Psoriasis treatment

There are many effective treatments available for psoriasis and we will endeavour to find a treatment that works for you and your lifestyle. Treatments can be broadly categorised into topical treatments (creams/ointments), phototherapy, systemic medications (tablets) and biological therapies (injections). Often a combination of these treatments will be recommended. It is useful to think of a treatment pyramid, where most people with psoriasis will be on topical treatments and fewer will require systemic or biological therapy.

Topical treatment

Emollients: we advise regular use of emollients and moisturisers in all people with psoriasis as it helps to keep the skin healthy. They do not have to be medically prescribed moisturisers and we advise that the best moisturiser is often one that you like and will therefore use on a regular basis. Perfumed moisturisers, if you prefer them, are not usually a problem for people with psoriasis.

‘Active’ topical treatments include:

  • Vitamin D analogues (Calcipotriol/Dovonex/Silkis), 
  • Tar-based treatments (Exorex/Sebco/Cocois/special mixtures)
  • Vitamin A analogues (Zorac)
  • Dithranol (Dithrocream) 
  • Potent steroid/Vitamin D combination treatment (Dovobet)

Topical steroids include:

  • Mild: Hydrocortisone 1% cream/ointment
  • Moderate: Clobetasone butyrate (Eumovate) cream/ointment, and betamethasone valerate 1 in 4 (Betnovate RD) cream/ointment
  • Potent: Mometasone furoate (Elocon), betamethasone valerate (Betnovate) cream/ointment
  • Super-potent: Clobetasol proprionate (Dermovate) cream/ointment and diflucortolone valerate 0.3% (Nerisone Forte Oily cream) – for use on the palms and soles only

Phototherapy

Phototherapy is provided on Monday, Wednesday and Friday by dedicated phototherapists and medical physicists. The phototherapy unit is located in the dermatology day unit opposite clinic 6 on the 1st floor of the Royal Free Hospital. The phototherapy clinic is open between 8.30am and 4.30pm.

Systemic treatments 

The following treatments are taken by mouth in tablet form. They all require monitoring with regular clinic appointments and blood tests.

  • Acitretin
  • Ciclosporin
  • Fumaric acid esters
  • Methotrexate

Monitoring of medication

If you are taking a tablet medication, we will ask you to have blood tests performed before your appointment (either the day before or week before) so that the results are available to us when we see you. If this is not possible for any reason, please come to your appointment and have the bloods checked on the day – just let a nurse know you are going to have your bloods checked, so we know where you are. It is very important that you are monitored closely whilst taking tablets for your psoriasis. Please let us know if this is difficult for any reason.

Biological treatments

These are treatments which are injected. To be eligible for these treatments you will need to have tried other systemic therapies first and have severe psoriasis which greatly impacts your life. If you require a biological medication and meet the national criteria, funding will be sought to secure treatment. Biological treatments available currently include:

  • Adalimumab (Humira)
  • Etanercept (Enbrel)
  • Infliximab (Remicade)
  • Ustekinumab (Stelara)