Treatment for Psoriatic Disease
There are two main types of psoriatic disease: psoriasis and psoriatic arthritis (PsA). Psoriasis causes scaly, red, itchy patches on your skin. PsA causes swollen, stiff joints — usually in addition to psoriasis symptoms.
Living with either disease can be painful and sometimes embarrassing, but the right treatments can greatly improve symptoms. Some therapies help with skin symptoms, others with joint symptoms, and a few help with both.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
NSAIDs, often prescribed for PsA, help control pain and swelling. Most people are familiar with over-the-counter (OTC) treatments like aspirin, ibuprofen, and naproxen sodium. But there are many prescription NSAIDs as well. Your doctor might try:
- Diclofenac (Arthrotec, Voltaren)
- Etodolac (Lodine)
- Indomethacin (Indocin)
- Ketoprofen (Orudis)
- Meclofenamate (Meclomen)
- Meloxicam (Mobic)
- Nabumetone (Relafen)
- Oxaprozin (Daypro)
- Piroxicam (Feldene)
- Sulindac (Clinoril)
- Tolmetin sodium (Tolectin)
NSAIDs are generally safe, but they aren’t risk-free. Some research suggests they increase the risk of a heart attack or stroke. They can also cause stomach irritation and bleeding.
Topical Treatments
Topical treatments are medications you put on your skin. Some reduce psoriasis lesions. Others can ease the pain and stiffness of PsA. A few examples:
Topical corticosteroids (steroids). These anti-inflammatory medicines can ease the redness and swelling of psoriasis lesions. Topical steroids require a prescription and are the most common treatment for psoriasis.
Non-steroid topicals. These treatments contain ingredients other than steroids. You may be prescribed anthralin (Drithocreme HP, Zithranol), roflumilast (Zoryve), tapinarof (Vtama), or tazarotene (Avage, Fabior, Tazorac).
Topical vitamin D. This human-made version of vitamin D can help:
- Slow the fast growth of skin cells
- Flatten psoriasis patches
- Remove scales on the skin
- Treat nail psoriasis
- Treat scalp psoriasis
OTC salicylic acid treatments. Salicylic acid is the active ingredient in many OTC creams and shampoos for psoriasis. It causes the top layer of your skin to peel, which helps lift scales and soften rough patches.
“Off-label” topicals. Some drugs approved for other skin conditions are also used for psoriasis. Two of these “off-label” drugs are in a class called topical calcineurin inhibitors (pimecrolimus cream and tacrolimus ointment).
Coal tar. Many psoriasis treatments, both prescription and OTC, contain coal tar. The ingredient often works well for plaque psoriasis, itching, scalp psoriasis, and scale.
Diclofenac. An NSAID used for painful arthritis symptoms, this drug comes in both pill and topical forms. The skin route lowers the risk of NSAID side effects. Topical diclofenac treatments include:
- Diclofenac epolamine patch (Flector)
- Diclofenac sodium gel (Voltaren)
- Diclofenac sodium liquid (Pennsaid)
Other NSAIDs. Diclofenac isn’t the only prescription NSAID you can put on your skin. A compounding pharmacy (a drugstore that makes its own medications) can make topical forms of ibuprofen, ketoprofen, and a few others.
Light Therapy
Light therapy is a drug-free way to find relief from psoriasis symptoms. Your choices are phototherapy or a wearable device.
During traditional phototherapy, a doctor shines a special light on your skin to clear up patches. It’s a safe treatment for most people and useful for:
- Extra-thick patches
- Widespread patches
- Long-term psoriasis on hands and feet
- Nail psoriasis
- Scalp psoriasis
If your psoriasis is mild, you may be able to use a wearable blue-light device. It’s approved by the FDA to treat mild psoriasis at home, but one drawback is that you can only strap it onto an arm or a leg.
Disease-Modifying Drugs
Disease-modifying drugs for both psoriasis and PsA include traditional disease-modifying antirheumatic drugs (DMARDs), usually taken by mouth, and biologic drugs, usually given as a shot or an IV. The list of these powerful drugs includes:
Apremilast (Otezla). Taken in pill form twice a day, apremilast is FDA-approved for psoriasis and PsA. It can help control plaque psoriasis, itching, nail psoriasis, and scalp psoriasis.
Cyclosporine. People with severe and disabling psoriasis may quickly improve on cyclosporine. Due to the risk of side effects, this drug should be taken only for a few months at a time.
Deucravacitinib (Sotyktu). Taken once daily, Sotyktu can help control moderate-to-severe psoriasis and can be used by those who can get systemic therapy or phototherapy. It is not recommended for use in combination with other potent immunosuppressants.
Methotrexate. This DMARD can treat severe psoriasis, nail psoriasis, and PsA. It’s available in pill, shot, and liquid forms.
Biologics. Biologics target the overactive parts of your immune system. Most of the ones approved for PsA are also approved for psoriasis. These include:
TNF-alpha inhibitors:
- Adalimumab (Humira)
- Certolizumab (Cimzia)
- Etanercept (Enbrel)
- Infliximab (Remicade)
IL-23 inhibitors:
- Guselkumab (Tremfya)
- Rizankizumab-rzaa (Skyrizi)
- Tildrakizumab-asmn (Ilumya)
IL-12/23 inhibitors:
- Ustekinumab (Stelara)
IL-17 inhibitors:
- Brodalumab (Siliq)
- Ixekizumab (Taltz)
- Secukinumab (Cosentyx)
Combination Therapy
Combination therapy involves two or more drugs that work together to make you feel better. It’s often used to treat both psoriasis and psoriatic arthritis. In fact, it’s the most common approach to psoriasis treatment in the United States.
For example, if your biologic doesn’t seem as effective as it once was, adding methotrexate can boost your body’s response. Other combination therapies for psoriatic disease include more than one topical treatment, or a topical treatment plus a disease-modifying drug.
Avoid Disease Triggers
While various medications can help ease psoriatic disease, there is no cure. The main goal of treatment is to get your disease under control. To do this, it’s important to take the medications your doctor prescribes. You can also reduce your chances of a flare by avoiding disease triggers.
A disease trigger is something that sets off symptoms. When you have psoriasis, triggers include skin injuries (cuts, bug bites, severe sunburns), stress, smoking, binge drinking, a lack of vitamin D, and certain medications.
If you find it hard to reduce or avoid your triggers, tell your doctor, who can recommend a therapist or other medications that support your healthy choices.