Though there is no cure for psoriasis, treatment may temporarily clear lesions or significantly improve the appearance of the skin. The goal of treatment is to clear lesions from the skin by reducing inflammation and slowing down the rapid cell growth and shedding. Treatment is highly individualized. What works for one patient may not work for another. It may also require periodic adjustment. Once treatment has eliminated present lesions, it is typically discontinued until new lesions appear. Most patients will require lifelong therapy to control the signs and symptoms associated with psoriasis. Patients with severe psoriasis may wish to consult a dermatologist.

Treatment generally focuses on certain factors, including:

• Softening and removing scales
• Relieving pruritus (itch)
• Reducing pain and discomfort
• Slowing rapid cell proliferation
• Helping to induce remission

Factors that determine the course of treatment to be used include:

• Type and severity of psoriasis present
• Location and size of lesions on the body
• Patient’s overall health, age and medical history
• Patient’s tolerance of specific medication, procedures or therapies
• Patient and physician’s opinion or preference.

Topical medications may be used to treat mild to moderate psoriasis. They may be used alone, in combination, or with exposure to ultraviolet light. Generally, any existing scales need to be removed before application because they block penetration. This may be accomplished through hydration, such as soaking in a warm bath, or with medications that soften the skin, such as keratolytic agents (e.g., salicylic acid). Topical psoriasis medications include:

• Emollients (moisturizers). Mild, non-perfumed moisturizers may be purchased without a prescription. They restore moisture and flexibility to affected skin and may reduce itching, scaling and inflammation. Increased use may be necessary in dry climates or during winter.
  
  
• Coal tar preparations. These may be applied directly to the lesion, added in bath water as a soak, or used in combination with ultraviolet B (UVB) light. They may be available with or without a prescription. For scalp psoriasis, a coal tar shampoo may be used.
  
  
• Corticosteroids. These are the most commonly prescribed medications for psoriasis. Though they can be quite helpful in mild to moderate psoriasis, they are not usually effective in severe psoriasis. Prolonged use can even result in rebound psoriasis worse than the original condition.
  
  
• Anthralin. Reduces increase in skin cells and inflammation. May be used for thicker, harder-to-treat lesions.

Occlusion may be used with topical medications. Lesions are covered with tape dressing, plastic wrap or a special suit. This increases the absorption of the medications.

Phototherapy is often used in the treatment of moderate to severe psoriasis. Natural sunlight or ultraviolet light exposure may help reduce lesions, although care must be taken not to burn. Sunburn can make psoriasis worse. Methods of delivering ultraviolet light include:

• Psoralen and long-wave ultraviolet radiation (PUVA). Psoralen is a medication usually applied topically before exposure to ultraviolet A light. PUVA therapy is not recommended in children under the age of 12, pregnant or breastfeeding women or individuals with certain medical conditions (e.g., kidney or liver dysfunction). Possible side effects include sunburn, nausea, vomiting, abnormal hair growth and hyperpigmentation (too much pigment in the skin).
  
  
• Narrow-band UVB (NB-UVB). Intense ultraviolet B light may also reduce lesions. Advantages over PUVA include shorter treatment times and no need for medications. NB-UVB can be used in children, pregnant or breastfeeding women and people with kidney or liver dysfunction. However, it is not widely available.

Oral medications may be used for severe, life-threatening cases of psoriasis that do not respond to other forms of treatment. They may be used alone or in combination. These can be more dangerous than topical treatments, so the benefits of their use must be weighed against their possible side effects. Some oral medications can cause life-threatening complications. Methotrexate is an antimetabolite that interrupts the growth of skin cells. Patients on this medication must be monitored for liver, kidney and blood changes. Retinoids, which normalize skin cell production, may be prescribed in some cases.

Biologics are the newest treatments for psoriasis. These are drugs administered intravenously (I.V.) or via intramuscular (IM) injection. They treat psoriasis and psoriatic arthritis by working on parts of the immune system which help trigger psoriasis.

People with psoriasis may find some relief from itching by adding Epsom salts or oatmeal to baths. Moisturizing the skin while it is wet may also be soothing.

Psoriasis can have a substantial effect on a person’s self-esteem and social life. In addition, living with the day-to-day discomfort associated with the condition can be frustrating and may add to a person’s stress level. Therefore, patients may benefit from seeking psychological counseling or joining a support group. Anti-anxiety medications or antidepressants may also be recommended.

New research is delving into many psoriasis issues, including:

• Understanding the role of family history in psoriasis
  
  
• New treatments that quiet the immune system
  
  
• New laser light treatments