Treatment options

There are many treatment options which can help control psoriasis and offer significant relief of its symptoms.

Psoriasis treatments aim to:

  • Interrupt the cycle that causes an increased production of skin cells. This reduces inflammation and plaque formation
  •  Remove scales and smooth the skin

Your physician will help you to decide which treatment is best for you. In addition, you may want to consider the following factors when selecting a treatment that is agreeable to you:

  • First, the treatment should never be worse than the psoriasis itself!
  • When choosing the treatment your lifestyle, available time and your budget has to be taken into account to help decide among the options
  •  The treatment has to be used until the condition is under control or as directed by your doctor. BUT! Remember that some products should only be used for a limited period of time because of risks of side effects, so speak to your physician about how long you can use the product safely.
  • Keep in mind: treatment compliance strongly influences treatment effectiveness (If you don’t use it, it won’t work! )

Types of Treatment

Treatments for scalp psoriasis can be divided into 3 main types:

  • Topical treatments (creams, foams, lotions or ointments applied to the skin)
  • Light (photo) therapy
  • Systemic therapies (taken by pill or injection)

For mild to moderate psoriasis, topical treatments can in many cases be used effectively on their own. But when the disease is more severe, your doctor may prescribe a regimen of different therapies to manage symptoms over time. The typical uses and side effects of various treatments are discussed below. Note that some of these products may not be available in your country or jurisdiction. Also, most of the products discussed below are indicated for use primarily in adults, so speak to your physician about the suitability of a particular therapy in children or adolescents younger than 18 years of age.

Main Topical Therapies for Scalp Psoriasis Mayo clinic, NPsF

 

Topical Therapy ATC Classification

Main Characteristics

Formulation

Side Effects & Cautions

Corticosteroids, dermatological preparations

Corticosteroids

Reduces inflammation, scaling, redness and itch
Most commonly used for mild-moderate psoriasis
Used in regimen with other treatments for moderate-to-severe psoriasis

Many formulations available Cream, ointment, gel, foam, spray, lotion, shampoo, etc.
Strengths range from superpotent (Class 1) to very weak (Class 7)

Avoid long-term use in sensitive areas of skin;
May cause skin thinning, changes in pigmentation, stretch marks and redness;
Regarding the treatment always follow the advice of your doctor;
use of superpotent medications can affect adrenal function.
Avoid contact with eyes and with skin around the eyes

Antipsoriatics
for topical use

Synthetic vitamin D3

Reduces scaling, inflammation and itch
Often combined with corticosteroids for more effectiveness and less irritation
Approved for longterm use

Ointment
Cream
Foam
Lotion
Scalp solution

Some preparations can be irritating, so contact with sensitive skin (face, eyes and lips) should be avoided;
Less common effects are dry skin, peeling and rash. These can also affect how your body metabolizes calcium, so tell your doctor if you have kidney disease or renal insufficiency

Antipsoriatics
for topical use

Retinoids

Vitamin A derivative
Slows skin cell growth and may reduce inflammation

Cream or gel (gel absorbs more rapidly, while cream may be less irritating if skin is dry or sensitive)

Irritated, dry skin
Avoid contact with eyes
Sun sensitivity

Antipsoriatics
for topical use

Coal tar

One of the oldest treatments
Reduces scale, itch and inflammation
Effectiveness varies from person to person

Many formulations available Cream, gel, oil, ointment, shampoo
The higher the tar concentration the stronger the product

May irritate, dry and redden the skin
Messy: Stains clothing, bedding and light coloured hair
Strong odour
Unpleasant smell

Antipsoriatics
for topical use

Anthracen derivatives

Slows growth of skin cells
Removes scales

Cream, paste, ointment, gel, scalp solution
Must be fresh to be effective (cream is bright yellow)

Extremely irritating on non-involved skin
Messy to use: staining skin, hair, clothing and bedding
Difficult to rinse out of hair

Emollients and protectives

Salicylic acid preparations

Softens scales making them easier to remove
In some areas, physicians recommend use with other medications to allow more effective drug delivery

Various formulations depending on if for use on skin or scalp

Attention!

Pregnant or breastfeeding women should consult a pharmacist or physician before taking any medication, in order to avoid doing harm to themselves or their babies. Make certain that you read the specific safety information about the therapy(s) prescribed for you, and speak to your physician about safety issues or concerns.

 

Light (photo) therapies Mayo clinic, NPsF

These treatments use artificial ultraviolet (UV) light to treat psoriasis.

Main systemic Medications Mayoclinic

The oral medications and biologics may help to clear psoriasis, but are only appropriate for moderate to severe cases. These drugs are potent and can have side effects that must be considered before taking.

Practical Treatment Tips NPsF

Preparing the Skin for Topical Therapy

In some areas of the world, it is recommended that the surface of a psoriasis plaque be “smoothed” to allow better penetration of the topical medication. Your doctor my suggest that you use a preparation containing salicylic acid or lactic acid before you apply other topical treatments. Make certain that you understand your doctor’s instructions before using this type of regimen, as it may result in additional irritation. Note that even if you do not you a pre-treatment preparation, the skin and plaques should be kept clean using a gentle cleanser to remove dirt and debris from the area.

It is important to always use topical medications as prescribed by your doctor. The following tips may help you in applying topical medications to help treat your psoriasis.

Effective application of topical medications NPsF

  1. Apply topical treatments only to psoriasis lesions if possible. This will help to avoid irritating unaffected skin.
  2. A thin layer of medication is generally sufficient.
  3. Wash your hands thoroughly after applying topical treatments, unless treating the hands.
  4. Do not apply topical treatments in areas of the skin not discussed with your doctor, especially near the eyes, genitals or other sensitive areas.
  5. When prescribed a regimen of topical treatments, apply them exactly as your physician instructed.
  6. Cleanse or prepare the lesions for treatment as directed by your doctor.  Do not cover or ‘occlude’ your topical medication with other products like moisturizers or other medications unless specifically directed to do so by your doctor. 

KEY MESSAGES:

HELPFUL HINT

Protect healthy skin with a thin layer of petroleum jelly before applying medications to the psoriatic lesions.

CAUTION:

Never cover or ‘occlude’ the treated skin, unless specifically directed by your doctor.

Stain protection

Here is a list of some easy and accessible household items you can use to protect from staining while treatments are active:

  • Towels
  • Plastic wrap
  • Plastic produce bags
  • Cotton socks

Do not occlude treated lesions and skin unless specifically directed by your doctor.

Keeping a Psoriasis Diary

KEY MESSAGES:
The goal of keeping a psoriasis diary is to help you and your doctor better manage your psoriasis symptoms and therapies.

A psoriasis diary can be useful for identifying triggers and determining the treatments that work well for you in relieving your psoriasis symptoms. The example diary here can help you to follow improvements in a psoriasis flare-up. Noting the factors that play a role in your psoriasis flare-ups is a small task, but it may go a long way in deciding on an effective treatment plan that works for you!

It is a good idea to take your psoriasis diary with you to your doctor’s visits. Make sure it is clear and legible. If you arrive prepared, many of the questions your doctor will ask can be answered quickly and more thoroughly.

Factors to Include in Your Psoriasis Diary:

1. When does your psoriasis seem to worsen?

  • This will help you to identify what factors trigger your psoriasis flare ups
  • When looking back at your diary, you may see that your psoriasis often occurs after certain types of events (e.g. environmental factors, emotional stress, with certain medications, after drinking alcohol, etc)

2. On a calendar, keep track of any treatments used for your psoriasis and the effect it had on your lesions

  • Make sure to record which symptoms, if any, improved after each treatment (e.g. itchiness, redness, scaling, etc)
  • Record changes in symptoms on a scale of 1 to 10, where 10 is the worse and 1 is better

Before beginning treatment for a flare-up, select and record your most distressing psoriasis symptom and note its severity
Use the table to record the psoriasis medications you are using, and how this symptom improves or worsens with each application of your psoriasis therapy. This will help you to follow the effectiveness of your psoriasis therapy.

Took medication for the following symptom (e.g. redness, scaling, itchiness):

Severity at start of treatment: (Normal)   1   2   3   4   5   6   7   8   9   10   (Severe)

Medication Name
(formulation, dose)

Date used

Left on for how long?
(if applicable)

Symptom Severity
(1 – 10)

Notes

 

 

 

 

 

 

 

 

 

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