When you have psoriasis, the most important thing to remember when managing your condition is to make sure you’re staying on track with treatment and talking with your doctor regularly. This also means noting any changes in your symptoms and discussing them with your doctor.

It’s likely your psoriasis treatment will change over time, which might mean your medication changes. Some reasons your doctor might start you on a new medication include:

  • new research or treatment guidelines recommending different ways to manage symptoms
  • a change in or worsening of your psoriasis symptoms
  • a change in your overall health
  • a new medical diagnosis

Never start a new treatment without talking with your doctor first.

This article explores the different psoriasis therapies as well as tips for a smooth transition if you need to change your treatment.

It’s important that you feel comfortable with any changes made to your treatment plan. Feel free to ask your doctor any questions that come to mind.

It may be helpful to write down these questions ahead of time. That way, you’ll have a list ready when it’s time to discuss the plan with your doctor. Consider some of the following questions:

  • How long does it take for the new medication to start working?
  • Does the treatment cause any side effects?
  • How often will I have to take the treatment? How often will I have doctors’ appointments?
  • Will the treatment interact with other medications I’m taking?
  • Will the treatment affect my other health conditions?
  • Will I have to make any lifestyle changes while taking the medication?

The ultimate goal is to find a treatment plan that improves your symptoms and makes you feel better.

When switching medications, you might also want to look into whether the new drug is covered under your insurance plan. If it’s not, ask your doctor whether there are other ways to help reduce the cost.

Oral drugs work throughout the body to lower inflammation. They also slow the production of skin cells. Oral medications can be especially helpful during a flare or if your psoriasis is widespread.

Some common oral drugs are:

  • Methotrexate: This drug is taken weekly. It reduces the immune response and slows skin cell production. It’s a powerful medication that can be used when other treatments don’t work.
  • Cyclosporine: This drug suppresses the immune system to reduce psoriasis symptoms. Symptoms may start to improve within a few weeks, which is faster than with other therapies. It’s usually only used for 1 year due to potential risks associated with long-term use.
  • Oral retinoids: This class of drug lowers skin cell production to help reduce plaques. It doesn’t suppress the immune system, making it a better choice for some people.
  • Apremilast: This drug reduces inflammation, resulting in less swelling and skin scaling.

Biologic drugs are made from living cells. These drugs target very specific parts of the immune system to “turn off” the actions that cause psoriasis symptoms.

Biologics are delivered through an injection or infusion. They usually cause fewer side effects than other psoriasis treatments.

Some common biologics include:

  • Adalimumab: This drug blocks part of your immune system to reduce inflammation by blocking the tumor necrosis factor (TNF) molecules from interacting with its cell-surface receptors.
  • Etanercept: This biologic is given weekly or twice weekly. It binds and blocks the chemical TNF-alpha, which prevents messages from being sent to other cells that then cause inflammation.
  • Infliximab: This drug is an antibody that binds to TNF-alpha and prevents it from connecting to its receptors.
  • Certolizumab pegol: This biologic works by blocking the action of TNF, which prevents pain and swelling the joints.
  • Risankizumab: This drug requires only four sets of injections per year for a maintenance dose. It binds to part of the anti‐interleukin (IL)‐23 monoclonal antibody and prevents IL‐23 from communicating with the IL-23 receptor.
  • Secukinumab: This novel biologic targets interleukin-17, a cornerstone messenger protein, which leads to tissue inflammation.
  • Tildrakizumab: This drug is a monoclonal antibody that targets a subunit of IL‐23 called p19 and prevents IL-23 from interacting with its receptor, preventing the release of pro-inflammatory cytokines.

Biologics are effective for a lot of people with psoriasis, but in some cases, the drug loses its effectiveness over time. If this happens, your doctor might switch you to a new biologic.

Topical treatments are applied to the affected skin areas. Some are available over the counter, and others need a prescription.

Topical psoriasis treatments include:

Corticosteroids

Corticosteroids can reduce the redness and irritation associated with psoriasis. Some common ones are fluocinonide and betamethasone.

Different strengths are available. Mild ones can be bought without a prescription. More potent types are best for short-term use and need a prescription.

Corticosteroids are quite effective, but they can thin your skin and increase the risk of damage. Treatment should last no longer than 2 to 4 weeks.

Follow your doctor’s advice to get the best results and minimize any negative effects.

Synthetic vitamin D

Synthetic vitamin D products slow skin cell growth and reduce inflammation. To lessen these side effects, they may be used with strong corticosteroids. Options include calcipotriene and calcitriol.

Retinoids

Retinoids are a form of vitamin A applied directly to the skin. They help reduce the thickening and redness of psoriasis patches. One example is tazarotene.

Coal tar

Coal tar can help reduce swelling and itchiness. This method for treating psoriasis has been around for about 100 years.

Coal tar is thick, sticky, and black, with a distinctive smell. It’s often combined with other ingredients in nonprescription shampoos, lotions, and ointments.

Be aware that it can stain skin, clothing, and furniture.

Salicylic acid

Products containing salicylic acid help remove and soften scales and plaques. This can help other topical products better reach and target the affected skin.

Products containing a lower concentration of salicylic acid are available without a prescription. Stronger types need a prescription.

Calcineurin inhibitors

Calcineurin inhibitors are immunosuppressants that block the chemical calcineurin, which causes inflammation, redness, and itching. Examples of calcineurin inhibitors include tacrolimus and pimecrolimus.

Phototherapy involves exposing the skin to specific types of UV rays. It’s been used for many years to treat psoriasis.

Some people find exposing affected skin to sunlight improves their symptoms. Others need more targeted therapy through regular appointments at a medical office. Sometimes, maintenance phototherapy is done at home after initial treatment in a clinic.

Like so many things, this treatment is about finding the right balance. Too much UV exposure can cause sunburn, which can make psoriasis symptoms worse.

There’s no cure for psoriasis, but you can manage your symptoms through treatment and lifestyle adjustments.

Your treatment plan will likely change over time, and that’s OK. It may take some patience and effort to figure out the combination that works for you. With time, you’ll find a treatment plan that improves your skin and health.