GoodRx Guide
Moderate to Severe Plaque Psoriasis: Your GoodRx Guide
Comprehensive information for you or a loved one — including treatment options and discounts on popular medications.
What is plaque psoriasis?
Psoriasis is an autoimmune skin disorder, and plaque psoriasis is the most common type. It causes rashes that can be painful or itchy. These rashes can occur anywhere on the body. Areas where the skin gets red and thick with white scales are called “plaques.” This is why it’s called plaque psoriasis.
Psoriasis is a chronic (lifelong) condition that can sometimes flare (worsen). Certain foods, medications, and lifestyle factors can trigger these flares.
About 1 in 3 people with psoriasis develop psoriatic arthritis. This causes joint pain, stiffness, and swelling along with psoriatic rashes. Many people with psoriasis also have nail changes and eye problems.
Diagnosis
A healthcare provider can usually diagnose plaque psoriasis by looking at your skin and learning about your symptoms. Sometimes they may recommend a biopsy to confirm the diagnosis. Most people with plaque psoriasis get a referral to a dermatologist (a skin specialist).
Your dermatologist may categorize your psoriasis as mild, moderate, or severe. The category depends on how much of your skin is affected and is measured as a percentage of your body’s surface area (BSA):
Mild psoriasis affects less than 3% of your BSA.
Moderate psoriasis affects 3% to 10% of your BSA.
Severe psoriasis affects more than 10% of your BSA.
You may also have moderate or severe plaque psoriasis if it affects your:
Hands
Feet
Face
Genitals
Psoriasis can also be very itchy, painful, or bothersome. If these symptoms affect your quality of life, your psoriasis may be moderate to severe.
Treatments
There’s no cure for psoriasis. But there are more treatment options available now than ever. Many people start with creams and ointments, but they may not do the trick on their own. When that happens, other treatments may come into play.
Non-medication treatments include:
Phototherapy
Complementary and alternative therapies, such as acupuncture
Lifestyle changes, such as quitting smoking and losing weight
Avoiding triggers, like stress and certain foods
Some medications can also worsen psoriasis. So it’s a good idea to review your medication list with your provider.
These treatments and changes are often helpful when used along with stronger medications (more on this below).
Medications
Over-the-counter moisturizers and creams are a good place to start. But they may not be enough for moderate to severe disease. In this case, prescription creams and systemic (whole body) treatments may be needed.
Many different prescription creams, gels, and ointments are available to treat psoriasis. Depending on your situation, you may use more than one type or combine them with other treatments:
Corticosteroid creams lower inflammation, itching, and redness. Examples include triamcinolone and mometasone.
Vitamin D analogues are chemically similar to vitamin D and help slow skin growth. One example is calcipotriene.
Aryl hydrocarbon receptor (AhR) agonists lower inflammation and improve the skin barrier. Vtama (tapinarof) is the first treatment in this class.
Phosphodiesterase-4 (PDE4) inhibitors change the immune system and lower inflammation. Zoryve (roflumilast) is the first treatment in this class.
Systemic medications for psoriasis include pills, injections, and IV (intravenous) infusions. They can be used alone or along with topical medications (those applied to the skin).
Oral medications for psoriasis include:
Methotrexate (Rheumatrex)
Cyclosporine modified (Neoral)
Acitretin (Soriatane)
Apremilast (Otezla)
Biologic medications usually come as an injection or IV infusion. Studies show that biologics may be better than pills at treating moderate to severe psoriasis. Some biologics used to treat psoriasis include:
Infliximab (Remicade)
Adalimumab (Humira)
Brodalumab (Siliq)
Ustekinumab (Stelara)
Tildrakizumab (Ilumya)
Treatment options continue to evolve. So talk with a provider who specializes in plaque psoriasis to learn more about your options.
References
Armstrong, A. W., et al. (2020). Comparison of biologics and oral treatments for plaque psoriasis: A meta-analysis. JAMA Dermatology.
Elmets, C. A., et al. (2019). Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. Journal of the American Academy of Dermatology.
Li, W., et al. (2012). Smoking and risk of incident psoriasis among women and men in the United States: A combined analysis. American Journal of Epidemiology.
Ludmann, P. (2023). Psoriasis: Diagnosis and treatment. American Academy of Dermatology Association.
National Psoriasis Foundation. (2022). Psoriasis statistics.
Rajguru, J. P., et al. (2020). Update on psoriasis: A review. Journal of Family Medicine and Primary Care.
Ramachandran, V., et al. (2020). Summary of published treatment guidelines. Advances in Psoriasis.
