Three dermatologists stand in front of a giant clipboard, which shows a treatment plan with various parts highlighted with visual examples.

How Are Plaque Psoriasis Treatments Chosen?

Last updated: December 2022

There are many treatment options for plaque psoriasis. Each person’s journey will look different. In some cases, the same drug might work better for one person than for another. A treatment also might have different side effects for different people.1

Common factors in treatment planning

Finding the best psoriasis treatment plan can take time and effort. It can be a trial-and-error process. One of the best ways to create a strong treatment plan is to work closely with your dermatologist.

Although there are many different treatment paths, there are some common factors that doctors consider. These may include:1-3

  • How severe your psoriasis is
  • Which parts of your body are affected
  • Whether you also have psoriatic arthritis (PsA)
  • Whether you are pregnant or could become pregnant
  • Your age (especially when treating kids)
  • The cost of the treatment
  • How effective the treatment is
  • How the treatment is administered
  • Your other health issues
  • What has or has not worked for you in the past

These specialists take many factors into account when prescribing treatments. They also can make changes based on your feedback.1

Local versus whole-body treatment

There are two main types of psoriasis treatment – topical and systemic. Topical, or local, treatments usually come in the form of lotions or creams. They are applied to specific areas of the skin.1-3

Systemic, or whole-body, treatment has wider effects. These treatment options include phototherapy or drugs that are taken to affect the immune system. Examples of systemic drugs include:1-3

  • Steroids
  • Methotrexate
  • Biologics

In many cases, topical and systemic treatments can be used together.1-3

Treatment planning based on severity

Psoriasis is defined based on how severe it is. Mild psoriasis affects less than 5 percent of the body's surface area. If psoriasis affects more than 5 to 10 percent of the body's surface area, it is considered moderate or severe.1

In general, topical treatments are the first treatment for mild psoriasis. They can be used alongside phototherapy or systemic drugs for more symptom relief. Systemic drugs also may be used in mild cases if the hands, feet, or face are affected.1

For moderate to severe psoriasis, systemic treatment options are generally used. Biologic drugs are the most effective treatment for severe psoriasis, but they are expensive. Biologic drugs are made from living cells.1-3

Other systemic drugs, such as methotrexate or steroids, can still be helpful and cost less. But some systemic treatments tend to have more side effects and cannot be taken by everyone. For example, people with liver problems or who are pregnant should not take methotrexate. And widespread phototherapy may not be safe in people who have had skin cancer.1

Treatment planning based on location

Topical treatments typically contain vitamin D, steroids, or a combination of the two. But some areas of the skin may be too sensitive for steroid treatment. This includes the face or skin folds. When psoriasis affects these areas, steroids may need to be avoided. In these cases, other topical options, like tacrolimus, can be helpful.1

The scalp is another tricky area. Scalp psoriasis is hard to treat with lotions or creams because they are messy. Shampoos, foams, or systemic drugs may be easier to use.1

Treatment options for special groups

There are some groups of people that may have unique factors to consider when planning psoriasis treatment. These include:1,4-7

  • People with psoriatic arthritis: People who have both plaque psoriasis and PsA may need to focus on drugs that target both skin and joint inflammation.
  • People who are pregnant:Those who are pregnant may need to avoid certain drugs, like methotrexate. Their doctor also may reduce doses of other treatments to prevent harm to their unborn baby.
  • Children: Not all psoriasis drugs are safe and effective for kids. Using the lowest possible doses and avoiding long-term use of steroids are important in planning.
  • People with chronic infections: Some systemic drugs increase the risk of certain infections becoming severe. People with HIV, chronic hepatitis, or latent tuberculosis are at higher risk for worsening infections.
  • People with other health conditions: Past or current health issues can also affect psoriasis treatment. These issues include liver problems, cancer, or inflammatory bowel disease.

Each person’s plan will be unique to them and their needs. If you have questions about your psoriasis treatment plan or are unhappy with it, talk with your doctor. Honest feedback can help you get the options that are best for you.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The PlaquePsoriasis.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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