There are many effective psoriasis treatment choices. The best treatment is individually determined by the treating doctor and depends, in part, on the type of disease, the severity, and amount of skin involved.

    For mild disease that involves only small areas of the body (like less than 10% of the total skin surface), topical treatments (skin applied), such as creams, lotions, and sprays, may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriatic plaque may be helpful.

    For moderate to severe disease that involves much larger areas of the body (>10% or more of the total skin surface), topical products may not be effective or practical to apply. This may require ultraviolet light treatments or systemic (total body treatments such as pills or injections) medicines. Internal medications usually have greater risks. Because topical therapy has no effect on psoriatic arthritis, systemic medications are generally required to stop the progression to permanent joint destruction.

    It is important to keep in mind that as with any medical condition, all medicines carry possible side effects. No medication is 100% effective for everyone, and no medication is 100% safe. The decision to use any medication requires thorough consideration and discussion with your health care provider. The risks and potential benefit of medications have to be considered for each type of psoriasis and the individual. Of two patients with precisely the same amount of disease, one may tolerate it with very little treatment, while the other may become incapacitated and require treatment internally.

    A proposal to minimize the toxicity of some of these medicines has been commonly called "rotational" therapy. The idea is to change the anti-psoriasis drugs every six to 24 months in order to minimize the toxicity of one medication. Depending on the medications selected, this proposal can be an option. An exception to this proposal is the use of the newer biologic medications as described below. An individual who has been using strong topical steroids over large areas of their body for prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy, like calcitriol (Vectical), light therapy, or a systemic drug.