Psoriasis medications & treatments
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Psoriasis is a chronic autoimmune skin disease that affects more than 3% (7.5 million people) of the US adult population. Worldwide, psoriasis is most common in northern Europe and least common in eastern Asia.
Psoriasis can start at any age, but most often develops in adults between 20 and 30 years old and between 50 and 60 years old. It affects men and women equally.
What is psoriasis?
Psoriasis is a long-term (chronic) disease that causes skin cells to multiply up to 10 times faster than normal. the overactive immune system speeds up skin cell growth. Normal skin cells grow and shed (fall off) every 3 to 4 weeks, but in psoriasis, this process only takes about 3 to 4 days. Instead of shedding, the skin cells pile up on the surface of the skin. The resulting build-up of skin cells results in raised plaques and scales on the skin. Plaques mostly appear on the scalp, elbows, knees, and lower back, although they can grow anywhere on the body. Even with treatment, you will typically have flare-ups of symptoms, followed by times when you have no symptoms of psoriasis present.
Scientists do not fully understand what causes psoriasis, but they know that it involves a mix of genetics and environmental factors. One thing they do know is that psoriasis is not contagious.
Psoriasis is usually brought on by triggers that will vary from person to person. Some common triggers include:
- Cuts, scrapes, or other skin injuries
- Drinking daily or having more than 2 drinks frequently
- Cold weather
- Medications such as NSAIDs, beta-blockers, lithium, and chloroquine
There are several options to treat psoriasis, and your treatment plan will depend on your type of psoriasis and the severity of your condition.
The types of psoriasis include:
- Plaque psoriasis. This is the most common type of psoriasis and affects over 80% of those who have this condition. Plaques usually form on the scalp, elbows, knees, or lower back but can appear anywhere on the body. They appear as raised patches of dry, itchy, and painful skin with silvery-white coated scales.
- Guttate psoriasis. This type typically causes small, red spots on the torso and arms or legs of children and young adults. It is usually brought on by an infection such as strep throat and will clear once the infection clears.
- Inverse psoriasis. It typically causes red, inflamed patches of skin that are smooth and not scaly. Inverse psoriasis affects the skin folds of the body, such as the groin, underarms, buttocks, and under breasts. You can have severe itching and it is worsened by sweating and rubbing in these areas.
- Pustular psoriasis. Pustular psoriasis causes pus-filled (pustules) bumps that usually appear only on the palms of your hands or soles of your feet.
- Erythrodermic psoriasis. This rare type of psoriasis is serious and can be life-threatening. Erythrodermic psoriasis requires immediate medical care. It appears as red, scaly skin all over the body. It will often shed layers of skin in large sheets and can cause severe itching and pain.
How is psoriasis diagnosed?
It is easiest to diagnose psoriasis when you are having active symptoms. Symptoms will vary depending on the type of psoriasis you have. Your doctor will examine your skin, scalp, and nails looking for the signs and symptoms of psoriasis.
Some common symptoms of psoriasis include:
- Plaques of red skin that are often covered with scales that vary in color from purple to silver.
- Itching, burning, and pain from these plaques
- Dry, cracked skin that will sometime bleed
- Small, red spots with scales on the torso, arms, or legs. This is usually seen in children.
In addition to a skin examination, your doctor may also take a small sample of skin from a plaque (biopsy) and look at it under a microscope to rule out other skin conditions like eczema.
What are some psoriasis treatment options?
Treatments will depend on the type and severity of your psoriasis, and where it is on your body. The main goal is to slow down or stop your skin cell growth while also removing any scales. You may have to try different medications or a combination of treatments to find which one works best for you. Even with severe psoriasis, some treatments can successfully manage your flare-ups.
Treatment of psoriasis can fall into the following categories:
- Corticosteroids. These steroid medications are commonly prescribed to treat mild psoriasis. Some creams and ointments such as hydrocortisone can be bought over the counter. If those are unsuccessful your doctor may prescribe a stronger topical corticosteroid such as Kenalog (triamcinolone), Diprolene (betamethasone), Olux (clobetasol), and Desonate (desonide). Long-term use of corticosteroids can thin the skin.
- Vitamin D analogs. These medications are used alone or can be combined with corticosteroids to help reduce inflammation and scaling with mild to moderate psoriasis. Examples include Sorilux (calcipotriene) and Vectical (calcitriol).
- Retinoids. These vitamin-A derivatives, such as Tazorac (tazarotene) are typically used in combination with other treatments. They are not recommended when you’re pregnant or breastfeeding or if you intend to become pregnant.
- Calcineurin inhibitors. Protopic (tacrolimus) and Elidel (pimecrolimus) can be used around sensitive areas of skin such as your face and around your eyes.
- Salicylic acid. This med is used to soften and thin scaly skin if you have scalp psoriasis. It needs to be used with caution because it can irritate your skin if you leave it on too long and cause temporary hair loss.
- Coal tar. Coal tar is used to treat inflammation, scales, and itching associated with psoriasis. It can cause sensitivity to UV light and is not recommended if you are pregnant or breastfeeding. Coal tar products are available over-the-counter in many dosage forms including shampoos, which are used for scalp psoriasis treatment.
Light therapy involves exposing your skin to certain types of ultraviolet light. Repeated treatments can slow down fast-growing skin cells if you have moderate to severe psoriasis. Different types of phototherapy include:
- UVB broadband. Using ultraviolet B (UVB) light from an artificial light source, this therapy can treat small patches as well as large areas of psoriasis.
- UVB narrowband. This targeted approach is more effective than UVB broadband but it can cause more serious side effects. It is considered safe for children, those who are pregnant or breastfeeding, and people with a weakened immune system.
- Goeckerman therapy. This therapy involves using coal tar and then exposing your skin to UVB light to help resolve psoriasis symptoms.
- Psoralen plus ultraviolet A (PUVA). With this treatment, you take psoralen by mouth or soak in a bath that contains the medication. It makes your skin more sensitive to light, which increases the amount of UVA light your skin will absorb.
Oral and injected medications
This systemic treatment used to treat moderate to severe psoriasis will work throughout your entire body and include:
- Biologics. These injectable medications slow down your immune system to help stop excessive skin cell production and reduce psoriasis plaques. Because they suppress your immune system, they increase your risk of serious infections. Some options include Otezla (apremilast), Enbrel (etanercept), Humira (adalimumab), Tremfya (guselkumab), and Remicade (infliximab).
- Retinoids. Oral retinoids such as Soriatane (acitretin) work slowly on plaque psoriasis and can take from 8 to 16 weeks of treatment before you see improvement and up to six months before you see the benefit from it.
- Methotrexate. Trexall (methotrexate) is typically used for severe psoriasis. It can be given as an oral tablet, injection, or infusion every week. You will need monitoring is needed for methotrexate as it can cause liver toxicity when used long-term.
- Cyclosporine. Sandimmune (cyclosporine) is mostly used for severe cases of psoriasis. If you take it long-term need you will need ongoing testing to monitor your blood pressure and kidney function.
What is the best medication for psoriasis?
The best medication for the treatment of psoriasis will depend on the individual’s specific medical psoriasis, medical history, medications that the individual is already taking that may potentially interact with psoriasis medications, and the individual’s potential response to the treatment. It is advisable to always speak with your dermatologist or healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter psoriasis medications approved by the Food and Drug Administration (FDA).
Best medications for psoriasis
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Otezla (apremilast)||PDE-4 inhibitors||Oral||30mg twice daily.||Diarrhea, nausea, headache, Upper respiratory infection|
|Humira (adalimumab)||TNF inhibitor||Injection||400mg under the skin every 4 weeks.||Injection site reaction, rash, infection, headache|
|Abrilada (adalimumab-afzb)||TNF inhibitor||Injection||400mg under the skin every 4 weeks.||Injection site reaction, rash, infection, headache|
|Remicade (infliximab)||TNF inhibitor||Injection||5mg/kg of body weight via IV infusion every 8 weeks.||Stomach pain, nausea, headache, infection|
|Enbrel (etanercept)||TNF inhibitor||Injection||50mg under the skin twice weekly for 3 months and then 50mg once weekly thereafter.||Injection site reactions, infections, diarrhea|
|Simponi (golimumab)||TNF inhibitor||Injection||200mg under the skin to start, 100mg at week 2, then 100mg every 4 weeks thereafter.||Upper respiratory tract infection, injection site reactions, viral infections|
|Entyvio (vedolizumab)||Integrin blocker||Injection||300mg IV infusion at 0, 2, and 6 weeks, then every 8 weeks thereafter.||Common cold, headache, joint pain|
|Stelara (ustekinumab)||Interleukin inhibitor||Injection||Initial weight-based IV infusion, then 90mg under the skin every 8 weeks thereafter.||Upper respiratory tract infection, injection site reaction, headache|
|Siliq (brodalumab)||Interleukin inhibitor||Injection||210mg under the skin weekly for 3 doses then 210mg every 2 weeks thereafter.||Headache, joint pain, fungal infections, injection site reactions|
|Tremfya (guselkumab)||Interleukin inhibitor||Injection||100mg under the skin at week 0, week 4, then 100mg every 8 weeks thereafter.||Infections, headache, injection site reactions, joint pain, elevated liver enzymes|
|Skyrizi (Risankizumab)||Interleukin inhibitor||Injection||150mg under the skin at week 0, week 4, then 150mg every 12 weeks thereafter.||Upper respiratory tract infections, headache, fatigue, injection site reactions|
|Cosentyx (secukinumab)||Interleukin inhibitor||Injection||300mg under the skin at weeks 0, 1, 2, 3, 4, and then 300mg every 4 weeks thereafter.||Infections, common cold symptoms, diarrhea|
|Taltz (ixekizumab)||Interleukin inhibitor||Injection||160mg under the skin to start, then 80mg every 2 weeks for 6 doses, then 80mg every 4 weeks thereafter.||Injection site reactions, upper respiratory infections, nausea|
|Soriatane (acitretin)||Retinoid||Oral||25mg to 50mg once daily.||Lip inflammation, hair loss, skin peeling, dry skin, increased triglyceride levels|
|Tazorac (tazarotene)||Retinoid||Topical cream/gel||Apply to the affected area(s) once daily.||Skin peeling, scaling, redness, burning, stinging|
|Luxiq (betamethasone)||Corticosteroid||Topical foam||Apply to the affected area(s) every 12 hours.||Dry skin, burning, thinning of the skin|
|Sernivo (betamethasone)||Corticosteroid||Topical spray||Apply to the affected area(s) every 12 hours.||Dry skin, burning, thinning of the skin|
|Olux-E (clobetasol propionate)||Corticosteroid||Topical foam||Apply to the affected area(s) every 12 hours for up to 2 weeks.||Thinning of the skin, spider veins, dry skin|
|Bryhali (halobetasol propionate)||Corticosteroid||Topical lotion||Apply a thin layer to the affected area(s) once daily for 8 weeks.||Spider veins, headache, itching, skin irritation|
|Sorilux (calcipotriene)||Vitamin-D analog||Topical cream||Apply a thin layer to the affected area(s) once daily in the evening on clean, dry skin.||Skin dryness, scaling redness, stinging, burning|
|Trexall (methotrexate)||Antimetabolite||Oral||May give weekly dose divided as 2.5mg every 12 hours for 3 doses.||Nausea, vomiting, diarrhea, stomach pain|
Your healthcare provider will determine the right dosage based on your response to the treatment, medical psoriasis, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of psoriasis medications?
As with all medicines, those used for psoriasis will have some side effects, depending on the class of medication and the route in which you take it.
For topical medications, the most common side effects include:
- Dry skin
- Skin peeling
- Burning and stinging
- Thinning of the skin
For oral medications, the most common side effects include:
- Stomach pain
For injectable medications, the most common side effects include:
- Injection site reactions
- Increased risk of infections
- Joint pain
This is not a complete list of side effects. You should call your primary care provider to discuss any possible side effects you may be experiencing.
What are some home remedies for psoriasis?
In addition to medications and phototherapy, there are some things you can do at home to help manage and prevent your symptoms.
Here are some natural and home remedies to try:
- Avoid your triggers. Once you identify what triggers your flare-ups, do your best to avoid them. Some common triggers include skin injuries, infections, and prolonged sun exposure.
- Soak in a bath. Soaking in a lukewarm bath and gently washing can help with shedding the scales on your skin. Adding Epsom salt, mineral oil, or oatmeal will help with this as well as calm the itch.
- Use moisturizers and lotions. Right after your bath or shower, pat yourself dry, then put your cream, lotion, or ointment on while your skin is still a little moist.
- Get some sun. Exposing your skin to a limited amount of sunlight is a natural form of phototherapy. Be careful, as too much sun can worsen your symptoms. Consult your doctor to see if this is a safe option for you.
- Quit smoking. Studies have shown that the more you smoke, the more severe your flare-ups can be.
- Drink in moderation or not at all. Heavy drinkers are more likely to suffer from psoriasis.
- Live a healthy lifestyle. In addition to improving your overall health, regular exercise and eating nutritious meals can help manage your psoriasis.
- Take care of your mental health. Psoriasis can make you feel isolated and affect your self-esteem. Finding a support group or mental health professional can help decrease your risk of anxiety and depression.
Frequently asked questions about psoriasis
What are some complications of psoriasis?
If you have psoriasis, the National Psoriasis Foundation estimates that you have between a 10% to 30% chance of developing psoriatic arthritis. You are also at a higher risk of heart disease, depression, anxiety, high blood pressure, type 2 diabetes, and obesity.
Can psoriasis be cured?
Right now, there is no cure for psoriasis. However, it can go into remission and show no signs of disease for long periods of time.
Is psoriasis contagious?
No, psoriasis cannot be spread from person to person. You can touch an active psoriatic lesion and it will not increase your chance of developing psoriasis.
Can the sun help my psoriasis?
Research says a limited amount of sun every day can help with your symptoms. You have to be careful not to get too much because a sunburn may lead to a flare-up.
Related resources for psoriasis
- Psoriasis overview. MayoClinic
- About psoriasis. National Psoriasis Foundation
- What is psoriasis? Centers for Disease Control and Prevention
- What is psoriasis? WebMD
- Psoriasis: overview. American Academy of Dermatology Association
- Psoriasis overview. NHS
- Psoriasis: Overview, Symptoms, Causes. National Institute of Arthritis and Musculoskeletal and Skin Diseases