the commonly prescribed choices. Apremilast is an oral medication that can be used to treat severe plaque psoriasis. Although it can be costly, it has shown to be effective for psoriasis and psoriatic arthritis. Side effects include headache, nausea, and weight loss.
Other medications are also currently being studied to treat psoriasis. Oral tofacitinib works by blocking the actions of inflammatory molecules in the body. Study results show that it is an effective treatment option for psoriasis. However, it is still being evaluated by the FDA. Tofacitinib is currently FDA-approved to treat rheumatoid arthritis and psoriatic arthritis.
What is the best medication for psoriasis?
Because psoriasis can vary in symptoms and triggers, finding the best medication can be hard to do. Many patients will have to try a few different medications before finding the one that works best. Your psoriasis treatment may be completely different than the one that works for another person. Consult a healthcare professional when selecting a medication for your psoriasis.
| Best medications for psoriasis | ||||||
|---|---|---|---|---|---|---|
| Drug Name | Drug Class | OTC/Rx | Administration Route | Standard Dosage | How It Works | Most Common Side Effects |
| Triderm (triamcinolone acetonide) | Steroid | Rx | Topical | 0.025%, 0.1%, and 0.5% Apply a thin layer of film 2 to 4 times daily | Reduces swelling, itching, and redness | Burning, itching, dryness |
| Sernivo (betamethasone dipropionate) | Steroid | Rx | Topical | 0.05% Apply to affected area 2 times daily | Reduces swelling, itching, and redness | Burning, irritation, dryness |
| Desowen (desonide) | Steroid | Rx | Topical | 0.05% Apply a thin layer of film 2 to 3 times daily | Reduces swelling, itchiness, and redness | Stinging, burning, dryness |
| Soriatane (acitretin) | Retinoid | Rx | Oral | 25 to 50 mg capsule once per day | Exactly how it works is not known. It is believed to have anti-inflammatory actions. | Itching, skin scaling, dryness, redness |
| Tazorac (tazarotene) | Retinoid | Rx | Topical | 0.05% or 0.1% Apply a small amount once a day | Exactly how it works is not known. It is believed to have anti-inflammatory actions. | Itching, irritation, redness, stinging |
| Sandimmune (cyclosporine) | Immunosuppressive calcineurin Inhibitor | Rx | Oral | 3 to 5 mg/kg once per day | Suppresses the immune system, reducing the inflammatory response that causes psoriasis | Headache, dizziness, unusual hair growth |
| Remicade (infliximab) | Biologic TNF-blocker | Rx | Infusion | 5 mg/kg injected over a series of 2, 6, then 8 weeks | Blocks the action of cells called TNF-alpha to prevent inflammation | Headache, stomach pain, nausea |
| Humira (adalimumab) | Biologic TNF-blocker | Rx | Injection | 80 mg injected once, followed by 40 mg injected every other week | Blocks a protein in the immune system that causes swelling and scaly patches | Redness, itching, pain at the injection site |
| Sorilux (calcipotriene) | Vitamin D Analog | Rx | Topical | 0.005% Apply a thin layer 2 times a day | Slows down the growth of skin cells | Redness, dryness, itching |
| Methotrexate | Antimetabolite | Rx | Oral or injection | 7.5 to 25 mg taken once a week | Controls excess skin growth | Stomach pain, nausea, vomiting |
| Otezla (apremilast) | Phosphodiesterase 4 (PDE4) inhibitor | Rx | Oral | 30 mg tablet taken twice a day | Helps combat inflammation and reduces cellular processes involved with psoriasis | Diarrhea, nausea, weight loss, dizziness |
| Xeljanz (tofacitinib) | Janus Kinase (JAK) Inhibitor | Rx | Oral | 5 mg tablet taken 1 to 2 times daily | Blocks cellular processes to control inflammation | Headache, diarrhea |
Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are common side effects of psoriasis medication?
There are a variety of medication types and drug classes used to treat psoriasis. This means that side effects can vary greatly depending on your lifestyle and other medications you’re taking. This is not a full list and you should discuss any possible side effects with your healthcare professional.
Some of the most common side effects of psoriasis medication include:
- Application site redness
- Application site dryness
- Itching
- Headache
- Stomach pain
- Stinging
How can I treat psoriasis naturally?
If you’re looking for organic remedies to use in addition to medications, there are many different natural treatments out there for psoriasis.
There are a few different things that may be triggering your psoriasis, which is a great place to start with natural treatment. Identifying and avoiding these triggers can help prevent a flare-up from occurring in the first place and increase quality of life. Triggers for psoriasis can include illness, stress, smoking, and injuries to the skin.
Aside from avoiding triggers, there are many other natural methods for the management of psoriasis. Below are a few different home remedies for psoriasis. Make sure to consult a doctor before trying any of the following remedies.
- Thick moisturizers and lotions Using a thick moisturizer or lotion such as petroleum jelly can ease the skin and reduce the redness. Many psoriasis patients have seen increased quality of life just by using moisturizers to soothe the skin.
- Coal tar Similarly to moisturizers, coal tar is used at home to treat psoriasis. Using coal tar may slow the growth of skin cells while reducing inflammation and redness. Tar comes in different forms such as creams, lotions, and shampoos.
- Apple cider vinegar This is especially useful for those with scalp psoriasis. It may reduce the itchiness of the scalp and prevent irritation. However, it is not recommended to use on cracked or bleeding skin, or severe psoriasis, as it could make the pain worse. It’s important to dilute the vinegar before using it to lower its acidity.
- Sit in the sun Ultraviolet B (UVB) rays can help against psoriasis. This is seen by many as another version of phototherapy. Getting consistent sunlight during midday for about five to 10 minutes may be helpful for treating psoriasis. However, it’s important to use sunscreen and not to stay out long enough to burn. Some medications can also increase the risk of sunburn, so consult a doctor before using natural sunlight.
- Salicylic acidUsing salicylic acid can help lift the skin scales as it works as a skin peeler. However, leaving it on the skin for too long can cause irritation and may cause a side effect of temporary hair loss according to the National Psoriasis Foundation.
- Soaking in the bathLukewarm baths can be soothing and helpful for shedding scales on the skin. Using Epsom salt or mineral oil can help remove scales while also soothing the skin. Hot baths are not recommended as they can cause further irritation.
- TurmericTaking turmeric capsules or adding the herb to your food can help with psoriasis and inflammation. Commonly used a home therapy for joint swelling, regular consumption of the herb can be helpful for reducing flare-ups for some people.
- Healthy diet Keeping your body in a healthy state is a great way to fight off or lessen the symptoms of psoriasis. Maintaining a healthy diet and exercise routine can keep your body as healthy as possible.
Frequently asked questions about psoriasis
How do I get rid of psoriasis fast?
Unfortunately, psoriasis is a chronic condition and flare-ups don’t tend to go away quickly. The best way to get rid of psoriasis as quickly as possible would likely be a combination of home remedies and prescription medication.
What is the new pill for psoriasis?
The most recent developments in psoriasis medication tend to be related to injections and newer injectable treatments. A few new treatments have received FDA approval in 2017 and 2018 after completing clinical trials. However, two oral medications Otezla (apremilast) and Xeljanz (tofacitinib) have recently become available as oral treatments for psoriasis. Otezla is recommended by doctors and dermatologists for plaque psoriasis whereas Xeljanz is typically being recommended for psoriatic arthritis.
What is the best oral medication for psoriasis?
The best medication for you will depend on your medical history, other medications, and information your doctor can provide you with. Each person is different and each medication that is the best for someone will also differ. Consult your healthcare professional to find the best oral medication for your psoriasis.
What's the best way to control psoriasis?
Everyone’s case of psoriasis is different, which means treatment will be different for every person. However, some of the best treatments for psoriasis seem to include a combination of lifestyle changes, home remedies, and prescription medications. This article contains information on treatments and medications. Using this article in combination with a consultation from your doctor can help you find the best way to control psoriasis.
What is the best cream for psoriasis?
Just like with any medication, the best cream for your psoriasis may be vastly different from the best cream for someone else. There are many different topical therapies on the market for treating psoriasis. You may need to try a few different ones before finding your perfect cream. Always consult your dermatologist or healthcare professional on what the best treatment for your psoriasis may be.