Psoriasis Treatments and Medications

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.

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