Psoriasis Treatment

Topical therapy is usually the first-line treatment for mild to moderate psoriasis. These products are applied directly to the skin and can help reduce redness, scaling, and itching.

• Corticosteroids: Anti-inflammatory creams or ointments that calm the immune response in the skin. They come in different strengths and are often used for short periods to control flare-ups.
• Vitamin D analogs: Medications such as calcipotriol or calcitriol help slow down the growth of skin cells, reducing plaque thickness.
• Coal tar: An older but still useful option that helps reduce scaling, itching, and inflammation.
• Salicylic acid: Works by softening thick scales, making it easier for other medications to penetrate the skin.
• Calcineurin inhibitors: Non-steroid creams like tacrolimus or pimecrolimus may be prescribed for sensitive areas such as the face or skin folds, or as part of a larger strategy to control psoriasis while minimizing medication side effects
• Immunomodulators: recently, more and more topical therapies shown to improve psoriasis have been those that affect cellular signaling via phosphodiesterases, Aryl Hydrocarbon Receptors, JAK/tyrosine kinases, or other receptors. Dr. Freedman is well-versed in the on and off-label use of medications to control psoriasis.
• Moisturizers and emollients: While not a medication, keeping skin hydrated is essential. Moisturizers reduce dryness, cracking, and itchiness, and they make other treatments more effective.

Light therapy is a medical treatment that uses ultraviolet (UV) light under controlled conditions. By exposing the skin to measured amounts of UV light, the overactive growth of skin cells slows down.

• Narrowband UVB therapy is the most common and uses a specific wavelength of light that is particularly effective for psoriasis.
• Excimer laser therapy delivers focused UVB light to smaller patches of psoriasis, sparing the surrounding skin. There is a growing body of literature supporting the integration of excimer laser therapy with topical and systemic agents for the management of psoriasis.
• PUVA therapy combines a light-sensitizing medication (psoralen) with UVA light, though this is used less often today because of long-term side effects.

Phototherapy requires a treatment schedule, often several times a week, and should be supervised by a dermatologist to ensure safety and effectiveness.

For moderate to severe psoriasis, or psoriasis that does not respond well to topical care and light therapy, systemic medications may be recommended. These work throughout the body to control the immune system and slow down skin cell turnover.

• Methotrexate: Reduces inflammation and skin cell production. It has been used for decades and can also help with psoriatic arthritis.
• Cyclosporine: Suppresses the immune system and is effective for severe cases, but is usually prescribed for limited periods due to potential side effects.
• Acitretin: An oral retinoid (vitamin A derivative) that helps normalize skin cell growth. It is sometimes combined with light therapy for better results.

These medications require careful monitoring through regular blood tests to check for side effects.

Biologics represent a newer generation of psoriasis treatments. These are protein-based drugs made from living cells that target specific parts of the immune system involved in psoriasis. They have been life-changing. Biologics are usually given by injection or intravenous infusion.

Examples include:

• TNF-alpha inhibitors such as adalimumab, etanercept, and infliximab.
• IL-12/23 inhibitors such as ustekinumab.
• IL-17 inhibitors such as secukinumab and ixekizumab.
• IL-23 inhibitors such as guselkumab and risankizumab.

Biologics are highly effective for many patients, often leading to clear or nearly clear skin. They are also used to treat psoriatic arthritis. Because they suppress parts of the immune system, regular medical supervision is essential.

In addition to biologics, newer oral medications target immune pathways with greater precision than traditional systemic drugs.

• Apremilast: A PDE4 inhibitor that helps control inflammation. It is taken as a pill and is generally well tolerated.
• Deucravacitinib: A recently approved TYK2 inhibitor that works on a specific part of the immune system involved in psoriasis.

These targeted therapies are an option for people who prefer pills over injections or for those who cannot take biologics.