Strep throat is a common trigger. Here are 10 more psoriasis triggers you can avoid. Creams and ointments applied directly to the skin can be helpful for reducing mild to moderate psoriasis.

People with moderate to severe psoriasis , and those who have not responded well to other treatment types, may need to use oral or injected medications. Many of these medications can have severe side effects, and for that reason, doctors usually prescribe them for short periods of time.

This psoriasis treatment uses ultraviolet UV or natural light. Sunlight kills the overactive white blood cells that are attacking healthy skin cells and causing the rapid cell growth.

Both UVA and UVB light may be helpful in reducing symptoms of mild to moderate psoriasis. Most people with moderate to severe psoriasis will benefit from a combination of treatments. This type of therapy uses more than one of the treatment types to reduce symptoms.

Some people may use the same treatment their entire lives. Learn more about your treatment options for psoriasis. If you have moderate to severe psoriasis — or if psoriasis stops responding to other treatments — your doctor may consider an oral or injected medication.

This class of medications alters your immune system and prevents interactions between your immune system and inflammatory pathways. These medications are injected or given through intravenous IV infusion. Retinoids reduce skin cell production. Once you stop using them, symptoms of psoriasis will likely return.

Side effects include hair loss and mucosal dryness. People who are pregnant or may become pregnant within the next 3 years should not take retinoids because of the risk of possible birth defects in unborn children.

This can ease symptoms of psoriasis. It also means you have a weakened immune system, so you may become sick more easily. Potential side effects include kidney problems and high blood pressure. Like cyclosporine, methotrexate suppresses the immune system.

It may cause fewer side effects when used in low doses. It can cause serious side effects long term and is not suitable during pregnancy. Serious side effects include liver damage and reduced production of red and white blood cells. Learn more about the oral medications used to treat psoriasis.

Food cannot cure or even treat psoriasis, but eating a nutrient-rich diet might help reduce your symptoms. These five lifestyle changes may help ease symptoms of psoriasis and reduce flare-ups:.

Reducing your intake of saturated fats , which are found in animal products, like meats and dairy, can be helpful in managing psoriasis. Psoriasis causes inflammation. Certain foods can cause inflammation as well.

Avoiding those foods might help improve symptoms. These foods include:. Alcohol consumption can increase your risk of a flare-up. Cutting back or quitting entirely can help lower your risk.

If you have alcohol use disorder, your doctor can help you create a treatment plan. Some doctors prefer a vitamin-rich diet to vitamins in pill form. However, even the healthiest eater may need help getting adequate nutrients.

Ask your doctor if you should be taking any vitamins as a supplement to your diet. Learn more about your dietary options. Having psoriasis can be challenging at times, but with the right approach, you can reduce flare-ups. These three areas will help you cope in the short and long term:.

Losing any excess weight to reach a moderate weight and eating a nutrient-dense diet can go a long way toward helping ease and reduce symptoms of psoriasis. This includes eating a diet rich in omega-3 fatty acids, whole grains, and plants.

Also, limiting foods that may increase inflammation in your body is important. These foods include refined sugars, dairy products, and highly processed foods.

Speak with your doctor about whether an anti-inflammatory diet is right for you. Stress can be a trigger for psoriasis. Learning to manage and cope with stress may help you reduce flare-ups and ease symptoms. Consider trying the following to help reduce your stress level:.

People with psoriasis are more likely to experience depression and self-esteem issues, according to research. You may feel less confident when new spots appear. Talking with your support network about how psoriasis affects you may be difficult. The constant cycle of the condition may also be frustrating.

All emotional issues associated with psoriasis are valid. Connecting with supportive resources is important for handling them. This may include speaking with a mental health professional or joining a support group for people with psoriasis.

Learn more about living with psoriasis. This type of arthritis causes swelling, pain, and inflammation in affected joints. The presence of inflamed, red or purple areas of skin with plaques usually distinguishes this type of arthritis from others.

Psoriatic arthritis is a chronic condition. Like psoriasis, the symptoms of psoriatic arthritis may come and go, alternating between flare-ups and remission. Psoriatic arthritis can also be continuous, with constant symptoms and issues. This condition typically affects joints in the fingers or toes.

It may also affect your lower back, wrists, knees, or ankles. Most people who develop psoriatic arthritis have psoriasis. Most people who receive an arthritis diagnosis without having psoriasis have a family member who has the skin condition. Treatments for psoriatic arthritis may successfully ease symptoms, relieve pain, and improve joint mobility.

As with psoriasis, losing any excess weight, eating a nutrient-rich diet, and avoiding triggers may also help reduce psoriatic arthritis flare-ups. An early diagnosis and treatment plan designed for your specific situation can help reduce the likelihood of severe complications, including joint damage.

Learn more about psoriatic arthritis. Around 7. Psoriasis may begin at any age, but most diagnoses occur in adulthood. The average age of onset is between 15 and 35 years old. Dermnet NZ notes that the risk of developing psoriasis peaks between the ages of 16—22 years and 50—60 years.

These are the ages at which psoriasis is most likely to appear. According to the WHO , males and females are affected equally. Psoriasis is disproportionately diagnosed at a higher rate in white people, but it may be underdiagnosed in people of color because of how it presents on darker skin tones.

Having a family member with the condition increases your risk of developing psoriasis, according to the National Psoriasis Foundation.

However, many people with the condition have no family history at all. Some people with a family history will not develop psoriasis. Around one-third of people with psoriasis will be diagnosed with psoriatic arthritis.

In addition, people with psoriasis are more likely to develop conditions such as:. Though the data is not complete , some psoriasis statistics suggest psoriasis diagnoses are becoming more common. Psoriasis is a skin condition that results from a faulty immune reaction.

Plaque psoriasis — the most common type — causes silvery, scaly lesions that may itch, but other types can appear differently. There is no cure for psoriasis, but a range of at-home remedies and medical treatments can help manage it.

Read this article in Spanish. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. VIEW ALL HISTORY.

Psoriasis flares can last for weeks or months, but you can do a lot to ease your symptoms and lower your risk of future flares. Learn how here. Federal regulators have approved a new drug, Sotyktu, to treat severe plaque psoriasis. It's a pill as opposed to current injectable treatments.

The aging process may affect the way psoriasis shows up. Read more about the physical and mental health changes that may increase flare-ups, plus how….

A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect. Everything You Need to Know About Psoriasis. Medically reviewed by Joan Paul, MD, MPH, DTMH , Dermatology — By Kimberly Holland — Updated on February 1, Where does it start?

Types Symptoms Causes Diagnosis Triggers Treatment What to eat Living with psoriasis Psoriasis and arthritis Statistics Summary Psoriasis causes symptoms such as scaly, dry, or itchy skin.

Where does psoriasis usually start? What are the different types of psoriasis? What are the symptoms of psoriasis? Concomitant psoriatic arthritis — Patients with psoriasis should be assessed periodically for signs and symptoms of psoriatic arthritis. The concomitant presence of psoriatic arthritis and moderate to severe psoriasis favors the selection of treatments that are effective for both skin and joint disease.

See "Clinical manifestations and diagnosis of psoriatic arthritis" and "Treatment of psoriatic arthritis". Special populations — The treatment of psoriasis in pregnant women and patients with hepatitis B, hepatitis C, human immunodeficiency virus infection, latent tuberculosis, or malignancy is reviewed separately.

See "Treatment selection for moderate to severe plaque psoriasis in special populations" and "Management of psoriasis in pregnancy".

There is an association between psoriasis and inflammatory bowel disease. Biologics such as infliximab , adalimumab , and ustekinumab can be effective for both diseases.

Etanercept and the anti-IL biologics secukinumab , brodalumab , and ixekizumab are effective for psoriasis, but not for inflammatory bowel disease, and should be used with caution in patients with inflammatory bowel disease because these drugs may exacerbate inflammatory bowel disease [ 14 ].

Referral — Referral to a dermatologist should be considered in the following settings:. TOPICAL THERAPIES — Patient adherence may be the largest barrier to treatment success with topical therapies [ 9 ]; early patient follow-up within a week of initiating treatment may improve adherence.

Published guidelines for the treatment of psoriasis with topical therapies are available [ 15 ]. Emollients — Hydration and emollients are valuable and inexpensive adjuncts to psoriasis treatment.

Keeping psoriatic skin soft and moist minimizes the symptoms of itching and tenderness. Additionally, maintaining proper skin hydration can help prevent irritation and thus the potential for subsequent Koebnerization development of new psoriatic lesions at sites of trauma.

The most effective are ointments such as petroleum jelly or thick creams, especially when applied immediately after a hydrating bath or shower. In practice, however, whichever moisturizer the patient finds most appealing may be the best choice.

Corticosteroids — Topical corticosteroids remain the mainstay of topical psoriasis treatment despite the development of newer agents [ 16 ]. The mechanism of action of corticosteroids in psoriasis is not fully understood.

Corticosteroids exert anti-inflammatory, antiproliferative, and immunosuppressive actions by affecting gene transcription.

The inherent potency of a topical corticosteroid is frequently reported using a I to VII scale based on vasoconstrictive assays table 1. Although ointments are sometimes thought to be inherently more effective because of their occlusive properties, this is not uniformly correct.

To minimize adverse effects and maximize compliance, the site of application needs to be considered in choosing the appropriately potent corticosteroid:.

Clobetasol 0. Patients who use scalp oils or ointments for general hair care a common practice among individuals with Afro-textured hair may prefer an oil or ointment vehicle for scalp involvement.

The typical regimen consists of twice daily application of topical corticosteroids. Most patients will show a rapid decrease in inflammation with such therapy, but complete normalization of skin or lasting remission is unpredictable.

Topical corticosteroids generally can be continued as long as the patient has thick active lesions. Skin atrophy from topical corticosteroids usually is not a problem unless the medication is continuously applied after the skin has returned to normal thickness or if areas without psoriasis are exposed.

Once clinical improvement occurs, the frequency of application should be reduced [ 17 ]. For patients in whom lesions recur quickly, topical corticosteroids can be applied intermittently eg, on weekends only to maintain improvement. The addition of noncorticosteroid topical treatments to the treatment regimen can also facilitate the avoidance of long-term daily topical corticosteroids.

See 'Limited disease' above. The risks of cutaneous and systemic side effects associated with chronic topical corticosteroid use are greater with high-potency formulations compared with lower-potency formulations.

Data support limiting the continuous application of class I topical corticosteroids to two to four weeks; thus, close clinician supervision should be employed if longer treatment durations are required, as often occurs in psoriasis table 1 [ 17 ].

Data are less clear regarding treatment durations for less potent topical corticosteroids. Side effects of topical corticosteroids, including the potential for suppression of the hypothalamic axis, are discussed separately. See "Topical corticosteroids: Use and adverse effects".

The cost of topical corticosteroids varies widely. The price of a 60 gram tube of a potent corticosteroid brand name product can be hundreds of dollars.

There are generic preparations in each potency class that have reduced the cost somewhat, though generic prices in the United States are rising [ 18 ]. Examples of available generics include, in order of increasing potency, hydrocortisone 2.

Different formulations have been developed in an effort to enhance the delivery of topical corticosteroids. The main advantage of these newer preparations is likely greater patient acceptance, which may translate into greater adherence; the main disadvantage is cost.

Betamethasone valerate in a foam had superior efficacy for scalp psoriasis and was preferred, on average, by patients when compared with betamethasone valerate lotion [ 19 ].

The foam becomes a liquid on contact with skin and is also well tolerated by patients with trunk and extremity psoriasis [ 20 ]. A clobetasol propionate spray is also available; like foams, sprays are easy to apply to large areas [ 21 ].

Placement of a corticosteroid solution in a spray bottle may be helpful for patients who desire a spray but are unable to obtain a commercially available product. Topical vitamin D analogs — Topical vitamin D analogs for the treatment of psoriasis include calcipotriene calcipotriol , calcitriol , and tacalcitol.

Although topical vitamin D analogs are effective as monotherapy for some patients, a systematic review found that combination therapy with a topical corticosteroid is more effective than either treatment alone [ 22 ].

Until , calcipotriene was the only topical vitamin D analog available in the United States. Calcipotriene is obtainable as a cream, solution, ointment, or foam, or as a combination ointment, suspension, or foam with betamethasone dipropionate. Topical calcitriol ointment has been prescribed in Europe for years and is now available in the United States.

When compared with calcipotriene, calcitriol appears to induce less irritation in sensitive areas of the skin eg, skin folds [ 23 ]. Calcipotriene — Calcipotriene calcipotriol is an established therapy in psoriasis.

The precise mechanism is not clear, but a major effect is the hypoproliferative effect on keratinocytes [ 24 ]. An immune modulating effect has been postulated for calcipotriene, but has not been shown to be significant in psoriasis to date [ 25 ].

Only potent topical corticosteroids appeared to have comparable efficacy at eight weeks. Skin irritation is the main adverse event associated with calcipotriene. Combined use of calcipotriene and superpotent corticosteroids increases clinical response and tolerability in clinical trials compared with either agent used alone [ ].

One regimen employed daily use of both calcipotriene ointment and halobetasol ointment for two weeks, followed by weekend use of the halobetasol ointment and weekday use of calcipotriene [ 27 ].

This regimen produced six-month remission maintenance in 76 percent compared with 40 percent with weekend halobetasol alone. A similar regimen with calcipotriene ointment and clobetasol propionate foam also appears to be effective [ 30 ]. In addition, a randomized trial found that an ointment preparation that combines calcipotriene with betamethasone dipropionate 0.

Patients who use topical corticosteroids in combination with calcipotriene must be monitored for adverse effects as with corticosteroid monotherapy.

Other vehicle options for this combination include oil, foam, and cream [ 32 ]. Cost can be a limiting factor for combination agents. See 'Corticosteroids' above. Thus, topical calcipotriene may be used as an alternative or adjunct to topical corticosteroid therapy. It is applied twice daily when used as monotherapy.

No controlled trials guide how best to use topical corticosteroids in conjunction with calcipotriene. Once daily use of each may be adequate. Acidic products can inactivate topical calcipotriene, and some topical corticosteroids may be acidic.

A reasonable approach to combination therapy is to have patients apply topical calcipotriene and topical corticosteroids each once daily at different times of day.

However, the potential impact on adherence from complicating the treatment regimen should be kept in mind. Other than skin irritation, side effects of topical calcipotriene are usually minimal; the risk of hypercalcemia is low when the drug is used appropriately [ 33 ].

However, topical calcipotriene is more expensive than many generic potent corticosteroids. Calcitriol — The mechanism of action of calcitriol is thought to be similar to that of calcipotriene and involves the drug's ability to inhibit keratinocyte proliferation and stimulate keratinocyte differentiation [ 34 ].

In addition, calcitriol inhibits T cell proliferation and other inflammatory mediators [ 34 ]. At the end of the study periods up to eight weeks , In a systematic review, calcipotriene and calcitriol were equally effective [ 22 ].

However, on sensitive or intertriginous areas of the skin, calcitriol appears to be less irritating than calcipotriene. Perilesional erythema, perilesional edema, and stinging or burning sensations were less common in the areas treated with calcitriol.

A week, open-label study of the safety of calcitriol ointment did not reveal an adverse effect on calcium homeostasis [ 36 ]. Similar to calcipotriene, calcitriol ointment is more expensive than many generic potent topical corticosteroids.

The drug is applied twice daily. Tar — The use of tar is a time-honored modality for treating psoriasis, although newer and less messy treatment options have reduced its popularity.

The precise mechanism of action of tar is not known but may involve aryl hydrocarbon receptors [ 37 ]. Tar has apparent anti-inflammatory and antiproliferative effects [ 38 ]. Tar can be helpful as an adjunct to topical corticosteroids.

Tar products are available without a prescription in the form of shampoos, creams, lotions, ointments, and oils. Newer products include a solution and a foam. Some patients may prefer the less messy formulations. Tar can also be compounded into creams and ointments.

Topical tar preparations, including shampoos, creams, and other preparations, can be used once daily. Patients should be warned that tar products have the potential to stain hair, skin, and clothing. It may help to use them at night and wear inexpensive night clothes eg, old pajamas as tar products tend to be messy.

Patients may also find the odor of tar products unpleasant. For shampoos, the emphasis should be on making sure the product reaches the scalp.

Tar shampoo should be left in place for 5 to 10 minutes before rinsing it out. Tazarotene — Tazarotene is a topical retinoid that was safe and effective in two randomized, vehicle-controlled trials that included patients with psoriasis [ 39 ].

The 0. In another study, once-daily administration of tazarotene gel, 0. Absorption of tazarotene was minimal over the week course of the study, suggesting that systemic toxicity is unlikely during long-term therapy.

A small uncontrolled study of short contact tazarotene found that a 20 minute application followed by washing appeared to be less irritating than traditional use, and seemed to have similar efficacy [ 41 ].

Irritation limits use of tazarotene by itself; the irritation is reduced by concomitant treatment with a topical corticosteroid [ 42 ]. Treatment with tazarotene is often combined with topical corticosteroid therapy to minimize skin irritation.

A combination product containing halobetasol propionate and tazarotene is available. In two phase 3 trials, patients with moderate to severe plaque psoriasis were randomly assigned in a ratio to once-daily application of either halobetasol propionate 0.

At week 8, 36 and 45 percent of patients in the halobetasol propionate plus tazarotene groups achieved at least a two-grade improvement in the Investigator's Global Assessment score and clear or almost clear disease status. In contrast, only 7 and 13 percent of patients in the vehicle groups achieved this endpoint.

Halobetasol propionate 0. Calcineurin inhibitors — Topical tacrolimus 0. Facial and intertriginous areas may be well suited to these treatments, which can allow patients to avoid or minimize chronic topical corticosteroid use:. Topical tacrolimus and pimecrolimus are generally well tolerated when used to treat facial and intertriginous psoriasis [ 48,49 ].

However, corticosteroid therapy may be more effective, at least compared with pimecrolimus. This was suggested in a four-week randomized trial in 80 patients with intertriginous psoriasis that compared various therapies applied once daily [ 50 ].

Betamethasone valerate 0. In , the US Food and Drug Administration FDA issued an alert about a possible link between topical tacrolimus and pimecrolimus and cases of lymphoma and skin cancer in children and adults [ 51 ], and in placed a "black box" warning on the prescribing information for these medications [ 52 ].

No definite causal relationship has been established; however, the FDA recommended that these agents only be used as second-line agents for atopic dermatitis. Subsequent studies have found no evidence of an increased risk of lymphoma [ 53,54 ].

See "Treatment of atopic dermatitis eczema ", section on 'Topical calcineurin inhibitors'. Tapinarof — Tapinarof is a topical aryl hydrocarbon receptor-modulating agent that may improve psoriasis through modulation of T helper type 17 Th17 cytokines, such as interleukin IL 17A and ILF; normalization of the skin barrier; and antioxidant activity.

The drug is applied to affected areas once daily:. At week 12, patients in the tapinarof groups were more likely to achieve the primary endpoint of a Physician Global Assessment PGA score of 0 clear or 1 almost clear and at least a two-point decrease in the five-point PGA scale than patients in the placebo group Seventy-five and 90 percent improvement in the Psoriasis Area and Severity Index PASI 75 and PASI 90, respectively rates were also greater in the tapinarof groups than in the vehicle groups.

Local adverse effects appear to be the most common adverse effects of tapinarof. In the PSOARING 1 and PSOARING 2 trials, folliculitis, contact dermatitis, and headache occurred more frequently in the tapinarof groups than in the vehicle groups [ 56 ]. Roflumilast — Roflumilast is a topical phosphodiesterase 4 inhibitor.

In , the FDA approved roflumilast 0. The cream is applied to affected areas once daily and is expected to become commercially available in At week 6, patients in the roflumilast 0.

Adverse effects considered by the investigators to be related to the intervention application site reactions and gastrointestinal adverse effects occurred with similar frequency in the roflumilast and placebo groups.

Efficacy of roflumilast has also been evaluated in unpublished phase 3 trials [ 59,60 ]. Anthralin — Topical anthralin also known as dithranol is an effective treatment for psoriasis and has been utilized since the early 20 th century [ ]. The mechanism of action of anthralin in psoriasis is not well understood, but may involve anti-inflammatory effects and normalization of keratinocyte differentiation [ 17 ].

Anthralin cream is no longer commercially available in many settings. Anthralin cream may be available through compounding pharmacies. Skin irritation is an expected side effect of anthralin that can limit the use of this therapy. This side effect and the ability of anthralin to cause permanent red-brown stains on clothing and temporary staining of skin have contributed to a decline in the use of anthralin therapy.

The shampoo should be applied, lathered, and then left on the scalp for three to five minutes prior to thorough rinsing. Where available, anthralin cream is usually prescribed as a short-contact regimen to minimize skin irritation.

The concentration is titrated according to patient tolerance. For example, treatment may begin with concentrations as low as 0. Then, weekly, serial increases in the concentration of anthralin can be performed eg, 0. Additionally, application to surrounding unaffected skin should be avoided.

Petrolatum or zinc oxide may be applied to uninvolved surrounding skin as a protectant prior to application. After the desired contact period has elapsed, anthralin should be washed off the treated area [ 17 ]. Benefit from anthralin therapy is often evident within the first few weeks of therapy.

When administered by patients in the outpatient setting, anthralin is less effective than topical vitamin D or potent topical corticosteroid therapy [ 22,65,66 ]. UV radiation may act via antiproliferative effects slowing keratinization and anti-inflammatory effects inducing apoptosis of pathogenic T cells in psoriatic plaques.

In choosing UV therapy, consideration must be given to the potential for UV radiation to accelerate photodamage and increase the risk of cutaneous malignancy.

Office-based phototherapy and photochemotherapy require the supervision of a dermatologist trained in these treatment modalities. Despite high efficacy and safety, the use of office-based phototherapy has declined in the United States because of administrative issues and the development of new systemic medications [ 67 ].

The American Academy of Dermatology and the National Psoriasis Foundation have issued joint guidelines for the treatment of psoriasis with phototherapy [ 68 ].

Conventional modalities — Therapeutic doses of UV light can be administered as narrowband ultraviolet B UVB phototherapy, broadband UVB phototherapy, or oral or bath psoralen plus ultraviolet A PUVA photochemotherapy.

Narrowband UVB and broadband UVB involve the delivery of nm and to nm of UVB radiation, respectively. Photochemotherapy PUVA involves treatment with a photosensitizer either oral or bath psoralen followed by ultraviolet A UVA radiation to nm.

See "UVB phototherapy broadband and narrowband " and "Psoralen plus ultraviolet A PUVA photochemotherapy". Phototherapy is typically administered three times per week during the treatment phase.

Upon achievement of a satisfactory response, the frequency of treatment may be tapered to the lowest frequency required to maintain improvement. Treatment protocols for phototherapy are reviewed separately. See "UVB phototherapy broadband and narrowband ", section on 'Dosimetry and treatment protocols' and "Psoralen plus ultraviolet A PUVA photochemotherapy", section on 'Treatment protocols'.

Selection among modalities of phototherapy is based upon consideration of efficacy, safety, availability, and ease of therapy. Narrowband UVB is generally preferred over PUVA photochemotherapy based upon greater ease of administration administration of psoralens not required and a less severe side effect profile.

Randomized trials comparing the efficacy of narrowband UVB with PUVA have yielded inconsistent findings, though it appears that oral PUVA may provide a faster and more sustained response [ 69 ].

There are few data on the comparative efficacy of oral and bath PUVA for psoriasis. A small, open, randomized trial of 74 patients with moderate to severe psoriasis did not find a significant difference in efficacy between the two treatments [ 70 ].

See "UVB phototherapy broadband and narrowband ", section on 'Short- and long-term adverse effects' and "Psoralen plus ultraviolet A PUVA photochemotherapy", section on 'Adverse effects'. Narrowband UVB is generally considered more effective than broadband UVB phototherapy, contributing to acceptance of narrowband UVB as the preferred form of UVB phototherapy for psoriasis, provided it is available [ 68 ].

Although greater efficacy of narrowband UVB over broadband UVB for plaque psoriasis is supported by some studies [ 71,72 ], this has not been confirmed in high-quality, randomized trials [ 69 ]. Home phototherapy — An alternative to office-based phototherapy is the use of a home UVB phototherapy unit prescribed by the treating clinician [ 73 ].

This option may be preferred by patients who are not in close proximity to an office-based phototherapy center, whose schedules do not permit frequent office visits, or for whom the costs of in-office treatment exceed those of a home phototherapy unit.

Insurance coverage of these units varies. For some dermatologists, uncertainty regarding the safety of home units has led to a reluctance to prescribe them. Some have expressed concern for the potential for improper or excessive usage of these devices [ 74 ].

In contrast, a randomized trial of subjects found that narrowband UVB administered via home units was as safe and effective as office-based treatments [ 74 ]. Home phototherapy units that are equipped with electronic controls that allow only a prescribed number of treatments are available and may help to mitigate clinician concerns.

Commercial tanning beds can improve psoriasis and are occasionally used for patients without access to medical phototherapy [ 75,76 ]. However, data are limited on this mode of treatment, and clinicians and patients should be cognizant that there is significant variability in the UV output of tanning beds [ 77 ].

Excimer laser — The excimer laser, a laser that emits UVB light, is an alternative for the treatment of localized areas of psoriasis. The nm excimer laser allows treatment of only involved skin; thus, considerably higher doses of UVB can be administered to psoriatic plaques at each treatment session when compared with traditional phototherapy.

See "Targeted phototherapy". Uncontrolled trials suggest that laser therapy results in faster responses than conventional phototherapy [ 78,79 ].

As an example, one study of excimer laser therapy involved patients with stable mild to moderate plaque psoriasis, of whom 80 completed the entire protocol [ 78 ]. Treatments were scheduled twice weekly.

After 10 or fewer treatments, 84 and 50 percent of patients achieved the outcomes of 75 percent or better and 90 percent or better clearing of plaques, respectively. This number of treatments was far fewer than that typically required of phototherapy 25 or more. Side effects of laser therapy included erythema and blistering; in contrast to whole body phototherapy burns, the localized phototherapy burns were generally well tolerated because of the limited areas treated, and no patient discontinued therapy because of adverse effects.

A common sequela of excimer laser therapy is the induction of UV-induced hyperpigmentation tanning in treated areas, which can be cosmetically distressing for some patients. Hyperpigmentation slowly resolves after the discontinuation of treatment. Like nm UVB, the excimer laser represents a therapeutic advance toward specific wavelength therapies for psoriasis.

While both the excimer laser and narrowband UVB are approved for use in psoriasis, inconsistencies in third party coverage for these treatments limit their utilization. Cancer risk — A concern with PUVA is an increased risk of nonmelanoma skin cancer and melanoma.

Ongoing monitoring is indicated in patients who have received prolonged courses of PUVA. In general, phototherapy is contraindicated in patients with a history of melanoma or extensive nonmelanoma skin cancer.

See "Psoralen plus ultraviolet A PUVA photochemotherapy", section on 'Skin cancer'. Folate deficiency — Folate deficiency has been associated with health disorders such as neural tube defects in fetuses of affected pregnant women, anemia, and hyperhomocysteinemia a risk factor for cardiovascular disease.

In an in vitro study, exposure of plasma to UVA led to a 30 to 50 percent decrease in the serum folate level within 60 minutes [ 80 ]. However, folate deficiency secondary to UVA exposure has not been proven to occur in vivo.

In a small randomized trial of healthy subjects, no difference in serum folate levels was identified between subjects irradiated with UVA for six sessions and untreated subjects [ 81 ]. In addition, an observational study of 35 psoriasis patients found that narrowband UVB had no effect on serum folate levels after 18 treatment sessions [ 82 ].

Saltwater baths — Exposure to natural sunlight improves psoriasis. Bathing in sea water in combination with sun exposure climatotherapy has also been used as a therapy for psoriasis, as has the use of saltwater baths with artificial UV exposure balneophototherapy.

See 'Ultraviolet light' above. In a large, open, randomized trial, treatment with UVB after a saltwater bath had greater efficacy than UVB after a tap-water bath, and similar efficacy to bath PUVA [ 83 ].

Although the raters of disease severity were intended to be blinded, raters knew treatment assignment in nearly 60 percent of cases. Additionally, less than half the patients were considered to have met the study's prespecified criteria for having been eligible and treated per protocol.

In per-protocol analyses, no difference was found between saltwater and tap-water baths, and bath PUVA was superior to UVB after a saltwater bath. Additional studies are required to demonstrate that combining saltwater baths with phototherapy is superior to tap-water baths plus phototherapy or to phototherapy alone.

SYSTEMIC THERAPIES — A variety of systemic medications are used for the treatment of psoriasis [ ], particularly for patients with more than 5 percent body surface area involvement or less extensive, but debilitating, disease. The American Academy of Dermatology AAD and National Psoriasis Foundation NPF have released guidelines for systemic treatments, including guidelines dedicated to systemic nonbiologic therapy and biologic therapy [ 87,88 ].

In addition, European S3-Guidelines on the systemic treatment of psoriasis have been published [ 89,90 ]. In , the British Association of Dermatologists released updated guidelines for biologic therapy [ 91 ]. See 'Society guideline links' below. Options for systemic therapy include immunosuppressive or immunomodulatory drugs such as methotrexate , cyclosporine , apremilast , biologic agents, and deucravacitinib.

Systemic retinoids, which improve psoriasis through effects on epidermal proliferation and differentiation as well as immunomodulation, are also used for the treatment of this condition [ 84 ]. Biologic agents include the most effective therapies for moderate to severe psoriasis.

Network meta-analyses support their efficacy and demonstrate varying degrees of efficacy among the individual biologic treatments [ ].

In a network meta-analysis of Psoriasis Area and Severity Index PASI response data from randomized trials assessing the efficacy of biologic treatments etanercept , adalimumab , certolizumab pegol , infliximab , ustekinumab , secukinumab , ixekizumab , brodalumab , tildrakizumab , guselkumab , and risankizumab or oral nonbiologic treatments apremilast , dimethyl fumarate , acitretin , cyclosporine , fumaric acid esters, and methotrexate for psoriasis, risankizumab, brodalumab, ixekizumab, and guselkumab had the highest PASI 75, 90, and response rates ie, achieved at least 75, 90, or percent improvement in PASI after 10 to 16 weeks [ 93 ].

There were no statistically significant differences in efficacy among these four treatments. PASI 90 rates ranged from 67 to 72 percent. These four treatments had the highest PASI 75, 90, and rates in a traditional meta-analysis that assessed long-term responses after 44 to 60 weeks [ 93 ].

Although knowledge of the relative efficacies of systemic treatments for psoriasis is useful, consideration of factors such as drug side effects, patient preference, drug availability, and treatment cost eg, the high cost of biologic agents compared with conventional therapies also play an important role in treatment selection.

Impact of COVID pandemic — The coronavirus disease COVID pandemic has led organizations, including the AAD and NPF , to issue guidance regarding the use of biologic agents or other systemic immunomodulatory drugs during the pandemic [ 99, ].

Our understanding of the impact of COVID on psoriasis and of psoriasis treatment on COVID is rapidly evolving. Use of systemic immunomodulatory therapies during this period is reviewed separately.

See "COVID Cutaneous manifestations and issues related to dermatologic care", section on 'Therapeutic considerations during the pandemic'. Methotrexate — The folic acid antagonist methotrexate has been used successfully in the treatment of psoriasis for over 50 years [ ].

It is also effective for the treatment of psoriatic arthritis and psoriatic nail disease. Initial thoughts on the mechanism of action centered around the antiproliferative effects of methotrexate on DNA synthesis in epidermal cells; subsequent evidence supports the concept that it is the immunosuppressive effects of methotrexate on activated T cells that controls psoriasis [ ].

See "Treatment of peripheral psoriatic arthritis". Methotrexate has multiple contraindications [ 87 ]. Absolute contraindications include pregnancy, nursing, alcoholism, alcoholic liver disease or other chronic liver disease, immunodeficiency syndromes, bone marrow hypoplasia, leukopenia, thrombocytopenia, significant anemia, or hypersensitivity to methotrexate.

Relative contraindications include liver and renal function abnormalities and active infection. In addition, concomitant treatment with certain drugs eg, nonsteroidal anti-inflammatory drugs [NSAIDs], certain antibiotics can increase risk for methotrexate toxicity.

Methotrexate appears to be less effective than at least some of the biologic agents see 'Biologic agents' below.

In one trial, patients with moderate to severe plaque psoriasis were randomized to receive oral methotrexate 7. After 16 weeks, the proportion of patients achieving PASI 75 with methotrexate was more than that with placebo but less than with adalimumab 36, 19, and 80 percent, respectively.

A placebo-controlled randomized trial evaluating subcutaneous methotrexate After 16 weeks, 37 of 91 patients 41 percent in the methotrexate group achieved PASI 75 compared with 3 of 29 patients 10 percent in the placebo group [ ]. Methotrexate is usually administered in an intermittent low-dose regimen such as once weekly.

Similar regimens are in use in patients with rheumatoid arthritis. Administration can be oral, intravenous, intramuscular, or subcutaneous; the usual dose range is between 7. Treatment is usually started at 10 to 15 mg weekly.

Older patients and other patients with decreased kidney function are at increased risk for hematologic toxicity and can be given a single test dose of 5 mg with blood work one week later, followed by upward titration and close monitoring for toxicity.

Dose can then be escalated every four to eight weeks depending on tolerance, efficacy, and toxicity. Unlike cyclosporine , which is generally used for only a limited duration of treatment because of cumulative renal toxicity, methotrexate can be used for long-term therapy. See "Use of methotrexate in the treatment of rheumatoid arthritis" and 'Cyclosporine' below.

Folic acid , 1 mg daily, protects against some of the common side effects seen with low-dose methotrexate such as stomatitis [ ]. Folate does not appear to protect against pulmonary toxicity, and it is uncertain whether it protects against hepatic toxicity; monitoring for bone marrow suppression and hepatotoxicity are necessary during therapy.

Concurrent use of other medications that interfere with folic acid metabolism, such as sulfa antibiotics, can increase the toxicity of methotrexate. See "Major side effects of low-dose methotrexate". Hepatotoxicity — For patients with one or more risk factors for hepatotoxicity from methotrexate , use of a different systemic drug should be considered.

Risk factors for hepatotoxicity from methotrexate include [ 87 ]:. Previously, the AAD and NPF advised obtaining blood liver function tests every one to three months as well as consideration of a liver biopsy after a cumulative methotrexate dose of 3.

The AAD-NPF joint guidelines for the management of psoriasis with nonbiologic therapies support less frequent blood liver function tests and incorporate use of newer noninvasive monitoring techniques, including serologic panels of markers of fibrosis and transient elastography [ 87 ].

See "Noninvasive assessment of hepatic fibrosis: Overview of serologic tests and imaging examinations" and "Noninvasive assessment of hepatic fibrosis: Ultrasound-based elastography". Acitretin — Systemic retinoids derivatives of vitamin A are utilized for patients with severe psoriasis, including pustular and erythrodermic forms, and in patients with HIV-associated psoriasis.

The retinoid of choice in psoriasis is acitretin. In a pilot study, 6 of 11 patients with psoriasis and HIV infection achieved good to excellent results with acitretin therapy, with four achieving complete clearing of their skin disease [ ].

The usual dose range of acitretin is 25 mg every other day to 50 mg daily. The onset of effect is relatively slow; the full benefit of acitretin may not be evident for three to six months [ 87 ]. Acitretin can be used in combination with UVB or psoralen plus ultraviolet A PUVA therapy.

Used in this way, patients have higher response rates with better tolerance and less UV exposure [ , ]. Monitoring for hypertriglyceridemia and hepatotoxicity are required with retinoid therapy.

Common side effects include cheilitis and alopecia. Acitretin is teratogenic; it is only indicated in men and in women of nonreproductive potential. Pregnancy is contraindicated for three years after discontinuing the drug [ ]. Cyclosporine — The T cell suppressor cyclosporine is effective in patients with severe psoriasis [ , ].

Improvement is generally observed within four weeks. Contraindications to cyclosporine therapy include prior PUVA treatment, abnormal renal function, uncontrolled hypertension, malignancy, and hypersensitivity to cyclosporine [ 87 ]. Caution is indicated in the setting of major infections or poorly controlled diabetes.

Cyclosporine also has multiple drug interactions. The use of cyclosporine in psoriasis is based upon multiple studies supporting its status as a highly and rapidly effective treatment [ 84, ]. In a placebo-controlled randomized trial, after eight weeks of treatment with 3, 5, or 7.

All three regimens were superior to placebo, and patients who received the 5 mg dose were least likely to require dose alterations due to side effects or lack of efficacy.

A few randomized trials have compared the efficacy of cyclosporine and methotrexate , utilizing varying treatment regimens and providing different results. Close monitoring is required since renal toxicity and hypertension are common and often limit the long-term use of cyclosporine in patients with psoriasis.

See "Cyclosporine and tacrolimus nephrotoxicity". An investigational oral calcineurin inhibitor, ISA, was efficacious in randomized trials in patients with moderate to severe plaque psoriasis, and may have less nephrotoxicity than cyclosporine [ ].

Apremilast — Apremilast , a phosphodiesterase 4 inhibitor, is another oral agent for the treatment of plaque psoriasis [ ]. Phosphodiesterase 4 inhibition reduces production of multiple cytokines involved in the pathogenesis of psoriasis.

Apremilast is costly, priced closer to biologics than to methotrexate. The drug can also be effective for psoriatic arthritis. Apremilast is indicated for the treatment of plaque psoriasis in patients who are candidates for phototherapy or systemic therapy.

The initial approval for moderate to severe psoriasis was supported by the findings of two week, multicenter, randomized trials in which adults with moderate to severe psoriasis were randomly assigned to receive 30 mg of apremilast twice daily or placebo [ ]. In the first trial, 33 percent of patients treated with apremilast achieved PASI 75 compared with only 5 percent of patients in the placebo group.

Results of the second trial were similar; 29 percent of adults treated with apremilast achieved PASI 75 compared with 6 percent of patients in the placebo group.

Although apremilast represents an alternative systemic agent for the treatment of psoriasis, reported treatment success rates with apremilast are lower than those frequently reported for biologic agents [ ].

The use of a 30 mg twice daily dose of apremilast is further supported by a phase 2 randomized trial of adults with moderate to severe plaque psoriasis that found lower efficacy with reduced doses.

Among patients treated with 30 mg twice daily, 20 mg twice daily, 10 mg twice daily, and placebo, PASI 75 was achieved by 41, 29, 11, and 6 percent of patients, respectively [ ]. Randomized trial data also support apremilast therapy for patients with mild to moderate psoriasis.

In the ADVANCE trial, adults with mild to moderate chronic plaque psoriasis that could not be controlled with one or more topical therapies were randomly assigned to either apremilast 30 mg twice daily or placebo [ ].

At week 16, 22 percent of patients in the apremilast group achieved the primary endpoint a static Physician Global Assessment score of 0 or 1 [clear or almost clear skin] and at least a two-point reduction from baseline compared with only 4 percent of patients in the placebo group.

Moreover, a higher proportion of patients achieved PASI 75 at week 16 in the apremilast group than in the placebo group 33 versus 7 percent, respectively. Apremilast is associated with a short-term risk of diarrhea, especially when treatment is started, occurring in roughly 15 to 20 percent of patients.

Tolerability of apremilast is improved by slowly ramping up the dose when treatment is initiated. The recommended dose titration schedule for adults is as follows:.

In adult patients with severe renal impairment, the recommended final dose is 30 mg once daily. At the start of therapy, only the morning dose of the above titration schedule is given.

Examples of other reported side effects of apremilast include nausea, upper respiratory infection, headache, drug interactions, and weight loss.

Periodic monitoring of weight is recommended [ ]. Advising patients, their caregivers, and families to be alert for worsening depression, suicidal thoughts, or other mood changes during treatment also is suggested based upon the possibility of a slight increase in risk for depression [ ].

Use of apremilast should be avoided in patients with known hypersensitivity reactions to apremilast or to excipients in the formulation [ ].

Hypersensitivity reactions, such as angioedema and anaphylaxis, have rarely been reported during postmarketing surveillance [ ].

Biologic agents — Biologic agents are important treatment options for moderate to severe plaque type psoriasis [ ]. The available biologics for psoriasis have excellent short-term and long-term efficacy and favorable tolerability. Examples of biologic therapies include etanercept , infliximab , adalimumab , ustekinumab , secukinumab , ixekizumab , brodalumab , guselkumab , tildrakizumab , risankizumab , and certolizumab pegol.

There is a concern that all TNF-alpha inhibitors have the potential to activate latent infections such as tuberculosis, and increased rates of infection have been seen in patients with rheumatoid arthritis treated with etanercept , infliximab , and adalimumab.

In addition, risk for herpes zoster may be increased in patients receiving biologic therapy in combination with methotrexate [ ]. Anti-IL biologic drugs eg, ixekizumab , secukinumab , brodalumab have been associated with a slight increase in risk for candidal infections [ ].

An analysis of data from adults with psoriasis in a large registry of patients eligible to receive or receiving conventional systemic or biologic therapy Psoriasis Longitudinal Assessment and Registry [PSOLAR] found a higher risk of serious infections with adalimumab and infliximab compared with nonbiologic systemic and no systemic therapies [ ].

Serious infection rates among patients treated with infliximab, adalimumab, etanercept , and ustekinumab were 2. Among patients who had never received a biologic therapy or methotrexate and patients who had never received a biologic therapy but had received methotrexate, rates were 1.

Another publication from the PSOLAR registry provides some reassurance regarding the use of biologic therapy for psoriasis [ ]. Compared with treatment with nonbiologic agents, biologic therapy did not appear to be a significant predictor of death, major adverse cardiovascular events MACE , or malignancy.

Patients were not randomized to the different treatment arms in the PSOLAR registry, and therefore selection bias could account for differences or lack of differences between groups.

Potential side effects of TNF-alpha inhibitors are reviewed in greater detail separately. See "Tumor necrosis factor-alpha inhibitors: Bacterial, viral, and fungal infections" and "Risk of mycobacterial infection associated with biologic agents and JAK inhibitors" and "Tumor necrosis factor-alpha inhibitors: Risk of malignancy" and "Tumor necrosis factor-alpha inhibitors: An overview of adverse effects".

TNF-alpha inhibitors — Biologic tumor necrosis factor TNF -alpha inhibitors utilized for psoriasis include etanercept , infliximab , adalimumab , and certolizumab pegol. Etanercept — The TNF-alpha inhibitor etanercept is of benefit in psoriasis [ ].

It is approved by the US Food and Drug Administration FDA for adults with psoriatic arthritis and for patients age four years or older with chronic moderate to severe plaque psoriasis.

Standard dosing for etanercept for adults is subcutaneous injection of 50 mg twice weekly for the initial three months of therapy, followed by a 50 mg injection once weekly for maintenance therapy. Standard pediatric dosing is 0. Etanercept is also an effective treatment for psoriatic arthritis.

A randomized trial of etanercept in adult patients with active but stable plaque psoriasis involving at least 10 percent of the body surface area found three doses of subcutaneous etanercept 25 mg weekly, 25 mg twice weekly, 50 mg twice weekly significantly superior to placebo [ ].

After 12 weeks, there was at least a 75 percent improvement in the PASI score in 14, 34, 49, and 4 percent, respectively. After 24 weeks, such an improvement was seen in 25, 44, and 59 percent, respectively no patients received placebo for more than 12 weeks.

Etanercept was well tolerated with adverse events and infections occurring at similar rates in all four groups. A week randomized trial found similar benefits with subcutaneous etanercept 50 mg twice weekly, and that, compared with placebo, patients receiving etanercept had significant improvements in measures of fatigue and depression [ ].

In another randomized trial, etanercept was effective for moderate to severe plaque psoriasis in children and adolescents [ ]. The long-term safety of etanercept for psoriasis is supported by a week study of etanercept 50 mg twice weekly [ ].

The formation of anti-etanercept antibodies has been reported to occur in 0 to 18 percent of patients treated with the drug for psoriasis [ ].

However, in contrast to antibodies against infliximab and adalimumab in patients treated for psoriasis with those agents, the formation of anti-etanercept antibodies does not appear to reduce treatment efficacy [ ].

Etanercept-szzs GP is an etanercept biosimilar that has similar efficacy and safety in patients with moderate to severe plaque psoriasis [ ].

Infliximab — The TNF-alpha inhibitor infliximab is of benefit in patients with moderate to severe plaque psoriasis and appears to generally be well tolerated [ ].

In addition, the findings of a systematic review suggest that the onset of action of infliximab is faster than several other commercially available biologic agents [ ]. Infliximab is also an effective treatment for psoriatic arthritis.

Infliximab was efficacious for psoriasis in a multicenter randomized trial in patients with severe plaque psoriasis. The duration of response appeared to be longer with the higher dose.

More patients treated with infliximab had serious adverse events 12 versus 0 , including four cases that the authors felt were reasonably related to treatment: squamous cell carcinoma, cholecystitis, diverticulitis, and pyelonephritis with sepsis.

At week 16, patients who did not achieve at least 50 percent improvement were able to switch to the alternative therapy. In addition, patients who were transitioned from methotrexate to infliximab fared better than those who switched to methotrexate from infliximab; 73 versus 11 percent achieved PASI Maintenance therapy with infliximab also appears to be effective [ ,, ].

Infliximab was generally well tolerated. In addition to experiencing better maintenance of response, there are some data that suggest that patients who receive continuous maintenance therapy with infliximab may be less likely to experience serious infusion-related reactions than patients who receive intermittent maintenance therapy.

In trials comparing the two modes of maintenance therapy, slightly higher rates of infusion-related reactions have been observed among recipients of intermittent maintenance therapy [ , ].

The reason for this observation was unclear. Whether other regimens of intermittent maintenance therapy would be less likely to yield infusion reactions remains to be seen.

Studies in psoriasis, inflammatory bowel disease, and rheumatoid arthritis have suggested that the production of antibodies to infliximab may contribute to the loss of response to infliximab in some patients with these diseases [ , ]. Anti-infliximab antibodies occur in 5 to 44 percent of patients who receive infliximab for psoriasis [ , ].

See "Tumor necrosis factor-alpha inhibitors: Induction of antibodies, autoantibodies, and autoimmune diseases", section on 'Anti-drug antibodies'. Infliximab-dyyb CT-PI3 is a biosimilar to infliximab. In a randomized trial that included patients with various infliximab-responsive diseases, including psoriasis, switching to infliximab-dyyb was not inferior to continued originator infliximab therapy [ ].

See "Overview of biologic agents in the rheumatic diseases", section on 'Biosimilars for biologic agents'. Adalimumab — Adalimumab , a humanized monoclonal antibody with activity against TNF-alpha, was originally used for patients with rheumatoid arthritis and is also effective for psoriatic arthritis see "Treatment of psoriatic arthritis".

Adalimumab is approved by the FDA for treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy. Standard dosing for adalimumab for adults is an initial subcutaneous injection of 80 mg of adalimumab followed by 40 mg given every other week, beginning one week after the initial dose.

Examples of studies supporting the efficacy of adalimumab include:. After 12 weeks, more patients treated with adalimumab every other week or weekly achieved PASI 75 53 and 80 percent, respectively versus 4 percent with placebo. In an open-label extension of the study, improvements were sustained for 60 weeks.

See 'Methotrexate' above. After 16 weeks, disease was cleared or almost cleared in 15 out of 49 patients in the adalimumab group 31 percent compared with 1 out of 23 patients in the placebo group 4 percent. Adalimumab may be an effective alternative for patients who fail to respond to etanercept [ ].

Treatment success rates approached 50 percent when adalimumab 40 mg weekly or every other week was given for an additional 12 weeks. Formation of antibodies against adalimumab is reported to occur in 6 to 50 percent of patients treated with adalimumab for psoriasis and may reduce the response to therapy [ ,, ].

Further study is necessary to determine whether assessing serum levels of adalimumab during treatment will be useful for improving responses to therapy [ ]. Drugs biosimilar to adalimumab include adalimumab-atto and adalimumab-adbm [ , ].

In a randomized trial that compared adalimumab-atto with adalimumab in adults with moderate to severe plaque psoriasis, the two drugs had similar efficacy and safety after 16 weeks of treatment [ ].

For these patients, a topical medication may be used along with light therapy or medication that works throughout the body like methotrexate or a biologic. Many patients use this medication to treat psoriasis.

A corticosteroid works quickly and is available in many strengths, which makes it beneficial for treating all types of psoriasis from the very mild to thick plaques. For more information about this medication, go to Psoriasis treatment: Corticosteroids you apply to the skin.

Also called a vitamin D analog, this medication differs from the oral supplements that people take when they need to get more vitamin D. This synthetic form has been tweaked to treat psoriasis. This medication is often used to treat psoriasis in areas with thinner skin, such as the face, neck, or body folds.

In these areas, a TCI can be quite effective. For more information, go to Psoriasis treatment: Tacrolimus ointment and pimecrolimus cream. An effective acne treatment, salicylic acid has also been used to treat psoriasis for many years.

It helps to reduce the scale and soften psoriasis plaques. Low concentrations of this medication can be safe to use during pregnancy. Your dermatologist can tell you how much you use. A retinoid that you apply to your skin, tazarotene can be used alone or along with a corticosteroid to treat plaque psoriasis.

To learn more about this medication, go to Psoriasis treatment: A retinoid applied to the skin. Approved to treat adults and children, this psoriasis cream is used to treat mild, moderate, or severe disease.

While many medications applied to the skin can treat plaque psoriasis, roflumilast can also effectively treat a type of psoriasis called inverse aka intertriginous psoriasis , which affects the body folds.

In the studies that led the FDA to approve roflumilast, the cream worked quickly to reduce the itch and clear psoriasis. This cream should be applied once a day to the skin with psoriasis and can be used for as long as needed.

This cream is prescribed for adults who have mild, moderate, or severe psoriasis. It can be applied anywhere on the body, including the face.

When patients cleared and stopped using the cream, on average, they stayed clear for 12 weeks. The most common side effect is a skin reaction. This medication has been used for more than years to treat psoriasis. To learn more about using coal tar to treat psoriasis, go to Psoriasis treatment: Coal tar.

Light therapy: This treatment uses special light bulbs or lasers to treat psoriasis. Treating yourself by using a tanning bed or lying in the sun can cause skin damage like sunburn, which can worsen psoriasis.

Over time, exposure to ultraviolet light UV from the sun or tanning beds can also cause skin cancer. To learn more about light therapy that dermatologists prescribe, go to: Psoriasis treatment: Light therapy. These devices have limitations. Medication that works throughout the body: Some people need strong medication to treat their psoriasis, especially if the psoriasis also affects their joints.

For these people, medication that works throughout the body may be the best option. Apremilast is used to treat plaque psoriasis and psoriatic arthritis. It can be taken by patients with complex medical issues who cannot be prescribed other medication that works throughout the body.

For many people, taking a biologic is life-changing because it helps control psoriasis, psoriatic arthritis, or both when other treatments fail. A biologic may be prescribed alone or along with another psoriasis treatment.

To learn more about biologics, go to Psoriasis treatment: Biologics. A biosimilar is a medication that is very similar to a biologic, but may cost less than the original biologic. For more information about biosimilars, read Biosimilars: 14 questions patients ask their dermatologist.

This medication comes in pill form and is prescribed for people who have extensive or disabling psoriasis. It tends to work quickly. Find out how long people typically take cyclosporine, what to avoid when taking it, and more at Psoriasis treatment: Cyclosporine. Used for more than 40 years to treat psoriasis, this medication is prescribed to treat severe, disabling psoriasis.

If this medication is part of your treatment plan, you should not drink alcohol while on methotrexate. To find out what else you should know, go to Psoriasis treatment: Methotrexate.

Approved to treat severe psoriasis, acitretin can effectively treat different types of psoriasis like plaque, guttate, and pustular psoriasis. The TYK2 inhibitor is a newer treatment option for psoriasis. The FDA approved this medication as a once-a-day tablet. Finding the right treatment can be challenging.

Sometimes, a medication used to treat another condition works best for treating severe psoriasis. To learn more about these medications, go to Psoriasis treatment: Off-label medications that work throughout the body. These appointments can be helpful because your dermatologist will:.

Watch for signs of psoriatic arthritis , a disease that you want to catch early. Assess your risk of developing other diseases that are more common in people with psoriasis like high blood pressure and diabetes. Your dermatologist can also answer questions you have about treating psoriasis.

Common questions that patients ask include:. How long will I have to treat my psoriasis? Can I treat psoriasis without prescription medication? Is financial assistance available if I cannot afford my psoriasis medication?

Skin care also plays an important role in treating psoriasis because it can help reduce flare-ups. Find out what dermatologists recommend at Psoriasis: Tips for managing.

How concerned should I be about my psoriasis? Scalp psoriasis: Shampoos, scale softeners, and other treatments. Nail psoriasis: What is it and how can I treat it? Image 2: Used with permission of the Journal of the American Academy of Dermatology.

Most cases of psoriasis are mild. Treatment starts with skin care. This includes keeping your skin moist with creams and lotions. These are often used with other treatments including shampoos, ultraviolet light, and medicines your doctor prescribes.

You may need to try different combinations of treatments to find what works for you. Health Tools help you make wise health decisions or take action to improve your health.

The exact cause of psoriasis isn't known. But experts believe that the immune system overreacts, causing inflammation and flaking of skin. Many scientists believe that psoriasis can be inherited runs in families. Having certain gene changes can make it more likely for a person to get psoriasis.

But it isn't clear that your genes alone determine whether you get psoriasis. Things that can cause these flare-ups include a cold and dry climate, infections, stress, dry skin, and taking certain medicines. Psoriasis isn't contagious.

It can't be spread by touch from person to person. Symptoms for each type may vary, but the major symptoms are:. Symptoms may disappear go into remission , even without treatment, and then return flare up.

Psoriasis is usually a long-term problem. Symptoms tend to come and go in a cycle. There are flares, when symptoms get worse, and then remission, when symptoms improve and go away for awhile. In other cases, psoriasis may persist for long periods of time without getting better or worse. A few flare-ups of psoriasis may go away without treatment.

But it's usually best to treat psoriasis so that it doesn't get worse. If it becomes severe and widespread, it may be much harder to treat.

If you are being treated for psoriasis, call your doctor if you:. Tests usually aren't needed. But one or more of the following tests may be done. Most cases of psoriasis are mild and can be treated with:. Depending on what type of psoriasis you have, treatment may also include:. In some cases, psoriasis can be hard to treat.

Treatment for psoriasis may go on for a lifetime. Most of the time psoriasis can be treated at home. These tips may improve your symptoms or help reduce the number of psoriasis flare-ups:.

You can do things at home to manage your psoriasis. By learning what triggers to avoid, you can improve your symptoms or help reduce the number of psoriasis flare-ups. Many types of medicines can help control psoriasis. They include:. You may be able to control mild psoriasis with an over-the-counter medicine.

These include corticosteroid creams. For moderate to severe psoriasis, you may need to use a topical medicine prescribed by your doctor.

For example, you may need a stronger corticosteroid or a medicine related to vitamin D. Medicines you take by mouth may be used to treat moderate to severe psoriasis.

Examples are retinoids and methotrexate. These medicines block the harmful response of the body's immune system that causes the symptoms of psoriasis. These may be used to treat severe psoriasis. Or they may be used to treat psoriasis that hasn't improved after other treatments.

Examples are infliximab Remicade and ustekinumab Stelara. Author: Healthwise Staff Medical Review: Adam Husney MD - Family Medicine E. Gregory Thompson MD - Internal Medicine Martin J.

Gabica MD - Family Medicine Kathleen Romito MD - Family Medicine Elizabeth T. Russo MD - Internal Medicine Amy McMichael MD - Dermatology. Author: Healthwise Staff. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.

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Flu Vaccines: Should I Get a Flu Vaccine? Relieving A Cough Colds. Cal's Story: Learning to Exercise When You have COPD Conserving Energy When You Have COPD or Other Chronic Conditions Nebulizer for COPD Treatment COPD Action Plan COPD: Help for Caregivers COPD: Keeping Your Diet Healthy COPD: Using Exercise to Feel Better COPD COPD Flare-Ups Bullectomy for COPD COPD and Alpha-1 Antitrypsin AAT Deficiency COPD and Sex Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease COPD COPD Oxygen Treatment for Chronic Obstructive Pulmonary Disease COPD COPD: Avoiding Weight Loss COPD: Avoiding Your Triggers.

Alzheimer's or Other Dementia: Should I Move My Relative Into Long-Term Care? Alzheimer's and Other Dementias: Coping With Sundowning Dementia: Assessing Pain Medical History and Physical Examination for Dementia or Alzheimer's Disease Alzheimer's and Other Dementias: Making the Most of Remaining Abilities Dementia: Helping a Person Avoid Confusion Alzheimer's and Other Dementias: Maintaining Good Nutrition Dementia: Tips for Communicating Agitation and Dementia Dementia: Bladder and Bowel Problems Dementia: Support for Caregivers Dementia: Legal Issues Dementia: Understanding Behaviour Changes Dementia: Medicines to Treat Behaviour Changes Dementia Mild Cognitive Impairment and Dementia.

Diabetes: Blood Sugar Levels Diabetes: Counting Carbs if You Don't Use Insulin Diabetes: Coping With Your Feelings About Your Diet Diabetes: Tracking My Feelings Diabetes: Taking Care of Your Feet Diabetes: Care of Blood Sugar Test Supplies Diabetes: Checking Your Blood Sugar Diabetes: Checking Your Feet Diabetes: Steps for Foot-Washing Diabetes: Protecting Your Feet Diabetes: Dealing With Low Blood Sugar From Medicines Diabetes: Dealing With Low Blood Sugar From Insulin Diabetes: How to Give Glucagon Low Blood Sugar Level Record Symptoms of Low Blood Sugar Diabetes: Preventing High Blood Sugar Emergencies Diabetic Ketoacidosis DKA High Blood Sugar Level Record Symptoms of High Blood Sugar Diabetes: Using a Plate Format to Plan Meals Diabetes: Giving Yourself an Insulin Shot Diabetes: Eating Low-Glycemic Foods Diabetes and Alcohol Continuous Glucose Monitoring Quick Tips: Diabetes and Shift Work Diabetes: How to Prepare for a Colonoscopy Type 2 Diabetes: Can You Cure It?

Diabetes, Type 2: Should I Take Insulin? Prediabetes: Which Treatment Should I Use to Prevent Type 2 Diabetes? Diabetes: Living With an Insulin Pump Form for Carbohydrate Counting. Autism Down Syndrome: Helping Your Child Eat Independently Down Syndrome: Grooming and Hygiene Down Syndrome: Helping Your Child Learn to Walk and Use Other Motor Skills Down Syndrome: Helping Your Child Learn to Communicate Down Syndrome Dyslexia Conditions Related to Dyslexia Autism: Behavioural Training and Management Autism: Support and Training for the Family Unproven Treatments for Autism Caring for Adults With Autism Down Syndrome: Helping Your Child Avoid Social Problems Down Syndrome: Training and Therapy for Young People Down Syndrome: Helping Your Child Dress Independently Down Syndrome, Ages Birth to 1 Month Down Syndrome, Ages 1 Month to 1 Year Down Syndrome, Ages 1 to 5 Down Syndrome, Ages 5 to 13 Down Syndrome, Ages 13 to Anorexia: Learning New Eating Behaviours Anorexia: Learning to Trust Others Binge Eating Disorder Bulimia Nervosa Eating Disorders: Cultural and Social Factors Eating Disorders: Feeling Better About Yourself Eating Disorders: Malnutrition Tests Eating Disorders: Things That Put a Person at Risk.

Absence Epilepsy Juvenile Myoclonic Epilepsy Temporal Lobe Epilepsy Focal Epilepsy Epilepsy: Simple Partial Seizures Epilepsy Epilepsy and Driving Epilepsy: Generalized Seizures Epilepsy: Generalized Tonic-Clonic Seizures Epilepsy: Myoclonic Seizures Epilepsy: Atonic Seizures Epilepsy: Tonic Seizures Epilepsy: Complex Partial Seizures Epilepsy Medicine Therapy Failure Stopping Medicine for Epilepsy Questions About Medicines for Epilepsy Epilepsy: Taking Your Medicines Properly.

Sleep Apnea: Should I Have a Sleep Study? Peripheral Arterial Disease of the Legs Bradycardia Slow Heart Rate Types of Bradycardia Cardiac Device Monitoring Angioplasty for Peripheral Arterial Disease of the Legs Isolated Systolic High Blood Pressure Atrial Fibrillation: Should I Try Electrical Cardioversion?

Change in Heartbeat Deep Vein Thrombosis Fast Heart Rate Heart Failure: Symptom Record Heart Failure: Compensation by the Heart and Body Heart Failure: Taking Medicines Properly Heart Failure: Watching Your Fluids Heart Failure: Avoiding Triggers for Sudden Heart Failure Heart Failure: Activity and Exercise Heart Tests: When Do You Need Them?

Low Blood Pressure Hypotension Cardiac Arrest Heart Failure Daily Action Plan Premature Ventricular Contractions PVCs Heart Rate Problems: Should I Get a Pacemaker? Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator ICD?

What to Do if Your Cardiac Device Is Recalled Venous Insufficiency Carotid Artery Stenting ICD: Living Well With It Diabetes: Lower Your Risk for Heart Attack and Stroke Pacemaker for Heart Failure Cardiac Resynchronization Therapy Heart Attack: How to Prevent Another One Stroke: How to Prevent Another One Sex and Your Heart Supraventricular Tachycardia: Should I Have Catheter Ablation?

Acute Coronary Syndrome Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke? Heart Failure: Should I Get a Pacemaker? Heart Failure: Should I Get an Implantable Cardioverter-Defibrillator ICD? Heart Valve Disease Myxoma Tumours of the Heart Aortic Dissection Heart Attack and Stroke Risk Screening High Blood Pressure: Checking Your Blood Pressure at Home Hypertensive Emergency Stroke Rehabilitation Treatment for Stroke-Related Spasticity Driving a Car After a Stroke Heart Failure: Avoiding Medicines That Make Symptoms Worse Stroke Recovery: Coping With Eating Problems Heart Murmur High Blood Pressure: Should I Take Medicine?

Coronary Artery Disease: Should I Have Angioplasty for Stable Angina? Tyrell's Story: Taking Pills for High Blood Pressure Stroke Prevention: Should I Have a Carotid Artery Procedure? Atrial Fibrillation: Which Anticoagulant Should I Take to Prevent Stroke?

Stroke: Should I Move My Loved One Into Long-Term Care? Atrial Fibrillation: Should I Take an Anticoagulant to Prevent Stroke? Smoking and Coronary Artery Disease.

Hepatitis C: Your Risk for Cirrhosis Hepatitis E Hepatitis B Immune Globulin - Injection Heparin - Injection Fulminant Hepatitis Protect Yourself From Hepatitis A When Travelling Hepatitis A Viral Hepatitis Hepatitis C Hepatitis D Hepatitis B: How to Avoid Spreading the Virus Hepatitis B Hepatitis Panel Hepatitis B Treatment Recommendations Hepatitis B: Should I Be Tested?

HIV Infection HIV Viral Load HIV: Stages of Infection Ways HIV Cannot Be Spread HIV and Exercise HIV: Giving Support HIV: Tips for Caregivers to Avoid Infection HIV: Preventing Other Infections When You Have HIV HIV Home Care Antiretroviral medicines for HIV Resistance to HIV Medicines HIV: Preventing Infections HIV: Antiretroviral Therapy ART Opportunistic Infections in HIV HIV: Taking Antiretroviral Drugs HIV: Non-Progressors and HIV-Resistant People HIV Screening HIV and Weight Loss HIV and Fatigue.

Anthrax Avian Influenza Avoiding Infections in the Hospital Bacterial Infections of the Spine Bites and Stings: Flu-Like Symptoms Boric Acid for Vaginal Yeast Infection Caregiving: Reducing Germs and Infection in the Home Central Venous Catheter: Flushing Chickenpox Varicella Chickenpox: Preventing Skin Infections Chikungunya Fever Complicated Urinary Tract Infections Complications of Ear Infections Cranberry Juice and Urinary Tract Infections Dengue Fever Ear Infection: Should I Give My Child Antibiotics?

Ear Infections Ebola or Marburg Virus Infection Ebola Virus Disease Enterovirus D68 EV-D68 Fever or Chills, Age 11 and Younger Fever or Chills, Age 12 and Older Fever Seizures Fever Temperatures: Accuracy and Comparison Feverfew for Migraines Fifth Disease Flu: Signs of Bacterial Infection Fungal Nail Infections Giardiasis Hand-Foot-and-Mouth Disease Kissing Bugs Measles Rubeola Middle East Respiratory Syndrome MERS Molluscum Contagiosum Monkeypox Mononucleosis Mono Mononucleosis Complications Mumps Nail Infection: Should I Take Antifungal Pills?

Neutropenia: Preventing Infections Non-Surgical Nail Removal for Fungal Nail Infections Noroviruses Pleurisy Pneumonia Preventing Tetanus Infections Pseudomonas Infection Recurrent Ear Infections and Persistent Effusion Recurrent Vaginal Yeast Infections Respiratory Syncytial Virus RSV Infection Rotavirus Rubella German Measles Scarlet Fever Sexually Transmitted Infections Sexually Transmitted Infections: Genital Examination for Men Sexually Transmitted Infections: Symptoms in Women Sexually Transmitted Infections: Treatment Shingles Smallpox Sore Throat and Other Throat Problems Staph Infection Strep Throat Symptoms of Pelvic Infection Thrush Tick Bites: Flu-Like Symptoms Tinea Versicolor Tuberculosis TB Tuberculosis Screening Urinary Tract Infections UTIs in Older Adults Vaginal Yeast Infection: Should I Treat It Myself?

Vaginal Yeast Infections Valley Fever West Nile Virus Zika Virus. Broken Collarbone Clavicle Shoulder Separation Frozen Shoulder Preventing ACL Injuries Living With a Spinal Cord Injury Classification of Spinal Cord Injuries Tendon Injury Tendinopathy Shin Splints Muscle Cramps Whiplash Fractured Rib.

Osteochondritis Dissecans of a Joint Back to Work? Acute Kidney Injury Versus Chronic Kidney Disease Nephrotic Syndrome Uremia Kidney Stones: Should I Have Lithotripsy to Break Up the Stone?

Chronic Kidney Disease Kidney Failure: When Should I Start Dialysis? Kidney Failure: Should I Start Dialysis?