Psoriasis Treatments and Medications: A Complete Overview

Psoriasis treatment goes step by step. It starts with creams and moves to light therapy, pills, and biologics based on how much skin is affected and how the disease responds. Most people with mild psoriasis do well with topicals alone. Moderate-to-severe cases often need body-wide drugs or biologics that target the immune system.

Finding the right psoriasis treatment can feel like trial and error. What works for one person may do little for another. Your plan will likely change over time. If you’re still learning the basics, our guide on what psoriasis is is a good place to start. This article covers every major treatment type. It starts with creams your skin doctor may prescribe first and goes up to biologics and JAK inhibitors for moderate-to-severe disease.

How Does the Treatment Ladder Work for Psoriasis?

Skin doctors follow a “treatment ladder.” It starts with gentle therapies and steps up based on how bad the disease is. Mild psoriasis (less than 3% of body surface area) typically begins with topicals. Moderate disease (3% to 10%) may add phototherapy. Severe psoriasis (over 10% of the body or greatly affecting daily life) usually calls for body-wide drugs or biologics.

Your skin doctor will look at how much skin is involved and which areas are affected. Scalp, nails, joints, and genital skin often need different approaches. How the disease affects daily life and whether you have psoriatic arthritis also matter.

The AAD says you should check your treatment plan every 3 to 6 months. If you haven’t met your goals, your doctor should talk about stepping up treatment. A common goal is 1% or less of your body affected, or at least a 75% improvement from where you started.

What Topical Treatments Are Used for Psoriasis?

Topical treatments are creams, ointments, and solutions put directly on psoriasis plaques. Steroids are the most prescribed topicals. They range from mild over-the-counter hydrocortisone to strong prescription formulas. Other topicals include vitamin D analogs (calcipotriene), retinoids (tazarotene), calcineurin inhibitors, and coal tar.

For most people with mild psoriasis, topicals are the first step. They work best on small areas and can be used alone or with other treatments.

Corticosteroids

Topical steroids lower inflammation, slow skin cell growth, and ease itching. They come in seven potency classes, from mild (Class VII) to super-potent (Class I).

Mild to moderate strength options like hydrocortisone and triamcinolone work well on sensitive areas such as the face, groin, and skin folds. High-potency formulas like fluocinonide and desoximetasone are used on thicker plaques on the elbows, knees, and trunk. Super-strong steroids like clobetasol propionate (Clobex, Temovate) are saved for stubborn plaques. Use is limited to 2 to 4 weeks because they can thin the skin.

Long-term use can thin the skin, cause stretch marks, and trigger rebound flares if you stop suddenly. Your skin doctor may suggest “weekend therapy” — using a strong steroid two days a week to keep control while cutting side effects.

Vitamin D Analogs

Calcipotriene (Dovonex) and calcitriol (Vectical) slow the excess skin cell growth that creates plaques. They work more slowly than steroids but are safer for long-term use. The combo product Enstilar (or Taclonex) pairs a vitamin D analog with a steroid. It is one of the most prescribed topicals for psoriasis.

Retinoids

Tazarotene (Tazorac) is a topical retinoid that slows excess skin cell growth. It can cause irritation and dryness, so skin doctors often pair it with a moisturizer or a mid-strength steroid. Tazarotene should not be used during pregnancy.

Calcineurin Inhibitors

Tacrolimus (Protopic) and pimecrolimus (Elidel) are used off-label for psoriasis in sensitive spots where steroids carry more risk. These include the face, eyelids, and genital skin. They don’t thin the skin, which makes them useful for long-term care in those areas.

Coal Tar

Coal tar is one of the oldest psoriasis treatments still in use. It reduces scaling, itching, and inflammation. It’s available over the counter in shampoos, creams, and bath solutions. The smell and staining put some people off, but it can work when other options haven’t helped.

How Does Phototherapy Treat Psoriasis?

Phototherapy uses UV light to slow the rapid skin cell growth that causes psoriasis plaques. Narrowband UVB is the most common form, typically given 2 to 3 times per week in a dermatologist’s office. PUVA combines UVA light with a photosensitizing drug called psoralen. The excimer laser sends targeted UVB light to single plaques without harming nearby skin.

Light therapy is a good choice for moderate psoriasis or when topicals alone haven’t worked.

Narrowband UVB

This is the most widely used form of phototherapy. You stand in a light booth for short sessions that grow longer over time, starting at about 30 seconds. A typical course runs 25 to 30 sessions. A review in JAAD found about 75% of patients see major clearing with narrowband UVB.

Home UVB units need a prescription. They are a good choice for people who can’t visit a clinic several times a week.

PUVA (Psoralen + UVA)

PUVA is more effective than UVB alone but carries more risk. You take psoralen (a drug that makes skin more light-sensitive) by mouth or put it on the skin, then get UVA light. PUVA is usually saved for thick plaques or palmoplantar psoriasis that doesn’t respond to UVB. Long-term PUVA raises skin cancer risk, so doctors limit the total number of sessions.

Excimer Laser

The excimer laser sends a focused beam of 308-nm UVB light to single psoriasis plaques. It’s useful for small, stubborn spots because it treats only the affected skin without exposing healthy skin to UV. Sessions are fast, often under 15 minutes. Clearing can happen in fewer sessions than full-body light therapy.

What Oral and Conventional Systemic Medications Treat Psoriasis?

Body-wide psoriasis drugs include methotrexate, cyclosporine, acitretin, and apremilast (Otezla). These oral drugs work throughout the body to reduce inflammation and slow skin cell turnover. Doctors prescribe them when psoriasis covers more than 10% of the body, when topicals and light therapy fail, or when psoriatic arthritis is present.

These drugs have been used for decades. They remain a good option when biologics are hard to get due to cost or insurance. The best choice depends in part on which type of psoriasis you have.

Methotrexate

Methotrexate has been used for psoriasis since the 1970s. Taken once a week (by mouth or injection), it dials down the overactive immune response that drives psoriasis. A 2023 review in the British Journal of Dermatology found methotrexate reaches PASI 75 (75% skin clearance) in about 40% to 45% of patients by week 16.

Regular blood tests are needed to check liver function and blood cell counts. Methotrexate is not safe during pregnancy or for people who drink alcohol often.

Cyclosporine

Cyclosporine works fast, often showing results within 4 to 6 weeks. It’s a strong immune-suppressing drug first made for organ transplant patients. Because it can harm the kidneys and raise blood pressure, doctors usually limit it to 1 to 2 years of use. Skin doctors sometimes prescribe short “rescue” courses for severe flares.

Acitretin

Acitretin (Soriatane) is an oral retinoid that slows skin cell growth. It suppresses the immune system less than methotrexate or cyclosporine. This makes it an option for people worried about infections. Acitretin works very well for pustular and erythrodermic psoriasis. Side effects include dry skin, lip cracking, and hair thinning. Women must avoid pregnancy for 3 years after stopping acitretin. The drug stays in body fat.

Apremilast (Otezla)

Apremilast is a PDE4 inhibitor that lowers inflammation without suppressing the whole immune system. Approved by the FDA in 2014, it achieves PASI 75 in about 33% of patients at week 16, according to the ESTEEM clinical trials. While less effective than biologics, apremilast needs no blood tests or shots. It also works for scalp and nail psoriasis. Common side effects include nausea and diarrhea. These usually get better after the first few weeks.

What Biologics Are Available for Psoriasis?

Biologics are shots or infusions that target specific immune system parts behind psoriasis inflammation. Four main classes exist: TNF-alpha inhibitors (like adalimumab and etanercept), IL-17 inhibitors (secukinumab, ixekizumab, brodalumab, bimekizumab), IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab), and the IL-12/23 inhibitor ustekinumab. Many patients achieve 90% or greater skin clearance with newer biologics.

Biologics are usually prescribed for moderate-to-severe psoriasis. That means the disease affects more than 10% of your body or has a big effect on daily life.

TNF-Alpha Inhibitors

TNF inhibitors were the first biologics approved for psoriasis. Options include:

• Adalimumab (Humira, plus biosimilars like Hadlima and Hyrimoz), self-injected every 2 weeks
• Etanercept (Enbrel), self-injected twice weekly then weekly
• Infliximab (Remicade), given by IV infusion at weeks 0, 2, and 6, then every 8 weeks
• Certolizumab pegol (Cimzia), self-injected every 2 weeks, and the only biologic with data showing minimal to no placental transfer, making it a consideration for people who are pregnant or planning pregnancy

TNF inhibitors reach PASI 75 in about 50% to 70% of patients. They have the longest safety record, but newer drugs with higher clearance rates have mostly taken over.

IL-17 Inhibitors

IL-17 is a key driver of the inflammation that causes psoriasis plaques. Blocking it produces some of the highest clearance rates available:

• Secukinumab (Cosentyx): achieves PASI 90 in about 60% to 70% of patients at week 16
• Ixekizumab (Taltz): achieves PASI 90 in about 70% of patients
• Brodalumab (Siliq): achieves PASI 100 (complete clearance) in about 40% of patients, the highest complete clearance rate among IL-17 drugs
• Bimekizumab (Bimzelx): a dual IL-17A and IL-17F inhibitor approved in October 2023 that achieves PASI 90 in roughly 85% of patients, according to the BE VIVID and BE READY trials

Oral thrush is a common side effect of IL-17 inhibitors. Your skin doctor will ask if you have inflammatory bowel disease. IL-17 drugs can worsen Crohn’s disease in rare cases.

IL-23 Inhibitors

IL-23 inhibitors block a protein that sits “upstream” in the process. They stop inflammation at an earlier point. This class offers high effectiveness with less frequent dosing:

• Guselkumab (Tremfya): injection every 8 weeks after loading doses, PASI 90 in about 70% of patients
• Risankizumab (Skyrizi): injection every 12 weeks after loading, PASI 90 in about 75% of patients at one year
• Tildrakizumab (Ilumya): injection every 12 weeks, PASI 75 in about 64% of patients

IL-23 inhibitors have a good safety record with some of the longest gaps between doses. Many people prefer this.

IL-12/23 Inhibitor

Ustekinumab (Stelara) blocks both IL-12 and IL-23. Approved in 2009, it was a landmark drug for psoriasis. Dosing is every 12 weeks after loading. It achieves PASI 75 in about 70% of patients but lower PASI 90 rates than newer IL-17 and IL-23 drugs. Biosimilars should enter the market in 2025-2026, which will lower costs.

What About JAK Inhibitors for Psoriasis?

Deucravacitinib (Sotyktu) is the first pill that targets TYK2 for moderate-to-severe plaque psoriasis. The FDA approved it in September 2022. It achieved PASI 75 in about 53% to 58% of patients at week 16 in the POETYK trials, outperforming apremilast. Unlike older JAK inhibitors, deucravacitinib targets only TYK2. This may mean fewer heart and blood clot risks.

Deucravacitinib fills a gap in the treatment ladder. You take it once a day by mouth. It doesn’t need shots, infusions, or routine blood tests. For people who want a body-wide drug but don’t want shots, it offers a middle ground.

Other JAK inhibitors (tofacitinib, baricitinib, upadacitinib) carry FDA boxed warnings for blood clots, heart events, and cancers. Deucravacitinib targets only TYK2, and its trials did not show those same risks. Long-term safety data is still being gathered. For more on deucravacitinib and other drugs in the pipeline, see our article on new and emerging psoriasis treatments.

When Should You Switch or Combine Psoriasis Treatments?

Talk to your skin doctor about changing treatment if you haven’t met your clearance goals after 3 to 4 months. Also speak up if a treatment that used to work stops helping (called secondary failure) or if side effects affect daily life. Pairing treatments can boost results when one drug alone falls short. For example, you might add a topical to a biologic or light therapy to a pill.

Some people do well on a biologic for years before their psoriasis slowly returns. Others don’t get enough clearing on their first body-wide drug. Both cases are common and don’t mean you’ve run out of options.

Common combination strategies include:

• Biologic plus topical corticosteroid for persistent plaques on elbows or knees
• Methotrexate plus a biologic to boost effectiveness and reduce anti-drug antibody formation
• Phototherapy plus a topical for moderate disease before stepping up to a systemic
• Acitretin plus phototherapy (re-PUVA or re-UVB), which can improve clearance rates while allowing lower UV doses

The National Psoriasis Foundation suggests a “treat to target” approach. Set a clearance goal with your skin doctor. Check progress at set times and step up if you’re not getting there. For practical tips on managing psoriasis day-to-day alongside your treatment plan, see our guide to living well with psoriasis.

Frequently Asked Questions

What is the most effective treatment for psoriasis?

For moderate-to-severe plaque psoriasis, IL-17 and IL-23 inhibitors currently show the highest clearance rates. Bimekizumab (Bimzelx) and risankizumab (Skyrizi) achieve PASI 90 in 75% to 85% of patients. The best treatment for you depends on your disease severity, other health conditions, and personal preferences.

Can psoriasis be cured?

No cure for psoriasis exists yet. Treatments can clear the skin entirely for months or years, but the underlying immune dysfunction remains. Stopping treatment usually leads to a return of symptoms, though some biologics produce lasting remission in a subset of patients even after discontinuation.

Are psoriasis medications safe long-term?

Most biologics have safety data spanning 5 to 10 years or more, with IL-23 inhibitors showing particularly favorable profiles. Your dermatologist will monitor for infections, liver changes, and other concerns based on the specific drug you’re taking.

What are the side effects of biologics for psoriasis?

Side effects vary by drug class. TNF inhibitors can increase infection risk and, rarely, reactivate tuberculosis. IL-17 inhibitors may cause oral thrush and should be used with caution in people with inflammatory bowel disease. IL-23 inhibitors generally have mild side effects like upper respiratory infections and headache. All biologics require TB screening before starting.

Does insurance cover psoriasis biologics?

Most insurance plans cover biologics but require prior authorization and documentation that you’ve tried less expensive treatments first (called step therapy). Manufacturer copay assistance programs can reduce out-of-pocket costs for commercially insured patients.

Can I use natural treatments for psoriasis?

Some people find relief with Dead Sea salt baths, aloe vera, and oat-based moisturizers, but clinical evidence for these is limited. Moisturizing regularly and avoiding known triggers (stress, skin injuries, certain medications) can complement medical treatment, though no natural remedy matches prescription options in controlled trials. See our guide on diet, lifestyle, and psoriasis for evidence-based recommendations.

How quickly do psoriasis treatments work?

Topical corticosteroids may show improvement within 1 to 2 weeks. Biologics typically need 12 to 16 weeks before you see their full effect. Methotrexate and apremilast take 3 to 4 months. Your dermatologist should set clear timeline expectations so you know when it’s time to reassess.

What is the treatment for psoriasis on the scalp or nails?

Scalp psoriasis is commonly treated with medicated shampoos (containing coal tar, salicylic acid, or clobetasol), topical solutions, and calcipotriene foam. Nail psoriasis is harder to treat and often requires systemic therapy or biologics for meaningful improvement. Adalimumab, ixekizumab, and risankizumab have shown particular effectiveness for nail disease in clinical trials.

Sources and References

1. American Academy of Dermatology. “Guidelines of care for the management and treatment of psoriasis with topical therapy.” Journal of the American Academy of Dermatology, 2021.
2. National Psoriasis Foundation. “Treatment Targets for Plaque Psoriasis.” psoriasis.org
3. Menter A, et al. “Joint AAD-NPF guidelines of care for the management of psoriasis with systemic nonbiologic therapies.” Journal of the American Academy of Dermatology, 2020.
4. Armstrong AW, et al. “Comparison of Biologics and Oral Treatments for Plaque Psoriasis: A Meta-Analysis.” JAMA Dermatology, 2020.
5. Gordon KB, et al. “Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials.” The Lancet, 2018.
6. Warren RB, et al. “Bimekizumab versus secukinumab in plaque psoriasis (BE RADIANT): a multicentre, randomised, double-blind, active-comparator-controlled phase 3b trial.” The Lancet, 2023.
7. Papp K, et al. “Apremilast, an oral phosphodiesterase 4 inhibitor, in patients with moderate to severe plaque psoriasis: results of the ESTEEM 1 trial.” Journal of the American Academy of Dermatology, 2015.
8. Armstrong AW, et al. “Deucravacitinib versus placebo and apremilast in moderate to severe plaque psoriasis: efficacy and safety results from the 52-week, randomized, double-blinded, POETYK PSO-1 and PSO-2 phase 3 trials.” Journal of the American Academy of Dermatology, 2023.
9. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). “Psoriasis.” niams.nih.gov, updated 2024.
10. Elmets CA, et al. “Joint AAD-NPF guidelines of care for the management of psoriasis with phototherapy.” Journal of the American Academy of Dermatology, 2019.
11. Coates LC, et al. “Treat-to-target in psoriatic disease.” Annals of the Rheumatic Diseases, 2022.
12. National Psoriasis Foundation. “Biologic Medications.” psoriasis.org/biologics
13. FDA. “FDA Approves First Oral Treatment for Moderate-to-Severe Plaque Psoriasis.” fda.gov, September 2022.

Psoriasis Daily is strictly a news and information website about psoriasis. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.