Psoriasis Treatment

Psoriasis Treatment: Understanding Your Options

Psoriasis is a chronic, immune-driven condition in which the skin renews itself far too quickly. New cells reach the surface within days rather than weeks and pile up as raised, scaly areas called plaques. It often runs in families, comes and goes in cycles and is not contagious.

Recognizing Plaque Psoriasis

Typical features of plaque psoriasis, the most common type:

• Sharply outlined, raised patches topped with silvery-white scale, looking pink or red on lighter skin and purple, gray or dark brown on darker skin
• A preference for the elbows, knees, scalp, lower back and the skin behind the ears
• Itching, soreness or painful cracks, especially on the palms and soles
• Nail changes such as tiny pits, discoloration or the nail lifting from its bed

Common triggers

Flares are often linked to stress, throat infections, skin injury or sunburn, smoking, heavy drinking, cold weather and some medicines, including lithium, certain beta-blockers and antimalarials. Suddenly stopping steroid tablets can also provoke a severe flare.

Topical Treatments

Mild to moderate psoriasis usually starts with skin treatments:

• Emollients: used generously every day to soften scale, ease itching and help other treatments work.
• Topical corticosteroids: calm inflammation quickly. A doctor matches the potency to the body area, using milder ones on the face and skin folds, and plans breaks to limit skin thinning.
• Vitamin D analogues such as calcipotriol: slow skin-cell growth and are often combined with a steroid.
• Salicylic acid and coal tar: help lift thick scale, particularly on the scalp. Salicylic acid creams are in our skin disorder range.

Tazarotene (Tazret)

Tazarotene, a vitamin A derivative (retinoid), helps skin cells mature normally and reduces inflammation within plaques. Apply a thin film once daily, usually in the evening, to the plaques only. It can make surrounding healthy skin red, dry and sore, so avoid the eyes, face and skin folds unless a doctor advises otherwise, and wash your hands afterwards. Doctors often pair it with a topical steroid to reduce irritation. It also increases sensitivity to sunlight.

Tazarotene must not be used during pregnancy. Women who could become pregnant need a negative pregnancy test before starting and effective contraception throughout. Tazarotene is also used for acne.

Oral Treatment: Apremilast (Aprezo)

Apremilast blocks an enzyme called phosphodiesterase 4 (PDE4) inside immune cells, turning down the signals that drive psoriatic inflammation. It is prescribed for plaque psoriasis and psoriatic arthritis, usually when creams alone are not enough.

• Titration: the labeled schedule starts at 10 mg and increases step by step over five days to reduce stomach upset. From day 6 the usual dose is 30 mg twice daily, about 12 hours apart. The early doses use lower-strength tablets from a starter pack; Aprezo 30 mg is the maintenance strength.
• Swallow tablets whole, with or without food. People with severe kidney impairment usually take 30 mg once daily.

Diarrhea and nausea are the most common side effects, mainly in the first weeks. Some people lose weight, so weight should be checked regularly. Apremilast has been linked with depression and mood changes: tell your doctor about any history of depression, and seek help promptly if you notice low mood or thoughts of self-harm. It is not recommended in pregnancy, and strong enzyme inducers such as rifampicin, carbamazepine, phenytoin or St John's wort can stop it working.

Treatments in This Range

Acitretin is harmful to an unborn baby, so women must not become pregnant while taking it or for three years afterwards, and no one on it should give blood within that period.

Phototherapy and Biologics

For extensive or stubborn psoriasis, or disease on the face, hands, feet, nails or genitals, a dermatologist may offer narrowband UVB phototherapy, tablets such as methotrexate or ciclosporin, or biologic injections that target specific immune messengers. These need specialist assessment and regular monitoring.

Psoriatic Arthritis: Warning Signs

Up to one in three people with psoriasis develop arthritis. See a doctor promptly if you notice:

• Painful, swollen or stiff joints, especially morning stiffness lasting over 30 minutes
• A whole finger or toe swelling up (a "sausage digit")
• Heel pain or pain where tendons attach to bone
• Lower back pain and stiffness that eases with movement

Early treatment helps prevent lasting joint damage. Seek urgent care if redness spreads over most of your body, or pus-filled spots appear with fever or feeling unwell.

Frequently Asked Questions

Is psoriasis contagious?

No. It stems from the immune system and genetics rather than an infection, so it cannot spread through touch or shared towels.

Will psoriasis go away permanently?

It is a long-term condition, but many people achieve long spells of clear or nearly clear skin with the right treatment. Stopping smoking, limiting alcohol and keeping to a healthy weight also help.

How long does tazarotene take to work?

Scaling often lessens within one to two weeks, with fuller benefit over about 12 weeks. Early irritation is common; report severe reactions to your doctor.

This guide offers general background and cannot replace tailored medical advice. Tazarotene, apremilast and acitretin are prescription medicines; speak to a dermatologist or pharmacist before starting, stopping or combining psoriasis treatments.