Psoriasis: Diagnosis and treatment
Wondering if you have psoriasis?
A board-certified dermatologist can tell you. These doctors specialize in diagnosing and treating diseases that affect the skin, hair, and nails, and psoriasis can affect all three.
How do dermatologists diagnose psoriasis?
To diagnose psoriasis, a dermatologist will examine your skin, nails, and scalp for signs of this condition. Your dermatologist will also ask if you have any:
Symptoms, such as itchy skin
Nail problems, such as thickening or yellowing nails or nail pain
Joint problems, such as pain and swelling or stiffness when you wake up
Blood relatives who have psoriasis
Recent changes in your life, such as an illness or increased stress
Sometimes, a dermatologist will remove a small piece of skin. This is called a skin biopsy. By looking at the removed skin under a microscope, a doctor can confirm whether you have psoriasis.
Psoriasis can appear on the skin in different ways
In darker skin tones, psoriasis tends to cause thicker plaques and more scale than in people with lighter skin tones.
How do dermatologists treat psoriasis?
If you have psoriasis, your dermatologist will create a treatment plan that meets your individual needs. An individualized treatment plan has many benefits. It can relieve symptoms like itching. It can help you see clearer (or clear) skin. It can also prevent psoriasis from worsening.
To create an individualized plan, your dermatologist will consider the:
Type(s) of psoriasis you have
Places psoriasis appears on your body
Severity of the psoriasis
Impact psoriasis has on your life
Other medical conditions you have
Medications you are taking
The goals of psoriasis treatment are to:
Relieve symptoms like itch
Improve your skin health by removing scale and clearing psoriasis
Treat nail changes if you have them
Reduce joint pain if you also have psoriatic arthritis
There is no one best treatment for psoriasis, and no one treatment works for everyone. Your dermatologist may choose one specific treatment or prescribe two or more treatments.
When treating psoriasis, it’s important to keep in mind that you may need to try a few different treatments or combinations of treatments before you find the treatment that works best for you. During this time, your dermatologist will refine your treatment plan.
Your treatment plan may include one or more of the following:
Medication that you apply to your skin: Most people treat psoriasis with this type of medication. If you have mild psoriasis, this is often the only treatment you need.
Topical (applied to the skin) medication may also be part of a treatment plan for patients with more extensive psoriasis. For these patients, a topical medication may be used along with light therapy or medication that works throughout the body like methotrexate or a biologic.
The topical medications that dermatologists use to treat psoriasis include:
Corticosteroids
Many patients use this medication to treat psoriasis. A corticosteroid works quickly and is available in many strengths, which makes it beneficial for treating all types of psoriasis from the very mild to thick plaques.
For more information about this medication, go to Psoriasis treatment: Corticosteroids you apply to the skin.
Synthetic vitamin D
Also called a vitamin D analog, this medication differs from the oral supplements that people take when they need to get more vitamin D. This synthetic form has been tweaked to treat psoriasis.
To find out how it’s used, go to Psoriasis treatment: Synthetic vitamin D.
TCI (topical calcineurin inhibitor)
This medication is often used to treat psoriasis in areas with thinner skin, such as the face, neck, or body folds. In these areas, a TCI can be quite effective.
For more information, go to Psoriasis treatment: Tacrolimus ointment and pimecrolimus cream.
Salicylic acid
An effective acne treatment, salicylic acid has also been used to treat psoriasis for many years. It helps to reduce the scale and soften psoriasis plaques.
Salicylic acid is often prescribed along with another medication like a corticosteroid.
This medication should not be used to treat a child.
If you’re pregnant, talk with your dermatologist before using salicylic acid. Low concentrations of this medication can be safe to use during pregnancy. Your dermatologist can tell you how much you use.
Tazarotene
A retinoid that you apply to your skin, tazarotene can be used alone or along with a corticosteroid to treat plaque psoriasis.
To learn more about this medication, go to Psoriasis treatment: A retinoid applied to the skin.
Roflumilast cream
Approved to treat adults and children, this psoriasis cream is used to treat mild, moderate, or severe disease.
While many medications applied to the skin can treat plaque psoriasis, roflumilast can also effectively treat a type of psoriasis called inverse (aka intertriginous) psoriasis, which affects the body folds.
In the studies that led the FDA to approve roflumilast, the cream worked quickly to reduce the itch and clear psoriasis. This cream should be applied once a day to the skin with psoriasis and can be used for as long as needed.
Tapinarof cream
This cream is prescribed for adults who have mild, moderate, or severe psoriasis. It can be applied anywhere on the body, including the face. It’s usually applied once a day to skin with psoriasis.
In the studies that led to this medication’s approval, about 40% of the patients were clear or almost clear after 12 weeks of using this medication. When patients cleared and stopped using the cream, on average, they stayed clear for 12 weeks. The most common side effect is a skin reaction.
Coal tar
This medication has been used for more than 100 years to treat psoriasis. Today, you’ll find coal tar in many different products used to treat psoriasis.
To learn more about using coal tar to treat psoriasis, go to Psoriasis treatment: Coal tar.
Light therapy: This treatment uses special light bulbs or lasers to treat psoriasis.
Only use light therapy under a dermatologist’s supervision. Treating yourself by using a tanning bed or lying in the sun can cause skin damage like sunburn, which can worsen psoriasis. Over time, exposure to ultraviolet light (UV) from the sun or tanning beds can also cause skin cancer.
To learn more about light therapy that dermatologists prescribe, go to: Psoriasis treatment: Light therapy.
You’ll also find light treatments that you can use at home to treat psoriasis. These devices have limitations. You’ll find information about one such device at Can a wearable blue light clear psoriasis?
Medication that works throughout the body: Some people need strong medication to treat their psoriasis, especially if the psoriasis also affects their joints. For these people, medication that works throughout the body may be the best option.
If you need medication that works throughout the body, your dermatologist may prescribe one or more of these medications that’s FDA approved to treat psoriasis:
Apremilast
This is a pill that’s taken twice a day. Apremilast is used to treat plaque psoriasis and psoriatic arthritis. It can be taken by patients with complex medical issues who cannot be prescribed other medication that works throughout the body.
You’ll find information about how to take this medication, possible side effects, and more at Psoriasis treatment: Apremilast.
Biologic or a biosimilar
For many people, taking a biologic is life-changing because it helps control psoriasis, psoriatic arthritis, or both when other treatments fail. A biologic may be prescribed alone or along with another psoriasis treatment. To learn more about biologics, go to Psoriasis treatment: Biologics.
A biosimilar is a medication that is very similar to a biologic, but may cost less than the original biologic. For more information about biosimilars, read Biosimilars: 14 questions patients ask their dermatologist.
Cyclosporine
This medication comes in pill form and is prescribed for people who have extensive or disabling psoriasis. It tends to work quickly.
Find out how long people typically take cyclosporine, what to avoid when taking it, and more at Psoriasis treatment: Cyclosporine.
Methotrexate
Used for more than 40 years to treat psoriasis, this medication is prescribed to treat severe, disabling psoriasis. If this medication is part of your treatment plan, you should not drink alcohol while on methotrexate.
To find out what else you should know, go to Psoriasis treatment: Methotrexate.
Retinoid pill (acitretin)
Approved to treat severe psoriasis, acitretin can effectively treat different types of psoriasis like plaque, guttate, and pustular psoriasis.Unlike many psoriasis treatments that work throughout the body, acitretin doesn’t suppress your immune system.
If you are pregnant or planning to become pregnant, you should not take acitretin.
You’ll find information about how to take it, possible side effects, and more at Psoriasis treatment: Oral retinoids.
TYK2 inhibitor
The TYK2 inhibitor is a newer treatment option for psoriasis. If you haven’t gotten the results you want from other treatments for moderate or severe psoriasis, this may be an option for you.
Deucravacitinib (Sotyktu®) is a TYK2 inhibitor that’s FDA approved to treat psoriasis. The FDA approved this medication as a once-a-day tablet.
In clinical trials, about half the patients taking deucravacitinib had 75% or greater clearing of their psoriasis after taking this medication for 16 weeks.
Finding the right treatment can be challenging. Sometimes, a medication used to treat another condition works best for treating severe psoriasis. To learn more about these medications, go to Psoriasis treatment: Off-label medications that work throughout the body.
Follow up appointments are essential
After you’ve received your psoriasis treatment plan, your dermatologist will want to see you for follow-up appointments. These appointments can be helpful because your dermatologist will:
Find out how well the treatment plan is working for you
Modify your treatment plan if necessary
Watch for signs of psoriatic arthritis, a disease that you want to catch early
Look for signs that psoriasis is affecting your nails
Assess your risk of developing other diseases that are more common in people with psoriasis like high blood pressure and diabetes
Help you set realistic expectations for managing your psoriasis
Your dermatologist can also answer questions you have about treating psoriasis. Common questions that patients ask include:
Skin care also plays an important role in treating psoriasis because it can help reduce flare-ups. Find out what dermatologists recommend at Psoriasis: Tips for managing.
Related AAD resources
Images
Image 1: Getty Images
Image 2: Used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2011;65:164.)
Image 3: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
References
Armstrong AW, Gooderham M, et al. “Deucravacitinib versus placebo and apremilast in moderate to severe plaque psoriasis: Efficacy and safety results from the 52-week, randomized, double-blinded, placebo-controlled phase 3 POETYK PSO-1 trial.” J Am Acad Dermatol. 2023;88(1):29-39.
Elmets CA, Korman NJ, et al. “Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures.” J Am Acad Dermatol. 2021 Feb;84(2):432-70.
McKenzie S, Brown-Korsah JB, et al. “Variations in genetics, biology, and phenotype of cutaneous disorders in skin of color. Part II: Differences in clinical presentation and disparities in cutaneous disorders in skin of color.” J Am Acad Dermatol. 2022 Dec;87(6):1261-70.
Menter A, Gelfand JM, et al. “Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies.” J Am Acad Dermatol. 2020 Jun;82(6):1445-86.
Strober B, Stein Gold L, et al. “One-year safety and efficacy of tapinarof cream for the treatment of plaque psoriasis: Results from the PSOARING 3 trial.” J Am Acad Dermatol. 2022 Oct;87(4):800-6.
U.S. National Library of Medicine. “Trial of PDE4 inhibition with roflumilast for the management of plaque psoriasis (DERMIS-1).” Last updated 12/7/2022 Last accessed 1/5/2023.
Written by:
Paula Ludmann, MS
Reviewed by:
Robert Brodell, MD, FAAD
Craig A. Elmets, MD, FAAD
Laurel Geraghty, MD, FAAD
Roopal V. Kundu, MD, FAAD
William Warren Kwan, MD, FAAD
Shari Lipner, MD, PhD, FAAD
Bassel Hamdy Mahmoud, MD, PhD, FAAD
Omolara Olowoyeye, MD, FAAD
Sanna Ronkainen, MD, FAAD
Mario J. Sequeira, MD, FAAD
Last updated: 5/19/23