Psoriasis is a skin condition that causes new skin cells to grow too quickly and build up in thick patches. Psoriasis has many forms and can range from mild to severe, depending on how it affects a person.
Many treatments for psoriasis are available. Doctors will often consider a different treatment approach for people with severe psoriasis than for those with a mild or moderate form of the condition.
In this article, we discuss the medical treatment for psoriasis and home remedies that may help.
Doctors will consider a range of factors when determining the severity of a person’s symptoms.
Erythrodermic psoriasis is almost always severe and needs urgent medical attention. A painful, peeling rash can cover large parts of the body, and life threatening complications can develop.
For other types of psoriasis, experts use various tools when assessing the severity of symptoms. Below are some of the tools.
Body surface area
This assessment method takes into account body surface area.
| Form of psoriasis | Body surface area affected |
|---|---|
| mild | less than 5% |
| moderate | 5–10% |
| severe | more than 10% |
Other key factors include:
- symptom intensity
- location of symptoms, for example, whether they are on the face, hands or feet or in skin folds
- the impact on a person’s daily life
Psoriasis area and severity index
The psoriasis area and severity index (PASI) measures both the extent and severity of symptoms. It takes into account the intensity of thickness and scaling, giving scores of none (0), mild (1), moderate (2), severe (3), or very severe (4).
There is a tool for individuals to use for an approximate PASI score. However, this tool does not guarantee accuracy, and people should contact a doctor if they have concerns about psoriasis symptoms.
PASI also measures redness, but it is important to note that not all skin affected by psoriasis becomes red.
For example, for people with dark skin tones, their skin may become darker or take on a purplish hue. Also, people with brown skin may develop coral-colored patches of skin, according to the American Academy of Dermatology.
People with dark skin have often had difficulty getting an accurate diagnosis of psoriasis. One reason for this is that changes may be easier to identify in light skin. However, diagnostic tools that only refer to how changes affect white skin may also have played a role.
Therefore, determining the presence of inflammation may be a better strategy than determining skin color changes when identifying the type of psoriasis for all skin types.
Dermatology Life Quality Index
Psoriasis can affect a person’s mental health, and people with psoriasis often experience anxiety, depression, and social isolation.
For this reason, doctors
Doctors may also factor in the results of a questionnaire on coping strategies.
Medications and therapies for psoriasis include the following:
- systemic or biologic drugs
- topical preparations
- light therapy
- natural, complementary, and alternative therapies
Topical creams and natural remedies can often treat mild symptoms, but a person with severe symptoms will likely need treatment with biologics or systemic drugs.
Drug options for treating severe psoriasis include the following:
Biologic drugs
Biologics are a relatively new type of drug that can help manage the symptoms and reduce the risk of flares.
They block inflammation and prevent the overproduction of skin cells by targeting specific parts of the immune system. Examples include:
A doctor may administer these drugs intravenously or as an infusion. The drugs affect how the immune system works, and they can increase the risk of infections. For this reason, they may not be suitable for everyone.
Other systemic therapies
Systemic drugs affect the whole body. They are an older treatment, but doctors still widely use them, either alone or with biologics. They are cheaper than biologics and available in the oral form.
Examples of systemic drugs for psoriasis are:
- methotrexate, available as an injection or orally
- cyclosporine (Neoral)
- acitretin (Soriatane)
- tofacitinib (Xeljanz)
- apremilast (Otezla)
Systemic drugs work in different ways. Methotrexate, cyclosporine, and apremilast reduce inflammation by suppressing the immune system.
Acitretin, which is a retinoid, reduces inflammation and affects skin cell production. It does not, however, suppress the immune system.
Systemic drugs can have adverse effects. A doctor will help an individual choose a suitable option, depending on the severity of their symptoms and other factors.
Learn about how systemic and topical treatments for psoriasis differ here.
Some treatments for psoriasis are for applying directly to the skin.
Topical therapies include:
- corticosteroids, whose strength will depend on the severity of symptoms
- topical tacrolimus and pimecrolimus, which are calcineurin inhibitors
- vitamin D analogs
- topical retinoids, such as tazarotene (Tazorac)
- moisturizers and emollients
- salicylic acid
- anthralin
- coal tar
A doctor may recommend a treatment alone or alongside a drug or another topical option.
Many topical treatments can have adverse effects, such as burning or irritation. Some treatments increase susceptibility to UV light. People should check with a medical professional before using any product.
Learn about lotions, creams, and ointments for psoriasis here.
Drug treatment for psoriasis can relieve symptoms, but it can also have adverse effects.
Light therapy may be an option if symptoms no longer respond to topical treatments and a person does not yet feel ready for systemic or biologic treatments.
There are different forms of light therapy. The most common one is controlled exposure to UVB rays. Often, administration of this therapy will take place in a phototherapy center, but some people may be able to have treatment at home.
Another option is to use the drug psoralen to sensitize the skin to UVA light.
Some people use natural, alternative, or complementary therapies alongside medical treatment.
For mild symptoms, a natural treatment alone may suffice. People with severe symptoms, however, will most likely need to use it in addition to treatment from the doctor.
Options that people sometimes use include:
- various treatments from traditional Chinese medicine
- herbal remedies, such as aloe vera and St. John’s wort
- dietary supplements, such as fish oil, vitamin D, turmeric, and zinc
- a gluten-free diet, for people with a diagnosis of celiac disease
- mind and body wellness strategies, such as hypnosis and meditation
- stress management strategies, including cognitive behavioral therapy and guided imagery
There is not enough scientific evidence to support the use of all these remedies, and they may not be safe and effective for everyone. People should seek guidance from a doctor before starting any new approach.
A doctor may also make recommendations regarding lifestyle measures, including:
- making dietary changes
- getting exercise regularly
- quitting smoking, if applicable
- limiting alcohol consumption, if applicable
Smoking and drinking alcohol can act as triggers for psoriasis and increase the risk of other conditions. Experts strongly recommend people with psoriasis quit or avoid smoking and limit alcohol consumption.
Psoriasis is a type of psoriatic condition, which also includes psoriatic arthritis (PsA). Some 30–33% of people with psoriasis may develop PsA, on average 10–11 years after psoriasis appears.
People with psoriasis also have a higher risk of developing other conditions, including depression, heart disease, and other aspects of metabolic syndrome.
A doctor will recommend appropriate treatment for complications, depending on an individual’s needs.
Mild psoriasis may respond to topical creams, ointments, and natural remedies. Most people with mild psoriasis will not need biologics or systemic drugs to manage their psoriasis symptoms.
However, severe symptoms often do not respond to home remedies and topical treatments, and a person will need biologic or systemic medication to manage symptoms and prevent flares. They may also need to combine several options.
A doctor may also prescribe biologics if symptoms are mild but affect the face, hands, or genitals.
In some cases, a person with severe psoriasis may need to spend time in the hospital.
Severe psoriasis can cause discomfort and have a serious impact on a person’s quality of life. Various treatment options can help people with severe psoriasis manage their symptoms.
A doctor can help an individual develop a suitable treatment plan, which may need adjusting over time.