Psoriatic Disease Treatment Overview

When to see a healthcare provider

See a healthcare provider if you have signs of psoriatic disease (psoriasis or psoriatic arthritis). Symptoms include red and itchy skin plaques, dry skin, pitted nails, and swollen, stiff, and painful joints.

If you have joint symptoms, your provider will want to rule out conditions that affect the joints, like rheumatoid arthritis.

Getting diagnosed

Psoriasis is diagnosed based on your symptoms. In some cases, you may need a skin biopsy to check for other skin conditions like eczema.

If your provider thinks you may have psoriatic arthritis (PsA), they may order any of these tests:

• X-rays to check for signs of damage to the joints.
• MRI to look for problems with the tendons and ligaments.
• Blood tests to detect inflammation and help rule out other arthritic conditions like rheumatoid arthritis and gout.
• A joint fluid test to rule out gout.

What to expect from your doctor visit

• Topical steroids are commonly prescribed for mild to moderate psoriasis. They calm inflammation, which reduces swelling and redness of psoriatic plaques.
• Your provider will talk to you about the medications you are taking as some can make psoriatic disease worse (beta blockers, lithium, hydroxychloroquine, quinidine).
• Steroid injections can help reduce joint inflammation in patients with PsA.
• Synthetic forms of vitamin D treat psoriasis by slowing rapid growth of skin cells, flattening thick psoriatic plaques, and removing scaliness. Examples include calcipotriene (Dovonex, Sorilux) and calcitriol (Vectical).
• The topical retinoid tazarotene (Tazorac) may be prescribed to control symptoms like scaling, redness, and swelling. A retinoid is a synthetic form of vitamin A. If psoriasis is severe, an oral retinoid, acitretin (Soriatane), may be recommended.
• If psoriatic plaques affect areas where skin is thin (like the eyelids), your doctor may recommend calcineurin inhibitors, which are gentler than topical steroids and retinoids. Examples include tacrolimus (Protopic) and pimecrolimus (Elidel).
• The tar cream anthralin (Dritho-Scalp, Zithranol RR) may be prescribed to remove scaling. It should not be used on the face or genitals.
• If topical medications aren’t helpful, your provider may suggest phototherapy (light therapy) before using oral or injectable medications. Exposure to ultraviolet light in a controlled way can help treat psoriasis by slowing the growth of skin cells. Repeated treatments are necessary. If you have moderate to severe psoriasis, phototherapy may be the first type of treatment your provider recommends.
• Oral medications called DMARDs (disease modifying anti-rheumatic drugs) may be prescribed if you have psoriatic arthritis. Most work by targeting the immune system to reduce inflammation. DMARDs can also prevent the condition from getting worse. Examples include methotrexate (Trexall) and sulfasalazine (Azulfidine).
• Injectable medications called biologics, which target the immune system, are used to treat moderate to severe psoriatic disease.
• Severe psoriasis may be treated with oral medication called cyclosporine (Gengraf, Neoral), which works by suppressing an overactive immune system to slow skin cell growth. It is typically prescribed when other treatments haven’t worked.
• Your provider may recommend prescription anti-inflammatory drugs (NSAIDs) for joint pain like diclofenac (Voltaren) or meloxicam (Mobic).
• If your joints have become extremely damaged, joint replacement surgery may be necessary.

Prescription psoriatic disease medications

• Synthetic vitamin D: calcipotriene (Dovonex, Sorilux), calcitriol (Vectical)
• Retinoids: tazarotene (Tazorac), acitretin (Soriatane)
• Calcineurin inhibitors: tacrolimus (Protopic), pimecrolimus (Elidel)
• Anthralin (Dritho-Scalp, Zithranol RR)
• DMARDs: methotrexate (Trexall), sulfasalazine (Azulfidine), leflunomide (Arava), apremilast (Otezla), tofacitinib (Xeljanz)
• Biologics approved for both psoriasis and psoriatic arthritis: etanercept (Enbrel) and infliximab (Remicade)
• Biologics approved for psoriasis: tildrakizumab (Ilumya), brodalumab (Siliq), and risankizumab (Skyrizi).
• Biologics approved for psoriatic arthritis: Golimumab (Symponi)
• Cyclosporine (Gengraf, Neoral)
• Prescription NSAIDs: diclofenac (Voltaren), piroxicam (Feldene), meloxicam (Mobic), and nabumetone (Relafen)

Types of psoriatic disease providers

• A primary care provider can evaluate you for signs of psoriatic disease.
• If you only have skin symptoms, you may be referred to a dermatologist (skin doctor).
• If you have joint symptoms (or both skin and joint symptoms), you should see a rheumatologist, who specializes in autoimmune disease and arthritis.

Treating psoriatic disease at home

Psoriatic disease (psoriasis or psoriatic arthritis) should be treated by a healthcare provider. When untreated, psoriatic disease may increase risk for heart disease and cause joint destruction and chronic pain.

Your provider may recommend treating mild joint symptoms with OTC non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve).

Tips for reducing flare-ups

Psoriatic disease cannot be prevented. But there are ways to help avoid recurrences or flare-ups.

• Apply moisturizer to hydrate the skin and prevent severe scaling, which can cause cracks in the skin and bleeding.
• Avoid dry, cold weather.
• Use shampoo with tar or salicylic acid if psoriatic disease affects the scalp.
• Set up a humidifier, which may increase moisture in the skin.
• Don’t smoke. Smoking can reduce the effectiveness of psoriatic disease treatments. In people with psoriasis, smoking can raise the risk of developing psoriatic arthritis.
• Avoid trauma to the skin, like scrapes, bumps, scratching and picking at the scales, and getting tattoos.
• Try relaxation techniques like meditation, deep breathing, and guided imagery to help relieve stress.
• Exercise regularly. Exercise reduces stress and can help relieve joint pain and stiffness.
• Use heat and cold packs if you have psoriatic arthritis. A warm bath can help relieve joint soreness, and applying ice packs to joints can reduce swelling.
• Maintain a healthy weight. Being overweight or obese puts more pressure on the joints.