The ultimate guide to treating psoriasis

There are a lot of treatments available for psoriasis (PsO), so it may feel a bit overwhelming to think about them all.¹ Different treatments work in different ways and are suitable for different situations,¹ so it’s important to work with your healthcare professional to find what’s right for you. Here are the four main treatment groups - find out more about what’s available. To figure out whether your PsO is mild, moderate or severe, take a look at the PsO severity checker.

Topical therapy is usually the first treatment used for mild PsO.² There is a wide variety available, including:²

• Creams
• Lotions
• Gels
• Ointments
• Shampoos

Topical treatments containing emollients may hydrate the skin and stop it drying out, or contain other ingredients, like vitamin D, coal tar or corticosteroids, but can take time to apply.² If you’re taking corticosteroids, these can cause side effects, like thinning of the skin, so ask your healthcare professional whether you should take breaks from applying these.²

Treatment using ultraviolet rays

If your PsO has not improved as much as you or your healthcare professional would like with treatments applied to your skin, you may be offered short wave ultraviolet B (UVB) phototherapy 2-3 times a week.³ Another type of phototherapy you could be offered is long wave ultraviolet A (UVA) light in combination with a chemical called psoralen in tablet form.³ This is called P-UVA and is often used to treat pustules on the palms and soles of the feet, although it can’t be used in pregnant women or some people who are at a higher risk for skin cancers.³

Pills or injections that act by spreading throughout the body

The first systemic therapy you would usually be offered is an immunosuppressant⁴ that slows down your body’s immune system and suppresses inflammation in psoriasis.¹ If the first agent you try isn’t effective, some other options may include:

• An oral retinoid which reduces how fast your skin grows.¹
• An inhibitor of phosphodiesterase-4 which changes the way your body deals with inflammation.¹
• An inhibitor of calcineurin which suppresses the immune system.¹
• Fumaric acid esters which normalise the balance of cytokines in your body.⁸ Cytokines are chemicals related to the immune system.⁵

Injections or infusions made from protein

Biologic medications are a type of treatment for PsO that work throughout your body.⁴ They are grown in a lab using living cells and target specific parts of the immune system.⁶ These should only be prescribed by a specialist doctor with experience treating PsO or PsA, although your symptoms and side effects may be monitored by a clinical nurse specialist.^1,4

There are a number of different types of biological treatment that the treatments above fall into:

• TNF inhibitors: these block an important protein for inflammation, called tumour necrosis factor (TNF).⁶ Treatments like this are injected under the skin or directly into a vein.¹
• IL-12/23 inhibitors: these block a specific part of the proteins called interleukins (IL) 12 and 23, which are also involved in inflammation.⁶ Treatments like this are injected under the skin.¹
• IL-17 inhibitors: these block a protein called IL-17 to stop inflammation from developing. Treatments like this are injected under the skin.⁶
• IL-23 inhibitors: treatment that targets a specific part of the protein called IL-23 to block psoriasis inflammation using an injection under the skin.^1,6

If you’re going to be taking a biologic, you will probably need to be tested for tuberculosis (TB) and have blood tests before and during treatment.⁷