Psoriasis treatment

Treatment for psoriasis may not cure the condition but it helps to keep it under control. Treatment can help you avoid serious flares and also prevent your psoriasis from becoming worse.

Psoriasis can be improved, and sometimes cleared, by regular use of a treatment or several treatments. Psoriasis can come back (relapses) if treatment is stopped. Read more about psoriasis

Different treatments may be necessary to keep your psoriasis stable or to control a flare-up.

On this page, you can find the following information: 

Emollients and moisturisers

Emollients work by moisturising dry skin and reducing dry skin flakes. They soften cracked areas and help other topical treatments get through the skin and work better. They can also be used instead of soap.

  • It is usually advised that they are applied about 30 minutes before other psoriasis treatments.
  • Very mild psoriasis may settle with emollients alone.
  • Emollients can be applied as often as needed until the skin is no longer dry.
  • As these emollients also soak into fabrics, it is important that you change your clothing and bedding regularly.
  • Some people may wear bandages or garments under the clothes to stop the topical treatments soaking through.
  • Read more about emollients and moisturisers.

Steroid creams or ointments

Steroid creams or ointments (also called topical steroids) work by reducing skin inflammation, or redness. They are available in different strengths, namely mild, moderate, potent (strong) and very potent (extra strong).

  • Mild topical steroids can be helpful on the face or in the skin folds (e.g. under the arms).
  • Very potent corticosteroids are usually reserved for palms and soles as the skin is much thicker in those areas.
  • If potent or very potent corticosteroids are used on the same area of skin for many months or years, there is a small risk of skin thinning so ongoing prescriptions should be monitored by your doctor.
  • Read more about steroid creams and ointments

Calcipotriol (Daivonex)

Calcipotriol is a vitamin-D like product. It reduces the thickness and scaliness of plaques. Calcipotriol  is safe and popular as they do not stain the skin or have a strong odour. They are not usually prescribed during pregnancy and breastfeeding and can irritate sensitive skin areas such as the face and skin folds. Treatment is applied once or twice a day, and can be continued long term. Calcipotriol is available in combination with a steroid called Daivobet and Enstilar. Read more about calcipotriol.

Salicylic acid

Salicylic acid can help reduce excessive scaling but may sometimes irritate the surrounding skin. It is generally used on thick areas of skin to reduce the thickness.

Coal tar

Tar preparations reduce the thickness of the psoriasis. Tar preparations include bath oils, creams, ointment and shampoos. Coal tar has a distinctive smell that some people dislike and tar preparations can be messy and stain clothing. They are safe.

Phototherapy

Phototherapy is ultraviolet light delivered in a controlled way to treat psoriasis. A course of treatment usually takes about 8-10 weeks and will require treatment sessions two to three times a week. Two types of light are used:

  • narrowband ultraviolet B light (nbUVB/TLO1) 
  • ultraviolet A light (PUVA).

The latter requires a sensitiser, known as a psoralen that can be taken as a tablet or added to a bath prior to treatment.

Pimecrolimus and tacrolimus 

These work by reducing skin inflammation (seen as redness on the skin). They are safe anywhere, including the face and skin folds (flexures). They sometimes cause a burning/ prickling sensation after application but this often eases over a few days to weeks. Read more about pimecrolimus and tacrolimus

Acitretin

Acitretin belongs to a group of medicines called retinoids. Retinoids are closely related to vitamin A and work by slowing down cell growth in your skin and reduces redness and swelling. Read more about acitretin

Methotrexate

Methotrexate is used in severe psoriasis that cannot be controlled with medicine applied to the skin or light treatments. Methotrexate works by suppressing the overactive immune system that causes psoriasis. Read more about methotrexate

Etanercept (Enbrel), adalimumab (Humira),  infliximab (Remicade)

These treatments are called biologics and are usually used when other treatments have not worked well. They work by blocking natural inflammatory substances in the body such as tumour necrosis factor-alpha (TNFa). They suppress or weaken your immune system, thereby slowing or stopping the damage from the disease. Read more about EnbrelHumira and Remicade

References

  1. Psoriasis – an overview British Association of Dermatologists
  2. Psoriasis DermNet NZ
  3. Preparation for psoriasis NZ Formulary
  4. Psoriasis – diagnosis and treatment American Academy of Dermatology Association
Credits: Sandra Ponen, Pharmacist. Last reviewed: 11 Jan 2022