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Psoriasis

Treatment
Psoriasis

Overview

Symptoms

Causes

Treatment

Living with

Treatment for psoriasis usually helps to keep the

condition under control. Most people can be
treated by their GP.

If your symptoms are particularly severe or not

responding well to treatment, your GP may refer
you to a skin specialist (dermatologist).

Treatments are determined by the type and

severity of your psoriasis, and the area of skin
affected. Your doctor will probably start with a
mild treatment, such as topical creams applied to
the skin, and then move on to stronger treatments
if necessary.

A wide range of treatments are available for

psoriasis, but identifying the most effective one
can be difficult. Talk to your doctor if you feel a
treatment is not working or you have
uncomfortable side effects.

Treatments fall into 3 categories:

topical – creams and ointments applied to your

skin

phototherapy – your skin is exposed to certain

types of ultraviolet light

systemic – oral and injected medications that

work throughout the entire body

Different types of treatment are often used in

combination.

Your treatment for psoriasis may need to be

reviewed regularly. You may want to make a care
plan – an agreement between you and your health
professional – as this can help you manage your
day-to-day health.

The various treatments for psoriasis are outlined

below.

Further information
NICE guidance on the assessment and
management of psoriasis

PAPAA: psoriasis treatments

Psoriasis Association: treatments for psoriasis

Care and support plans

Topical treatments
Topical treatments are usually the first treatments
used for mild to moderate psoriasis. These are
creams and ointments you apply to affected areas.

Some people find that topical treatments are

all they need to control their condition,
although it may take up to 6 weeks before there's
a noticeable effect.

If you have scalp psoriasis, a combination of

shampoo and ointment may be recommended.

Emollients

Emollients are moisturising treatments applied

directly to the skin to reduce water loss and cover
it with a protective film. If you have mild psoriasis,
an emollient is probably the first treatment your
GP will suggest.

The main benefit of emollients is to moisturise the

skin and reduce itching and scaling. Some other
topical treatments are thought to work better on
moisturised skin. Wait at least 30 minutes before
applying another topical treatment after an
emollient.

Emollients are available as a wide variety of

products and can be bought over the counter from
a pharmacy or prescribed by your GP, nurse or
health visitor.

Read more about emollients.

Steroid creams or ointments

Steroid creams or ointments (topical

corticosteroids) are commonly used to treat mild
to moderate psoriasis in most areas of the body.
The treatment works by reducing inflammation.
This slows the production of skin cells and reduces
itching.

Topical corticosteroids range in strength from mild

to very strong. Only use them when recommended
by your doctor.

Stronger topical corticosteroids can be prescribed

by your doctor and should only be used on small
areas of skin or on particularly thick patches.
Overusing topical corticosteroids can lead to skin
thinning.

Vitamin D analogues

Vitamin D analogue creams are commonly used

along with or instead of steroid creams for mild to
moderate psoriasis affecting areas such as the
limbs, trunk or scalp. They work by slowing the
production of skin cells. They also have an anti-
inflammatory effect.

Examples of vitamin D analogues are calcipotriol,

calcitriol and tacalcitol. There are very few side
effects as long as you do not use more than the
recommended amount.

Calcineurin inhibitors

Calcineurin inhibitors, such as tacrolimus and

pimecrolimus, are ointments or creams that reduce
the activity of the immune system and help to
reduce inflammation. They're sometimes used to
treat psoriasis affecting sensitive areas, such as the
face, the genitals and folds in the skin, if steroid
creams are not effective.

These medications can cause skin irritation or a

burning and itching sensation when they're
started, but this usually improves within a week.

Coal tar

Coal tar is a thick, heavy oil and is probably the

oldest treatment for psoriasis. How it works is not
exactly known, but it can reduce scales,
inflammation and itchiness.

It may be used to treat psoriasis affecting the

limbs, trunk or scalp if other topical treatments are
not effective.

Coal tar can stain clothes and bedding and has a

strong smell. It can be used in combination with
phototherapy.

Dithranol

Dithranol has been used for more than 50 years to

treat psoriasis. It has been shown to be effective in
suppressing the production of skin cells and has
few side effects. However, it can burn if it's too
concentrated.

It's typically used as a short-term treatment, under

hospital supervision, for psoriasis affecting the
limbs or trunk, as it stains everything it comes into
contact with, including skin, clothes and bathroom
fittings.

It's applied to your skin (by someone wearing

gloves) and left for 10 to 60 minutes before being
washed off.

Dithranol can be used in combination with

phototherapy.

Further information

Psoriasis Association: treatments for psoriasis

PAPAA: emollients

Phototherapy
Phototherapy uses natural and artificial light to
treat psoriasis. Artificial light therapy can be given
in hospitals and some specialist centres, usually
under the care of a dermatologist. These
treatments are not the same as using a sunbed.

Ultraviolet B (UVB) phototherapy

UVB phototherapy uses a wavelength of light

invisible to human eyes. The light slows down the
production of skin cells and is an effective
treatment for some types of psoriasis that have
not responded to topical treatments.

Each session only takes a few minutes, but you

may need to go to hospital 2 or 3 times a week for
6 to 8 weeks.

Psoralen plus ultraviolet A (PUVA)

For this treatment, you'll first be given a tablet

containing compounds called psoralens, or
psoralen may be applied directly to the skin. This
makes your skin more sensitive to light.

Your skin is then exposed to a wavelength of light

called ultraviolet A (UVA). This light penetrates
your skin more deeply than UVB light.

This treatment may be used if you have severe

psoriasis that has not responded to other
treatment.

Side effects include nausea, headaches, burning

and itchiness. You may need to wear special
glasses for 24 hours after taking the tablet to
prevent the development of cataracts.

Long-term use of this treatment is not

encouraged, as it can increase your risk of
developing skin cancer.

Combination light therapy

You may be offered creams or ointments (topical

treatments) alongside light therapy if:

your psoriasis is not responding to light therapy

alone

you cannot, or do not want to, take medicines

for your psoriasis

Further information

Psoriasis Association: treatments for psoriasis

PAPAA: psoriasis and phototherapy

Tablets, capsules and injections

If your psoriasis is severe or other treatments have
not worked, you may be prescribed systemic
treatments by a specialist. Systemic treatments
work throughout the entire body.

These medications can be very effective in treating

psoriasis, but they all have potentially serious side
effects. All the systemic treatments for psoriasis
have benefits and risks. Before starting treatment,
talk to your doctor about your treatment options
and any risks associated with them.

If you're planning for a baby, become pregnant or

are thinking of breastfeeding, you should also
speak to your doctor first before taking any new
medicine to check it's suitable for use during
pregnancy or breastfeeding.

There are 2 main types of systemic treatment,

called non-biological (usually given as tablets or
capsules) and biological (usually given as
injections).

Non-biological medications

Methotrexate

Methotrexate can help control psoriasis by slowing

down the production of skin cells and suppressing
inflammation. It's usually taken once a week.

Methotrexate can cause nausea and may affect the

production of blood cells. Long-term use can cause
liver damage. People who have liver disease
should not take methotrexate, and you should not
drink alcohol when taking it.

Methotrexate can be very harmful to a developing

baby, so it's important that women use
contraception and do not become pregnant while
they take this drug and for at least 6 months after
they stop.

Men are advised to delay trying for a baby until at

least 6 months since their last dose of
methotrexate.

Ciclosporin

Ciclosporin is a medicine that suppresses your

immune system (immunosuppressant). It was
originally used to prevent transplant rejection but
has proved effective in treating all types of
psoriasis. It's usually taken daily.

Ciclosporin increases your chances of kidney

disease and high blood pressure, which will need
to be monitored.

Acitretin

Acitretin is an oral retinoid that reduces skin cell

production. It's used to treat severe psoriasis that
has not responded to other non-biological
systemic treatments. It's usually taken daily.

Acitretin has a wide range of side effects,

including dryness and cracking of the lips, dryness
of the nasal passages and, in rarer cases, hepatitis.

Acitretin can be very harmful to a developing

baby, so it's important that women use
contraception and do not become pregnant while
taking this drug, and for at least 3 years after they
stop taking it. However, it's safe for a man taking
acitretin to father a baby.

Other drugs

Apremilast and dimethyl fumarate are medicines

that help to reduce inflammation. They are taken
as daily tablets. These medicines are only
recommended for use if you have severe psoriasis
that has not responded to other non-biological
treatments.

Further information

Psoriasis Association: systemic treatments

Biological treatments

Biological treatments reduce inflammation by

targeting overactive cells in the immune
system. They are usually used if you have severe
psoriasis that has not responded to other
treatments, or if you cannot use other treatments.

Etanercept

Etanercept is injected twice a week, and you'll be

shown how to do this. If there's no improvement
in your psoriasis after 12 weeks, the treatment will
be stopped.

The main side effect of etanercept is a rash where

the injection is given. However, as etanercept
affects the whole immune system, there's a risk of
serious side effects, including severe infection.

If you have had tuberculosis in the past, there's a

risk it may return.

You'll be monitored for side effects during your

treatment.

Adalimumab

Adalimumab is injected once every 2 weeks, and

you'll be shown how to do this. If there's no
improvement in your psoriasis after 16 weeks, the
treatment will be stopped.

The main side effects of adalimumab include

headaches, a rash at the injection site and nausea.
However, as adalimumab affects the whole
immune system, there's a risk of serious side
effects, including severe infections.

You'll be monitored for side effects during your

treatment.

Infliximab

Infliximab is given as a drip (infusion) into your

vein at the hospital. You'll have 3 infusions in the
first 6 weeks, then 1 infusion every 8 weeks. If
there's no improvement in your psoriasis after 10
weeks, the treatment will be stopped.

The main side effect of infliximab is a headache.

However, as infliximab affects the whole immune
system, there's a risk of serious side effects,
including severe infections.

You'll be monitored for side effects during your

treatment.

Ustekinumab

Ustekinumab is injected at the beginning of

treatment, then again 4 weeks later. After this,
injections are every 12 weeks. If there's no
improvement in your psoriasis after 16 weeks, the
treatment will be stopped.

The main side effects of ustekinumab are a throat

infection and a rash at the injection site. However,
as ustekinumab affects the whole immune system,
there's a risk of serious side effects, including
severe infections.

You'll be monitored for side effects during your

treatment.

Other biological treatments

There is an increasing number of biological

treatments that are given as injections. These
include guselkumab, brodalumab, secukinumab,
ixekizumab, bimekizumab and risankizumab.

They're recommended for people who have severe

psoriasis that has not improved with other
treatments or when other treatments are not
suitable.

Further information

Psoriasis Association: biologic treatments

Page last reviewed: 08 April 2022

Next review due: 08 April 2025

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