What Are the Most Effective Psoriasis Therapy Options?

Medically reviewed by William Truswell, MD

Psoriasis is a chronic skin condition with many options to help manage your disease and reduce symptoms. The right psoriasis therapy for you depends on various factors, including disease severity, other co-occurring conditions, and your personal preferences.

A healthcare provider may recommend topical medications (those applied to the skin), oral medications, or newer biologic therapies via injection for psoriasis. Light therapy can help many people, as can working on the mind/body connection through various stress management techniques.

Finding the right combination of therapies may take some trial and error. This article covers some standard approaches to treating psoriasis.

Choosing the Right Psoriasis Therapy for You

There are many things to consider when deciding on psoriasis therapy. For example, some treatments are only appropriate for people with moderate or severe psoriasis but not for those with mild symptoms. Some treatments might work particularly well for specific, less common forms of psoriasis.

You might want to avoid a specific treatment because of your other health conditions or have personal preferences regarding the type of treatment and how often you are treated. Cost and availability are also important practical factors to consider.

Topical Therapy

Topical therapies are relatively low-cost and usually the first approach in people with mild to moderate psoriasis, especially if symptoms are limited to a specific area of the body. Many people use them alongside other psoriasis treatments.

Topical therapies are often available in multiple formulations, such as creams, gels, lotions, shampoos, and sprays.

Corticosteroids

Corticosteroid topical therapies like Betnovate (betamethasone valerate) are one of the cornerstones of psoriasis treatment, and they are available in different strengths. They can effectively clear up psoriasis patches found on a limited region of your body, but symptoms usually come back after you stop using them.

Corticosteroids can have side effects, like thinned skin, and because of this, you shouldn’t use them for long periods. They might also be inappropriate for people with certain medical conditions, like diabetes, and you shouldn’t use them in certain sensitive areas of the body.

Vitamin D

Another option is compounds derived from vitamin D, such as Dovonex (calcipotriene). Some healthcare providers combine them with corticosteroids for the best effect, and together, the two may be more effective than either medication alone. They have fewer overall safety concerns than corticosteroids, and most people can use them long-term.

Retinoids

Retinoids, compounds related to vitamin A, are another topical option. Retinoids such as Tazorac (tazarotene) often work best when combined with other agents, such as corticosteroids and phototherapy. They are usually used only for a limited period.

Retinoids may be particularly helpful for people with palmar-plantar (palm and sole) and nail psoriasis, but some people find them irritating to the skin. They are also dangerous during pregnancy, so they aren’t a good option if you are pregnant or planning to become pregnant soon.

Moisturizers

Non-medicated moisturizers are also important to reduce itchy and scaling skin in psoriasis treatment. They are very safe and can be used with all other psoriasis therapies.

Light Therapy

Light therapy, also known as phototherapy, is another broad treatment approach, particularly if you have moderate to severe psoriasis or if you can’t get control of your symptoms with topical treatments alone. Light therapy uses exposure to different kinds of ultraviolet (UV) light to help reduce your symptoms.

Light therapy can be used alone, but it’s typically used with other approaches. It is relatively low-cost, has few side effects, and can be used during pregnancy.

One drawback of light therapy is the time commitment. Healthcare providers recommend beginning treatment with 20 to 36 half-hour sessions three times a week, then switching to once weekly. Most versions are given in a clinic, so travel can also take time.

Ultraviolet B (UVB)

The first type of phototherapy used was broadband UVB (BB-UVB), sometimes just called “UVB.” It exposes the skin to specific wavelengths of light. Narrowband UVB (NB-UBV) was developed a little later and uses a limited wavelength spectrum within that larger range.

NB-UVB is the most common type of phototherapy. It tends to be more effective than BB-UVB and is easier to use than some other forms of phototherapy. Plus, it may have fewer side effects than other forms of light therapy.

Many people have in-home NB-UVB units. However, they may not be as safe or effective as getting it in a clinic.

Targeted UVB

Targeted UVB approaches, such as excimer lasers, also utilize UVB energy. These methods apply higher doses of radiation to a smaller area of skin, so they are best suited to people with a small affected region of skin.

Psoralen Plus UVA (PUVA)

Another approach to light therapy uses ultraviolet A, a range of the ultraviolet light spectrum with a little less energy than ultraviolet B. Because of that, it’s used with a drug, psoralen, that helps sensitize your skin to light therapy. You might take psoralen orally, applied onto your skin, or by soaking in water containing the medication.

Psoralen plus UVA (PUVA) is the second most common form of light therapy. It seems more effective than BB-UVB and may work more in fewer sessions than NB-BB. It may be particularly helpful if your psoriasis is limited to a specific region, for example, for someone with the palmoplantar form of the disease.

Climatotherapy

Some parts of the world have climates that improve psoriasis symptoms. They may have different levels of UVA and UVB natural radiation from the sun, allowing for safer exposure. They are often close to the sea, and the moist and salty air may be protective.

Climatotherapy is an approach to improving your skin by moving to a particular part of the world. For example, some people travel to the Dead Sea in Israel or to the Canary Islands as part of temporary treatment. It might particularly make sense for people who don’t want to pursue other treatment options.

Pharmaceutical Systemic Therapy (Non-Biologic)

People with moderate to severe psoriasis may want to explore oral drug therapies. These drugs are less expensive than newer biologic therapies, and some insurance companies may require that you try them before they cover a biologic treatment.

Methotrexate

Methotrexate is often the first drug used in this category, as it is best overall in terms of safety and effectiveness. You can also take it as a shot once a week instead of via pill.

However, it’s often not safe for people with liver disease. It’s also not safe during pregnancy or breastfeeding.

Retinoids

Vitamin A-based therapies like Soriatane (acitretin) are another approach. They may be a good option if you have an immune system problem, like HIV. Unlike other forms of non-biologic or biologic systemic therapies, it doesn’t directly affect the immune system.

Soriatane might be a good choice for some less common kinds of psoriasis, like erythrodermic or palmar-plantar, but it can cause itching and burning skin and hair loss at high doses. Like retinoids used topically, Soriatane should never be used during pregnancy.

Cyclosporine

Cyclosporine can be a very effective and quick treatment for people with severe disease, or disease that has been hard to treat. However, because of the risk of serious side effects, it can’t be taken long-term (unlike a drug like methotrexate). Your symptoms may come back after you stop taking the drug.

It’s probably not a good choice for people with kidney disease, uncontrolled high blood pressure, or people who have had a lot of prior PUVA treatments (because of the potentially increased risk for cancer).

JAK Inhibitors

Sotyktu (deucravacitinib) is a new oral medication for moderate to severe psoriasis. It is a Janus kinase (JAK) inhibitor that inhibits an enzyme that promotes inflammation. It may work just as well as some biologics, but it's more expensive than older oral systemic drugs.

Biologic Systemic Therapy

Biologic therapies are an option for some people with moderate or severe psoriasis. Biologic therapies are made from components of living things. They must be refrigerated and are given via an injection instead of orally. They target different components of the immune system to tone down its response.

These biologics suppress your immune system and may increase your risk for certain potentially serious infections. Although they share some slight differences in terms of potential side effects, they all can effectively treat moderate to severe disease.

Some important Food and Drug Administration (FDA)-approved biologics for psoriasis include:

• Tumor necrosis factor (TNF) inhibitors like Humira (adalimumab), Remicade (infliximab), and Cimzia (certolizumab)

• Interleukin (IL)-12/IL-23 inhibitors like Stelara (ustekinumab)

• IL-17 inhibitors like Cosentyx (secukinumab) and Taltz (ixekizumab)

• IL-23 inhibitors like Tremfya (guselkumab) and Ilumya (tildrakizumab)

Certain biologics may be a better choice if you have certain medical conditions. For example, Humira or Cosentyx might be good choices if you have psoriatic arthritis and psoriasis symptoms. Conversely, Humira might not be a good choice if you have inflammatory bowel disease.

Mental Health and Mind/Body Therapies

People with psoriasis are more prone to having problems like depression, anxiety, and low self-esteem, partly because of the way the disease affects their personal lives. Addressing some of these problems through mental health therapies can improve your mood and overall well-being.

Moreover, stress plays a role in exacerbating symptoms of psoriasis, perhaps through effects on the sympathetic nervous system and the release of certain hormones, like cortisol. So, complementary therapies that can help you deal better with stress may also help reduce your skin symptoms.

If you work with a professional in person, mental health and mind/body approaches may be difficult for some people to access. However, many more options are now available through phone apps, online resources, or remote support, which may make this approach more practical.

Depending on the setting, you may work with someone who blends one or more of these techniques or related techniques, such as hypnosis.

Psychological Counseling and Cognitive Behavioral Therapy (CBT)

Various kinds of mental health counseling may be helpful for some people. It’s a place where you can talk about your thoughts and feelings to a supportive person, which helps you find a better way to deal with them.

Some evidence indicates that a specific kind of talk therapy called cognitive behavioral therapy (CBT) may be particularly helpful for people with psoriasis. It helps you change some of your distorted thoughts and feelings, improving your emotional regulation as you develop coping strategies.

Meditation

Meditation, a process of training one’s attention over time, may also be helpful for psoriasis. Many different approaches are available, but you might focus your attention on an object, work to increase your feelings of kindness, or try to be mindful of the present moment without judging it.

Biofeedback

In biofeedback, you are connected to a machine that monitors some aspect of psychological tension, like your heart rate or sweating.

You might get feedback through tones you hear or a special kind of video game. Over time, you learn to recognize when you are becoming stressed, and you learn how to relax more easily. One study combining CBT with biofeedback found positive results for people with psoriasis.

Relaxation Therapy

Relaxation therapy might include a number of different approaches to help you decrease your stress response. Through techniques like guided imagery or progressive muscle relaxation, you learn how to let stress and anxiety move out of your mind and body more easily.

Related: Psoriasis Treatment: How Therapy Can Help

How to Combine Psoriasis Therapy Options

Although some people use just one type of psoriasis therapy, many get improved results when combining one or more approaches. You may start with one but add another if you still have remaining symptoms.

For example, you might use one or more topical creams with phototherapy or oral medication like methotrexate. Or you might use both phototherapy and a systemic treatment like methotrexate, which might allow you to use lower doses of both, potentially reducing the risks of side effects.

Some people with severe disease might combine a non-biologic systemic treatment with a biologic treatment, potentially in addition to treatments from other categories.

Apart from topical creams and mental health approaches, you typically wouldn’t use more than one treatment from the same category. For example, you wouldn’t use more than one biologic or more than one type of phototherapy at the same time. But otherwise, most combinations are OK.

Summary

There isn’t one single ideal treatment for psoriasis. The best treatment or combination of treatments for you will depend on many factors, like the type and severity of your psoriasis, other medical conditions, cost considerations, availability in your area, and personal preferences.

Treatments applied to the skin are generally the starting point for psoriasis treatment, but people with moderate or severe disease often need additional approaches. These might include phototherapy, oral drug or biologic treatments, and mind/body approaches.

Some people do well with a single therapeutic approach. However, many people get the best results if they combine more than one category of psoriasis treatment. Your healthcare provider can help you decide on the best approach for you.

Read the original article on Verywell Health.