The Three Stages of Psoriasis Treatment

Doctor William C Lloyd Healthgrades Medical Reviewer
Medically Reviewed By William C. Lloyd III, MD, FACS
Written By Chris Illiades, MD on October 22, 2022
  • psoriasis 1
    The 1-2-3 Approach to Treating Psoriasis
    Psoriasis is a challenging condition to live with, but you have a wide variety of treatment options to reduce symptoms and, in some cases, completely clear your skin. Psoriasis treatments generally fall into three categories, and doctors take what’s often called the “1-2-3” approach because they usually move through each category of treatment depending on how severe your psoriasis is and how you respond. Here’s a look at some of the most widely used psoriasis treatments in each of these stages.
  • prescription medical cream coming out of tube
    Stage 1 Treatments: Topical Corticosteroids
    A prescription-strength corticosteroid cream is usually the first treatment for psoriasis. These creams are applied to your skin to block psoriasis inflammation. They can be almost 1,000 times stronger than the steroid creams available over the counter at your drugstore. Because your psoriasis may become resistant to these creams over time, your doctor may want you to use them only when your psoriasis is active.
  • man-applying-cream-to-elbow
    Stage 1 Treatments: Anthralin
    Anthralin is another topical medication that works by slowing down your body’s production of new skin cells. It helps remove psoriasis scales and makes your skin smoother. Anthralin can stain your skin and clothing brown or purple, so you might leave it on for 15 to 30 minutes and then wash it off. This type of short-contact treatment is called SCAT, which stands for short-contact anthralin therapy. Anthralin does not work as well on very active psoriasis.
  • unidentified woman washing hair with shampoo in shower
    Stage 1 Treatments: Coal Tar
    Coal tar is one of the oldest psoriasis treatments. You can apply it directly to your skin or scalp (in shampoo form) or add coal tar products to your bathwater. Coal tar does have a strong smell and can be messy to use, but it’s safer for your skin than steroid creams. Coal tar also makes your skin more sensitive to sunlight, so your doctor may have you use it in combination with light therapy.
  • woman-applying-ointment-to-swab
    Stage 1 Treatments: Vitamin D Ointment
    Like anthralin, a topical vitamin D works by slowing down the growth of skin cells. About two-thirds of people with psoriasis get good results with vitamin D ointment. The ointment can irritate the sensitive skin of your face or genital area, but there are other cream and liquid formulations that your doctor can recommend for these delicate places. Because vitamin D can build up in your body, your doctor may limit how long you can use it.
  • ointment-on-finger
    Stage 1 Treatments: Vitamin A Ointment
    A topical treatment made from vitamin A is another option that can slow down the growth of skin cells. When you use this ointment, it can turn your psoriasis plaques bright red before they start to clear. This treatment can cause skin dryness, burning, and itching, especially if your skin is exposed to sunlight. You will need to wear sunblock and protective clothing when you’re out in the sun.
  • UV light therapy hand
    Stage 2 Treatments: UV Light Therapy
    Sunlight can improve psoriasis symptoms. The simplest form of light therapy involves getting controlled amounts of natural sunlight on exposed, unprotected skin. Another option is an artificial form of sunlight that uses UVB wavelengths. You can get these treatments in a light booth at a doctor’s office a few times a week, and your doctor may also prescribe a light box you can use at home. This is controlled light; using a tanning bed on your own can be harmful and isn’t an alternative in most cases.
  • man taking medication (pills) for illness
    Stage 2 Treatments: PUVA
    PUVA combines an oral medication called psoralen (the P in PUVA) with an artificial form of UVA light. Psoralen makes your body more sensitive to the light treatment. PUVA is used when you have active psoriasis that covers more than 10 percent of your body and when your psoriasis is not responding to other treatments. Because there is a risk of skin cancer, you can get PUVA treatments for short periods of time only.
  • Pills
    Stage 3 Treatments: Oral Retinoids
    Oral retinoids are a very concentrated form of vitamin A—much more powerful than the type of vitamin A in food or even a vitamin supplement, neither of which is strong enough to help your psoriasis. Retinoid drugs are usually used for psoriasis only when other drugs aren’t effective because they can cause dangerous side effects, including birth defects if taken by pregnant women. However, retinoids do work well for serious psoriasis and can also be combined with light therapy.
  • variety-of-pills
    Stage 3 Treatments: Other Oral Medications
    If you have psoriasis, your immune system thinks your skin is injured and it goes into overdrive, making new skin cells at an alarming rate. You can take certain drugs in pill form to slow down your immune system. Examples include methotrexate and cyclosporine. Because these drugs can cause serious side effects, they are used only for severe psoriasis and need to be taken with special care.
  • psoriasis 11
    Stage 3 Treatments: Biologics
    Biologic therapies are made from living cells in a laboratory. They work by blocking your immune system and are given by injection or through an IV. Biologics are used for advanced psoriasis that is not responding to other treatments. Biologics are expensive and not every patient is a good treatment candidate. Because these drugs disarm your body’s defense system, you’ll need to take extra precautions to avoid getting an infection while taking them.
The Three Stages of Psoriasis Treatment
  1. Psoriasis: An Overview, Cleveland Clinic (http://my.clevelandclinic.org/disorders/psoriasis/hic_psoriasis_an_overview.aspx);
  2. Psoriasis, American Osteopathic College of Dermatology (http://www.aocd.org/skin/dermatologic_diseases/psoriasis.html);
  3. Questions and Answers About Psoriasis, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH (http://www.niams.nih.gov/Health_Info/Psoriasis/default.asp#5);
  4. Mild Psoriasis: Non-steroidal Prescription Topical Treatments, National Psoriasis Foundation (http://www.psoriasis.org/page.aspx?pid=414);
  5. Moderate to Severe Psoriasis: Biologic Drugs, National Psoriasis Foundation (http://www.psoriasis.org/page.aspx?pid=455);
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Last Review Date: 2022 Oct 22
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