What treatments are out there?

Topical therapy is usually the first treatment used for mild Pso.^[2]There is a wide variety available, including:^[2]

• Creams
• Lotions
• Gels
• Ointments
• Shampoos

Topical treatments containing emollients may hydrate the skin and stop it drying out, or contain other ingredients, like vitamin D, coal tar or corticosteroids, but can take time to apply.^[2] If you’re taking corticosteroids, these can cause side effects, like thinning of the skin, so ask your healthcare professional whether you should take breaks from applying these.^[2]

Treatment using ultraviolet rays

If your Pso has not improved as much as you or your healthcare professional would like with treatments applied to your skin, you may be offered short wave ultraviolet B (UVB) phototherapy 2-3 times a week.^[3] Another type of phototherapy you could be offered is long wave ultraviolet A (UVA) light in combination with a chemical called psoralen in tablet form.^[3] This is called P-UVA and is often used to treat pustules on the palms and soles of the feet, although it can’t be used in pregnant women or some people who are at a higher risk for skin cancers.^[3]

Pills or injections that act by spreading throughout the body

The first systemic therapy you would usually be offered is methotrexate,^[4]which suppresses inflammation in psoriasis.^[1] If you and your healthcare professional decide that methotrexate isn’t appropriate, or it isn’t effective, some other options may include:

• Acitretin, which reduces how fast your skin grows^[1]
• Apremilast, which changes the way your body deals with inflammation^[1]
• Ciclosporin, another drug that suppresses the immune system^[1]
• Fumaric acid esters, which normalise the balance of cytokines in your body, which are chemicals related to the immune system^[5]

Your dose will probably be started low and slowly increased until you reach the dose that helps you with your symptoms.^[4]

Injections or infusions made from protein

Biologic medications are a type of treatment for Pso that work throughout your body.^[4]They are grown in a lab using living cells and target specific parts of the immune system.^[6] These should only be prescribed by a specialist doctor with experience treating Pso or PsA, although your symptoms and side effects may be monitored by a clinical nurse specialist.^[1][4]

There are a number of different types of biological treatment that the treatments above fall into:

• TNF inhibitors: these block an important protein for inflammation, called tumour necrosis factor (TNF).^[6] Treatments like this are injected under the skin or directly into a vein.^[1] Examples of this type of treatment are adalimumab, etanercept or infliximab, which needs to be done in a hospital.^[6]
• IL-12/23 inhibitors: these block a specific part of the proteins called interleukins (IL) 12 and 23, which are also involved in inflammation.^[6] Treatments like this are injected under the skin.^[1] An example of this type of treatment is ustekinumab.^[6]
• IL-17 inhibitors: these block a protein called IL-17 to stop inflammation from developing. Treatments like this are injected under the skin.^[6] Examples of this type of treatment are ixekinumab or secukinumab.^[6]
• IL-23 inhibitors: treatment that targets a specific part of the protein called IL-23 to block psoriasis inflammation using an injection under the skin.^[1][6] Examples of this type of treatment are guselkumab or risankizumab.^[6]

If you’re going to be taking a biologic, you will probably need to be tested for tuberculosis (TB) and have blood tests before and during treatment.^[7]