Psoriasis starts in the immune system. An overactive immune response speeds up skin cell growth, so cells pile up faster than the skin can shed them. The result is thick, red or discolored plaques covered with silvery scale, most often on the elbows, knees, scalp, lower back, palms and soles. Treatment aims to slow that cell growth, calm inflammation and clear the scale.
Topical treatments
For mild to moderate psoriasis, treatment usually starts with medicines applied to the skin:
- Topical corticosteroids reduce inflammation and itching. Milder strengths are used on the face and skin folds; stronger ones on thick plaques. Long-term use of strong steroids can thin the skin, so follow your dermatologist's directions.
- Vitamin D analogues such as calcipotriene slow skin cell growth and are often combined with a steroid.
- Calcineurin inhibitors (tacrolimus, pimecrolimus) are useful on thin skin such as the face and eyelids, where steroids can cause side effects.
- Newer non-steroid creams such as roflumilast and tapinarof can be used long term on many areas of the body.
- Salicylic acid softens and lifts scale, especially on the scalp, and helps other medicines absorb.
Light therapy (phototherapy)
When topical treatment isn't enough, controlled exposure to ultraviolet light can slow skin cell growth. Narrowband UVB is the most common option and is usually given two to three times a week for several weeks. Excimer laser targets UVB light at individual plaques. PUVA combines a light-sensitizing medicine with UVA light and is reserved for hard-to-treat cases because of a higher long-term skin cancer risk.
Brief, careful sun exposure helps some people, but sunburn can trigger new plaques. Talk with your dermatologist before using sunlight as treatment, and protect unaffected skin with sunscreen.
Oral and biologic medicines
Moderate to severe psoriasis, or psoriasis with joint pain, often calls for treatment that works throughout the body. Options include oral medicines such as methotrexate, apremilast and deucravacitinib, and biologic injections that block specific immune signals. Biologics have changed psoriasis care, and many patients see major improvement. These medicines need regular monitoring by your dermatologist.
Daily habits that help
- Moisturize every day with a thick, fragrance-free cream
- Take short, lukewarm baths; Dead Sea salt or oatmeal baths can ease itching and loosen scale
- Limit alcohol and avoid smoking, both of which can worsen psoriasis
- Manage stress, a common trigger for flares
- Avoid scratching and injuring the skin, which can cause new plaques
- Ask your doctor before trying supplements or herbal remedies; evidence for most of them is limited
If over-the-counter products aren't controlling your psoriasis, or you have joint pain or stiffness, see a dermatologist to review your options.
This article is for general education and isn't a substitute for a visit with a physician.