Psoriasis treatment

Psoriasis is a chronic (long-lasting) skin inflammation condition that causes red, itchy patches on the skin that can be scaly or flaky. Psoriasis can be sore or sometimes burn. It affects around 2% of the population and is more common in adults than in children.

Most types of psoriasis go through cycles, meaning symptoms are worse for a few weeks or months before easing or stopping.

What causes psoriasis?

Research shows that psoriasis is caused by a problem with the immune system. Your immune cells become overactive and produce molecules that cause a rapid production of skin cells. This means that the process of creating new skin cells takes just 3 to 7 days instead of 3 to 4 weeks, causing flaky, crusty patches.

How psoriasis develops is not fully known, but it’s thought to be influenced by both genetics and environmental factors. Symptoms of psoriasis can come and go and can be triggered by:

• stress
• injury to the skin
• smoking
• hormonal changes
• certain medications, such as lithium, some antimalarials, and anti-inflammatory medicines, including ibuprofen
• immune disorders like HIV

Types of psoriasis

There are several types of psoriasis, and many people will have 1 type, but it’s possible to have 2 types together. The most common is chronic plaque psoriasis, which can affect your knees, elbows, chest, scalp, stomach, and other areas.

Other types of psoriasis include:

• guttate psoriasis – usually affects your chest, arms, legs, and scalp and can occur after a streptococcal throat infection, causing small (less than 1cm) drop-shaped sores that will likely disappear within a few weeks
• palmoplantar psoriasis – causes pustules on the hands and feet that gradually turn into circular scaly spots and then peel off, which may reappear every few days or weeks
• pustular psoriasis – a rare type of psoriasis that usually affects the hands and feet, causing pus-filled blisters to appear on the skin, which sometimes covers larger parts of the body and may require urgent hospital treatment
• inverse psoriasis – affects the folds or creases of the skin, such as the armpits, groin, under the breasts, and between the buttocks, causing smooth, red patches on the skin and can be made worse by friction and sweat

The symptoms of psoriasis vary from person to person depending on the type, but some common symptoms include:

• patches of thick, red, scaly, or flaky skin that some people find itchy, sore, or may burn
• dry cracked skin that itches or bleeds
• thick, ridged, pitted nails

If you’re experiencing any of these symptoms, especially if they are severe, persistent, and are affecting your life negatively, you should speak to your doctor about finding treatment.

Most treatments for psoriasis work to slow down the rapid skin cell growth, moisturise the skin, and/or reduce inflammation. There is a range of treatments available depending on the severity of your symptoms and where on your body is affected. Your doctor will normally start you off with a mild treatment to help keep the condition under control and then move you onto stronger ones if necessary.

Mild psoriasis treatments

Topical emollients are offered first if your symptoms are mild. These are moisturisers that put moisture back into the skin, reducing dryness, itching, and protecting the skin. They are often found over the counter as creams, lotions, and bathing products.

Mild to moderate psoriasis treatments

For moderate psoriasis or mild psoriasis that has not improved with emollients, topical corticosteroids are usually prescribed. These slow down skin cell growth and reduce inflammation, and should only be used when required.

Mild to moderate psoriasis on the limbs, trunk, and scalp can also be treated with topical products containing vitamin D, such as Dovonex, which also reduces skin cell growth and inflammation.

Moderate to severe psoriasis treatments

If these treatments do not work, light therapy (phototherapy) or systemic treatments (strong prescription medications) can be given. Light therapy exposes your skin to different types of light, such as ultraviolet B, which can slow down skin cell production.

Systemic treatments are used for severe psoriasis, which are usually tablets, capsules, or injections, and target the affected cells to slow down production of skin cells and reduce inflammation.

➤ We have more detailed information on each treatment under the ‘What psoriasis treatments are there?’ section.

How effective is psoriasis treatment?

Treatments for psoriasis are usually effective at reducing and managing symptoms, but they will not cure the underlying condition.

How long does it take for psoriasis treatment to work?

Different types of treatment can take longer to work than others, for:

• topical treatments, it can take up to 6 weeks for a noticeable improvement to be seen
• phototherapy, it can take 30 treatments to see improvements
• systemic treatments vary, treatments will be stopped after 10 to 16 weeks if no improvement is seen

Can psoriasis come back after treatment?

Yes, psoriasis is a chronic condition, so it cannot be cured. The symptoms can be managed and inflammation reduced, but the underlying condition will always be present. Many people with psoriasis will experience a cycle of remission, where the symptoms disappear and then relapse, where they return.

There are several treatments available for psoriasis. Your treatment will depend on the severity of the psoriasis and the parts of the body that are affected. If you find one treatment is not working, your doctor may recommend something different or combining your current treatment with another option.

Topical treatments

Topical treatments include creams or ointments that are applied directly to the affected areas and are typically the first line of treatment for mild to moderate psoriasis. Topical treatments can take up to 6 weeks to have a noticeable effect, but are an effective treatment for psoriasis.

Emollients

Emollients are usually the first treatment option for mild psoriasis. They are a moisturising treatment that reduces itching and scaling by reducing water loss and covering the skin with a protective film. Some can be bought over the counter and come in a wide variety of forms, such as lotions or soap substitutes.

Emollients can be used frequently, especially after bathing or showering and should be applied gently onto the skin in the direction of hair growth. If you are using other topical treatments, wait 20 to 30 minutes before applying them after the emollient.

Steroid creams and ointments

Steroid creams and ointments (topical corticosteroids) are a common treatment for mild to moderate psoriasis that work to reduce inflammation and slow down the production of skin cells. They come in a range of strengths from mild to very strong.

Steroid creams should be applied directly to the affected area 2 to 3 times a day for 3 weeks and then gradually used less and less. Topical corticosteroids should only be used when they have been recommended by a doctor, and it’s important to follow your doctor's instructions for use, as overuse can lead to skin thinning.

Topical steroids should not be used around the eyes or on broken skin.

Vitamin D treatments

Vitamin D treatments work by slowing the production of skin cells and have anti-inflammatory effects. They are used to treat mild to moderate psoriasis that affects the limbs, trunk, and scalp.

ZAVA offers a topical treatment called Dovonex, a vitamin-D related ointment. Dovonex contains the active ingredient calcipotriol, which reduces the excessive growth of skin cells. Dovonex is applied directly to affected areas but should not be used on the face. A thick layer of ointment should be used. You can use Dovonex when your psoriasis symptoms are less visible to help prevent flare-ups and make them less severe.

Phototherapy

Phototherapy treatment exposes your skin to certain types of natural and artificial light. It’s given at hospitals or specialist centres by a dermatologist. Phototherapy is estimated to noticeably improve or completely remove symptoms of psoriasis in 50 to 90% of people.

Types of artificial light therapies include:

1. Ultraviolet B (UVB) phototherapy slows down the production of skin cells. You’ll usually have 2 to 3 sessions, which are a few minutes long, every week for 6 to 8 weeks. This is a good option for psoriasis that has not responded to topical treatments.
2. Psoralen plus ultraviolet A (PUVA) uses a compound called psoralen to make the skin more sensitive to light and then exposes you to ultraviolet A. This is used for severe psoriasis that has not responded to other treatments. Long-term treatment is not recommended.
3. Combination light therapy is the use of a combination of light therapy with topical treatments.

Systemic treatments

Systemic treatments are usually used to treat severe psoriasis or when other treatments have not worked and may be given by a specialist. These medications work by reducing inflammation by targeting overactive cells. They can be an effective psoriasis treatment, but also have potentially serious side effects.

Non-biological

Non-biological treatments are usually given as tablets or capsules. Common types of non-biological systemic treatments include:

1. Methotrexate, which helps to slow down the production of skin cells and reduce inflammation. It’s taken once a week and can cause you to feel sick (nausea). Methotrexate should not be taken by people with liver disease, and long-term use can cause liver damage.
2. Ciclosporin, which suppresses your immune system (immunosuppressant) and is usually taken daily. It increases your chance of kidney disease and high blood pressure.
3. Acitretin, which is an oral retinoid that is used to treat severe psoriasis that does not respond to other non-biological treatments. It’s usually taken daily and can cause dryness, cracking of the lips, and dryness in the nostrils.

Biological

Biological treatments are usually given as injections and are used to target overactive cells and reduce inflammation. They are used to treat severe psoriasis that has not responded to other treatments or for people who cannot use other treatments. Biological treatments include:

1. Etanercept, which you inject 2 times a week. If there has been no improvement after 12 weeks, the treatment will be stopped. Using etanercept can cause a rash at the injection site.
2. Adalimumab is injected once every 2 weeks. Treatment is stopped after 16 weeks if there is no improvement. Adalimumab can cause headaches, nausea, and a rash at the injection site.
3. Infliximab is given at the hospital as a drip (infusion) into your vein. For the first 6 weeks, you will have 3 infusions a week and then 1 every 8 weeks. If there is no improvement after 10 weeks, treatment will be stopped. Infliximab can lead to headaches.

As biological treatments affect the entire immune system, there is a chance of severe infections.

What’s the best treatment for psoriasis?

Mild plaque psoriasis, the most common type of psoriasis, is usually effectively managed with topical treatments, making these the best treatment to try first. Using shop-bought and over-the-counter creams or ointments regularly, along with good skin care, may be enough to manage your symptoms.

If not, your doctor can prescribe a stronger topical treatment, like corticosteroids. Studies have found that after several weeks, there were either no more or hardly any visible areas of plaque psoriasis left on the skin in:

• 9 out of 100 people who did not apply a topical corticosteroid
• 41 out of 100 people who used a topical corticosteroid

When topical treatments do not work on moderate to severe psoriasis, light therapy may be the best treatment. This can noticeably improve or completely remove psoriasis in 50 to 90% of people, but you need quite a lot of sessions. PUVA light therapy has been proven to be more effective than UVB, though there’s a risk of skin cancer, so you cannot use this as a long-term treatment.

For severe psoriasis, the best treatment may be strong medications or injections. Non-biological treatments are usually effective for:

• about 20 to 30 out of 100 people using methotrexate
• 25 out of 100 people using ciclosporin, with results in 4 weeks

Biologic treatments are very effective but come with the biggest risk of side effects, so they are only the best treatment to use when other treatments have failed and you have severe symptoms. Research shows that biologic treatments can clearly relieve plaque psoriasis in 40 to 70 out of 100 people within 3 to 4 months.

You may have to try a number of treatments before you find what is best for you.

You can buy psoriasis treatments in a number of ways. Some can be bought over-the-counter, and others require a prescription. Treatments can also be bought online from a trusted pharmacy.

Can I buy psoriasis treatment online?

Yes, you can request some psoriasis treatments online with us by filling out a short online assessment about your health and lifestyle and then:

1. Selecting your preferred treatment option.
2. A ZAVA doctor will check your assessment to see if your chosen treatment is right for you.
3. If your selected treatment is right for you, it’s either posted to your preferred address or you can collect it from a local Post Office instead.

Our service is quick, convenient, and discreet. We will dispatch your order in plain packaging to maintain your privacy. There’s also no need for a face-to-face appointment with our online consultation. Simply answer a few questions about your current health, and one of our doctors will assess if your chosen treatment is safe for you.

Can I get psoriasis treatment over the counter?

Yes, some topical psoriasis treatments, such as mild steroid creams, emollients, and moisturisers, can be bought over the counter. Over-the-counter treatments are normally for mild to moderate psoriasis, not severe.

Can I get psoriasis treatment on the NHS?

Yes, you can get psoriasis treatments on the NHS. There are a variety of options available, including stronger topical treatments, phototherapy, and systemic treatments. You will need to make an appointment with your doctor to discuss which option is best for you.

There is a chance of side effects with all types of psoriasis treatments.

Topical treatments

Common side effects include:

• a rash, possibly with red, itchy bumps
• psoriasis getting worse
• pain where treatment is used
• skin or hair follicle inflammation and irritation
• flaky, dry, or red skin
• itchy or burning feeling on skin

Less common side effects include:

• allergic reaction
• calcium buildup in the body
• skin becomes puffy or swollen

Long-term use of topical treatments can lead to:

• skin thinning
• changes in skin colour
• rosacea or acne
• stretch marks
• bruising

Phototherapy

Common side effects include:

• feeling sick (nausea)
• headaches
• burning or stinging
• redness

Less common side effects include:

• hair follicle infections
• raised red patches

In rare cases, side effects can include:

• blistering burns

Long-term use of phototherapy is not recommended as it can lead to an increased chance of skin cancer.

Systemic treatments

Common side effects include:

• headache
• nausea
• redness, itching, swelling, and bruising at the injection site

Less common side effects include:

• increased chance of infections such as cystitis or upper respiratory tract infections

How long do these side effects last

Common side effects from topical treatments, such as burning and stinging, can last for a few minutes after first applying the cream, but should stop after you have been using it for a few days. More serious side effects, such as skin thinning, take longer to fade but will usually happen over time.

Most people will not experience corticosteroid side effects if they are used for less than 4 weeks.

Side effects from phototherapy may happen during treatment or for a few hours to a few days after, but this should go away as you get used to treatment. Systemic treatment side effects can last anywhere from a few hours to a few weeks.

You should speak to your doctor if side effects worsen or do not improve.

What to do if you get side effects

Many side effects of topical treatments are mild and can be easily dealt with at home. The best way to deal with side effects, like itching and burning, is to avoid scratching. You can do this by:

• keeping nails short
• tapping or patting instead
• applying something cool to the skin, like a damp towel
• wearing loose clothing
• distracting yourself
• staying hydrated

If you experience dry, flaky skin, it can be helpful to use an unscented moisturiser. This should be applied 30 minutes after you have used corticosteroids. Inflamed or irritated hair follicles can be treated by using warm compresses and keeping the area clean.

You can use over-the-counter painkillers to relieve side effects like nausea or headaches, which can happen with systemic treatments, but always check your patient information leaflet to make sure these do not interact with your treatment, or ask a doctor or pharmacist for advice.

Treatment for psoriasis may not be suitable or safe for everyone. If you have a certain medical condition or use some medications, they could interfere with psoriasis treatments. You should speak with your doctor before using psoriasis treatments if you:

• are pregnant, might be pregnant, or are planning to get pregnant
• are breastfeeding
• have an allergy to any ingredients in the treatments

Medical conditions

Before using psoriasis treatment, you should speak to your doctor if you have:

• liver or kidney problems
• abnormal levels of calcium in your body
• acne
• rosacea

Medication

Topical medications are usually safe to use with other medications, but you should speak with your doctor before starting psoriasis treatments if you are using:

• anticoagulants such as warfarin
• medicines used to prevent seizures (anticonvulsants)
• diabetes medications
• HIV medications

Speak to your doctor about any conditions you have been diagnosed with, any allergies, and any medications you take, including over-the-counter medications, before starting any psoriasis treatment. You can also check the patient information leaflet of your chosen treatment for further information on who should not take it.