Treatment - Psoriasis

Treatment usually helps keep psoriasis under control. It slows the speed your skin cells grow.

Talking to your GP

Your GP can treat your psoriasis with a cream, ointment or lotion (topical treatment).

Seeing a specialist

Your GP may refer you to a skin specialist (dermatologist) if your symptoms are severe or if the treatment is not working well.

Treatment

There is a range of treatments for psoriasis.

Treatments depend on:

• the type of psoriasis
• how severe it is
• the area of skin affected

There are 3 types of treatments:

• topical - creams and ointments you put on your skin
• phototherapy - light therapy a dermatologist uses on your skin
• systemic - medicines that work throughout your entire body

Different types of treatment are often used together.

Finding the one that works best for you can be hard. You may need to go to your GP regularly so they can check how treatment is working.

Tell your GP or dermatologist if you feel a treatment is not working or you have uncomfortable side effects.

Creams and ointments

Topical treatments (creams and ointments) are usually the first treatments used for mild to moderate psoriasis. They may be all you need to control your condition.

It may take up to 6 weeks before you will notice a change.

If you have scalp psoriasis, your GP may recommend both a shampoo and an ointment.

Moisturising treatments (emollients)

Emollients are moisturising treatments you use on your skin. You can get them as creams, ointments, lotions and sprays. You can get emollients from a pharmacy without a prescription.

Emollients reduce itching and scaling.

Some other treatments you use on your skin work better if you moisturise your skin with an emollient beforehand. Wait at least 30 minutes before putting on another treatment such as a cream or ointment.

Emollients

Steroid creams or ointments

Your GP might recommend a steroid cream or ointment (topical corticosteroids).

This is for mild to moderate psoriasis. It can be used on most areas of the body.

Steroid cream or ointments will reduce inflammation. Your skin cells will grow more slowly and you will have less itching.

Topical corticosteroids go from mild to very strong. Only use them if your GP tells you to.

Your GP can prescribe stronger topical corticosteroids. These are for small areas of skin or very thick patches of psoriasis.

Vitamin D analogues

A vitamin D analogue cream called Calcipotriol can be used for mild to moderate psoriasis on your arms, legs, upper body or scalp.

You use it with or instead of steroid creams.

It slows down the growth of skin cells and reduces inflammation.

There are very few side effects as long as you do not use more than the recommended amount.

Calcineurin inhibitors

Calcineurin inhibitors are ointments or creams.

They reduce the activity of your immune system and help to reduce inflammation.

They're sometimes used to treat psoriasis in sensitive areas. For example, your scalp, genitals and folds in your skin.

These ointments or creams can irritate your skin at first. This usually gets better within a week.

Coal tar

Coal tar reduces inflammation and scaling.

It is used when other topical treatments are not working.

You can get shampoos or creams that have coal tar in them.

Coal tar can stain your clothes and bedding and has a strong smell.

Dithranol

Dithranol is a short-term treatment for psoriasis.

It's for psoriasis on your arms, legs and upper body. It is very good at slowing the growth of skin cells.

Dithranol stains everything it comes into contact with. It will stain your skin, your clothes and bathroom fittings.

It has few side effects. But it can burn your skin if it's too concentrated.

Phototherapy

Phototherapy is when you get light therapy to treat your psoriasis.

It is given in dermatology department at the hospital. Your dermatologist will use a special form of light.

Phototherapy is not the same as using a sunbed.

Phototherapy uses specific wavelengths of UV light. These are different to the ones used in sunbeds.

If you have psoriasis do not use sunbeds - they increase your risk of skin cancer.

Systemic treatments

Your dermatologist may prescribe systemic treatments - medicines that work throughout the entire body.

This may happen if your psoriasis is very bad, other treatments have not worked, or if you have psoriatic arthritis.

There are 2 main types of systemic treatment:

• non-biological (usually given as tablets or capsules)
• biological (usually given as injections)

All systemic treatments for psoriasis have benefits and risks.

Non-biological treatments

Non-biological types of medicines are usually given as tablets or capsules.

Biological treatments

Biological treatments reduce inflammation. They block molecules called cytokines. These are produced by overactive cells in your immune system.

Biological treatments are given as injections. Your dermatologist may tell you to use them if:

• your psoriasis is moderate to severe
• other treatments did not work
• other treatments are not a good match for you

If there is no improvement in your psoriasis after 12 or 16 weeks, treatment will be stopped.

Infection risk

They work by lowering a part of the immune system - this increases your risk of infection.

If you had tuberculosis in the past, there's a risk it may come back if you take some of these medicines.