Psoriasis Treatment

Psoriasis is one of the most common skin diseases worldwide, particularly in the United States, where eight million people suffer from the condition and approximately 20 percent of these individuals also have psoriatic arthritis. Because psoriasis can resemble other skin rashes, such as eczema or Tinea corporis (fungal infections), those without specialized dermatologic training often misdiagnose it. A psoriasis doctor, like Dr. Michele Green, is a board-certified dermatologist who specializes in diagnosing psoriasis and other dermatologic conditions and providing the most effective topical or systemic treatment available.

Many psoriasis treatment options are now available for this chronic skin disease, ranging from topical steroids such as hydrocortisone and salicylic acid to calcipotriene ointments, retinoids, phototherapy, systemic therapies, and biologics. Because psoriasis varies widely in severity and presentation, treatment must be individualized. Dr. Green designs a unique plan for each patient to help manage the disease safely and effectively.

Dr. Michele Green is an internationally recognized, board-certified dermatologist based on the Upper East Side of Manhattan, New York City, with decades of experience treating patients with psoriasis and other complex skin conditions. She combines advanced medical dermatology with a compassionate, individualized approach to help each patient achieve clearer, healthier skin. Dr. Green stays at the forefront of dermatologic innovation, offering patients access to the latest FDA-approved treatments and biologic therapies for psoriasis.

What is psoriasis?

Psoriasis is a common, chronic skin condition in which skin cells grow at an accelerated rate. This skin disease is believed to be an autoimmune disorder, caused by overactive skin cells, which leads to a buildup of thick plaque on the skin, forming either large or small scaly patches. Psoriasis can be caused or aggravated by genetic or environmental factors, such as obesity, skin injuries, skin irritants, certain infections, or medications.

Psoriasis can be itchy or uncomfortable, and your dermatologist should be your first stop for the best psoriasis treatment. Board-certified dermatologist Dr. Michele Green is trained to identify and treat psoriasis symptoms, working with you to explore skin care treatment options and create personalized, holistic health care

As a dermatologist, Dr. Green can treat all forms of psoriasis, from mild plaque psoriasis to more severe forms such as pustular or erythrodermic psoriasis, using a combination of topical, systemic, and biologic treatments tailored to each patient’s needs.

Types of Psoriasis

Plaque Psoriasis

Plaque psoriasis is the most common type. It ranges from mild (covering 3% of the skin) to severe (covering 10% or more of the body). It is caused by accelerated skin cell growth: instead of developing over several weeks, cells develop over several days, leading to the most identifiable symptom, plaque buildup. Plaque may range in color from silver to red and typically appears on the feet, knees, lower back, elbows, and hands. Other symptoms and skin problems include nail psoriasis and:

• Dry skin that may flake, crack, or bleed
• Itchy, stinging, or burning skin that is sensitive to touch
• Thick or rounded fingernails
• With severe psoriasis: pus-filled blisters

Plaque psoriasis symptoms can occur anywhere on the body. Because it is chronic, symptoms will usually wane during periods of remission and later return as flare-ups, similar to atopic dermatitis (eczema).

Guttate Psoriasis

Guttate psoriasis is less common than plaque psoriasis and appears as smaller, teardrop-shaped red spots on the skin. Guttate psoriasis occurs when the immune system begins to attack normal cells within the body and is often triggered by an initial infection, such as:

• Bacterial Infection (primarily strep throat)
• Tonsilitis
• Upper Respiratory Infection

Guttate psoriasis also varies in intensity from mild to severe, but depending on the location, it may be considered more severe. For example, if a patient has lesions on the face or scalp psoriasis requiring specialized shampoos, a dermatologist may classify this as more severe due to the way it affects the patient’s quality of life.

Erythrodermic Psoriasis

Erythrodermic psoriasis is a very rare, very severe form of psoriasis that can lead to other medical complications and can sometimes be life-threatening. This form occurs when the immune system produces an excess of T-cells, which are typically used to fend off disease, and the T-cells move to destroy healthy skin cells. Symptoms of erythrodermic psoriasis usually develop from other forms of psoriasis, though newer biologics like ixekizumab (brand name Taltz) are being studied for various severe presentations. Additionally, symptoms can include:

• Pain in the joints and nails
• Severe redness, itching, and pain
• Sheets (rather than flakes) of skin shedding
• Burnt-looking dermis
• Pustules and blisters
• Higher heart rate
• Large body temperature changes

Erythrodermic psoriasis often develops with inconsistent psoriasis treatment, but an allergic reaction, sunburn, or overuse of corticosteroids can also trigger it. In some cases, erythrodermic psoriasis can disrupt a psoriasis patient’s body chemistry, increasing the risk of life-threatening complications such as fluid retention, infection, pneumonia, or congestive heart failure. Therefore, contact your health provider if you think you may have erythrodermic psoriasis.

Pustular Psoriasis

Pustular psoriasis is another rare form of psoriasis that can sometimes occur alongside plaque psoriasis. It is more common in adults than in children and is identified by white, pus-filled bumps that appear on the hands and feet, as in palmoplantar psoriasis, or in skin folds, as in inverse psoriasis. Three distinct types of pustular psoriasis vary in intensity.

The first, Palmoplantar pustulosis, is the mildest form, in which small blisters can crust over or crack and symptoms may fade. Acropustulosis involves more severe pain, with very small white blisters and lesions on the affected area. If you observe red, tender skin that quickly develops large blisters, you may have generalized pustular psoriasis, an extremely rare, severe form of psoriasis that requires immediate medical attention.

Psoriatic Arthritis

According to a National Psoriasis Foundation study, 30% of psoriasis patients in the United States develop psoriatic arthritis. This painful condition causes joint stiffness and limited mobility because inflammation from psoriasis affects the joints.

People with psoriasis and psoriatic arthritis are often at higher risk for other medical issues, such as cardiovascular disease and diabetes. They should keep all health care providers up to date on any flare-ups or further developments. Psoriatic arthritis may also require joint care from your dermatologist and a rheumatologist, as rheumatology focuses on a variety of arthritic diagnoses.

What are my psoriasis treatment options?

Although there is currently no cure for psoriasis, clinical trials are underway to investigate the condition further. Psoriasis symptoms can be treated with a range of options, including coal tar and vitamin D analogs:

• Topical treatments such as topical corticosteroids, calcineurin inhibitors, moisturizers, creams, lotions, oils, and gels (over-the-counter and prescription)
• Therapies that target and support the immune system through immunosuppressive medications (cyclosporine, methotrexate, retinoids like acitretin, or anthralin)
• Live-organism therapy (biologic agents like Enbrel, also known as etanercept, or Humira, also known as adalimumab)
• Light therapy (ultraviolet light lasers, PUVA, narrowband UVB, and UVB phototherapy)

How does light therapy treat psoriasis?

Phototherapy, or light therapy, exposes the skin to lasers, LED lights, and ultraviolet or infrared radiation to treat the whole body or target specific areas of irritated skin. Excimer lasers are a preferred form of light therapy because they can target specific areas of the skin in fewer treatments, preventing damage to healthy skin and other side effects.

In extremely severe cases of psoriasis, doctors may use PUVA phototherapy. It is an aggressive therapy used to keep severe psoriasis symptoms at bay. Ongoing studies are examining light therapy treatments and their increased risk of skin cancers, such as squamous cell carcinoma and malignant melanoma.

Frequently Asked Questions

What Causes Psoriasis?

Psoriasis develops when the immune system mistakenly accelerates skin cell turnover, causing new cells to form in days rather than weeks. Both genetic and environmental factors can trigger or worsen psoriasis, including obesity, skin injuries, infections, certain medications, and stress. Because the underlying cause is immune-related rather than purely dermatologic, effective psoriasis treatment often targets both the visible plaques and the overactive immune response that drives them.

What Does Psoriasis Look Like?

Psoriasis typically appears as raised, well-defined patches of skin covered with silvery-white scale, most often on the elbows, knees, scalp, and lower back, though it can appear anywhere on the body. The appearance varies by type: plaque psoriasis tends to be thick and scaly, guttate psoriasis presents as white, pus-filled bumps marking small, teardrop-shaped spots, and pustular psoriasis. Dr. Green can help patients distinguish these presentations from other skin conditions with a similar appearance, such as eczema or fungal infections.

What Are the Symptoms of Psoriasis?

In addition to visible plaques or scaly patches, psoriasis symptoms often include itching, burning, or stinging skin; dry skin that may crack or bleed; and thickened or pitted nails. Some patients also experience joint pain and stiffness associated with psoriatic arthritis. Because symptoms range from mild to severe and can flare unpredictably, an accurate diagnosis from a board-certified dermatologist like Dr. Green is essential for selecting the right psoriasis treatment plan.

What Is the Latest Treatment for Psoriasis?

The most recent advances in psoriasis treatment are biologic therapies that target specific components of the immune system responsible for triggering psoriasis. Newer biologics, such as risankizumab, guselkumab, and ixekizumab, have shown strong results in achieving clear or nearly clear skin and have a favorable safety profile compared with older systemic treatments. Dr. Green stays current on emerging biologic and systemic therapies to offer her patients access to the most advanced options available.

Is There a Permanent Treatment for Psoriasis?

No permanent cure for psoriasis exists; it is a chronic autoimmune condition that tends to cycle between flare-ups and periods of remission. However, with a personalized combination of topical, phototherapy, systemic, or biologic treatments, most patients can achieve long-lasting symptom control and extended periods of remission. Dr. Green works closely with each patient to adjust their psoriasis treatment plan as needed over time.

What Is the Best Treatment for Plaque Psoriasis?

Mild to moderate plaque psoriasis often responds well to topical treatments, including corticosteroids, calcipotriene, or calcineurin inhibitors, along with regular moisturizers to reduce scaling and irritation. For more extensive plaque psoriasis, phototherapy or systemic and biologic treatments may be recommended to control the accelerated skin cell growth at its source. Dr. Green tailors treatment for each patient based on plaque severity and location.

What Is Scalp Psoriasis?

Scalp psoriasis causes red, scaly patches on the scalp that can extend to the forehead, neck, or behind the ears. It is often more difficult to manage because of hair coverage. Treatment typically includes medicated shampoos, topical corticosteroids, or scalp-specific calcipotriene. More severe or widespread cases may require systemic or biologic therapy. Dr. Green can recommend a scalp-specific regimen to relieve itching and scaling while minimizing impact on hair and quality of life.

What Is the Treatment for Nail Psoriasis?

Nail psoriasis can cause pitting, thickening, discoloration, or separation of the nail from the nail bed, and is often associated with psoriatic arthritis. Treatment may include topical corticosteroids or calcineurin inhibitors applied to the nail and surrounding skin, corticosteroid injections, or systemic and biologic therapies for more severe or widespread disease. Because nail psoriasis can respond slowly, Dr. Green typically recommends a treatment plan that addresses the nails alongside other affected skin areas.

What Is the Treatment for Genital Psoriasis?

Genital psoriasis, a form of inverse psoriasis that occurs in skin folds, requires especially gentle treatment because of the area’s sensitivity. Clinicians typically use low-potency topical corticosteroids or calcineurin inhibitors for short periods to minimize irritation, and they may consider systemic or biologic treatments for more persistent or widespread cases. Dr. Green approaches genital psoriasis with discretion and care, helping patients manage symptoms comfortably and effectively.

What Is the Best Treatment for Severe Psoriasis?

Severe psoriasis, including widespread plaque psoriasis, erythrodermic psoriasis, or generalized pustular psoriasis, typically requires systemic or biologic therapy rather than topical treatment alone. Treatment options may include immunosuppressive medications such as methotrexate or cyclosporine, oral retinoids like acitretin, or targeted biologics such as ustekinumab, adalimumab, or etanercept. Because severe psoriasis can pose serious health risks, Dr. Green closely monitors patients receiving systemic treatment to ensure safety and effectiveness.

What Is Biologic Treatment for Psoriasis?

Biologic treatments are medications derived from living organisms that target specific immune proteins that drive psoriasis. Commonly used biologics include etanercept, adalimumab, ustekinumab, guselkumab, risankizumab, and ixekizumab, each acting through a slightly different immune pathway. Candidacy for biologic therapy is based on psoriasis severity, treatment history, and overall health.

Does UVB Light Therapy Help Psoriasis?

Yes, UVB phototherapy, including narrowband UVB, is an effective psoriasis treatment that slows accelerated skin cell growth and reduces inflammation with regular, controlled exposure. It is often used for patients with moderate psoriasis who have not responded well to topical treatment alone or prefer to avoid systemic medication.

How Long Does Psoriasis Treatment Take to Work?

Most psoriasis treatments take several weeks to show visible improvement: topical treatments may begin working within two to four weeks, while phototherapy and systemic or biologic therapies often take one to three months to reach their full effect. Because psoriasis is chronic, treatment is generally ongoing rather than a one-time fix, even after symptoms improve. Dr. Green sets realistic expectations for each patient and closely monitors progress throughout treatment.

Why Is My Psoriasis Treatment Not Working?

Psoriasis treatment can lose effectiveness for several reasons, including inconsistent use, an inaccurate initial diagnosis, or the body developing tolerance to a particular medication over time. New stressors, such as infection, sunburn, or lifestyle factors like obesity, can also trigger flare-ups. If a psoriasis treatment plan isn’t working, Dr. Green can reassess the diagnosis and adjust the approach, which may include switching topical treatments, adding phototherapy, or transitioning to a systemic or biologic treatment.

When Should I See a Dermatologist for Psoriasis?

Patients should see a dermatologist as soon as they notice persistent scaly patches, unexplained rashes, or joint pain that may indicate psoriatic arthritis, because early diagnosis leads to better long-term outcomes. Seek immediate care for symptoms of erythrodermic or generalized pustular psoriasis, which can become medical emergencies. Dr. Green provides comprehensive evaluations to accurately diagnose psoriasis and rule out other skin conditions that may look similar.

How Much Does Psoriasis Treatment Cost?

The cost of psoriasis treatment varies widely by type and severity, ranging from affordable topical treatments and over-the-counter moisturizers to more costly phototherapy sessions or biologic medications. Many biologic and systemic treatments are partially covered by insurance when deemed medically necessary, though coverage varies by plan and provider. Dr. Green’s office can help patients understand their treatment options and navigate insurance coverage for psoriasis.

Schedule Your Psoriasis Treatment Consultation with Dr. Michele Green Today

Psoriasis is a common, chronic condition that ranges from mild plaque psoriasis to severe forms such as erythrodermic or pustular psoriasis. While there is no permanent cure, today’s wide range of topical, phototherapy, systemic, and biologic treatments makes it possible to manage symptoms and maintain long periods of remission. Because psoriasis can be difficult to distinguish from other skin conditions and treatment must be tailored to each patient’s disease type and severity, working with an experienced psoriasis doctor is essential to finding lasting relief. Dr. Michele Green draws on her extensive dermatologic expertise to create individualized psoriasis treatment plans for every patient she sees.

As an internationally recognized, board-certified dermatologist based on the Upper East Side of Manhattan, Dr. Michele Green offers expert psoriasis care. Castle Connolly, New York Magazine, Super Doctors, and The New York Times consistently name Dr. Green among NYC’s top dermatologists for her clinical expertise and commitment to her patients. If you’re frustrated by the appearance or symptoms of your psoriasis, don’t wait to get the care you deserve. Contact us online or call Dr. Michele Green’s office today at 212-535-3088 to schedule your consultation and learn more about the most effective psoriasis treatment options for you.