Psoriasis Treatment

Psoriasis is a chronic immune-mediated skin condition where the immune system speeds up skin cell turnover, producing thick red plaques with silvery scale. Genetics play a strong role, and common flare triggers include stress, skin injury (the Koebner phenomenon), infections — particularly strep throat, which can precipitate guttate psoriasis — certain medications (beta-blockers, lithium, antimalarials), smoking, alcohol, and cold or dry weather. It is not contagious.

Plaque psoriasis is by far the most common form — thick, well-defined red plaques with silvery scale on the elbows, knees, scalp, and lower back. Other types include guttate (small drop-like lesions, often after strep), inverse (smooth red patches in skin folds), pustular (small pus-filled bumps), and erythrodermic (widespread redness — a medical emergency). Nail changes and scalp involvement are common across types.

Treatment is matched to severity and body-surface area. Mild cases respond to topical corticosteroids, vitamin D analogs (calcipotriene), and coal tar. Moderate cases add phototherapy (narrow-band UVB) or oral options like methotrexate, apremilast, or acitretin. For moderate-to-severe or resistant psoriasis, biologics targeting TNF, IL-17, or IL-23 — adalimumab, secukinumab, ixekizumab, guselkumab, risankizumab, ustekinumab — can produce near-complete clearance for many patients.

About 30% of people with psoriasis develop psoriatic arthritis — joint pain, stiffness, and swelling that can lead to permanent damage if untreated. Any new joint symptoms should prompt evaluation, since early treatment protects joints. Psoriasis is also associated with cardiovascular disease, metabolic syndrome, inflammatory bowel disease, and depression, so annual screening and comprehensive care matter.

Topical corticosteroids can cause skin thinning with prolonged use. Vitamin D analogs may cause mild irritation. Methotrexate requires regular lab monitoring (liver function, blood counts) and is contraindicated in pregnancy. Apremilast commonly causes GI upset and headache. Biologics have a strong track record but modestly increase infection risk and require TB screening before starting; injection-site reactions are common.