Psoriasis

Psoriasis

Topic Overview

What is psoriasis?

Psoriasis (say "suh-RY-uh-sus") is a long-term (chronic) skin problem that causes skin cells to grow too quickly, resulting in thick, white, silvery, or red patches of skin. Normally, skin cells grow gradually and flake off about every 4 weeks. New skin cells grow to replace the outer layers of the skin as they shed. But in psoriasis, new skin cells move rapidly to the surface of the skin in days rather than weeks. They build up and form thick patches called plaques (say "plax").

The patches range in size from small to large. They most often appear on the knees, elbows, scalp, hands, feet, or lower back. Psoriasis is most common in adults. But children and teens can get it too.

Having psoriasis can be embarrassing, and many people, especially teens, avoid swimming and other situations where patches can show. But there are many types of treatment that can help keep psoriasis under control.

See a picture of psoriasis.

What causes psoriasis?

Experts believe that psoriasis occurs when the immune system overreacts, causing inflammation and flaking of skin.

In some cases, psoriasis runs in families. Researchers are studying large families affected by psoriasis to find out how it is passed from parents to their children and what might trigger the condition.

People with psoriasis often notice times when their skin gets worse. Things that can cause these flare-ups include a cold and dry climate, infections, stress, and dry skin. Also, certain medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and medicines used to treat high blood pressure or certain mental illnesses, may trigger an outbreak or make your psoriasis worse.

Smoking, especially in women, makes you more likely to get psoriasis and can make it worse if you already have it.

Psoriasis is not contagious. It cannot be spread by touch from person to person.

What are the symptoms?

Symptoms of psoriasis appear in different ways. Psoriasis can be mild, with small areas of rash. When psoriasis is moderate or severe, the skin gets inflamed with raised red areas topped with loose, silvery, scaling skin. If psoriasis is severe, the skin becomes itchy and tender. And sometimes large patches form and may be uncomfortable. The patches can join together and cover large areas of skin, such as the entire back.

In some people, psoriasis causes joints to become swollen, tender, and painful. This is called psoriatic arthritis (say "sor-ee-AT-ik ar-THRY-tus"). This arthritis can also affect the fingernails and toenails, causing the nails to pit, change color, and separate from the nail bed. Dead skin may build up under the nails.

Symptoms often disappear (go into remission), even without treatment, and then return (flare up).

How is psoriasis diagnosed?

A doctor can usually diagnose psoriasis by looking at the patches on your skin, scalp, or nails. Sometimes a skin KOH test is used to rule out a fungal infection. But otherwise, special tests are usually not needed.

How is it treated?

Most cases of psoriasis are mild, and treatment begins with skin care. This includes keeping your skin moist with creams and lotions. These are often used with other treatments including shampoos, ultraviolet light, and medicines your doctor prescribes.

In some cases, psoriasis can be hard to treat. You may need to try different combinations of treatments to find what works for you. Treatment for psoriasis may continue for a lifetime.

What can you do at home for psoriasis?

Skin care at home can help control psoriasis. Follow these tips to care for psoriasis:

  • Use creams or lotions, baths, or soaks to keep your skin moist.
  • Try short exposure to sunlight or ultraviolet (UV) light.
  • Gently soften and remove psoriasis crusts by putting cream on the crusts and then peeling the loose crusts off. Removing crusts may help your skin to absorb creams and lotions. Remove them carefully, though, so you don't irritate the skin.
  • Follow instructions for skin products and prescribed medicines. It may take a period of trial and error until you know which skin products or methods work best for you. For mild symptoms of psoriasis, some over-the-counter medicines, such as aloe vera, may be soothing.

It is also important to avoid those things that can cause psoriasis symptoms to flare up or make the condition worse. Things to avoid include:

  • Skin injury. An injury to the skin can cause psoriasis patches to form anywhere on the body, including the site of the injury. This includes injuries to your nails or nearby skin while trimming your nails.
  • Stress and anxiety. Stress can cause psoriasis to appear suddenly (flare) or can make symptoms worse.
  • Infection. Infections such as strep throat can cause psoriasis to appear suddenly, especially in children.
  • Certain medicines. Some medicines, such as NSAIDs, beta-blockers, and lithium, have been found to make psoriasis symptoms worse. Talk with your doctor. You may be able to take a different medicine.
  • Overexposure to sunlight. Short periods of sun exposure reduce psoriasis in most people, but too much sun can damage the skin and cause skin cancer. And sunburns can trigger flares of psoriasis.
  • Alcohol. Alcohol use can cause symptoms to flare up.
  • Smoking. If you smoke, try to quit. Smoking, especially in women, makes you more likely to get psoriasis and can make it worse if you already have it.

Studies have not found that specific diets can cure or improve the condition, even though some advertisements claim to. For some people, not eating certain foods helps their psoriasis. Most doctors recommend that you eat a balanced diet to be healthy and stay at a healthy weight.

Frequently Asked Questions

Learning about psoriasis:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with psoriasis:

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  Psoriasis: Skin care

Cause

The exact cause of psoriasis is not known. Many scientists believe that the condition may be passed down from parents to their children (inherited). About one-third of people who have psoriasis have one or more family members with the condition.1 But it is not clear that genetic factors alone determine whether you develop psoriasis. Psoriasis is not contagious—it cannot be spread by touch from person to person.

Doctors believe that the immune system is a factor in the development of psoriasis. This is because increased numbers of white blood cells are present between the abnormal layers of skin and because psoriasis responds to drugs that suppress the immune system.

Other factors may contribute to the development of psoriasis, make the condition worse, or make it return, including:

  • Climate. Cold, dry weather causes symptoms to become worse. Hot weather, sunlight, and humidity may improve symptoms.
  • Skin injury. An injury to the skin can cause psoriasis patches to form anywhere on the body, including the site of the injury. This includes injuries to your nails or nearby skin while trimming your nails.
  • Stress and anxiety. Stress can cause psoriasis to appear suddenly (flare) or can make symptoms worse.
  • Infection. Infections such as strep throat can cause psoriasis to appear suddenly (guttate psoriasis), especially in children.
  • Certain medicines. Certain medicines, such as NSAIDs, beta-blockers, and lithium, have been found to make psoriasis symptoms worse. Whenever your doctor prescribes any medicines for you, tell him or her that you have psoriasis.

Symptoms

The classic symptoms of psoriasis are raised, red patches of skin topped with loose, silvery scales, usually on the knees or elbows.

There are several types of psoriasis. Symptoms for each type may vary in severity and appear in a wide array of combinations. In general, the major symptoms of psoriasis include:

  • Bright red areas of raised patches (plaques) on the skin, often covered with loose, silvery scales. Plaques can occur anywhere, but commonly they occur on the knees, elbows, scalp, hands, feet, or lower back. Nearly 90% of people with psoriasis have plaque-type psoriasis.1
  • Tiny areas of bleeding when skin scales are picked or scraped off (Auspitz's sign).
  • Mild scaling to thick, crusted plaques on the scalp.
  • Itching, especially during sudden flare-ups or when the psoriasis patches are in body folds, such as under the breasts or buttocks.
  • Nail disorders. Nail disorders are common, especially in severe psoriasis. Nail symptoms include:
    • Tiny pits in the nails (not found with fungal nail infections).
    • Yellowish discoloration of the toenails and sometimes the fingernails.
    • Separation of the end of the nail from the nail bed.
    • Less often, a buildup of skin debris under the nails.

Other symptoms of psoriasis may include:

  • Similar plaques in the same area on both sides of the body (for example, both knees or both elbows).
  • Flare-ups of many raindrop-shaped patches. Called guttate psoriasis, this condition often follows a strep infection and is the second most common type of psoriasis. It affects less than 10% of those with psoriasis.1
  • Joint swelling, tenderness, and pain (psoriatic arthritis).

Koebner's phenomenon can occur when a person with psoriasis has an injury (such as a cut, burn, or excess sun exposure) to an area of the skin that is not affected by psoriasis. Psoriasis patches then appear on the injured skin or any other part of the skin from several days to about 2 weeks after the injury. Because this response is common, it is important for people who have psoriasis to avoid irritating or injuring their skin.

Several other skin conditions have symptoms similar to psoriasis. Some medicine reactions can cause symptoms (such as reddened skin) similar to psoriasis. Talk to your doctor about the medicines you are taking.

What Happens

Psoriasis is usually long-lasting, returns often (chronic), and can be unpredictable. Symptoms may come on suddenly (flare) and then improve and go away (remission). This cycle continues over and over. In some cases, psoriasis may go away without treatment. But in moderate to severe cases, it is best to treat psoriasis so that it does not get worse.

Several factors can make the condition worse, depending on the type of psoriasis. These factors include cold, dry climates; stress; infection; skin injury; and certain medicines.

The severity of psoriasis is indicated by the amount of redness and scaling, the thickness of the large areas of raised skin patches (plaques), and the percentage of your skin that is affected.

Mild psoriasis causes plaques that cover a small portion of the body, such as the elbows or knees.

Moderate psoriasis causes:

  • Several large areas of plaque. For example, most of the scalp may be affected.
  • Plaques that may cover up to 20% of the skin (about equal to having both arms completely covered).
  • Mild joint pain that is not disabling.
  • Concern about plaques being visible to other people.

Severe psoriasis includes:

  • Plaques that may cover large areas (20% to 30%) of the body. When determining the percent of coverage, consider that the palm of your hand equals about 1% of your body surface, and the total surface of both arms equals about 20%.
  • Psoriasis on the face.
  • Pustular psoriasis with large, fluid-filled plaque and severe scaling, or erythrodermic psoriasis with severe inflammation and shedding (sloughing) of the skin.
  • Psoriatic arthritis, which includes ongoing joint swelling, tenderness, limitation of range of motion, or joint warmth or redness. Severe cases can result in joint destruction.

Psoriasis may persist for long periods of time without getting better or worse.

Psoriasis can cause a lot of stress and lowered self-esteem. You can get specialized treatment and emotional support from psoriasis day care centers. For more information on available resources, see the Other Places to Get Help section of this topic.

What Increases Your Risk

Many doctors believe that psoriasis may be passed down from parents to their children (inherited). White (Caucasian) people who carry a certain gene have a much greater risk of developing psoriasis.2 About one-third of people who have psoriasis have one or more family members with the condition.1

Other factors that can contribute to the development of psoriasis include:

  • Cold climates. Cold weather makes symptoms worse.
  • Emotional or physical stress. Stress may cause psoriasis to appear suddenly or make symptoms worse (although this has not been proven in studies).
  • Infection. Infections such as strep throat can cause psoriasis to appear suddenly, especially in children.
  • Skin injuries. An injury to the skin can cause psoriasis patches to form anywhere on the body, including the site of the injury. This includes injuries to your nails or nearby skin while trimming your nails.
  • Certain medicines. Certain medicines, including some heart medicines (beta-blockers) or medicines to treat mental illness (for example, lithium), may make psoriasis symptoms worse.
  • Smoking. Smoking may make you more likely to get psoriasis and make the symptoms more severe.3 Smoking may also make your symptoms last longer.4
  • Weight gain in women. A large study has shown that women who gain weight throughout adult life are more likely to develop psoriasis.5

When To Call a Doctor

Call your doctor if you have symptoms of psoriasis, such as:

  • Bright red areas of raised patches (plaques) that are covered with loose, silvery, scaling skin.
  • Thick, crusted patches on the scalp.
  • Tiny pits or yellowish discoloration in the nails, separation of the nail from the skin, or buildup of skin debris under the nail.
  • Signs of developing bacterial infection. These include:
    • Increased pain, swelling, redness, tenderness, or heat.
    • Red streaks extending from the area.
    • A discharge of pus.
    • Fever of 100.4°F (38°C) or higher with no other cause.

If you are currently being treated for psoriasis, call your doctor if you:

  • Have severe and widespread psoriasis and your skin is more irritated or inflamed than usual, especially if you have another illness.
  • Are taking medicine for psoriasis and have serious side effects, such as vomiting, bloody diarrhea, chills, or fever.

Watchful Waiting

If you have symptoms of psoriasis, talk to your doctor, because treatment when symptoms are first noticed may help stop the condition from progressing.

Who To See

Health professionals who can diagnose and treat psoriasis include:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Your doctor can often recognize psoriasis by the appearance and location of the patches on your skin, scalp, or nails. Psoriasis usually involves bright red areas of raised patches that are often covered with loose, silvery, scaling skin and are commonly located on the knees, elbows, scalp, hands, feet, or lower back.

Special tests are usually not needed. If it is hard to diagnose the condition by looking at your skin, your doctor may remove a small skin sample (biopsy) and send it to a lab for analysis. If you have joint pain, X-rays may be taken to diagnose psoriatic arthritis. Blood work may help rule out other forms of arthritis.

Guttate psoriasis is a less common type of psoriasis. The small [less than 0.4 in. (1 cm) in diameter], scaly, circular elevations (papules) that occur with guttate psoriasis appear more on the trunk of the body than on the arms or legs. If you have these papules, your doctor may perform a throat culture to check for strep throat.

Sometimes a skin KOH test is done to rule out a fungal infection.

Treatment Overview

Currently there is no cure for psoriasis. But many types of treatment are available, including products applied to the skin, phototherapy, and oral medicines, which can help control psoriasis. Most cases are mild and can be treated with skin products. In some cases, psoriasis can be hard to treat if it is severe and widespread. Most psoriasis returns, even mild forms.

The purpose of treatment is to slow the rapid growth of skin cells that causes psoriasis and to reduce inflammation. Treatment is based on the type of psoriasis you have, its location, its severity, and your age and overall health. It also depends on how much you are affected by the condition, either physically (because of factors such as joint pain) or emotionally (because of embarrassment or frustration from a skin rash that may cover a large or visible area of the body).

Medicines applied to the skin (topical treatments)

Treatment for mild psoriasis, characterized by a few isolated raised patches, begins with skin care, which includes keeping your skin moist. Basic treatment often involves combining treatments and products that you can get without a prescription, including:

  • Creams, ointments, and lotions to moisturize the skin.
  • Shampoos, oils, and sprays to treat psoriasis of the scalp.
  • Some exposure to sunlight.

It is also important to avoid what can trigger a flare-up of psoriasis or make the condition worse. Stress, skin injury, infection, and use of alcohol can all contribute to symptom flare-ups. Streptococcal infections, which usually affect the upper respiratory tract, are associated with guttate psoriasis.

Effective treatment will improve your overall well-being and reduce your physical symptoms.

You may try prescription medicines if your psoriasis is not helped by products you can get without a prescription. Topical medicines for psoriasis treatment include:

A treatment called occlusion therapy may be effective for some people. This involves first applying skin products, such as moisturizers, medicated creams, or gels, then wrapping the skin with tape, fabric, or plastic. Occlusion helps keep the area moist and increases the effectiveness of medicated creams. Talk to your doctor before using occlusion therapy, to make sure that you do it safely.

Treatment using more than one topical medicine is often done. This can help prevent side effects from some of the stronger medicines. For example, you may use one medicine during the week but another on the weekend.

Creams, ointments, lotions, and other medicines spread on the skin work better for some people than for others. If one medicine does not clear up your psoriasis, your doctor will likely advise you to try another medicine or combination of treatments.

Phototherapy

Creams and ointments may be used in combination with sunlight or ultraviolet light (phototherapy) for moderate psoriasis that affects less than 20% of the skin surface (about equal to having both arms completely covered).

If you use phototherapy (brief exposures to ultraviolet light such as ultraviolet B light, also known as UVB), follow your doctor's instructions carefully to avoid serious skin damage.

  • UVB light therapy often improves psoriasis. UVB treatment is usually done 3 times a week. Treatment of psoriasis with UVB and with medicines spread on the skin, such as tar or calcipotriene, is safe and effective.6
  • Psoralen and UVA light therapy (PUVA) combines a medicine and ultraviolet A light (UVA) for psoriasis treatment. First, you use a medicine, called a psoralen. You may take it as a pill, spread it on your skin as a lotion, or use it as bath salts. The medicine makes the skin more sensitive to UVA light. Then you walk into a chamber where your skin is exposed to UVA light. PUVA treatment usually is done for weeks before the psoriasis symptoms go away.

Treatment with UVB appears to be safer than PUVA, but it is less effective.7

Medicines taken by mouth (oral)

If you have moderate to severe psoriasis, your doctor may recommend a medicine you take by mouth (oral medicine), such as methotrexate, some retinoids, and cyclosporine. Oral medicines also may be used if topical medicines and phototherapy are not controlling your psoriasis well enough.

  • For many people, methotrexate works well to control psoriasis that has not improved after other treatments. Methotrexate also is used to treat psoriatic arthritis. Methotrexate cannot be used for women who are pregnant or are planning to become pregnant within 3 months. Men whose partners are planning to become pregnant should also avoid using methotrexate.7
  • Retinoids are medicines related to vitamin A. Acitretin is the most common oral retinoid used to treat psoriasis. Because retinoids do not weaken the immune system, they are sometimes used for children and for people who have psoriasis along with other conditions such as HIV infection.7 Retinoids cannot be used for women who are pregnant or who are planning to become pregnant.
  • Cyclosporine may be used as a short-term treatment for moderate to severe psoriasis. But this medicine weakens the immune system and so is often rotated with other medicines to treat psoriasis.

These oral medicines are usually used along with medicated products you spread on your skin (topical treatments). They also may be used along with exposure to ultraviolet light.

Oral treatment for children is reserved for severe psoriasis, because the safety of these medicines in children has not been well tested.

In rare cases, medicine may be injected into a skin sore or patch (plaque).

Biologics

Biologics are medicines similar to or the same as proteins made by the body. These medicines, such as alefacept and etanercept, block the harmful response of the body's immune system that causes the symptoms of psoriasis.

Biologics are used mainly for people who cannot use other treatments or whose psoriasis did not improve with other types of therapy. Although biologics may not be more effective than other treatments for psoriasis, they may be safer for organs, such as the liver or kidneys, that some oral medicines can damage. But the long-term safety of biologics is not known.

What To Think About

You may need to try different treatments before you find one that works well for you. It is important to discuss your treatment and progress with your doctor.

One study found that education, stress reduction, and muscle relaxation training can help many people who have psoriasis. Adding these elements to a treatment plan can reduce disability, anxiety, and stress related to dealing with psoriasis.8

Treatments for psoriasis have potential side effects. People with moderate or severe psoriasis may need treatment for the rest of their lives. Many doctors will recommend that treatments be changed or rotated after a certain period of time to make treatment more effective and to reduce side effects.

Prevention

There is no way to prevent psoriasis. But the following tips may improve symptoms or help reduce the number of psoriasis flare-ups.

  • Keep your skin moist.
  • Avoid cold, dry climates. Cold weather may make symptoms worse. Hot, humid weather and sunlight may improve symptoms. (But hot, humid weather may make certain types of psoriasis worse.)
  • Avoid scratching and picking skin, and avoid skin injuries (cuts or scrapes). An injury to the skin can cause psoriasis patches to form anywhere on the body, including the site of the injury. This includes injuries to your nails or nearby skin while trimming your nails.
  • Avoid stress and anxiety. Stress may cause psoriasis to appear suddenly (flare) or can make symptoms worse, although this has not been proved in studies.
  • Avoid infection. Infections such as strep throat can cause one type of psoriasis (called guttate psoriasis) to appear suddenly, especially in children.
  • Try to avoid certain medicines. Some, including beta-blockers and lithium, have been found to make psoriasis symptoms worse. When your doctor prescribes any medicines for you, tell him or her that you have psoriasis.
  • Limit alcohol to no more than 2 drinks a day for men or 1 drink a day for women. Alcohol use can cause symptoms to flare up.
  • Don't smoke. Smoking may make you more likely to get psoriasis and may make it more severe.3 Smoking may also make your symptoms last longer.4

Home Treatment

Skin care at home can help control psoriasis. Skin care and treatment may include using creams or lotions, pills, baths or soaks, and ultraviolet (UV) light. Skin care for psoriasis includes the following:

  • Take care of your skin, and keep your skin moist.
  • Gently soften and remove psoriasis crusts by putting cream on the crusts and then peeling the loose crusts off. This may help creams and lotions be absorbed into the skin. But removing crusts should be done very carefully so that the skin is not irritated.
  • Follow instructions for skin products and prescribed medicines. It may take a period of trial and error until you know which skin products or methods work best for you. For mild symptoms of psoriasis, various over-the-counter products, such as aloe vera, may be soothing.
  • Follow your schedule for sunlight or ultraviolet light treatments.
  • Seek information or counseling from your doctor. Psoriasis day care centers, where you can get intensive treatment for severe psoriasis, may be available in some areas. To find a center near you, ask your doctor or contact the National Psoriasis Foundation at www.psoriasis.org.

For more information on caring for your skin, see:

Click here to view an Actionset. Psoriasis: Skin care.

Other helpful suggestions to control psoriasis include:

  • Protect your skin. Treat all infections promptly, and try to avoid skin injuries and irritation.
  • Take care of your scalp. When you have psoriasis on your scalp, treat your scalp, not your hair.
  • Trim your nails. Keep your nails trimmed to prevent the spread of psoriasis or flare-ups.
  • Be careful in the sun. Although short periods of sun exposure reduce psoriasis in most people, too much sun exposure can damage the skin and cause skin cancer. Also, sunburns can trigger flares of psoriasis.
  • Be aware of possible medicine reactions. Certain medicines can trigger psoriasis or make symptoms worse.

Studies have not found any "psoriasis diet" that can cure or improve the condition, despite claims over the years. Try to eat a balanced, low-fat diet, and stay at a healthy weight.

Medications

Treatment for psoriasis usually begins with topical medicines that you spread on the affected areas of your skin. You may use one medicine or a combination of medicines to clear up the psoriasis patches. For mild psoriasis, you may be able to control psoriasis using an over-the-counter medicine.

Softening and removing psoriasis crusts and scales can help creams and other skin products be absorbed into the skin. Psoriasis crusts can be removed by gently rubbing cream into the crusts to soften them and then carefully peeling the crusted patches off. But this should be done with great care so that the skin is not irritated.

For moderate to severe psoriasis, you may need to use a topical medicine prescribed by your doctor, such as a corticosteroid or a medicine related to vitamin D called calcipotriene. Other topical medicines include anthralin and tars.

Occlusion therapy uses moisturizers or medicated creams or gels applied to the skin. After the product is applied, the skin is wrapped with tape, fabric, or plastic. Occlusion keeps the area moist and can make the medicated creams work better. Steroid cream may be used with the occlusion treatment method for small areas, but not for more than a few days. Occlusion of large areas may cause side effects such as thinning of the skin. Talk to your doctor before using occlusion therapy, to make sure that you do it safely.

Creams and ointments may be used together with sunlight or ultraviolet light, such as ultraviolet A (UVA) or B (UVB), to treat moderate psoriasis. This is called phototherapy. Treatment of psoriasis with UVB and medicines spread on the skin, such as tar or calcipotriene, is safe and effective.6

UVA light therapy may be combined with a medicine (called a psoralen) that makes your skin more sensitive to the UVA light. This treatment is known as PUVA (psoralen and UVA). First, you use the psoralen. You may take it as a pill, spread it on your skin as a lotion, or use it as bath salts. Then you walk into a chamber where your skin is exposed to UVA light.

Medicines taken by mouth (oral medicines) also may be used to treat moderate to severe psoriasis. The most commonly used oral medicines include methotrexate, cyclosporine, and retinoids, which are medicines related to vitamin A. In rare cases, medicine may be injected directly into a psoriasis sore or patch.

Scalp and nail psoriasis can be difficult to treat. Both conditions are more likely to improve with oral medicine. Treatment for the scalp often includes tar shampoos, corticosteroid solutions, or zinc and selenium sulfide shampoos.

If you are taking topical or oral medicines for psoriasis, you will need regular follow-up visits with your doctor to check for possible side effects. You may take one medicine for a while, then switch to another to reduce the chance that a serious side effect will occur.

Medicines called biologics have shown promise for the treatment of severe psoriasis or psoriasis that has not improved after other treatments. Biologics are similar to or the same as proteins made by the body. These medicines, including alefacept and etanercept, block the harmful response of the body's immune system that causes the symptoms of psoriasis. The long-term safety of biologics is not known.

Medication Choices

In general, treatment for psoriasis starts with medicines you spread on the affected areas of your skin (topical medicines).

Many types of nonprescription products are available to treat psoriasis. Examples of active ingredients include:

  • Salicylic acid, found in products such as Psoriasin Body Wash or Dermasolve e70.
  • Coal tar, found in products such as Elta Tar or Neutrogena T/Gel.
  • Zinc pyrithione, found in products such as SkinCure and Derma-Cap. These are new products that come in spray, soap, or solution form.

These products are used to treat small patches of psoriasis and symptoms, including itching, redness, flaking, and scaling of the skin and scalp. For some people, they may eliminate scales and sores caused by psoriasis.

Topical medicines that may be prescribed by your doctor to treat psoriasis include:

  • Corticosteroids, which are the most common treatment for psoriasis. Betamethasone is an example of a topical corticosteroid.
  • Calcipotriene, which is a form of vitamin D.
  • Retinoids, which are medicines related to vitamin A. An example is tazarotene.
  • Anthralin and tars. The use of anthralin and tars has decreased recently, replaced by other medicines such as calcipotriene and tazarotene.

If topical medicines alone do not relieve your psoriasis symptoms, they may be combined with exposure to ultraviolet (UV) light (phototherapy). Examples include combinations of:

  • Psoralen and UVA light (called PUVA).
  • Tars and UVB light (called Goeckerman treatment).
  • Anthralin and UVB light (called the Ingram regimen).

If psoriasis cannot be controlled with topical medicines and ultraviolet light therapy, you may consider taking medicines by mouth (oral medicines). Oral medicines used to treat psoriasis include:

Newer medicines, which change the immune system response to reduce the symptoms of psoriasis, may be used to treat psoriasis that other medicines don’t help.

  • Biologics.
    • Alefacept (Amevive), etanercept (Enbrel), and infliximab (Remicade) have been approved by the U.S. Food and Drug Administration (FDA) for treatment of moderate to severe psoriasis.
    • Adalimumab (Humira), etanercept, golimumab (Simponi), and infliximab have been approved to treat psoriatic arthritis.

These medicines are given through a needle. Early clinical trials of biologic therapies for moderate to severe psoriasis have produced promising results. But the medicines are expensive, and long-term effects are not known. Biologics may increase the long-term risk of cancer or infections.9, 10, 11

What To Think About

People respond differently to psoriasis treatments. A treatment that worked one time may not work again. A treatment that didn't work the first time may work when tried again later.

Some medicines used to treat psoriasis can cause serious side effects. You and your doctor will discuss how long to use treatments that could cause harm. You will also need to see your doctor regularly and may have blood tests while using some medicines.

Many oral or injected medicines used to treat psoriasis are not safe during pregnancy. If you are pregnant, talk to your doctor before taking any medicines.

Researchers are studying other medicines for their safety and effectiveness in treating psoriasis. These include medicines that affect the immune system and medicines used to treat cancer.

Surgery

Surgery is not used to treat psoriasis of the skin or scalp. But surgery may be used to treat nails that are severely disfigured or damaged from psoriasis. Surgical removal of a nail may be done in a clinic or doctor's office as an outpatient procedure.

Other Treatment

Other treatment for psoriasis includes phototherapy. Phototherapy uses ultraviolet (UV) light exposure to slow the rapid growth of cells that occurs in psoriasis. Exposure to UV light to treat this condition can be effective, but your skin should be checked often by your doctor (at least once or twice a year) for any skin damage or skin cancer.

Complementary or alternative therapies are often used by people with skin diseases, including psoriasis. Complementary therapies include the use of herbs, vitamins, certain diets, and stress reduction. These therapies may relieve psoriasis symptoms in some people.12 Some notice that natural sunlight and seawater (climatotherapy) help their psoriasis symptoms. People seeking this treatment may go to seaside resorts, some of which have special programs and medical help for people with psoriasis. For more information, see the Web site of the National Psoriasis Foundation at www.psoriasis.org.

Other Places To Get Help

Organizations

National Psoriasis Foundation
6600 SW 92nd Avenue
Suite 300
Portland, OR  97223
Phone: 1-800-723-9166

(503) 244-7404
Fax: (503) 245-0626
Email: getinfo@psoriasis.org
Web Address: www.psoriasis.org
 

This organization provides a monthly bulletin and pamphlets with information about treatments, research, and self-care for psoriasis and psoriatic arthritis. Membership is based on donations. A mail-order pharmacy service is provided.


American Academy of Dermatology
P.O. Box 4014
Schaumburg, IL  60168
Phone: 1-866-503-SKIN (1-866-503-7546) toll-free

(847) 240-1280
Fax: (847) 240-1859
Web Address: www.aad.org
 

The American Academy of Dermatology provides information about the care of skin, hair, and nails. You can find a dermatologist in your area by calling 1-888-462-DERM (1-888-462-3376).


American Skin Association
346 Park Avenue South, 4th Floor
New York, NY  10010
Phone: 1-800-499-SKIN (1-800-499-7546)

(212) 889-4858
Fax: (212) 889-4959
Email: info@americanskin.org
Web Address: www.americanskin.org
 

The American Skin Association (ASA) is a volunteer-led health organization that engages in research, education, and advocacy dedicated to saving lives and alleviating suffering caused by the full spectrum of skin disorders.


National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health
1 AMS Circle
Bethesda, MD  20892-3675
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Web Address: www.niams.nih.gov
 

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is a governmental institute that serves the public and health professionals by providing information, locating other information sources, and participating in a national federal database of health information. NIAMS supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases and supports the training of scientists to carry out this research.

The NIAMS Web site provides health information referrals to the NIAMS Clearinghouse, which has information packages about diseases.


References

Citations

  1. Abel E, Lebwohl M (2008). Psoriasis. In EG Nabel, ed., ACP Medicine, section 2, chap. 3. Hamilton, ON: BC Decker.
  2. Gudjonsson JE, et al. (2002). HLA-Cw6-positive and HLA-Cw6-negative patients with psoriasis vulgaris have distinct clinical features. Journal of Investigative Dermatology, 118(2): 362–365.
  3. Gudjonsson JE, Elder JT (2008). Psoriasis. In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 1, pp. 169–193. New York: McGraw-Hill Medical.
  4. Behnam SM, et al. (2005). Smoking and psoriasis. Skinmed, 4(3): 174–176.
  5. Setty AR, et al. (2007). Obesity, waist circumference, weight change, and the risk of psoriasis in women: Nurses' Health Study II. Archives of Internal Medicine, 167(15): 1670–1675.
  6. Naldi L, Rzany B (2009). Psoriasis (chronic plaque), search date August 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  7. Menter A, Griffiths CEM (2007). Current and future management of psoriasis. Lancet, 370(9583): 272–284.
  8. Fortune DG, et al. (2002). A cognitive-behavioural symptom management programme as an adjunct in psoriasis therapy. British Journal of Dermatology, 146(3): 458–465.
  9. Abramowicz M (2008). Drugs for acne, rosacea and psoriasis. Treatment Guidelines From The Medical Letter, 6(75): 75–82.
  10. Reich K, et al. (2005). Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: A phase III, multicentre, double-blind trial. Lancet, 366(9494): 1367–1374.
  11. Krueger GG, et al. (2005). Patient-reported outcomes of psoriasis improvement with etanercept therapy: Results of a randomized phase III trial. British Journal of Dermatology, 153(6): 1192–1199.
  12. Aloe (2004). In A DerMarderosian, J Beutler, eds., Review of Natural Products. St. Louis: Wolters Kluwer Health.

Other Works Consulted

  • Giezen TJ, et al. (2008). Safety-related regulatory actions for biologicals approved in the United States and the European Union. Journal of the American Medical Association, 300(16): 1887–1896.
  • Kimball AB, et al. (2008). National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening. Journal of the American Academy of Dermatology, 58(6): 1031–1042.
  • Nestle FO, et al. (2009). Psoriasis. New England Journal of Medicine, 361(5): 496–509.
  • Schmitt J, et al. (2008). Efficacy and tolerability of biologic and nonbiologic systemic treatments for moderate-to-severe psoriasis: Meta-analysis of randomized controlled trials. British Journal of Dermatology, 159(3): 513–526.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Alexander H. Murray, MD, FRCPC - Dermatology
Last Revised January 13, 2010

Last Revised: January 13, 2010

Author: Healthwise Staff

Medical Review: Kathleen Romito, MD - Family Medicine & Alexander H. Murray, MD, FRCPC - Dermatology

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