Psoriasis Treatment

What Is Psoriasis?

Psoriasis is a chronic, immune-mediated skin disease in which T-cells mistakenly attack healthy skin cells, triggering a cycle of rapid skin cell turnover. Normal skin cells mature and shed in about 28–30 days. In psoriasis, that cycle compresses to 3–4 days — causing cells to pile up on the skin surface and form the raised, red, scaly plaques characteristic of the disease.

According to the World Health Organization, psoriasis affects approximately 125 million people worldwide. In the United States, the American Academy of Dermatology estimates 7.5 million Americans live with the condition. It can begin at any age but most commonly appears between ages 15–35 or 50–60.

Psoriasis is not merely a cosmetic concern. Beyond the skin, it is associated with an increased risk of psoriatic arthritis, cardiovascular disease, metabolic syndrome, and depression. Treating the skin condition may also reduce systemic inflammation and its associated risks.

Types of Psoriasis

• Plaque psoriasis: The most common form — accounting for 80–90% of cases. Raised, red or pink plaques covered with thick, silvery-white scales. Most often appears on the elbows, knees, lower back, and scalp.
• Guttate psoriasis: Small, drop-shaped lesions that appear suddenly, often following a streptococcal throat infection. More common in children and young adults.
• Inverse psoriasis: Smooth, red, shiny patches in skin folds — the armpits, groin, under the breasts, and around the genitals. Often worsened by friction and sweating.
• Pustular psoriasis: White pustules (non-infectious) surrounded by red skin. Can be localized (palms and soles) or widespread (generalized pustular psoriasis, a medical emergency).
• Erythrodermic psoriasis: A rare, severe form in which widespread, fiery-red skin covers most of the body. Requires immediate medical attention.

Symptoms of Psoriasis

• Raised, red or pink plaques covered with silvery-white scales
• Dry, cracked skin that may bleed
• Itching, burning, or soreness
• Thickened, pitted, or ridged nails (nail psoriasis)
• Scalp scaling that may extend beyond the hairline
• Joint pain, stiffness, and swelling (psoriatic arthritis)

Psoriasis Treatment at Dermatology of Seattle

Treatment is selected based on disease severity, location, patient health history, and prior treatment response. Dermatology of Seattle offers every level of the treatment ladder — from gentle topicals for mild disease to advanced biologics for moderate-to-severe psoriasis.

Topical Treatments (Mild to Moderate)

• Topical corticosteroids — reduce inflammation and slow skin cell turnover
• Vitamin D analogues (calcipotriol/Dovonex, calcitriol) — normalize skin cell growth
• Topical retinoids (tazarotene) — reduce scaling and plaque thickness
• Coal tar — reduces scaling, itching, and inflammation; available in shampoo for scalp psoriasis
• Salicylic acid — softens and removes scales to improve penetration of other treatments
• Topical calcineurin inhibitors — for sensitive areas such as the face and skin folds

Phototherapy (Moderate to Severe)

• Narrowband UVB (NB-UVB) — the most widely used form of phototherapy; effective for plaque and guttate psoriasis; available at Dermatology of Seattle
• PUVA (psoralen + UVA) — for extensive disease not responding to NB-UVB
• Excimer laser — targets localized plaques with high-intensity UVB

Biologic Therapies (Moderate to Severe)

Biologics are injectable or infused medications that target specific immune pathways driving psoriasis. They represent a major advance in treatment and can achieve near-complete skin clearance in many patients.

• TNF-alpha inhibitors — adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade)
• IL-17 inhibitors — secukinumab (Cosentyx), ixekizumab (Taltz), bimekizumab (Bimzelx)
• IL-23 inhibitors — guselkumab (Tremfya), risankizumab (Skyrizi), tildrakizumab (Ilumya)
• IL-12/23 inhibitor — ustekinumab (Stelara)

Oral Systemic Medications

• Methotrexate — long-established; also treats psoriatic arthritis
• Cyclosporine — rapid onset; used for severe flares
• Acitretin — oral retinoid; particularly effective for pustular and erythrodermic psoriasis
• Apremilast (Otezla) — oral PDE4 inhibitor; well-tolerated with no required lab monitoring
• Deucravacitinib (Sotyktu) — oral TYK2 inhibitor; newest oral option with strong efficacy