Treatment options for psoriasis 

Treatment
Pros
Cons

Useful links

 

 

 

Self help

A healthy diet and regular exercise can reduce stress, which often leads to an improvement in symptoms

  • Also reduces risk of heart disease, cancer and diabetes
  • None

Topical treatments: creams, lotions and ointments

Topical corticosteroids

Steroid creams and ointments that help block the harmful effects of the immune system on the skin

  • Usually effective in treating mild to moderate psoriasis
  • Cannot be used on large areas of the skin, due to the risk of side effects
  • Long-term use can cause thinning of the skin
Vitamin D analogues

Creams, lotions and ointments that help slow the production of new skin cells

  • Usually effective in treating mild to moderate psoriasis
  • Can cause skin irritation in around 1 in 3 cases
  • Can make skin more sensitive to sunlight and other forms of bright light
  • Not usually suitable if you are pregnant or breastfeeding
Calcineurin inhibitors

Medicines, such as tacrolimus and pimecrolimus, that reduce the activity of the immune system and help to reduce inflammation

  • Can be effective in treating psoriasis in sensitive areas, as topical corticosteroids are ineffective
  • Can cause skin irritation or a burning and itching sensation when they are first started in around 1 in 2 cases
  • Small increased risk of developing cold sores on the treated skin during the first few weeks of treatment
  • Can make skin more sensitive to sunlight and other forms of bright light
  • Not usually recommended if you are pregnant, breastfeeding or have a weakened immune system
Dithranol

Cream that works in a similar way to vitamin D, by slowing the production of new skin cells

  • Is often an effective short-term treatment for flare-ups of psoriasis
  • Can burn the skin
  • Can temporarily stain the skin and hair, and permanently stain surfaces at home, such as bedroom and bathroom fittings
  • It is still unclear whether dithranol is safe to use if pregnant or breastfeeding, so contraception is recommended
Coal tar

A thick oil in the form of shampoo, ointment or as an additive that you add to the bath; bathing in coal tar can relieve symptoms

  • It is still unclear how coal tar works, but it has a proven effectiveness in reducing scales, inflammation and itchiness
  • Not suitable if you have broken skin, a skin infection or pustular psoriasis
  • Can stain clothes and has a strong smell
  • Can cause acne or worsen existing acne
  • Not safe to use during the first three months of pregnancy
  • Not suitable for children

Phototherapy: using natural and artificial light to treat psoriasis

UVB phototherapy

Using an artificial light to slow down the production of new skin cells

  • Can be an effective treatment for guttate or plaque psoriasis that has not responded to topical treatment
  • Can cause redness and itchiness of the skin, though this should pass in time
  • Requires frequent hospital visits; usually around three times a week (home UVB phototherapy kits are available, but cost around £150)
Psoralen plus ultraviolet A (PUVA)

Medication called psoralen (either in cream or tablet form) makes skin more sensitive to light, which allows UVA light to penetrate more deeply than UVB light; again, this helps slow the production of new skin cells

  • Can be an effective treatment for severe psoriasis that has not responded to other treatments
  • Side effects include feeling sick, headaches, and burning and itchy skin
  • Not suitable for long-term use and it can increase the risk of skin cancer

Systemic medication: oral or injected medications that work throughout the body

Methotrexate

Medication available in both tablet and as an injection that helps to reduce the harmful activities of the immune system on the skin

  • Effective treatment for pustular psoriasis, psoriatic erythroderma and extensive plaque psoriasis
  • Can cause birth defects, so women being treated with methotrexate will need an effective method of contraception during treatment and for three months afterwards
  • Can damage the quality of men’s sperm, so men being treated with methotrexate will also need an effective method of contraception during treatment and for three weeks after it stops
  • Can cause liver damage, so not suitable for people with liver disease or for people who are unable to abstain from alcohol
  • Common side effects include mouth ulcers, increased vulnerability to infection, eye pain and irritation, general loss of interest in sex and, in men, erectile dysfunction, feeling sick, upset stomach
Acitretin

A medication, available in capsule form, that slows down the production of new skin cells

  • Often an effective treatment for cases of severe, widespread psoriasis that do not respond to other treatment
  • Has an extremely high risk of causing birth defects, so women being treated with acitretin will need an effective method of contraception during treatment and for two years after it stops
  • Not usually suitable for people with kidney or liver disease
  • Not suitable for people who drink a lot of alcohol and are unable to stop
  • Common side effects include eye dryness and irritation, runny nose, nosebleed, dry lips, diarrhoea, stomach pain, feeling sick, being sick
Ciclosporin

Medication available in both tablet and liquid form that reduces harmful activities of the immune system on the skin

  • Found to be effective in treating almost all cases of psoriasis
  • Can increase risk of premature birth if taken while pregnant, so contraception is recommended
  • Common side effects include high blood pressure, uncontrollable shaking, kidney damage, increased vulnerability to infection
Etanercept

Medication given by injection that blocks the effects of two harmful proteins released by the immune system; this helps to protect healthy skin tissue

  • Often effective in cases of psoriasis that fail to respond to phototherapy and/or the medications listed above
  • Not suitable for anyone with an active infection
  • It is unclear whether etanercept is safe to take during pregnancy, so contraception is recommended
  • Common side effects include increased vulnerability to infection and redness, soreness and irritation at the site of the injection
Adalimumab

Medication, given by injection every two weeks, that blocks the effect of a harmful protein called TNF alpha

  • Can be effective in severe cases that fail to respond to other treatments, or if you cannot have other treatments for medical reasons
  • It is unclear whether adalimumab is safe to take during pregnancy, so contraception is recommended
  • Common side effects include increased vulnerability to infection, headache, feeling sick, being sick, abdominal pain, skin rash, and bone, muscle and joint pain
Infliximab

Medication given via a drip that works in the same way as adalimumab

  • Can sometimes be effective in very severe cases of psoriasis that fail to respond to any of the treatments listed above
  • May not be suitable for people with a history of hepatitis B or heart failure
  • It is unclear whether infliximab is safe to take during pregnancy, so contraception is recommended
  • Common side effects include increased vulnerability to infection, headache, stomach pain, feeling sick, problems sleeping, changes in mood – such as depression, dizziness, changes in blood pressure (which can either rise or a fall)
Ustekinumab

Medication given by injection into the skin. A further dose is then given 4 weeks after, and then every 12 weeks. Blocks the harmful effects of the immune system on the skin

  • Can be effective in treating severe plaque psoriasis that does not respond to any of the treatments listed above
  • It is unclear whether ustekinumab is safe to take during pregnancy, so contraception is recommended
  • Common side effects include throat infection, dizziness, headache, depression, itchy skin rash, back pain, muscle pain, redness at the injection site