Proper skincare and lifestyle choices can also help you gain control of a disorder that continues to affect as many as 7.5 million Americans, according to the American Academy of Dermatology.
Prescriptions
Topical corticosteroids, also known as steroids, are considered the most effective means of treating mild plaque psoriasis. However, as a chronic autoimmune disorder, plaque psoriasis may require more than that. In some cases, the autoimmune response will need to be tempered to prevent the body from causing further harm.
To this end, doctors often turn to drugs that target the immune response, either systemically (as a whole) or in part.
Topical Corticosteroids
Topical corticosteroids are often used as a solo treatment for people with mild plaque psoriasis, and they can be used alongside other drugs in people with moderate to severe cases. Topical steroids are available by prescription as well as over the counter in a variety of lotions, creams, ointments, shampoos, foams, and sprays.
If prescribing a topical steroid, your dermatologist will consider the location and severity of your plaques. For those on the face or genitals, a lower-strength preparation may be prescribed, while a medium- to high-potency steroid can be used on other parts of the body.
Lexette (halobetasol propionate) and Ultravate (halobetasol propionate) are two topical corticosteroids approved for use by the U.S. Food and Drug Administration (FDA). Lexette is a foam ideal for scalp psoriasis, while Ultravate is a cream.
Non-Biologic Drugs
Non-biologic drugs are those that have been synthesized in the lab. There are three non-biologics commonly used to treat plaque psoriasis:
Methotrexate is an immune-suppressive drug that has been around for more than 50 years. It works by dampening the immune response as a whole. It is typically used in the first-line treatment of moderate to severe plaque psoriasis. Side effects can range from hair loss and fatigue to liver and bone marrow toxicity. Periodic blood tests are needed to avoid treatment complications. Cyclosporine is an immune-suppressive drug similar to methotrexate. It is used when psoriasis is either extensive or has not responded to at least one other systemic drug. While cyclosporine works quickly on the immune system, it also requires frequent monitoring for side effects, which include high blood pressure and kidney impairment. Otezla (apremilast) was approved in 2014 for the treatment of psoriasis and psoriatic arthritis. Otezla works by blocking an enzyme known as phosphodiesterase 4 that regulates cellular inflammation. While Otezla is well-tolerated, it may cause diarrhea, nausea, or headaches when first started. Less commonly, people may experience weight loss or signs of depression.
Biologic Drugs
Biologic drugs are those made from human or animal proteins. An increasing number of biologics have been approved for the treatment of moderate to severe plaque psoriasis. Unlike methotrexate, biologics target a specific component of the immune response rather than the immune system as a whole.
Biologics are delivered either by injection or intravenously (through a vein). They are usually prescribed for people with moderate to severe psoriasis who have not responded to other treatments.
The drugs target one of two components of the immune response:
TNF inhibitors like Humira (adalimumab), Enbrel (etanercept), and Remicade (infliximab) block tumor necrosis factor (TNF), a signaling protein involved in systemic inflammation. Human monoclonal antibodies like Stelara (ustekinumab), Cosentyx (secukinumab), Illumya (tildrakizumab), Siliq (brodalumab), Taltz (ixekizumab), Skyrizi (risankizumab-rzaa), and Tremfya (guselkumab) block interleukin, a protein that helps regulate the immune response.
Common side effects include injection site pain, respiratory infections, and flu-like symptoms. In rare cases, certain cancers and neurological disorders (e.g., seizures and multiple sclerosis) may develop.
Supportive Medications
There are a number of other prescription drugs commonly used to support the primary treatment of psoriasis. Among them:
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Anthralin was once the gold standard of psoriasis treatment. Although it has been supplanted by more effective (and less messy) topical treatments, anthralin is still used today if other standard medications fail to provide relief. Dovonex (calcipotriene) is a synthetic vitamin D3 analog first introduced in the 1990s to treat chronic plaque psoriasis. It is believed to improve symptoms by tempering the overproduction of keratinocytes in the skin. Other vitamin D3 analogs include calcitriol, tacalcitol, and the co-formulated drug Taclonex (which combines calcipotriene with the topical steroid betamethasone). Soriatane (acitretin) is an oral retinoid derived from vitamin A that can slow skin cell production and reduce inflammation. Approved for the treatment of severe psoriasis, it has side effects that include lip inflammation, hair loss, and drying of the eyes, nose, and mouth. This medication should not be used during pregnancy. Tazorac (tazarotene) is a topical retinoid used to treat mild to moderate psoriasis. It is also marketed under the brand names Avage and Fabior. Side effects include skin irritation and sun sensitivity. Tazorac should be avoided during pregnancy due to the risk of birth defects.
Off-Label Treatments
In dermatology, it is not uncommon to use a drug for purposes other than those for which it was approved. Known as “off-label” treatment, the practice is often supported by medical research but lacks the large-scale human trials required by the FDA.
Vtama is the first and only FDA-approved non-steroidal topical medication in its class.
Among the drugs commonly used for the off-label treatment of chronic psoriasis:
Cimzia (certolizumab) and Simponi (golimumab) are TNF inhibitors like Humira and Enbrel that are used to treat many autoimmune diseases but are yet to receive FDA approval for psoriasis. Calcineurin inhibitors like Protopic (tacrolimus) and Elidel (pimecrolimus) work by blocking a chemical needed to trigger the inflammation. Approved for the treatment of eczema, they are commonly used to treat mild to moderate psoriasis. Orencia (abatacept) blocks a type of white blood cell, known as a T-cell, which the immune system uses to instigate the inflammatory response. It is approved for the treatment of psoriatic arthritis, but not psoriasis.
Phototherapy
Sunlight can alleviate the symptoms of psoriasis, but prolonged exposure can lead to sunburns and a worsening of symptoms. To this end, UV light therapy, also known as phototherapy, has become a safe option for those who fail to respond to medications alone. Ultraviolet B (UVB) radiation, in particular, is able to penetrate the skin and slow the hyperproduction of skin cells.
Treatments can be performed in a doctor’s office or with a home unit. While your skin may initially get worse before it gets better, consistency usually renders the best results.
Another form of light therapy, known as psoralen + UVA (PUVA), combines UVA radiation with a light-sensitizing drug known as psoralen. PUVA is more effective for stable plaque psoriasis than acute flares.
Excimer laser therapy is another type of phototherapy that uses a focused beam of UVB radiation to treat smaller lesions in people with mild to moderate psoriasis.
Over-the-Counter Treatments
In addition to non-prescription topical steroids, there are a number of other over-the-counter (OTC) products available to treat psoriasis. As some can be harsh or interfere with prescribed medicines, it is important to speak with your dermatologist before starting treatment.
Among some of the more useful OTC options for psoriasis:
Coal tar has been used to treat psoriasis for more than 100 years, and there are some who still swear by it. Coal tar is available without a prescription and can be found in a variety of preparations, including shampoos, ointments, lotions, creams, and foams. While soothing, some of the products can be messy and cause staining. Salicylic acid is a peeling agent used to soften and remove flaking skin. It is contained in a variety of moisturizing creams, lotions, and ointments. Avoid using multiple salicylic products, and limit the application to no more than 20% of the body. Anything more may cause excessive absorption and toxicity. Topical anti-itch remedies contain ingredients approved by the FDA for the treatment of pruritus (itch). Anti-itch agents include calamine, hydrocortisone, camphor, diphenhydramine hydrochloride, benzocaine, and menthol. While useful, some of these products may increase dryness and flaking.
Home Remedies and Lifestyle
While there is an ever-increasing array of medications available to treat plaque psoriasis, there are home therapies and self-care practices that can also help.
Home Remedies
The primary aim of home therapies is to alleviate the itchiness, burning, and discomfort of plaques while gently removing accumulated skin cells without injury.
Among some of the more effective options:
Therapeutic baths made with Epsom salt, mineral oil, milk, oatmeal, or olive oil can soothe the skin while gently lifting scales from the outer layer (known as the epidermis). Fragrance-free moisturizers, such as petroleum jelly, aloe vera gel, or mineral oils, can aid in the shedding of cells while trapping moisture in the skin. These emollient-rich lotions should be applied after a bath to counteract moisture loss. Natural sunlight can slow the overproduction of skin cells, but exposure needs to be limited to around 10 minutes a day. You can gradually increase that time, but always do so while wearing protective clothing and a minimum SPF 30 sunscreen.
Skin Care
Good skin care is essential to control plaque psoriasis symptoms. Central to this is the avoidance of deodorant soaps, exfoliating scrubs, and alcohol-based astringents and cleansers. They can inflame sensitive skin and trigger a flare.
Other key skin care tips include:
Cleanse and moisturize the skin just once daily to avoid drying. Wash with lukewarm water. Hot water increases inflammation and can strip away much of your body’s natural oils. Choose a mild soap or cleanser formulated for psoriasis. Use your hands or a soft cloth to lather up. Avoid loofahs, pumice stones, or anything that can scratch or irritate the skin. Do not over-soap the skin. The more you do, the drier your skin will be. Only soap those parts of your body that need it. In winter months, switch from a lighter lotion to a heavier moisturizing cream to compensate for the loss of humidity. Avoid perfumes and colognes that contain alcohol. While you should avoid makeup if you have facial psoriasis, you can try using a skin-safe concealer like Dermablend or Covermark to conceal plaques and scars.
Taking care of your skin is also an important part of self-care when you have psoriasis. Avoid harsh soaps, exfoliating scrubs and loofahs, alcohol-based cleansers, and hot water, and keep your skin moisturized and protected against irritations, injury, and insect bites.
