Treatment & preventive care

Healthcare professional listening to a patient during an appointment

PsO treatment selection

PsO treatments are typically selected based on the severity of the condition, patient characteristics (eg, associated comorbidities), and response to previous therapies.

Each patient's treatment plan is tailored to considering factors like the type and severity of PsO, response to previous treatments, comorbidities, and personal preferences.

The goal is to balance effectiveness with safety, especially when considering long‑term treatment medications for chronic conditions like PsO.

Treatment for mild‑to‑moderate PsO

Treatments for mild‑to‑moderate PsO may be topical, which can be safely prescribed in primary care.

Treatment for complex/severe PsO

For more complex or severe cases, a combination of treatments is often used, such as topical agents, and systemic agents including biologics.

Systemic therapy algorithm

One example of a systemic therapy algorithm from the National Psoriasis Foundation.

1.Does the psoriasis affect >3% body surface area (BSA)?

2.Is the patient disabled by the psoriasis?

3.Does the psoriasis have a significant impact on the patient’s quality of life?

4.Does the patient have psoriatic arthritis?

No to all

Yes, if any apply

The patient is not a candidate for total body phototherapy or systemic treatment.

5.Does the patient have psoriatic arthritis?*

6.Was systemic treatment required in the past?

7.Is phototherapy contraindicated or unavailable, or is the psoriasis resistant to phototherapy?

No to all

Yes, if any apply

The patient is not a candidate for systemic treatment, but may be a candidate for phototherapy if they have >3% BSA.

The patient is a candidate for systemic treatment.

*Phototherapy can be used for treatment of psoriasis skin lesions in patients with psoriatic arthritis, but these patients also require systemic treatment for the joint involvement.

Bhutani T, Haberman R, Khattri S, et al. The Psoriasis and Psoriatic Arthritis Pocket Guide: Treatment Algorithms and Management Options 9th ed. Alexandria, VA: National Psoriasis Foundation; 2025.

Additional NPF resources can be found here: https://www.psoriasis.org/for-medical-professionals

PsO treatments

Therapy

Mechanism of action

How used

Severity use

Corticosteroids	Bind to a receptor in the cytoplasm of cells and are transported to the nucleus, affecting gene transcription; have anti‑inflammatory, immunosuppressive and antiproliferative properties	Potency and the appropriate vehicle is based on disease severity, location, patient preference, and age	Mild to moderate
Vitamin D analogs	Bind to vitamin D receptors, which inhibit keratinocyte proliferation and enhance keratinocyte differentiation	May be used as maintenance treatment with/after topical corticosteroids	Mild to moderate
Retinoids	Help normalize skin cell growth and reduce inflammation	May be used as maintenance treatment after topical corticosteroids	Mild to moderate
Calcineurin inhibitors	Bind to calcineurin, blocking its phosphorylation and thus, inhibiting T‑cell activation and the synthesis of several proinflammatory cytokines	May be used as maintenance treatment after topical corticosteroids	Mild to moderate
Salicylic acid	Believed to involve the reduction of the binding between keratinocytes. Helps to minimize scaling and softens psoriatic plaques	May be used alone or with other topical therapy	Mild to moderate
Coal tar	Polyaromatic hydrocarbons bind to aryl hydrocarbon receptors; decreases keratinocyte proliferation by suppressing DNA synthesis. Helps reduce inflammation	May be used alone or with ultraviolet B radiation therapy	Mild to moderate
Aryl hydrocarbon receptor (AhR) agonist	Binds to and activates the AhR, a ligand‑dependent transcription factor that regulates cytokine and skin‑barrier‑protein expression and antioxidant activity	May be considered as first‑line treatment for mild psoriasis	Mild to moderate to severe
Phosphodiesterase 4 (PDE4) inhibitor	Selectively inhibits PDE4, leading to accumulation of cAMP	May be considered as first‑line treatment for mild psoriasis	Mild to moderate to severe

Narrow and ultraviolet B (UVB) or psoralen plus ultraviolet A (PUVA)

Slows the rapid growth of skin cells and reduces inflammation

May be used alone or with topical or systemic medications

Moderate to severe

Retinoids	Modulate epidermal differentiation and proliferation and have anti‑inflammatory and immunomodulatory effects	Often combined with other treatments	Moderate to severe
Immunosuppressants	Slow skin cell turnover and suppress the immune system	May be used alone	Moderate to severe
Small molecules	Includes PDE4 inhibitors, modulate inflammatory response	May be used alone	Moderate to severe
Tumor necrosis factor (TNF)‑α inhibitors	Block TNF‑α, a key inflammatory cytokine, to reduce inflammation and skin cell turnover	May be used alone	Moderate to severe
Interleukin (IL)‑12/23, IL‑17 and IL‑23 inhibitors	Target specific immune pathways, such as IL‑12, IL‑17, and IL‑23, by reducing inflammation and plaque formation	May be used alone	Moderate to severe
Tyrosine kinase 2 (TYK2) inhibitors	Reduce inflammation by blocking IL‑12, IL‑23, and type I interferon signaling	May be used alone	Moderate to severe

View & download PsO treatments table

Preventive medicine and health maintenance checklist

The joint American Academy of Dermatology and National Psoriasis Foundation guidelines for care of patients with PsO, including those receiving biologics recommend the following prevention and health maintenance care. It may be advisable to coordinate with dermatology on assuring these assessments and interventions are completed.

Cardiovascular risk monitoring

Alcohol monitoring and counseling

Smoking cessation

Infection monitoring and vaccines

Screening for tuberculosis (TB) and hepatitis

Blood monitoring

Cancer screening

Ophthalmologic screening

Mental health monitoring

Medication adherence and access

View & download checklist

Medication adherence & access

Medication nonadherence worsens outcomes

Screen for nonadherence and offer support (education, reminders, organization tools, or help accessing medications).

Referral can help

Social workers, pharmacists, or patient navigators can assist with medication or insurance issues.

Use the National Psoriasis Foundation (NPF) navigation center

The NPF provides tools to support access and adherence. See the resources section for links.

Remote resources to improve care access

Telemedicine and eConsults improve access to dermatological care by enabling timely diagnosis, treatment, and follow‑up, particularly benefiting patients in underserved or rural areas.

Shared decision-making (SDM) in PsO treatment selection

SDM helps ensure treatment choices reflect the patient’s preferences, lifestyle, values, and clinical evidence. It involves collaboration between patient and provider to choose among options like topicals, systemics, or biologics.

Key components of SDM

Discuss disease severity and treatment goals
Review efficacy, side effects, and quality of life impact
Consider cost, route, and frequency of administration

Benefits of SDM

Increases patient engagement and satisfaction
Can increase self‑efficacy and reduce decisional conflict

Shared decision-making support