The Best Plaque Psoriasis Treatments, According to Dermatologists

Having plaque psoriasis is physically—and sometimes, emotionally—painful. The good news is that plenty of treatment options exist. Plaque psoriasis is the most common type of psoriasis, a skin condition that causes red and silver thick, scaly patches of skin.

"Wearing your disease on the outside of your body can be very difficult, which is why it's wonderful that we have so many plaque psoriasis treatments that we can use to make people better," Robert T. Brodell, MD, chair of the department of dermatology at the University of Mississippi Medical Center, told Health.

There are several ways to treat plaque psoriasis, from topical treatments and light therapy to systemic medications.

"Over the past 20 years, we've seen a lot of advancements in treatments. Your dermatologist has many options to tailor treatment for you," said Dr. Brodell.

Here's what you need to know about the three best options for treating symptoms and reducing flares of plaque psoriasis.

How Do Dermatologists Treat Plaque Psoriasis?

There is no cure for psoriasis. But there is almost always a treatment option that can help, Adam Friedman, MD, a professor of dermatology at George Washington School of Medicine and Health Sciences, told Health.

Suppose that after seeking treatment, you're still experiencing symptoms and flares of your moderate-to-severe psoriasis. Still, a healthcare provider isn't offering you another option. That should be a warning sign to you, explained Dr. Friedman. 

"We know under-treatment is a problem," added Dr. Friedman.

Here are three treatment categories that dermatologists commonly recommend, plus several non-traditional remedies experts say may be worth a try. A healthcare provider may use one or a combination of the following to relieve you.

Topical Treatments

Topical treatments, like steroid creams, reduce scaling and redness. Healthcare providers often try topical therapies for plaque psoriasis, no matter what part of the body it presents on.

"A strong topical treatment is what we might start with if someone has localized psoriasis, and if no progress is made, we'll move on," noted Dr. Brodell.

Some topicals are available by prescription only, while others can be purchased over the counter (OTC). In addition to steroids, other topical treatments include non-steroidal options, including calcipotriene, tazarotene, calcineurin inhibitors, and roflumilast. Additionally, OTC lotions, foams, bath products, and shampoos can help.

Some OTC treatments contain active ingredients approved by the Food and Drug Administration for psoriasis treatment. For example, salicylic acid works by softening plaques and scales and removing them from the skin. And tar, made from coal or wood, slows skin cell growth and reduces inflammation, itching, and scaling.

A word of caution, though: tar can irritate the skin. And some people (including pregnant or breastfeeding people) should avoid using it.

You may review the National Psoriasis Foundation (NPF) Seal of Recognition to ensure that OTC products are not irritating and safe for psoriasis.

Light Therapy

By shining ultraviolet (UV) rays on the skin, light therapy (also known as phototherapy) can help skin cells grow more slowly. Light therapy helps with psoriasis by suppressing the immune system. In turn, inflammation reduces, which allows the skin to heal and stop itching.

Light therapy can be an effective treatment for the skin but pointed out a fundamental limitation: "It works pretty well for skin disease. But doesn't have an effect on joint disease or underlying medical problems associated with psoriasis," explained Dr. Friedman.

And having to go to an office a few times a week to receive light therapy can deter people, added Dr. Friedman. So, the question is whether that's even necessary. 

Beginning in 2019, a large randomized controlled trial, called the LITE Study and funded by the independent nonprofit Patient-Centered Outcomes Research Institute, compared the safety and effectiveness of 12 weeks of at-home versus office-based UVB phototherapy for the treatment of psoriasis.

"We're trying to see if getting the treatment at home is a viable option," said Dr. Friedman, whose institution was among the trial sites.

But light therapy isn't without side effects. In some cases, the skin may become red and tender, like a sunburn, afterward. Also, people with medium-to-dark skin may develop dark spots.

Systemic Medications

If you've tried topical treatments or light therapy with no relief, a healthcare provider may prescribe oral medications or biologics.

Either prescription or OTC oral medicines work within the body to slow down the immune system. Some common options may include the following:

• Methotrexate
• Soriatane (acitretin)
• Otezla (apremilast)
• Sotyktu
• Cyclosporin

Healthcare providers may also try one of several intravenous and injectable biologics available to target specific areas of the body, which include:

• Anti-TNF therapies, such as Cimzia, Enbrel, and Humira
• Anti-IL-17 inhibitors, such as Taltz and Cosentyx
• Anti-IL-23 inhibitors, such as Tremfya, Skyrizi, and Ilumya

"There are now 13 or 14 biologic drugs, which are targeted therapies that keep most of your immunity functioning normally," said Dr. Brodell. "Targeted therapies for some patients are almost magical in the way they can knock down psoriasis."

Healthcare providers often rotate among several systemic drugs to find the one that works best for you, added Dr. Brodell. As with any medication you take, discussing the potential side effects with a healthcare provider is essential.

Do Complementary and Alternative Approaches Work for Plaque Psoriasis?

Plenty of people with psoriasis turn to non-traditional therapies for relief. Some people find that integrating natural treatment can be helpful when combined with traditional therapies.

In responding to a patient survey described in 2019 in the Journal of the American Academy of Dermatology, 41% of people reported using alternative treatments instead of traditional medicine. And 50% of people said they had added complementary remedies to their treatment regimen.

But some remedies can interact with medications or might not be a good fit for you, so it's important to talk with a healthcare provider first. Below are some options.

Aloe Vera

Aloe vera gel may help reduce redness and scaling caused by psoriasis and can be applied up to three times a day. Try finding a cream containing 0.5% aloe.

Apple Cider Vinegar

Applying apple cider vinegar a few times a week can help with itching on the scalp caused by psoriasis. But only try apple cider vinegar if you don't have cracked skin or bleeding areas on the scalp. 

To avoid burning, use organic apple cider vinegar diluted with water in a one-to-one ratio.

Capsaicin

Capsaicin derived from chili peppers can block nerve endings that cause pain when added to creams and ointments. 

Other benefits? Capsaicin may quell inflammation and reduce redness and scaling. However, more research is needed on capsaicin's long-term benefits and safety.

Sea Salt

Adding Dead Sea salt or Epson salts to a warm, 15-minute bath can help scales fall off and relieve itching.

Turmeric

Curcumin, the active ingredient in turmeric, can effectively treat psoriasis. Turmeric and curcumin products are taken orally or applied topically in recommended amounts and "are probably safe," per the National Center for Complementary and Integrative Health (NCCIH).

However, those products may be unsafe when used by pregnant people in large amounts. Also, little is known about their safety during breastfeeding.

Mahonia

When applied to the skin, mahonia, an antimicrobial herb, can help mild to moderate psoriasis. A cream with 10% mahonia is an effective treatment. 

Additionally, per a review published in 2018 in the Journal of Clinical and Aesthetic Dermatology, mahonia use is associated with significant symptom improvement and minimal side effects.

Physical Therapy and Massage

Some people with psoriasis may develop psoriatic arthritis. With psoriatic arthritis, you may experience painful, stiff, and swollen joints.

Physical therapy can help with psoriatic arthritis by increasing mobility in the affected joints. Because massage can help loosen and stretch muscles and joints, physical therapy may be helpful for those with psoriasis and psoriatic arthritis.

Acupuncture

Acupuncture involves inserting needles into specific spots on the body to relieve symptoms in those areas. 

According to a review published in 2018 in JAMA Dermatology, acupuncture, a traditional Chinese therapy, may be beneficial for treating psoriasis. However, the researchers note that, based on the available studies at the time of the review, it was difficult to discern the most effective technique for treating psoriasis.

Mind-Body Therapies

Since stress can trigger psoriasis flares, some researchers have examined the role of meditation and relaxation techniques. For example, some of those techniques use guided imagery. 

Based on a few studies, according to a 2021 study published in Medicina, mind-body interventions may be a beneficial complementary treatment.

Indigo Naturalis

Applied topically, indigo naturalis, a derivative of indigo plants, is safe and effective for treating psoriasis.

Per the 2018 JAMA Dermatology review, there's reasonable evidence to recommend trying indigo naturalis, which is traditional Chinese medicine, also known as qing dai. But the researchers noted that the optimal dosage is uncertain and cautioned consumers that it might be challenging to find a reputable source for this product.

Cannabis

The effects of medical cannabis on those with psoriasis were being studied as of November 2022, said Dr. Friedman.

"There is pre-clinical data about how it could be anti-inflammatory, but we don't have a lot of information," added Dr. Friedman.

However, per a study published in 2022 in Clinical Rheumatology, researchers found no differences between the pain scores reported by cannabis users and non-users."

Anti Inflammatory Diet

No diet can cure psoriasis, but eating certain foods may be able to help your condition. That's because some foods have been shown to reduce inflammation in the body. Some of them include the following:

• Tomatoes
• Olive oil
• Green leafy vegetables such as kale and spinach
• Nuts such as almonds and walnuts
• Fatty fish (salmon, mackerel, tuna, and sardines)
• Fruit

A Quick Review

Plaque psoriasis is a physically and emotionally painful skin condition. Luckily, plenty of treatments exist to ease the symptoms. Some of the best options for treating symptoms and reducing flares of plaque psoriasis include topical therapies, light therapy, and systemic medications. 

But many people with psoriasis also utilize complementary therapies in conjunction with those treatments. Those therapies may include aloe vera, turmeric, physical therapy, and massage. 

It's essential to consult a healthcare provider about your symptoms to decide what treatments are for you.