Treatments aim to reduce inflammation and scales, slow the growth of skin cells, and remove plaques. Psoriasis treatments fall into several categories: topical treatments, phototherapy (light therapy), systemic medications (oral or injectables), and a specific class of systemics: biologics. Some also find alternative and complementary therapies helpful, which should be discussed with your doctor.
There is a psoriasis decision aid to help you choose which treatment is best for you.
For people living with psoriasis, about 80-90% are considered mild to moderate, and most can be treated with topical agents—treatments applied on the skin. Topical agents may be used alone or in combination with other therapies, such as phototherapy or systemic medications. Topical psoriasis treatments include:
• Topical corticosteroids
• Vitamin D analogues/ derivatives
• Topical retinoids
• Salicylic acid
• Coal tar
Learn more about using topicals to treat psoriasis.
Phototherapy (light therapy)
Phototherapy is the use of ultraviolet light (UV) as a form of treatment. Several different forms of light treatment for psoriasis are available, including exposure to natural sunlight when conditions permit.
The goal of phototherapy is to expose the patient’s affected skin to UV light. Treatments are available at doctors’ offices, phototherapy clinics or at home. It is used to treat moderate to severe psoriasis with plaques covering more than 3% of the skin. Both UVA and UVB light may be helpful in reducing symptoms of mild to moderate psoriasis. UVA is for the most severe cases, and always used in conjunction with a photosensitizing drug called psoralen; a treatment called PUVA (Psoralen Ultra-Violet A) light therapy ).
Phototherapy is NOT suitable for individuals with a light-sensitive disease, an allergy to the sun, skin cancer, and those taking photosensitizing medications. Repeated exposure to UV may cause premature aging of the skin and skin cancer. NEVER GET BURNED, as that may exacerbate the primary disease and greatly increase the risk of skin cancer and premature aging of the skin.
Many medications, cosmetics and herbal remedies can increase the skin’s sensitivity to ultraviolet radiation. If using any such products, consult your physician before UV phototherapy. The eyes should be protected from ultraviolet light by wearing UV-blocking goggles or sunglasses as UV can permanently damage the eyes. Most people with moderate to severe psoriasis will benefit from a combination of treatments. This type of therapy uses more than one of the treatment types to reduce symptoms.
Systemic treatments are delivered orally (in tablet or liquid form) or through injection or intravenous infusion (drip), that work within the body rather than topical treatments, which are applied directly on the skin.
People with moderate to severe psoriasis, and those who have not responded well to other treatment types, may need to use systemics. Many of these medicines have severe side effects, so doctors usually prescribe them for short periods of time. The medications include:
Learn more about using systemics to treat psoriasis.
Biological response modifiers or biologics are considered a highly effective treatment option for patients with moderate to severe psoriasis. A biologic is a protein-based drug that is produced from living cells. Until more recent years, biologics have mainly been prescribed for patients who cannot use other treatments or whose psoriasis no longer responds with other types of therapy.
Most biologics are currently given by injection just under the skin (subcutaneous injection) and can be administered by a nurse or by the patients themselves after proper training. Treatment may be given by intravenous infusion or “drip” at a day clinic or hospital rheumatology department under medical supervision.
Biologics are generally divided into groups on the basis of how they work:
• TNF inhibitors
• Interleukin inhibitors
Biosimilars (also referred to as a subsequent entry biologic or SEBs) are medications that are similar to, but not identical versions of an existing biologic. Biosimilars are often mistakenly called "generic” versions of the innovator biologic drug. While generics are exact copies of the innovator drug (with the same medicinal ingredient) biosimilars are only similar to the original. Since biologics are large molecules that are produced by living organisms it is not possible to make an exact copy of them.
Learn more about using biologics to treat psoriasis.
Alternative and complementary therapies
More than 70% of Canadians regularly use alternative and complementary therapies such as vitamins and minerals, herbal products, homeopathic medicines and other natural health products to stay healthy and improve their quality of life1. Talk to your doctor about complementary therapies that may be right for you.
Healthy Diet: Many scientific studies have shown that a balanced, low-fat diet can improve your health and prevent many serious illnesses. Healthy eating can also improve your general well-being. Some experts believe that psoriasis may cause nutritional deficiencies in protein, folates (related to medication), water and calories. Correcting deficiencies may help to improve your overall health.
Acupuncture: There is no scientific evidence to recommend the use of acupuncture for psoriasis, and its effectiveness has not been proven in clinical studies. If you go this route, choose your practitioner carefully. Look for a trained, certified acupuncturist. Make sure that only sterile, single-use needles are used to avoid the risk of transmittable infectious diseases, such as hepatitis or HIV.
Herbal supplements: Herbal supplements of any kind can change how medications work. Before taking supplements, check with your doctor and do not exceed the doses that are recommended on the product’s label. No herbal supplement can cure psoriasis, but there is some solid scientific evidence that favours the use of some supplements over others. Some supplements used include milk thistle, evening primrose oil, aloe vera, fish oil, zinc pyrithione, tea tree oil, vitamins, and oregano oil.
1Health Canada, About Natural Health Products