Psoriasis

Diagnosis

Your health care provider begins diagnosis by asking questions about your health history and examining your skin, scalp, and nails. A small sample of skin may be taken for a biopsy, which is examined under a microscope. This helps identify the type of psoriasis and rule out other skin disorders.

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Skin biopsy
Psoriasis: What to share with your doctor

Treatment

Psoriasis treatment aims to slow the rapid growth of skin cells and remove scales. Options include topical therapy, light therapy, and oral or injected medications. Your treatment depends on the severity of psoriasis and how well you respond to previous therapies. Many people need to try several treatments or combinations before finding what works best. Even with successful care, psoriasis commonly returns.

Topical therapy

Corticosteroids are the most frequently prescribed options for mild to moderate psoriasis. They come as oils, ointments, creams, lotions, gels, foams, sprays, and shampoos.

Mild corticosteroids may be recommended for:

• Sensitive areas such as the face and skin folds

• Widespread patches

• Once-daily use during flares and occasional use during remission

Stronger corticosteroids such as triamcinolone or clobetasol may be used for smaller or tougher areas. Long-term use of strong corticosteroids may thin the skin or become less effective over time.

Vitamin D analogues like calcipotriene and calcitriol slow skin cell growth. They may be used alone or with corticosteroids. Calcitriol is often less irritating on sensitive skin.

Retinoids such as tazarotene are applied once or twice daily. They may increase irritation and sensitivity to light and are not recommended during pregnancy or breastfeeding.

Calcineurin inhibitors such as tacrolimus and pimecrolimus help reduce scaling and inflammation, particularly in thin-skinned areas like around the eyes. They are not intended for long-term use due to a potential increased risk of certain cancers.

Salicylic acid shampoos and solutions reduce scalp scaling and can be used alone or with other topical treatments.

Coal tar can reduce scaling, itching, and inflammation. It may irritate the skin, stain fabrics, and has a strong odor. It is not recommended during pregnancy or breastfeeding.

Anthralin slows skin cell growth, reduces scales, and smooths the skin. It can stain surfaces and is usually applied for short periods before washing off.

Light therapy

Light therapy is a first-line option for moderate to severe psoriasis. It may be used alone or with medications. Treatment requires repeated sessions.

Options include:

• Sunlight: brief daily exposure may help; ask your provider about safe use

• UVB broadband: useful for patches or widespread psoriasis

• UVB narrowband: often more effective and commonly used two to three times a week

• PUVA: involves psoralen plus UVA exposure; useful for more severe psoriasis

• Excimer laser: targets only affected skin with high-intensity UVB

Possible side effects vary by method and may include itching, burning, or increased skin sensitivity.

Oral or injected medications

Systemic medications are used for moderate to severe psoriasis or when other treatments fail.

Options include:

• Steroid injections for a few small, persistent patches

• Retinoids such as acitretin to reduce skin cell production

• Biologics (etanercept, infliximab, adalimumab, ustekinumab, risankizumab-rzaa, ixekizumab, guselkumab, apremilast, bimekizumab-bkzx, secukinumab) that target immune pathways involved in psoriasis

• Methotrexate to slow cell growth and decrease inflammation

• Cyclosporine for severe psoriasis when rapid symptom control is needed

• Other medications such as thioguanine and hydroxyurea for people unable to take other drugs

Biologics may increase the risk of serious infections, so screening for tuberculosis is required before starting treatment.

Treatment considerations

Treatment choice depends on the severity and type of psoriasis. Care often begins with the mildest options, such as topical medications and phototherapy. Stronger systemic medications may be used if symptoms do not improve or if the psoriasis is pustular or erythrodermic. The goal is to slow cell turnover using the least aggressive treatment that remains effective.

Alternative medicine

Some integrative therapies may help reduce itching and scaling, though strong scientific evidence is lacking. These options are generally safe when used for mild to moderate psoriasis.

Common alternatives include:

• Aloe extract cream applied several times daily for a month or more

• Fish oil supplements taken orally or applied topically with dressings

• Oregon grape (barberry) applied to the skin to reduce severity

Always discuss alternative therapies with your health care provider.