Psoriasis Treatment Options, Compared

While there is no permanent cure for psoriasis, scientists are constantly developing new treatment options to help manage symptoms. If you live with psoriasis, your treatment pathway depends largely on how much of your body is affected and how well your skin responds to initial therapies. Current topical therapies—including corticosteroids, vitamin D analogs, tapinarof, and roflumilast—remain the mainstay for mild disease, while oral systemic and biologic options are for moderate to severe cases.

The good news is that the psoriasis treatment landscape has expanded dramatically in recent years. The psoriasis treatment landscape in 2025 includes expanded indications for existing therapies and novel agents, enhancing patient choice and treatment efficacy. Understanding the main categories of treatments and how they differ can help you and your healthcare provider find an approach that works for your situation.

Topical Treatments for Localized Psoriasis

The broad categories for topical treatments are steroidal and nonsteroidal. These creams, ointments, and other preparations have anti-inflammatory effects on the skin to clear psoriasis plaques. Topical steroids work quickly and are often a first-line choice for small areas of active psoriasis, but although effective and fast-acting, topical steroids have potential side effects. Doctors typically limit the use of topical steroids to no more than two consecutive weeks for most medications.

Nonsteroidal topical options have become increasingly available. Roflumilast cream was approved by the FDA in 2022 for management of plaque psoriasis in adults and adolescents. Roflumilast is a topical PDE4 inhibitor. This type of medication works differently from steroids and can be used for longer periods without the same skin-thinning concerns. Roflumilast is the only topical treatment for which efficacy has been specifically demonstrated in the management of intertriginous psoriasis.

Vitamin D analogs are also available as topical treatments and work by regulating skin cell growth. These medications can often be safely used long-term compared to steroids. Topical treatments work best for localized disease (10% body surface area) and may be tried first before moving to stronger systemic options.

Phototherapy: Light-Based Treatment

Light therapy, specifically UVB (Ultraviolet B) and PUVA (Psoralen + Ultraviolet A), is considered effective for treating psoriasis. UV light induces apoptosis of keratinocytes and T cells in the epidermis and dermis. UV light promotes immunosuppression by promoting migration of Langerhans cells out of the epidermis as well as decreasing mast cell degranulation and histamine release.

Narrowband UVB phototherapy is the most commonly prescribed light-based approach. Approximately 60% of patients who completed on average 2 or more sessions per week over a 12-week period of home or office phototherapy achieved clear or almost clear skin, which is a high bar of effectiveness. This treatment can be delivered in a dermatologist's office or, with proper training and monitoring, at home using a portable device.

The excimer laser can target areas of the skin affected by mild-to-moderate psoriasis. Research indicates it is a particularly effective treatment for scalp psoriasis. Another option, topical PUVA involves either soaking in a bath or applying a lotion containing psoralen followed by UVA treatment. However, the disadvantages of UVA and PUVA treatments include a high risk of cancer along with immediate reactions including, nausea, headache, burning of the skin and photosensitivity.

Oral Systemic Medications

For moderate to severe psoriasis that does not respond adequately to topical or light therapies, doctors may prescribe oral medications that work throughout the body. Examples with Food and Drug Administration (FDA) approval for treating psoriasis include: Methotrexate and cyclosporine: These decrease immune system activity to block inflammation.

Oral TYK2 inhibitors and IL-23 receptor blockers show promising efficacy and safety in late-stage trials, offering alternatives to injectable biologics. These newer oral options represent a shift toward more targeted immunomodulation, meaning they work on specific parts of the immune system rather than suppressing it broadly. Oral medications are typically used when topical treatments and phototherapy have not provided adequate relief or when psoriasis covers large areas of the body.

Biologic Therapies: Targeted Immune Approaches

A biologic is a type of medication that can specifically target, or quiet, the part of the immune system that is overactive because of psoriasis. They are more specific than traditional drugs and do not generally suppress the immune system. This targeted approach is a major advantage over older systemic treatments that dampen overall immune function.

There are now more than 13 FDA-approved biologic options for moderate to severe psoriasis. Biologic drugs fall into several classes based on which immune pathways they target. The IL-23 drugs are higher up in the inflammatory pathway cascade than the IL-17 therapies, and Bimzelx (bimekizumab-bkzx) is an IL-17 A/F inhibitor whose MOA includes blockage of IL-23-independent pathways. Its indications include psoriasis, PsA, ankylosing spondylitis, and hidradenitis suppurativa.

Biologics mostly are administered by subcutaneous injection. There are a few that are given by an IV. Most patients can self-administer injections at home on a regular schedule, making biologics accessible for long-term management. This means that biologics have less risk of causing problems with the liver, kidneys, and other organs than do other strong psoriasis medications.

🔄 Key Biologic Considerations

• 😊 A biologic is an important treatment option for people with moderate-to-severe psoriasis, psoriatic arthritis, or both.
• ⚕️ Because the biologics work by calming down part of your immune system, anyone taking a biologic has an increased risk of developing a serious infection. The risk is higher in patients who have diabetes, smoke or chew tobacco, or have a history of infections.
• 💊 You will need to get some tests while taking a biologic; however, you will need fewer tests than when taking another strong psoriasis medication like cyclosporine or methotrexate.
• 💰 Biosimilars aren't exact replicas of biologics. Instead, they're reverse-engineered to produce similar results as biologics. Like generic drugs, biosimilars are made once the original biologic goes off patent. The advantage of biosimilars is that they often cost a lot less than the original product.

Treatment Comparison Table

Choosing a Treatment Approach

The treatment path typically follows a step-wise approach based on disease severity and response. Typically, localized disease (10% body surface area) is managed with topical medications while larger areas require phototherapy or systemic therapy. If you don't respond well to initial options, your dermatologist can adjust your plan.

In many cases, other topical and systemic medications for psoriasis (eg, methotrexate) may also be prescribed in an attempt to improve efficacy. Combination therapy—using more than one treatment at the same time—is common and often more effective than a single agent alone. Biological medication is often very effective in psoriasis. However, in some cases, they lose their effectiveness after a period of time (secondary failure) and other treatment may be required.

Special Situations and Sensitive Areas

Psoriasis on certain body areas presents unique challenges. Ideal candidates for biologics include patients who have psoriasis in sensitive locations, locations that really create a lot of psychological and physical morbidity or that are just hard to treat. The scalp, the face, the hands, and the palms and the soles specifically and the genital areas. Those are areas where we think about biologics very early in the treatment process. Psoriasis in skin folds and genital areas can be difficult to treat with topical steroids, so doctors may consider stronger options sooner.

Disease localized to the palm and soles is often treated systemically, since skin thickness in this area is not amenable to topical therapy. The thick skin in these locations requires treatments that work from within the body rather than on the surface.

Moving Forward With Treatment

Finding the right psoriasis treatment often requires patience and collaboration with your healthcare team. Not every therapy works equally well for every person, and side effects can vary widely. Talk with a qualified healthcare provider about your specific situation, including which areas of your body are affected, how much your psoriasis impacts your daily life, and any other health conditions you have. Your doctor can help determine whether to start with topical options, move to phototherapy, or consider systemic or biologic medications based on your individual needs and preferences.

The expanding range of treatment options means there is likely an effective approach for your psoriasis. Whether you're managing mild localized plaques or extensive skin involvement, modern treatments offer better control of symptoms than ever before, allowing many people to achieve significant improvement in skin clearance and quality of life.