Psoriasis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]


The mainstay of therapy for psoriasis consists of the application of topical agents directly onto the lesions. Topical agents include corticosteroids, vitamin D analogues, tar, anthralin, tazarotene, calcineurin inhibitors, and aloe vera extracts. Systemic therapy may also be used, including immunosupressants to counteract the progression of the disease.

Medical Therapy

Therapies are administered according to disease severity as assessed by the Psoriasis Area and Severity Index (PASI, ranging from 0 to 72), which takes into account appearance and extension of the lesions. Interventions in medical therapy for psoriasis include:

Topical therapy

  • The disadvantages of topical agents are that they can often irritate normal skin, can be time consuming and awkward to apply, cannot be used for long periods, can stain clothing, and can have a strong odor. As a result, it is sometimes difficult for people to maintain the regular application of these medications.
  • Abrupt withdrawal from the use of some topical agents, particularly corticosteroids, can cause an aggressive recurrence of the condition.
  • Some topical agents are commonly used in conjunction with other therapies, especially phototherapy.


  • It has long been recognized that daily, short, non-burning exposure to sunlight can help clear or improve psoriasis.[8]
  • Niels Finsen was the first physician to investigate the therapeutic effects of sunlight scientifically and to use sunlight in clinical practice. This became known as phototherapy.
  • The narrow band part of the UVB spectrum (311 to 312 nm) is most helpful for the management of psoriasis. Exposure to UVB several times per week over several weeks can facilitate remission from psoriasis.

Systemic therapy

The following drugs may be used in the treatment of psoriasis:[9][10][11][12][13]

Type of agent Mechanism of action Name Molecular target Formulation Administration route
Biologic Anti-metabolite Methotrexate DHFR NA Oral or IV
Anti-T cell Cyclosporine Cyclophilin NA Oral or IV
Alefacept CD2 Human LFA-3/IgG1 fusion protein IM or IV
Efalizumab CD11a Humanized IgG1 monoclonal antibody SC
Abatacept CTLA-4 Human CTLA4–Ig-IgG1 fusion protein SC or IV
Anticytokine Etanercept TNF Human TNF-R (p75)-lgG1 fusion protein SC
Infliximab TNF Mouse-human IgG1 chimeric monoclonal antibody IV
Adalimumab TNF Human IgG1 monoclonal antibody SC
Ustekinumab IL-2, IL-23 Human IgG1 monoclonal antibody SC
Briakinumab (discontinued in USA in 2011) IL-12, IL-23 Human IgG1 monoclonal antibody SC
Guselkumab IL-23p19 Human IgG1 monoclonal antibody SC
Brodalumab IL-17R Human IgG2 monoclonal antibody SC
Ixekizumab IL-17 Humanized IgG4 monoclonal antibody SC
Secukinumab IL-17 Human IgG1 monoclonal antibody SC or IV
Fezakinumab IL-22 Human IgG1 monoclonal antibody SC or IV
Small molecule PDE4 inhibitor Apremilast PDE4 NA Oral
JAK inhibitor Tofacitinib JAK1 and JAK3 NA Oral
Baricitinib JAK1 and JAK2 NA Oral
PKC inhibitor AEB071 PKC NA Oral
A3AR agonist CF101 A3AR NA Oral


DHFR: Dihydrofolate reductase

SC: Sub-cutaneous

IV: Intra-venous

IM: Intra-muscular

NA: Not Applicable

PDE4: Phosphodiesterase 4

JAK: Janus Kinase

PKC: Protein Kinase C

LFA: Lymphocyte function associated antigen

TNF: Tumor necrosis factor

Treatment of psoriasis according to severity

The American Academy of Dermatology has published guidelines for the treatment of psoriasis. The guidelines are as follows:[14]

Treatment of psoriasis according to disease sub-type

Treatment of various sub-types of psoriasis includes the following:[15][16]

Treatment of psoriasis in specific populations

Specific populations may require modified regimens for the treatment of psoriasis. The following are the considerations:[17][18][19][20]

Note: All treatments of psoriasis may include mid-potency topical corticosteroids (if not using topical steroids already), emollients, wet dressings, and oatmeal baths

Treatment of psoriatic arthritis

The following drugs may be used in the treatment of psoriatic arthritis:[21]

Drug Mechanism Comments
  • Unknown mechanism
  • More often used for cutaneous psoriasis
  • Humanized monoclonal antibody directed against CD11a, which disrupts T cell costimulatory LFA-1/ICAM-1 interaction


  1. Smith CH, Barker JN (2006). "Psoriasis and its management". BMJ. 333 (7564): 380–4. doi:10.1136/bmj.333.7564.380. PMC 1550454. PMID 16916825.
  2. Ashcroft DM, Po AL, Williams HC, Griffiths CE (2000). "Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis". BMJ. 320 (7240): 963–7. PMC 27334. PMID 10753146.
  3. Syed TA, Ahmad SA, Holt AH, Ahmad SA, Ahmad SH, Afzal M (1996). "Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study". Trop. Med. Int. Health. 1 (4): 505–9. PMID 8765459.
  4. Naldi L, Rzany B (2009). "Psoriasis (chronic plaque)". BMJ Clin Evid. 2009. PMC 2907770. PMID 19445765.
  5. Escobar SO, Achenbach R, Iannantuono R, Torem V (1992). "Topical fish oil in psoriasis--a controlled and blind study". Clin. Exp. Dermatol. 17 (3): 159–62. PMID 1451289.
  6. Levine D, Even-Chen Z, Lipets I, Pritulo OA, Svyatenko TV, Andrashko Y, Lebwohl M, Gottlieb A (2010). "Pilot, multicenter, double-blind, randomized placebo-controlled bilateral comparative study of a combination of calcipotriene and nicotinamide for the treatment of psoriasis". J. Am. Acad. Dermatol. 63 (5): 775–81. doi:10.1016/j.jaad.2009.10.016. PMID 20599292.
  7. "Topical treatments for chronic plaque psoriasis - Mason - 2013 - The Cochrane Library - Wiley Online Library".
  8. Naldi L, Rzany B (2009). "Psoriasis (chronic plaque)". BMJ Clin Evid. 2009. PMC 2907770. PMID 19445765.
  9. Rosmarin DM, Lebwohl M, Elewski BE, Gottlieb AB (2010). "Cyclosporine and psoriasis: 2008 National Psoriasis Foundation Consensus Conference". J. Am. Acad. Dermatol. 62 (5): 838–53. doi:10.1016/j.jaad.2009.05.017. PMID 19932926.
  10. Schmitt J, Rosumeck S, Thomaschewski G, Sporbeck B, Haufe E, Nast A (2014). "Efficacy and safety of systemic treatments for moderate-to-severe psoriasis: meta-analysis of randomized controlled trials". Br. J. Dermatol. 170 (2): 274–303. doi:10.1111/bjd.12663. PMID 24131260.
  11. Nowicki B, Holthöfer H, Saraneva T, Rhen M, Väisänen-Rhen V, Korhonen TK (1986). "Location of adhesion sites for P-fimbriated and for 075X-positive Escherichia coli in the human kidney". Microb. Pathog. 1 (2): 169–80. PMID 2907770.
  12. Hsu S, Papp KA, Lebwohl MG, Bagel J, Blauvelt A, Duffin KC, Crowley J, Eichenfield LF, Feldman SR, Fiorentino DF, Gelfand JM, Gottlieb AB, Jacobsen C, Kalb RE, Kavanaugh A, Korman NJ, Krueger GG, Michelon MA, Morison W, Ritchlin CT, Stein Gold L, Stone SP, Strober BE, Van Voorhees AS, Weiss SC, Wanat K, Bebo BF (2012). "Consensus guidelines for the management of plaque psoriasis". Arch Dermatol. 148 (1): 95–102. doi:10.1001/archdermatol.2011.1410. PMID 22250239.
  13. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, Lebwohl M, Koo JY, Elmets CA, Korman NJ, Beutner KR, Bhushan R (2008). "Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics". J. Am. Acad. Dermatol. 58 (5): 826–50. doi:10.1016/j.jaad.2008.02.039. PMID 18423260.
  14. "Psoriasis: Recommendations for broadband and narrowband UVB therapy | American Academy of Dermatology".
  15. Rosenbach M, Hsu S, Korman NJ, Lebwohl MG, Young M, Bebo BF, Van Voorhees AS (2010). "Treatment of erythrodermic psoriasis: from the medical board of the National Psoriasis Foundation". J. Am. Acad. Dermatol. 62 (4): 655–62. doi:10.1016/j.jaad.2009.05.048. PMID 19665821.
  16. de Jager ME, de Jong EM, van de Kerkhof PC, Seyger MM (2010). "Efficacy and safety of treatments for childhood psoriasis: a systematic literature review". J. Am. Acad. Dermatol. 62 (6): 1013–30. doi:10.1016/j.jaad.2009.06.048. PMID 19900732.
  17. Frankel AJ, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Bebo BF, Gottlieb AB (2009). "Treatment of psoriasis in patients with hepatitis C: from the Medical Board of the National Psoriasis Foundation". J. Am. Acad. Dermatol. 61 (6): 1044–55. doi:10.1016/j.jaad.2009.03.044. PMID 19811848.
  18. Murase JE, Heller MM, Butler DC (2014). "Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy". J. Am. Acad. Dermatol. 70 (3): 401.e1–14, quiz 415. doi:10.1016/j.jaad.2013.09.010. PMID 24528911.
  19. Heller MM, Wu JJ, Murase JE (2011). "Fatal case of disseminated BCG infection after vaccination of an infant with in utero exposure to infliximab". J. Am. Acad. Dermatol. 65 (4): 870. doi:10.1016/j.jaad.2011.04.030. PMID 21920245.
  20. Weatherhead S, Robson SC, Reynolds NJ (2007). "Management of psoriasis in pregnancy". BMJ. 334 (7605): 1218–20. doi:10.1136/bmj.39202.518484.80. PMC 1889937. PMID 17556479.
  21. Day MS, Nam D, Goodman S, Su EP, Figgie M (2012). "Psoriatic arthritis". J Am Acad Orthop Surg. 20 (1): 28–37. doi:10.5435/JAAOS-20-01-028. PMID 22207516.

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