From the Guidelines
Treatment options for psoriasis include topical therapies, phototherapy, and systemic medications, with the approach depending on severity and affected areas, and the most recent guidelines recommend a step-wise approach starting with topical therapies for mild to moderate cases, and progressing to phototherapy and systemic medications for more severe cases, as outlined in the 2020 joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies 1. The treatment of psoriasis depends on the severity and extent of the disease, as well as the patient's medical history and preferences.
- For mild to moderate psoriasis, first-line treatments include:
- Topical corticosteroids (like betamethasone or clobetasol)
- Vitamin D analogs (calcipotriene)
- Retinoids (tazarotene) These are typically applied once or twice daily to affected areas.
- For moderate to severe cases, phototherapy using UVB light or PUVA (psoralen plus UVA) may be administered 2-3 times weekly for several months.
- When these approaches are insufficient, systemic medications are considered, including:
- Methotrexate (7.5-25 mg weekly)
- Cyclosporine (2.5-5 mg/kg/day)
- Oral retinoids like acitretin (10-50 mg daily)
- Biologics such as adalimumab (Humira), etanercept (Enbrel), ustekinumab (Stelara), or newer IL-17 inhibitors like secukinumab (Cosentyx) These treatments work by reducing inflammation, slowing skin cell growth, or modulating immune responses that drive psoriasis, as discussed in the guidelines of care for the management of psoriasis and psoriatic arthritis: section 4 1. Patients should moisturize regularly, avoid triggers like stress and alcohol, and be monitored for potential side effects of medications, particularly with systemic therapies that may affect liver function or increase infection risk, as noted in the guidelines of care for the management of psoriasis and psoriatic arthritis: section 6 1. The British Association of Dermatologists' guidelines for biologic interventions for psoriasis 2009 also provide guidance on the use of biologic therapies in severe chronic plaque psoriasis, and recommend their use in patients who have failed to respond to conventional systemic therapies or have contraindications to their use 1. Overall, the treatment of psoriasis requires a comprehensive approach that takes into account the patient's individual needs and circumstances, and the most recent guidelines and evidence-based recommendations should be followed to optimize outcomes, as outlined in the 2020 joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies 1.
From the FDA Drug Label
Following repeated nonocclusive application in the treatment of scalp psoriasis, there is some evidence that clobetasol propionate topical solution has the potential to depress plasma cortisol levels in some patients Topical corticosteroids such as clobetasol propionate are effective in the treatment of corticosteroid-responsive dermatoses primarily because of their anti-inflammatory, antipruritic, and vasoconstrictive actions.
Treatment options for psoriasis include topical corticosteroids such as clobetasol propionate. This medication is effective in treating corticosteroid-responsive dermatoses, including psoriasis, due to its anti-inflammatory, antipruritic, and vasoconstrictive actions. 2
From the Research
Treatment Options for Psoriasis
The treatment options for psoriasis include:
- Topical therapies, such as corticosteroids and vitamin D analogs, which are the mainstay for patients with limited or mild psoriasis 3, 4, 5, 6
- Phototherapy, which is often indicated for patients with more severe disease 3, 7
- Conventional systemic agents, such as acitretin, cyclosporine, and methotrexate, which may be contemplated when psoriasis is moderate or severe 7
- Biologics, which are often used in combination with topical therapies or other treatments 3
Topical Therapies
Topical therapies are the most widely prescribed treatments for psoriasis, and include:
- Corticosteroids, such as betamethasone 3, 4, 5, 6
- Vitamin D analogs, such as calcipotriene 3, 4, 5, 6
- Keratolytics 4
- Calcipotriol/betamethasone propionate compound 4
- Tazarotene, anthralin, tacrolimus, and pimecrolimus 6
Combination Therapies
Combination therapies, such as combining topical agents with biologics, conventional systemic agents, or phototherapy, may provide additional clinical benefits and improve treatment outcomes 3, 5, 6
Treatment Goals
The goal of treatment is to control the clinical symptoms of the skin, reduce systemic disease potential, and improve the patient's quality of life 3