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While there is no cure for psoriasis, the primary goal of treatment is to slow the growth of skin cells. Despite the many options available, psoriasis treatment can be challenging because of its unpredictable nature, and because treatments can have different results in different people. Your skin also can become resistant to various treatments over time, and the most potent psoriasis treatments can have serious side effects. There are three main categories of treatment: topical, light/photo therapy and systemic medications.
Drugs range from milder corticosteroid topical creams to stronger oral or intravenous drugs such as methotrexate and biologics, typically reserved for more severe cases of psoriasis. The traditional approach is to start with the mildest treatments — topical creams and ultraviolet light therapy — and then progress to stronger ones only if necessary due to the side effects of these stronger options.
Topical creams and ointments are designed to remove scales and smooth the skin. Topical corticosteroids slow cell turnover by suppressing the immune system, synthetic forms of vitamin D to slow skin cell growth, and topical retinoids to normalize DNA activity in skin cells.
Oral or injected medications are usually reserved for those with severe psoriasis or who don’t respond well to milder treatments. Some of these treatments can only be used for short time periods due to their severe side effects. These include oral retinoids to reduce the production of skin cells; methotrexate, to decrease production of skin cells and suppress inflammation; and biologics such as are etanercept, infliximab, and adalimumab, given by intravenous infusion, intramuscular injection or subcutaneous injection. Cyclosporine, a drug that suppresses the immune system, offers similar efficacy to methotrexate.
Light therapy involves exposing the skin to controlled amounts of natural sunlight or artificial ultraviolet (UV) light. The UV rays slow skin cell turnover and reduce inflammation; however, excess sun exposure can worsen symptoms and cause skin damage. It’s thus important that this treatment be monitored by a health provider.
Home remedies include moisturizing lotions or creams to alleviate skin dryness and reduce the risk of skin cracking. Soaking in a tub of colloidal oatmeal, apple cider vinegar or Epsom salts can help alleviate symptoms of mild psoriasis and slough off scaly skin. One method called “occlusion” helps calm pain quicker than other home remedies. It involves applying moisturizer or oil to sore areas and wrapping them with plastic wrap or covering them with socks, a plastic bag, or gloves (if the soreness is in the hands or feet). It’s also important to manage stress given the link between stress and psoriasis flares.