Psoriasis is a skin condition that causes new skin cells to grow too quickly and build up in thick areas. Psoriasis has many forms and can range from mild to severe, depending on how it affects a person.
There are lots of treatments for psoriasis. Physicians often consider a different treatment approach for people with severe psoriasis than for people with a mild or moderate form of the condition.
In this article, we discuss medical treatment for psoriasis and home remedies that may help.
What is severe psoriasis?
Doctors will consider a number of factors when assessing the severity of a person’s symptoms.
Erythrodermic psoriasis is almost always severe and requires urgent medical treatment. A painful, peeling rash can cover large parts of the body and can lead to life-threatening complications.
In other types of psoriasis, experts use various tools to assess the severity of symptoms. Here are a few tools.
This evaluation method takes into account the body surface area.
|Form of psoriasis||Body surface affected|
|easy||less than 5%|
|difficult||more than 10%|
Other key factors include:
- symptom intensity
- Location of symptoms, such as whether they are on the face, hands or feet, or in the skin, wrinkles
- Effects on a person’s daily life
Psoriasis area and severity index The
Psoriasis area and the Severity Index (PASI) measure both the extent and severity of symptoms. It takes into account the intensity of thickness and scale and gives values of none (0), light (1), moderate (2), heavy (3) or very heavy (4).
There is a tool that individuals can use for an approximate PASI score. However, this tool does not guarantee accuracy, and people should contact a doctor if they have concerns about psoriasis symptoms.
PASI also measures redness, but it’s important to note that not all skin affected by psoriasis turns red.
For example, people with dark skin tones may have their skin darker or take on a purple tint. According to the American Academy of Dermatology, people with brown skin may also develop coral-colored patches of skin.
People with dark skin often had difficulty getting an accurate diagnosis of psoriasis. One reason is that changes are easier to see in fair skin. However, diagnostic tools that only relate to how changes affect white skin may also have played a role.
Therefore, determining the presence of inflammation may be a better strategy than determining skin color changes when identifying the type of psoriasis for all skin types.
Dermatology Life Quality Index
Psoriasis can affect a person’s mental health, and people with psoriasis often suffer from anxiety, depression, and social isolation.
For this reason, doctors can also use a Dermatology Life Quality Index questionnaire to assess the impact of symptoms on a person’s quality of life. Symptoms that look mild to others can have serious effects on mental health and daily functioning.
Physicians may also consider the results of a questionnaire on coping strategies.
Learn more about skin diseases that mimic psoriasis here.
Medications and treatments for psoriasis include the following:
- systemic or biological drugs
- topical preparations
- natural, complementary and alternative therapies
Topical creams and natural remedies can often treat mild symptoms, but a person with severe symptoms will likely need treatment with biologics or systemic medications.
Medication options for treating severe psoriasis include:
Biologics are a relatively new type of medication that can help alleviate symptoms and reduce the risk of flares.
They block inflammation and prevent overproduction of skin cells by targeting specific parts of the immune system. Examples include:
- Adalimumab (Humira)
- Certolizumab (Cimzia)
- ustekinumab (Stelara)
A doctor may give these medicines intravenously or as an infusion. The drugs influence the functioning of the immune system and can increase the risk of infection. For this reason, they may not be right for everyone.
Other systemic therapies
Systemic drugs have an effect on the entire body. They are an older treatment, but doctors still use them frequently, either alone or with biologics. They are cheaper than biologics and are available in oral form.
Examples of systemic medicines for psoriasis include:
- Methotrexate, available by injection or by mouth
- Cyclosporine (Neoral)
- Acitretin (Soriatane)
- Tofacitinib (Xeljanz)
- Apremilast (Otezla)
Systemic drugs work in different ways. Methotrexate, cyclosporine, and apremilast reduce inflammation by suppressing the immune system.
Acitretin, a retinoid, reduces inflammation and affects skin cell production. However, it does not suppress the immune system.
Systemic medications may have adverse effects. A doctor will help a person choose a suitable option, depending on the severity of their symptoms and other factors.
Learn how systemic and topical treatments for psoriasis differ here.
Some treatments for psoriasis are applied directly to the skin.
Topical therapies include:
- corticosteroids, whose strength depends on the severity of symptoms
- topical tacrolimus and pimecrolimus, calcineurin inhibitors
- Vitamin D analogs
- , topical retinoids such as tazarotene (tazorac)
- moisturizers and emollients.
- salicylic acid
- coal tar
A doctor may recommend treatment alone or with a medication or other topical option.
Many topical treatments can have harmful effects, such as burning or irritation. Some treatments increase vulnerability to UV light. People should check with a doctor before using any product.
Learn more about lotions, creams and ointments for psoriasis here.
Drug treatment for psoriasis can alleviate symptoms, but it can also have negative effects.
Light therapy may be an option when symptoms no longer respond to topical treatments and a person does not yet feel ready for systemic or biological treatments.
There are various forms of light therapy. The most common is controlled exposure to UVB rays. Often, this therapy is administered at a phototherapy center, but some people may be able to get treatment at home.
Another option is to use the drug Psoralen to sensitize the skin to UVA light.
Natural, alternative and complementary remedies
Some people use natural, alternative or complementary therapies in addition to medical treatment.
For mild symptoms, natural treatment alone may be sufficient. However, people with severe symptoms will most likely need to use it in addition to treatment from the doctor.
Options that people sometimes use include:
- various treatments using herbal remedies from traditional Chinese medicine
- such as fish oil, vitamin D, turmeric and zinc
- , a gluten-free diet for people with a diagnosis
- Celiac disease wellbeing strategies for mind and body, such as hypnosis and meditation strategies
- for stress management, including cognitive-behavioral therapy and guided images
such as aloe vera and St. John’s wort supplements
There isn’t enough scientific evidence to support the use of all of these funds, and they may not be safe and effective for everyone. People should seek advice from a doctor before starting a new approach.
Find out more about 12 home remedies to treat psoriasis here.
A doctor may also make recommendations on lifestyle measures, including:
- Dietary changes
- regular exercise
- , smoking cessation, if applicable
- Limit alcohol consumption, if applicable
Smoking and alcohol consumption can act as triggers for psoriasis and increase the risk of other conditions. Experts strongly recommend quitting or avoiding smoking and limiting alcohol consumption.
Learn more about 11 triggers for psoriasis here.
treatment of complications
Psoriasis is a type of psoriatic disease that includes psoriatic arthritis (PsA). Approximately 30-33% of people with psoriasis can develop PsA, on average 10—11 years after the onset of psoriasis.
People with psoriasis are also at higher risk of developing other conditions, including depression, heart disease, and other aspects of metabolic syndrome.
A doctor will recommend appropriate treatment for complications, depending on the individual’s needs.
Learn more about psoriasis complications here.
How is treatment for severe psoriasis different?
Mild psoriasis may respond to topical creams, ointments, and natural remedies. Most people with mild psoriasis don’t need biological or systemic medications to treat their psoriasis symptoms
However, severe symptoms often do not respond to home remedies and topical treatments, and a person needs biological or systemic medication to manage the symptoms and prevent relapses. They may also need to combine multiple options.
A doctor may also prescribe biologics if symptoms are mild but involve the face, hands, or genitals.
In some cases, a person with severe psoriasis may need to spend time in hospital.
Severe psoriasis can cause discomfort and seriously impair a person’s quality of life. Several treatment options can help people with severe psoriasis manage their symptoms.
A doctor can help a person develop an appropriate treatment plan that may need to be adjusted over time.