Understanding Your Treatment Options for Psoriasis
If you have psoriasis, you may sometimes feel overwhelmed by your disease and what you have to do to keep it under control. Fortunately, there are many options, which vary in how they work, what you need to do, and the side effects or risks that come with them. Your doctor is your best resource for helping you make decisions about what treatments are best for you.
When choosing a treatment plan, you should consider:
- The type and severity of your psoriasis
- Your individual history, risks, and preferences
- Cost of treatment
- Using a tiered approach–starting with the treatment that is easiest to use, least expensive, and has the fewest risks and side effects
Treatment Options for Mild or Moderate Psoriasis
People with mild or moderate psoriasis usually have less than 5% of their skin affected, without complicating factors. Your doctor will usually recommend topical medications (applied to the skin) or phototherapy (light treatments).
Topical medications treat psoriasis by reducing inflammation of the skin, slowing skin growth, flattening plaques, or removing scales. When used according to your doctor’s directions, side effects are usually mild and local–meaning they affect the area treated or nearby only. The most common side effects include thinning of the skin, redness, irritation, burning, or changes in skin color.
The most commonly-prescribed topical medications include:
- Corticosteroids. They are by far the most frequently-used medications for psoriasis, limited to short-term use for flares
- Vitamin D analogs such as calcipotriol (Dovonex). These take longer to work, but effects can last longer than corticosteroids
- Retinoids such as tazarotene (Tazorac). Retinoids are a form of vitamin A that slow the development and renewal of skin cells and reduce inflammation.
Less frequently used topical medications include coal tar, anthralin, calcineurin inhibitors, and salicylic acid.
Phototherapy involves exposing the skin to ultraviolet light on a regular basis until your skin clears. You usually need multiple treatments, which may be hard to fit into your schedule. Phototherapy can cause redness, itching, or burning. It can also increase your risk of skin damage and skin cancer.
There are several different types of phototherapy:
- PUVA (psoralen plus UVA). The medication psoralen is either applied to your skin or taken orally and activated by UVA light
- UVB treatments. These can be done in your doctor’s office or even at home
Laser treatments, including the excimer and pulsed dye lasers. Lasers are used only on the affected skin. This reduces the side effects to your healthy skin.
Treatment Options for Severe Psoriasis or Psoriatic Arthritis
People with severe psoriasis have over 5% of their skin affected or are resistant to other treatments.
Your doctor may prescribe topical medications or phototherapy, but he or she will also likely add systemic medications. Systemic medications work throughout the body to slow down the growth of skin cells, reduce inflammation, and/or suppress the immune system. These medications can have serious side effects and risks. Many increase your risk of infection or certain cancers. Others can cause problems with your liver, kidney, skin, blood, nervous system, or other organs. You will need regular monitoring, including blood tests and tests for infections, before and during treatment for most of these medications.
The most common systemic medications include:
- Older oral medications including methotrexate, cyclosporine, and acitretin (Soriatane)
- Biologics such as etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), and ustekinumab (Stelara). Biologics are drugs made from living cells in a lab. They are given by injection or intravenous infusion. Biologics are especially useful for people with psoriatic arthritis
- The newest oral medication, apremilast (Otezla). Your doctor may consider prescribing this new medication if you can’t take or don’t respond to the usual medications
The Bottom Line
There are many treatment options for people with psoriasis, and there will likely be many more in the future. Your doctor will work with you to find a treatment or combination of treatments that improve your symptoms and fit your personal goals and lifestyle. Talk to your doctor about what’s most important to you when choosing a treatment plan. In addition, make sure you lead a healthy lifestyle by eating well, exercising, taking care of your skin, avoiding triggers, and keeping stress under control.