The 3 Best Plaque Psoriasis Treatments, According to Dermatologists
If all you want is for the itchiness and redness of your plaque psoriasis to go away, there's good news: plenty of treatment options exist.
"Wearing your disease on the outside of your body can be very difficult, which is why it's wonderful that we have so many treatments that we can use to make people better," Robert T. Brodell, MD, chair of the department of dermatology at the University of Mississippi Medical Center, tells Health.
From topical treatments and light therapy to medications that work within the body, rest assured that there are plenty of ways to take control of your psoriasis.
"Over the past 20 years, we've seen a lot of advancements in treatments. Your dermatologist has many options to tailor treatment for you," says Dr. Brodell.
How do dermatologists treat plaque psoriasis?
Although there is no cure for psoriasis, Adam Friedman, MD, professor of dermatology at George Washington School of Medicine and Health Sciences, says there is almost always a treatment option that can help.
If, after seeking treatment, you're still experiencing symptoms and flare-ups of your moderate-to-severe psoriasis, but your doctor isn't offering you another option, that should be a warning sign to you, says Dr. Friedman. "We know under-treatment is a problem," he tells Health.
Here are three categories of treatment that dermatologists commonly recommend, plus several non-traditional remedies that experts say may be worth a try. Your doctor may use one, or a combination of the following, to bring you relief.
Topical treatments, such as steroid creams to reduce swelling and redness, are often what many doctors try first when treating plaque psoriasis, no matter which part of the body it presents on.
"A strong topical treatment is what we might start with if someone has localized psoriasis, and if no progress is made, we'll move on," says Dr. Brodell.
Some topicals are available by prescription only, while others can be purchased over-the-counter, says the National Psoriasis Foundation (NPF).
In addition to steroids, this treatment category includes non-steroidal options (such as calcipotriene, a synthetic form of vitamin D for scalp and nail psoriasis) and over-the-counter lotions, creams, shampoos, and bath products.
The NPF says some OTC treatments contain these active ingredients approved by the US Food and Drug Administration for psoriasis treatment:
- Salicylic acid, which works by softening plaques and scales and removing them from the skin.
- Tar (made from coal or wood), which slows skin cell growth and reduces inflammation, itching, and scaling.
A word of caution, though: Tar can irritate the skin. And some people (including those who are pregnant or breastfeeding) should avoid using it, says the American Academy of Dermatology Association (AAD).
To ensure that OTC products are not irritating and are safe to use for psoriasis, review NPF's Seal of Recognition program.
By shining ultraviolet (UV) rays on the skin, light therapy (aka phototherapy) can help skin cells grow more slowly. The AAD explains that this form of treatment can help with psoriasis because it suppresses the immune system, which in turn can reduce inflammation, allowing the skin to heal and stop itching.
While Dr. Friedman says light therapy can be an effective treatment for the skin, he points to a key limitation: "It works pretty well for skin disease, but doesn't have an effect on joint disease or underlying medical problems associated with psoriasis."
Additionally, having to go to an office a few times a week to receive the therapy can deter people, he says. The question is whether that's even necessary. A large randomized controlled trial, called the LITE Study, funded by the independent, nonprofit Patient-Centered Outcomes Research Institute, will compare the safety and effectiveness of 12 weeks of at-home versus office-based UVB phototherapy for the treatment of psoriasis. "We're trying to see if getting the treatment at home is a viable option," says Dr. Friedman, whose institution is among the trial sites.
UV light treatments aren't without side effects. As AAD notes, your skin may be red and tender (like a sunburn) afterward, and people with medium-to-dark skin may develop dark spots.
If you've tried topical treatments or light therapy with no relief, your doctor may move on to prescribing oral medicines or biologics, says the NPF.
Either by prescription or over-the-counter, oral medicines work within the body to slow down the immune system. Options include methotrexate, synthetic vitamin A, apremilast (Otezla), tofacitinib (Xeljanz), and others, says the NPF.
Doctors may also try one of a slew of intravenous and injectable biologics that target specific areas of the body. The NPF says these include certolizumab pegol (Cimzia), ixekizumab (Taltz), guselkumab (Tremfya)—and the list goes on.
"There are now 13 or 14 biologic drugs, which are targeted therapies that keep most of your immunity functioning normally," says Dr. Brodell. "Targeted therapies for some patients are almost magical in the way they can knock down psoriasis."
Oftentimes doctors will rotate among several systemic drugs to find the one that works best for you, he says.
As with any medications you take, it's important to discuss the potential side effects with your doctor.
Do complementary and alternative approaches work for plaque psoriasis?
Plenty of people with psoriasis turn to non-traditional therapies for relief. Responding to a 2019 patient survey described in the Journal of the American Academy of Dermatology, 41% of patients reported using alternative treatments in place of traditional medicine in the last five years, while 50% said that they have added complementary remedies to their treatment regimen.
When used in combination with traditional treatments, some people find that integrating natural treatment can be helpful, says the NPF. But some remedies can interact with medications or might not be a good fit for you, so it's important to talk with your doctor first. Below are some options.
Aloe vera. This plant gel may help reduce redness and scaling caused by psoriasis and can be applied up to three times a day, according to the NPF. The foundation suggests finding a cream containing 0.5% aloe.
Apple cider vinegar. Applying apple cider vinegar a few times a week can help with itching on the scalp that is caused by psoriasis, as long as you don't have cracked skin or bleeding areas on the scalp. To avoid burning, the NPF recommends using organic apple cider vinegar that is diluted with water in a one-to-one ratio.
Capsaicin. When added to creams and ointments, this ingredient derived from chili peppers can block nerve endings that cause pain, says the NPF. Other benefits? It may quell inflammation and reduce redness and scaling, it says. However, the foundation cautions that more research is needed on capsaicin's long-term benefits and safety.
Sea salt. Adding Dead Sea or Epson salt to a warm, 15-minute bath can help scales fall off and relieve itching, says the NPF.
Turmeric. The NPF cites research suggesting that curcumin, the active ingredient in turmeric, has antioxidant and anti-inflammatory properties that may benefit some people by reducing their psoriasis and psoriatic arthritis flare-ups. Turmeric and curcumin products taken orally or applied topically in recommended amounts "are probably safe," says the National Center for Complementary and Integrative Health (NCCIH). However, these products may be unsafe when used by pregnant people in amounts greater than what's found in food, and little is known about its safety during breastfeeding, says NCCIH.
Mahonia. This antimicrobial herb can help mild-to-moderate psoriasis when applied to the skin, says the NPF, which suggests using a cream with 10% mahonia. A 2018 review in the Journal of Clinical and Aesthetic Dermatology identified several studies in which mahonia use was associated with significant symptom improvement and minimal side effects.
Physical therapy and massage. Physical therapy can be used to help with psoriatic arthritis by increasing mobility in joints. Because massage can help loosen and stretch muscles and joints, the NPF says it can be helpful for those with psoriasis and psoriatic arthritis.
Acupuncture. Acupuncture involves inserting needles into certain spots on the body with the intention of relieving symptoms in those areas. A 2018 systematic review in JAMA Dermatology noted that this traditional Chinese therapy appears to be beneficial for the treatment of psoriasis. But based on existing studies, it's difficult to determine the most effective technique for treating psoriasis, according to the review.
Mind-body therapies. Since stress can trigger psoriasis flare-ups, researchers have examined the role of meditation and relaxation techniques using guided imagery, for example. Based on a small number of studies, it appears that these mind-body interventions may be a beneficial, complementary treatment, per the JAMA Dermatology review.
Indigo naturalis. Applied topically, this derivative of indigo plants has been shown to be safe and effective for treating psoriasis, says the AAD. The JAMA Dermatology review says there's reasonable evidence to recommend trying this traditional Chinese medicine (also known as qing dai), but says the optimal dosage is uncertain and cautions consumers that it may be difficult to find a reputable source of this product.
Cannabis. Dr. Friedman says the effects of medical cannabis for those with psoriasis is being studied. "There is pre-clinical data about how it could be anti-inflammatory, but we don't have a lot of information," he says.
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