What Is the Best Psoriasis Treatment for You?

Psoriasis is a chronic autoimmune disease that causes thick, scaly, and itchy patches that can be red, brown, or tan, depending on your skin tone. It affects over 8 million people in the U.S. and 125 million people around the world. 

Even though there’s no cure for psoriasis, there are many good treatment options. Treatment can help you feel better by decreasing symptoms, like pain and itching. It can also improve the look of your skin. Which treatment you use depends on a few factors, like the type of psoriasis you have, the part of your body it affects, and your personal preferences.

Keep reading to find out more about the best psoriasis treatments and how to choose the right treatment for you.

Topical psoriasis treatments: Creams, ointments, and shampoos

Topical treatments include creams or ointments that you apply directly to the skin and shampoos that you use on the scalp. They’re available both over-the-counter (OTC) and with a prescription. 

For mild psoriasis, one or more topical treatments may be all you need. 

For moderate to severe psoriasis, most people use topical treatments along with other medications (more on these below). 

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The most common side effects with topical treatments are burning, itching, and skin irritation. 

Over-the-counter topical psoriasis treatments

Some topical treatments are available OTC (without a prescription). You can try these alone or combine them with prescription medications. 

Here are some examples of OTC products, as well as ingredients to look for in OTC psoriasis treatments:

• Moisturizers: Moisturizers relieve dry, itchy, red skin and can be helpful for everyone with psoriasis. Cream- or ointment-based moisturizers provide the most moisture because they’re thicker than lotions. Examples include Eucerin Advanced Repair Cream and Cetaphil Moisturizing Cream.

• Topical steroids: Topical steroids can ease itching and inflammation. Hydrocortisone 1% (like Cortizone-10) is a low-dose, OTC option that’s great for mild psoriasis affecting small areas or areas with sensitive skin, like the face. However, don’t use it for more than 2 weeks at a time.

• Salicylic acid: Salicylic acid can soften and remove the scale that occurs in thick psoriasis plaques. Examples of products that contain salicylic acid include MG217 Medicated Moisturizing Cream and CeraVe Psoriasis Moisturizing Cream.

• Coal tar products: Products containing coal tar can relieve itch and slow the rapid growth of skin cells. Some options include MG217 2% Coal Tar Multi-Symptom Ointment and DHS Tar Shampoo.

• Zinc pyrithione: This ingredient helps lower skin inflammation and can also fight skin infections. One option is DHS Zinc Shampoo. It’s usually used for dandruff, but it can also help psoriasis. 

• Anti-itch products: Anti-itch products containing calamine, camphor, or menthol can help relieve itching. One example is Sarna Calm + Cool Anti-Itch Lotion. 

Prescription topical treatments

If you need stronger treatment, then you’ll move on to try prescription topical psoriasis medications. These may include:

• Prescription topical corticosteroids: All topical corticosteroids work in a similar way to reduce inflammation, redness, and itching. But prescription topical steroids are available in higher strengths and different formulations (creams, ointments, and shampoos) than OTC hydrocortisone. Examples include triamcinolone (Trianex) and clobetasol (Clobex).

• Vitamin D analogues: These medications are chemically similar to vitamin D. They slow skin growth, which helps control psoriasis. You can use this treatment together with steroids. Examples of vitamin D analogues include calcitriol (Vectical) and calcipotriene (Dovonex).

• Calcineurin inhibitors: These lower the activity of the immune system. They’re a good alternative to steroids, especially for sensitive areas, like the face. Examples of topical calcineurin inhibitors are tacrolimus (Protopic) and pimecrolimus (Elidel). Both of these medications are considered “off-label” treatments for psoriasis.

• Keratolytics: These slow skin growth and break down thick plaques. Examples include a retinoid called tazarotene (Tazorac) and prescription-strength salicylic acid (Salex). 

Medications for moderate and severe psoriasis 

Moderate and severe cases of psoriasis often need treatment with prescription medications that you take by mouth (pills) and/or anti-inflammatory injections (biologics). You’ll also need these if you have psoriasis-related joint disease (psoriatic arthritis). Whole body medications, like pills and injections, are often combined with topical treatments. 

Figuring out whether an oral medication or biologic is right for you will depend on:

• Your personal preferences

• Your insurance coverage

• What psoriasis treatments you’ve tried in the past

• Your overall health

Oral treatments for psoriasis

Most oral medications for psoriasis have been around for many years. These psoriasis pills can be good starter treatments for moderate to severe psoriasis. They’re generally affordable and may be easier to take than biologic injections. 

Here are some common oral medications for psoriasis:

• Methotrexate (Rheumatrex)

• Cyclosporine (Sandimmune)

• Apremilast (Otezla)

• Tofacitinib (Xeljanz) (This is FDA approved for psoriatic arthritis, but it’s an off-label treatment for psoriasis.)

• Acitretin (Soriatane)

With the exception of acitretin, the above medications also treat psoriatic arthritis.

Side effects of oral psoriasis medications

Side effects of oral psoriasis treatments vary depending on the medication. Some common side effects include:

• Nausea

• Diarrhea

• High blood pressure

• Abnormal cholesterol levels

• Worsening kidney or liver function

Biologics and biosimilars

Biologics are medications that target the immune system. They’re used to treat more moderate to severe psoriasis and psoriatic arthritis. 

Biosimilars are medications that are very similar to a biologic medication, but they’re usually available at a lower cost. Biosimilars are also an option for treating moderate to severe psoriasis and psoriatic arthritis.

Most biologics and biosimilars come as an injection or an infusion (IV). Research shows that many biologics are more effective than oral treatments for moderate to severe psoriasis. 

Here are some biologics used to treat psoriasis: 

• Infliximab (Remicade)

• Adalimumab (Humira)

• Brodalumab (Siliq)

• Ustekinumab (Stelara)

• Tildrakizumab (Ilumya)

Biosimilars are available for Remicade, Humira, and Stelara. 

Side effects of biologics and biosimilars

Taking biologics and biosimilar medications can increase the risk of some infections. So, before starting treatment, a healthcare professional may test you for infections, like tuberculosis and viral hepatitis. 

These medications can also affect the liver and kidneys. So, you may not be able to take them if you have other health conditions that affect these organs. Once you start these medications, your care team will monitor you for side effects. This can include regular blood work. 

Phototherapy psoriasis treatment

Phototherapy, or light therapy, involves exposing the skin to certain wavelengths of UV light to treat psoriasis. UV light works by slowing the growth of skin cells and reducing skin inflammation and itching. 

Phototherapy treatments are usually done in a dermatology office. However, phototherapy at home is an option if your insurance covers it. A typical starting schedule is 3 times a week, for a minimum of 2 to 3 months. Once you see improvements, you can reduce how often you get it. Phototherapy can be used alone to treat psoriasis or in combination with medications. 

Types of phototherapy treatments

There are a few different types of phototherapy, which differ by:

• Wavelength

• Safety

• Availability

• Cost 

Some types of phototherapy are better for certain types of psoriasis or certain parts of the body. This includes:

• Narrowband ultraviolet B (UVB): This uses a specific wavelength to treat plaque psoriasis. It’s safer and more effective than broadband UVB and psoralens plus ultraviolet A (PUVA), so it’s generally preferred.

• Broadband UVB: This is similar to narrowband phototherapy, but it uses a broader wavelength range. It’s an older type of phototherapy and isn’t used as often. 

• Psoralen plus UVA (PUVA): This is a combination of UVA light and psoralen, a medication that makes the skin more sensitive to light. Psoralen is available to take as a pill, cream, or mixed in bathwater. Then, your skin is exposed to the UVA light. PUVA is useful for treating plaque psoriasis, guttate psoriasis, and psoriasis on the palms and soles.

• Excimer laser, or targeted therapy: This newer form of phototherapy uses a specific wavelength on a small area of skin. It’s usually only an option if you have a few small patches of psoriasis, like on your hands or feet. It’s also the only light therapy option for scalp psoriasis, since the narrow beam can more easily penetrate through hair. 

Potential risks and side effects

Since phototherapy uses UV light, it can increase your risk of developing skin cancer and photodamage (like wrinkles and brown spots) over the long term. 

Short-term side effects of phototherapy include:

• Redness

• Itching

• Burning

• Blistering

• Swelling of the skin

Choosing the best psoriasis treatment

If you have psoriasis, healthcare professionals will help you decide the best treatment for you. Most primary care providers can treat mild psoriasis. But, for more severe cases, you’ll need to see a dermatologist (a skin specialist).

Psoriasis is different for everyone, and it’s likely that your treatment needs will change over time. 

With that in mind, a typical approach to treating psoriasis may look something like this:

• Mild psoriasis: If you have mild psoriasis involving a small area of your body, first try topical treatments or targeted phototherapy. If those don’t work, the next step is an oral medication, and then a biologic. 

• Moderate to severe psoriasis: If you have moderate to severe psoriasis involving a larger area of the body or a sensitive area (like the palms or soles), then pill medications or injections are a better first treatment. 

• Psoriasis with psoriatic arthritis: If you have both psoriasis and psoriatic arthritis, then you’ll need pills or injectable psoriasis medications to treat both conditions.

Finding the right treatment isn’t always easy. It’s hard to predict how you’ll respond to treatment, and sometimes you might have to try a few medications before finding one that works. And you may need more than one medication.

This process of trial and error can be frustrating. But it pays to be patient and methodical in your approach. For most people, this means starting with the basics and working your way through treatment options until you find the combination that works for you. 

Self-care tips for living with psoriasis

Finding out you have psoriasis can be very difficult. In fact, the data shows that people with psoriasis more frequently report symptoms of depression. It’s not unusual for the condition to get in the way of daily activities and negatively affect your quality of life.

If you’re struggling with psoriasis, it may help to speak with others who can relate. Consider checking out the National Psoriasis Foundation for information on community resources, support networks, and more.

Lifestyle changes to improve psoriasis

Making some lifestyle changes can also improve your psoriasis, no matter which psoriasis treatment you use. 

The following changes may also help you improve — or even avoid — some of the common psoriasis-related conditions (like diabetes and heart disease): 

• Quitting smoking

• Weight loss, if you have a BMI that is considered overweight or obese

• Limiting or avoiding alcohol

• Exercising regularly

• A diet that prioritizes whole foods and limits added sugars and ultra-processed foods

Common psoriasis triggers

In addition, it’s helpful to know and avoid your psoriasis triggers. These are behaviors or exposures that make your psoriasis symptoms worse. 

Triggers aren’t the same for everyone, but some common psoriasis triggers include:

• Emotional stress

• Cold, dry winter weather

• Common illnesses, like a cold or strep throat

• Cuts, sunburn, and other types of skin injury

Frequently asked questions

Why trust our experts?

Written by:

Sarah Pozniak, MD

Sarah Pozniak, MD, has 9 years of experience since graduating medical school (6 since completing residency). She is a board-certified general internal medicine physician and has practiced as a primary care physician in both Utah and Washington, D.C. Currently, she cares for patients with chronic illnesses such as diabetes and high blood pressure using telemedicine as part of a virtual care program.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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