Psoriasis is a skin condition with different classifications. It can differ in type, site, and severity. Your treatment should be tailored to your unique needs and condition.
Here are some current psoriasis treatment options, and some reasons why they may or may not be working for you.
Topical treatments are best for treating mild to moderate psoriasis. They include corticosteroids and non-steroid treatments.
When used alone or with vitamin D, topical corticosteroids are effective in treating localized psoriasis. One downside of using corticosteroids, and possibly why they aren't working for you, is that psoriasis symptoms may return if therapy is stopped. There are several types of topical corticosteroids, so talk to your doctor about which one may be right for you.
Non-steroid topical treatment
Non-steroid treatments include retinoids, coal tar, and vitamin D analogues. These treatments may be effective, but are typically less effective than corticosteroids.
Topical retinoids can help reduce inflammation and how often skin cells develop and regrow.
Coal tar is an ancient treatment, and has been used to treat psoriasis for more than 80 years. It's not as appealing as other treatments because of its strong odor and staining properties.
Dithranol is a popular topical treatment for psoriasis. You can apply it as a mixed paste or directly for short contact in higher concentrations. Only a few side effects are possible, including skin irritation and staining.
When done consistently, phototherapy can be successful in treating psoriasis. Phototherapy options include ultraviolet B (UVB), ultraviolet light A (UVA), and laser treatments. UVA can be very effective when combined with a drug called psoralen. The combination treatment is known as PUVA.
Systemic or prescription medications include methotrexate, oral retinoids, and cyclosporine.
Methotrexate is FDA approved to treat many diseases including psoriasis. It can be very effective and is not as expensive as other treatments. One potential side effect is liver toxicity. Your doctor might start you on folic acid to reduce your risk of such toxicities.
Oral retinoids are prescription drugs. Currently, acitretin (Soriatane) is the only FDA-approved oral retinoid for psoriasis. Acitretin isnít recommended for women who are pregnant or may become pregnant within three years after treatment.
Cyclosporine (Sandimmune) is an oral medication thatís most effective when used short-term. Long-term use is connected to increased risk of hypertension and kidney toxicity.
Biologics are target-specific drugs that act by blocking certain inflammatory cytokines. Currently, there are seven biologics that are FDA approved to treat moderate to severe psoriasis:
- infliximab (Remicade)
- adalimumab (Humira)
- etanercept (Enbrel)
- ustekinumab (Stelara)
- apremilast (Otezla)
- ixekizumab (Taltz)
- secukinumab (Cosentyx)
Biologics are generally a last resort for treatment, so talk to your doctor about if they're right for you.
If the above treatments aren't working for your psoriasis, you may want to consider small molecules or JAK inhibitors.
According to a preclinical study, small molecules can treat psoriasis in people who aren't responding well to traditional treatments. Apremilast (Otezla) is a new small molecule pill that can help control active psoriatic arthritis or plaque psoriasis.
Finding the right treatment for your psoriasis may take some time, but it's possible. Make an appointment with your doctor if you think your current treatment is no longer working.
Written by Jennifer Abayowa
Medically Reviewed by Mohamed Jalloh, PharmD on July 5, 2016Read more in Psoriasis Resources
- Dvorakova, V., & Markham, T. (2013, May). Psoriasis: current treatment options and recent advances. Prescriber, 24(10), 13ñ20. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/psb.1059/abstract
- Henseler, T. & Schmitt-Rau, K. (2008, October). A comparison between BSA, PASI, PLASI and SAPASI as measures of disease severity and improvement by therapy in patients with psoriasis. International Journal of Dermatology, 47 (10), 1019-1023. Retrieved from http://www.ncbi.nlm
- Mason, A. R., Mason, J., Cork, M., Dooley, G., & Hancock, H. (2013, March 28). Topical treatments for chronic plaque psoriasis. Cochrane Database of Systematic Reviews. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005028.pub3/abstract
- Noda, S., Krueger, J. G., & Guttman-Yassky, E. (2014, December 23). The translational revolution and use of biologics in patients with inflammatory skin diseases. Journal of Allergy and Clinical Immunology, 135(2), 324ñ336. Retrieved from http://www.jacionline.org/article/S0091-6749(14)01669-8/abstract
- Papp, K. A., Menter, M. A., Abe, M., Elewski, B., Feldman, S. R., Gottlieb, A. B., Ö Wolk, R. (2015). Tofacitinib, an oral Janus kinase inhibitor, for the treatment of chronic plaque psoriasis: results from two randomized, placebo-controlled, phase III trials. British Journal of Dermatology, 173(4), 949ñ961. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/bjd.14018/abstract
- Phototherapy. (2015). Retrieved from https://www.psoriasis.org/phototherapy
- Psoriasis area & severity index. (2015). Retrieved from http://www.papaa.org/articles/psoriasis-area-severity-index
- Robinson, A., Kardos, M, & Kimball, A.B. (2012, March). Physician global assessment (PGA) and psoriasis area and severity index (PASI): why do both? A systematic analysis of randomized controlled trials of biologic agents for moderate to severe plaque psoriasis. Journal of the American Academy of Dermatology, 66(3), 369-375. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22041254
- Samarasekera, E. J., Sawyer, L., Wonderling, D., Tucker, R., & Smith, C. H. (2013, April 25). Topical therapies for the treatment of plaque psoriasis: systematic review and network meta-analyses. British Journal of Dermatology, 168(5), 954ñ967. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/bjd.12276/abstract
- Sehgal, V. N., Verma, P., & Khurana, A. (2014, October). Anthralin/dithranol in dermatology. International Journal of Dermatology, 53(10), e449ñe460. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2012.05611.x/abst...
- Torres, T. & Filipe, P. (2015, August). Small molecules in the treatment of psoriasis. Drug Development Research, 76 (5), 215ñ227. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/ddr.21263/abstract