There is no cure for psoriasis or psoriatic arthritis, but people have a wide range of treatment options at their disposal to help them gain control over their psoriasis or psoriatic arthritis. Many different therapies can effectively eliminate or reduce the symptoms associated with psoriasis and psoriatic arthritis. No single treatment works for everyone, but something is likely to work in most cases. Some experimentation may be required before an effective approach is discovered.

Appropriate treatments are determined by a number of factors, including the type of psoriasis, its location on the body, its severity and a person's age and medical history. A physician, particularly a dermatologist, can provide guidance in selecting the right therapy.

Doctors generally treat psoriasis in steps based on the severity of the disease, the extent of the areas involved, the type of psoriasis, or the patient’s responsiveness to initial treatments. This is sometimes called the “1-2-3” approach. In step 1, medicines are applied to the skin (topical treatment). Step 2 focuses on light treatments (phototherapy). Step 3 involves taking medicines internally, usually by mouth (systemic treatment).

• Sunlight--Daily, regular, short doses of sunlight that do not produce a sunburn clear psoriasis in many people.

• Corticosteroids--Available in different strengths, corticosteroids (cortisone) are usually applied twice a day. Short-term treatment is often effective in improving but not completely clearing psoriasis. If less than 10 percent of the skin is involved, some doctors will begin treatment with a high-potency corticosteroid ointment (for example, Diprolene^®,* Temovate^®, Ultravate^®, or Psorcon^®). High-potency steroids may also be used for treatment-resistant plaques, particularly those on the hands or feet. Long-term use or overuse of high-potency steroids can lead to worsening of the psoriasis, thinning of the skin, internal side effects, and resistance to the treatment’s benefits. Medium-potency corticosteroids may be used on the torso or limbs; low-potency preparations are used on delicate skin areas.

  *Brand names included in this fact sheet begin with a capital letter and are provided as examples only. Their inclusion does not mean that these products are endorsed by PPSI. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

• Calcipotriene--This drug is a synthetic form of vitamin D₃. (It is not the same as vitamin D supplements.) Applying calcipotriene ointment (for example, Dovonex^®) twice a day controls excessive production of skin cells. Because calcipotriene can irritate the skin, however, it is not recommended for the face or genitals. After 4 months of treatment, about 60 percent of patients have a good to excellent response. The safety of using the drug for cases affecting more than 20 percent of the skin is unknown, and using it on widespread areas of the skin may raise the amount of calcium in the body to unhealthy levels.

• Coal tar--Coal tar may be applied directly to the skin, used in a bath solution, or used on the scalp as a shampoo. It is available in different strengths, but the most potent form may be irritating. It is sometimes combined with ultraviolet B (UVB) phototherapy. Compared with steroids, coal tar has fewer side effects, but it is messy and less effective and thus is not popular with many patients. Other drawbacks include its failure to provide long-term help for most patients, its strong odor, and its tendency to stain skin or clothing.

• Anthralin--Doctors sometimes use a 15- to 30-minute application of anthralin ointment, cream, or paste to treat chronic psoriasis lesions. However, this treatment often fails to adequately clear lesions, it may irritate the skin, and it stains skin and clothing brown or purple. In addition, anthralin is unsuitable for acute or actively inflamed eruptions.

• Topical retinoid--The retinoid tazarotene (Tazorac) is a fast-drying, clear gel that is applied to the surface of the skin. Although this preparation does not act as quickly as topical corticosteroids, it has fewer side effects. Because it is irritating to normal skin, it should be used with caution in skin folds. Women of childbearing age should use birth control when using tazarotene.

• Salicylic acid--Salicylic acid is used to remove scales, and is most effective when combined with topical steroids, anthralin, or coal tar.

• Bath solutions--People with psoriasis may find that bathing in water with an oil added, then applying a moisturizer, can soothe their skin. Scales can be removed and itching reduced by soaking for 15 minutes in water containing a tar solution, oiled oatmeal, Epsom salts, or Dead Sea salts.

• Moisturizers--When applied regularly over a long period, moisturizers have a cosmetic and soothing effect. Preparations that are thick and greasy usually work best because they hold water in the skin, reducing the scales and the itching.