Types of Psoriasis Medications

Several classes of medications are used to treat psoriasis, an autoimmune skin condition that can affect the eyes and joints, depending on the type, extent and stage of the disease. Topical medications, DMARDs, corticosteroids, and monoclonal antibodies. These drugs target both disease processes and relieve symptoms.

Psoriasis medications are used in the treatment of psoriasis, a skin condition that can also affect the eyes or joints in some people. Several classes of medications are used to treat psoriasis depending on the type, extent and stage of the disease.

Psoriasis medications are prescribed to relieve symptoms, reduce inflammation and regulate an overactive immune system. Psoriasis medications are available as topical applications, injections and oral formulations. Medications for psoriasis include:

• Ointments and creams to relieve the skin symptoms of psoriasis, smoothen the skin and reduce scale formation that characterizes psoriasis.
• Eye drops and ointments to treat eye conditions such as blepharitis and conjunctivitis that can arise from psoriasis.
• Medications to manage psoriatic arthritis, a painful condition that typically affects peripheral joints such as fingers, wrist, toes, ankles and knees.

Topical formulations with corticosteroids and vitamin D constitute the primary treatment for mild to moderate psoriasis. Topical formulations of vitamin A known as retinoids are used to treat severe skin psoriasis.

Systemic medications such as methotrexate are antimetabolites which prevent excessive skin cell growth in psoriasis. Methotrexate is also a disease-modifying antirheumatic drug (DMARD), useful for treating psoriatic arthritis. DMARDs work by modifying cellular activity.

Other medications used in psoriasis treatment include immunomodulator drugs and biologic protein formulations such as monoclonal antibodies which suppress immune activity and prevent progression of the disease.

Psoriasis is an inflammatory auto-immune condition, in which the immune system attacks the skin, leading to overgrowth of skin cells known as keratinocytes. The rate of keratinocyte growth greatly outpaces its shedding, resulting in red, inflamed, flaky skin patches known as plaques. Pustules or shiny red patches form in some types of psoriasis.

Psoriasis most commonly affects skin regions such as the elbows, knees, scalp, lower back, buttock cleft and the head of the penis, but can occur all over the body. Psoriasis is a chronic condition but not contagious.

Psoriasis affects eyes in approximately 10% of patients, while it affects joints in up to 30% of patients, who may develop psoriatic arthritis. Some people may develop more than one type of psoriasis.

The types of psoriasis include:

• Plaque psoriasis: Also known as psoriasis vulgaris, plaque psoriasis is the most common type, accounting for approximately 80% of psoriasis. Plaque psoriasis typically affects elbows, knees, scalp and lower back, but can also affect palms, feet soles, navel region and nails.
  • Symptoms include: Red, raised and inflamed skin lesions with silvery, flaky scales that can cause itching, burning and bleeding.
• Guttate psoriasis: Guttate psoriasis, also known as eruptive psoriasis, is more common in children and young adults, often occurring after a respiratory infection such as strep throat. Guttate psoriasis predominantly occurs on the torso, arms and legs.
  • Symptoms include: Individual, pink, scaly spots with itching that can be severe in some cases.
• Inverse psoriasis: Inverse psoriasis more often occurs in the excess folds of skin from obesity, which include armpits, groin, buttocks, and under the breasts.
  • Symptoms include: Red, shiny, smooth lesions, but scaling is uncommon.
• Pustular psoriasis: Pustular psoriasis typically occurs on the palms and soles, but in rare cases it can be generalized all over the body and may require hospitalization.
  • Symptoms include: Non-infectious fluid-filled pustules which may crack and form scales. Generalized pustular psoriasis can cause:
    • Intense itching
    • Fever and chills
    • Rapid heart rate
    • Headache and nausea
    • Muscle weakness and fatigue
    • Joint pain
• Erythrodermic psoriasis: Erythrodermic psoriasis is a rare, highly inflammatory and severe form of psoriasis which can affect the entire body. This type of psoriasis poses a high risk for infection (cellulitis) and sepsis.
  • Symptoms include: Red skin with a peeling rash, pain and itching.
• Scalp psoriasis: Scalp psoriasis affects approximately 50% of psoriasis patients. Scalp psoriasis can extend to forehead, hairline, back of the neck and behind the ears.
  • Symptoms include: Redness, skin flaking, intense itching, thick scalp sores and hair loss.
• Nail psoriasis: Nail psoriasis can occur on fingernails and toenails, and affects 50% of psoriasis patients.
  • Symptoms include:
    • Yellow/red/brown discoloration of the nails
    • Nail pitting and white patches on the nails
    • Skin thickening under the nails
    • Horizontal lines and redness in the halfmoon area
    • Crumbling and brittle nails
    • Separation of nail from the nail bed
• Oral psoriasis: Oral psoriasis occurs in the mouth along with skin psoriasis in a few people.
  • Symptoms include:
    • Red patches on the tongue
    • Ulcers inside the mouth
    • Cracked and bleeding lip corners.
    • Peeling skin on the gums
• Napkin psoriasis: Napkin psoriasis is rare and occurs in the diaper region of children up to two years. Napkin psoriasis is usually guttate psoriasis and can be mistaken for diaper rash.
• Linear psoriasis: A rare form of psoriasis that forms in a linear distribution along what is known as Blaschko’s lines on the skin. Blaschko’s lines are normally invisible lines along which skin cells normally develop and grow.
• Psoriatic arthritis: Psoriatic arthritis most often occurs in people who have had psoriasis for a relatively long period. People with psoriatic arthritis have both psoriasis and arthritis, an inflammatory disease of the joint. Psoriatic arthritis usually affects hands and feet, but can also affect larger joints. 
  • Symptoms include:
    • Pain and stiffness in the joint
    • Swelling of fingers and toes
    • Warm and discolored joints

The exact cause of psoriasis is unclear, but research indicates that the following factors play a role in psoriasis:

• Genetic: Patients with psoriasis usually have a genetic predisposition for developing psoriasis. Genetic variations in certain cell-surface proteins known as human leukocyte antigen (HLA) are known to be associated with psoriasis.
• Immunologic: Psoriasis is an autoimmune disease in which immune cells known as T-cells in the skin become overactive, often because of an infection in another part of the body, and mistakenly attack healthy skin cells.
• Environmental: Psoriasis can be triggered by environmental factors and/or drugs that include:
  • Stress
  • Certain foods
  • Allergies
  • Infections
  • Injury
  • Alcohol
  • Obesity
  • Some medications such as:
    • Lithium
    • Beta-blockers
    • Aspirin
    • Antimalarial
    • Botulinum A

Psoriasis cannot be completely cured, but appropriate treatment can help manage the symptoms, prevent flares and prolong periods of remission. Adopting a healthy lifestyle, maintaining healthy weight and avoiding psoriasis triggers can help prevent flares and reduce the intensity of symptoms.

Treatment for psoriasis depends on its type, extent and severity, and the presence or absence of psoriatic arthritis. A combination of therapies may be required to effectively manage the condition.

Treatments of psoriasis may involve one or more of the following:

• Medications, both topical and systemic, based on the type of psoriasis
• Light therapy (phototherapy) using ultraviolet rays
• Photochemotherapy (PUVA) which involves use of a light-sensitive drug known as psoralen before radiation with ultraviolet rays, to enhance its effects
• Laser therapy

Simple adjunct home remedies that can help reduce scaling and soothe skin irritation include:

• Sun exposure
• Sea baths
• Oatmeal baths
• Moisturizers and salicylic acid
• Avoiding alcohol and foods that trigger a psoriasis flare-up
• Maintaining a healthy weight
• Avoiding stress

The types of medications used depend on the type of psoriasis and whether eyes and/or joints are involved. Some medications provide symptom relief, some reduce plaque formation and inflammation, while some drugs work on the immune system to reduce its inflammatory activity.

A combination of medications may be required depending on the type of psoriasis. The types of medications used for psoriasis include the following:

• Topical corticosteroids (for the skin)
• Ophthalmic corticosteroids (for the eyes)
• Keratolytic agents
• Vitamin D analogs
• Topical retinoids
• Topical combinations
• Antimetabolites
• Immunomodulators
• Tumor necrosis factor (TNF) inhibitors
• Phosphodiesterase-4 enzyme inhibitors
• Interleukin inhibitors
• Injectable corticosteroids
• Ophthalmic agents

Medications used to treat psoriasis work in unique ways in managing the condition and alleviating its symptoms.

Topical corticosteroids

Topical corticosteroids are powerful anti-inflammatory agents which can reduce plaque formation. The strength of topical steroids and the type of formulation depend on the thickness of the plaques and their location in the body. Creams and ointments are typically used on the body, while foams and solutions may be easier to apply on scalp.

FDA-approved Topical corticosteroids used for psoriasis include:

• Triamcinolone acetonide topical (Triderm)
• Betamethasone valerate topical (Dermabet)
• Halobetasol propionate (Bryhali, Lexette, Ultravate)

Ophthalmic corticosteroids

Ophthalmic corticosteroids are used to treat eye inflammation caused by psoriasis. FDA approved ophthalmic corticosteroids include:

• Prednisolone acetate ophthalmic (Pred Forte, Pred Mild, Omnipred)
• Dexamethasone ophthalmic (Maxidex, Ozurdex)

Keratolytic agents

Keratolytic agents cause loosening and shedding of dead skin cells and slow down skin cell growth. Removal of plaques helps corticosteroids reach the tissue underneath and improves outcome from the treatment. Keratolytic agents available over the counter as shampoos, foams, creams and gels include:

Coal tar (DHS Tar, Balnetar, Cutar, Polytar, Theraplex T): Coal tar is antibacterial and soothes itching. Coal tar is often used along with topical corticosteroids, and it also enhances the effects of phototherapy. Coal tar is particularly useful in widespread psoriasis and plaques on hairy regions of the body.

Anthralin (Dritho-Scalp, Zithranol): Anthralin based creams and shampoos are used for scalp psoriasis, though they are not a top choice because anthralin can irritate healthy skin.

Vitamin D analogs

Vitamin D analogs are synthetic vitamin D formulations which inhibit immune cell activity on the skin and regulate skin cell production. Vitamin D analogs are available as ointments which can be used on the face and foams and solutions for the scalp. FDA-approved vitamin D analogs for plaque psoriasis include:

• Calcitriol ointment (Vectical)
• Calcipotriene (Dovonex, Sorilux)

A combination Vitamin D analog with corticosteroid is:

• Calcipotriene/betamethasone dipropionate (Enstilar, Taclonex)

Topical retinoids

Retinoids are compounds derived from vitamin A. Retinoids modulate the growth of epithelial cells, a type of cell on the skin surface. Retinoids may be a choice for use in the face, but it should not be used by pregnant women. An example of topical retinoid used for psoriasis is:

• Tazarotene (Tazorac, Fabior, Avage)

Topical combinations

Topical corticosteroid/retinoid combination drug approved by FDA for plaque psoriasis is:

• Halobetasol propionate/tazarotene (Duobrii)

Antimetabolites

Antimetabolites are synthetic protein molecules which interfere with cell metabolism and DNA replication in cells. Antimetabolites inhibit the rapid proliferation of skin cells in psoriasis. The FDA-approved antimetabolite prescribed for psoriasis, which is also a disease-modifying antirheumatic drug (DMARD) used for treating psoriatic arthritis, is:

• Methotrexate (Trexall, Otrexup)

Immunomodulators

Immunomodulators help reduce skin cell growth in psoriasis and inhibit progression of psoriatic arthritis by suppressing immune activity. Immunomodulators prescribed for psoriasis include:

• Tacrolimus Topical (Protopic) used off-label for psoriasis
• Cyclosporine (Sandimmune, Neoral, Gengraf) FDA-approved for psoriasis

Tumor necrosis factor (TNF) inhibitors

TNF inhibitors are biologic drugs which neutralize the activity of tumor necrosis factor-alpha (TNF-A), an inflammatory protein (cytokine) produced by T cells. TNF inhibitors are useful in reducing skin inflammation in psoriasis as well as joint inflammation from psoriatic arthritis. FDA-approved TNF inhibitors used for plaque psoriasis and psoriatic arthritis include: 

• Infliximab (Remicade)
• Etanercept (Enbrel)
• Etanercept-szzs (Erelzi)
• Adalimumab (Humira)

Phosphodiesterase-4 (PDE4) enzyme inhibitors

The mechanism of phosphodiesterase-4 enzyme (PDE4) inhibitors in psoriasis is not fully understood. Inhibition of PDE4 enzyme’s activity has been effective in reducing inflammation. The FDA-approved PDE4 inhibitor for active psoriatic arthritis and moderate to severe plaque psoriasis is:

• Apremilast (Otezla)

Interleukin inhibitors

Interleukin inhibitors are lab-produced protein molecules known as monoclonal antibodies which block the activity of interleukins. Interleukins are a group of cytokines which play an important role in inflammation in autoimmune diseases. Each type of monoclonal antibodies targets a specific interleukin to prevent inflammation in psoriasis.

FDA has approved the following Interleukin inhibitors for moderate to severe plaque psoriasis and active psoriatic arthritis in patients who are candidates for systemic therapy or phototherapy:

• Secukinumab (Cosentyx)
• Ixekizumab (Taltz)
• Brodalumab (Siliq)
• Ustekinumab (Stelara)
• Risankizumab-rzaa (Skyrizi)
• Guselkumab (Tremfya)
• Tildrakizumab-asmn (Ilumya)

Injectable corticosteroids

The injectable corticosteroid approved by FDA for administration into plaques and psoriatic nails is:

• Triamcinolone (Kenalog, Aristospan)

Ophthalmic agents

Ophthalmic formulations are used to moisturize and reduce irritation in the eyes from psoriasis. Many brands of over-the-counter eye-moisturizing agents are available such as:

• Artificial tears (Tears Naturale Forte, Bion Tears, Murine Tears)

• Please visit our medication section of each drug within its class for more detailed information.
• If your prescription medication isn’t on this list, remember to look on MedicineNet.com drug information or discuss with your healthcare provider and pharmacist.
• It is important to discuss all the drugs you take with your doctor and understand their effects, possible side effects and interaction with each other.
• Never stop taking your medication and never change your dose or frequency without consulting with your doctor.