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How Do You Treat Severe Psoriasis?

Psoriasis is a skin condition in which new skin cells start growing too quickly, causing a build-up of thick patches of skin. There are many forms of psoriasis and it can range from being mild to being severe, depending on how many areas of an individual’s body the disease affects. Severe psoriasis can cause several types of side effects and also have multiple symptoms. The results of treatment vary from person to person and due to this most doctors prefer treating severe psoriasis with a combination of treatments. Today we look at these different treatments available for severe psoriasis. So let’s find out how to treat severe psoriasis.

What is Psoriasis?

Psoriasis is a skin condition that is characterized by red, itchy, and scaly patches. The scaly patches happen because, in the areas affected by psoriasis, the skin cells start growing rapidly, causing a build-up of skin cells, resulting in the patchy looking skin. It is believed that psoriasis is a result of an immune system problem and triggers can stress, cold, and certain infections.

Severe psoriasis or moderate psoriasis are terms used to describe how much of the body is covered by the disease. In cases of severe psoriasis, more than 10 percent of the body may be covered, while in moderate psoriasis, 3 to 10 percent of the body is covered.

The level of psoriasis you suffer from is one of the biggest factors that doctors take into consideration before prescribing your treatment.

How Do You Treat Severe Psoriasis?

How Do You Treat Severe Psoriasis?

Severe psoriasis is known to cause several side effects as well as multiple symptoms. This is why treatment also differs from person to person. This is why doctors tend to prefer treating severe psoriasis with a combination of treatments. The exact cause of psoriasis is not fully understood and this is why treatment for severe psoriasis typically involves a multifaceted approach.

It is possible sometimes that psoriasis is actually covering less than 10 percent of the body, but is still causing a severe disruption in the person’s life. In these cases as well, the condition will be treated to be that of severe psoriasis. An example of this would be when psoriasis affects a person on the soles of their feet or on the palms of their hands. Therefore, the condition may still be classified as severe psoriasis, regardless of what percentage of the body is covered by the disease. It is because psoriasis has an extreme emotional and physical impact on a person’s life and usually, natural treatment options are not preferred for individuals who are suffering from severe psoriasis.

Why Does Severe Psoriasis Need a Combination Treatment Plan?

Sometimes, standalone psoriasis treatments also work well on their own. However, in cases of severe psoriasis, using a combination of treatments has several benefits. A study published in 2012 looked at the use of combination treatment plans for the treatment of psoriasis. While the study concluded that more research is needed, it nevertheless showed that combination therapies are better tolerated and more effective at treating severe psoriasis as compared to standalone, single-therapy treatments.
One of the biggest benefits of combination therapy is that it allows a doctor to prescribe smaller diseases of each medication. This lowers the risk of side effects and is also cheaper. Furthermore, certain combination therapies are known to also lower the risk of skin cancer, which is generally quite high in people having psoriasis.

Another important advantage of using combination treatments is that there are several possible combinations of treatments this method offers. As there is no known cure available for psoriasis, people are able to depend on these large supply of valuable combination treatments for keeping their symptoms under control.

How Does Combination Treatments for Psoriasis Work?

Combination treatments are prescribed in stages. The treatment begins with ‘the quick fix’, which is the first step. This step begins by clearing the skin lesions during a psoriasis outbreak. In the case of severe psoriasis, the first stage treatment is done with the use of either oral immunosuppressants or with the use of a strong topical steroid.

The second stage is known as the transitional phase and it involves the gradual introduction of a maintenance drug. This would include a rotational therapy that would alternate between combinations of treatments. The ultimate goal of this stage of treatment is to keep the disease under control and to lower the side effects and resistance to the medications.

The last state is known as the maintenance phase. During this phase, the medication dosage is generally decreased as the symptoms slowly start to diminish.

Treatments Available for Severe Psoriasis

These are the treatments that are available for treating severe psoriasis.

Topical Medications

  • Ointments and creams
  • Shampoos
  • Any other types of medications that are applied to the surface of the skin

Generally, topical treatments that are used for treating severe psoriasis contain steroids and are used to reduce inflammation, block the production of new skin cells, and relieve itching.

Apart from steroids, topical drugs that are also used in combination treatment include.

These topical treatments are usually used in combination with other more potent treatments as topical treatments alone are not sufficient for treating severe psoriasis.

Systemic Medications

Unlike topical medications, systemic medications are used for the entire body and not just the skin. These are taken either through an injection or orally. The commonly used systemic medications for severe psoriasis include.

These type of drugs are effective for treating severe psoriasis on their own and do not need to be used in combination with other medications. However, there are many side effects associated with these medications, and they may range from being moderate to severe. Some doctors, though, do combine systemic medications with other treatments, which allows them to prescribe a lower dose and potency of these drugs, lowering the chances of side effects as well.

Light Therapy (Phototherapy)

Light therapy makes use of ultraviolet light on the skin, performed under medical supervision, to clear up the skin either completely or at least significant improvement can be witnessed. This therapy is generally given only in small doses and the dosage is increased gradually so as to avoid any burns on the skin.

Phototherapy is almost always used in combination with another therapy and also as a secondary treatment form. Some doctors will even recommend sitting outside in the sunlight for a couple of minutes each day in order to soak up the ultraviolet rays of the sun.

There are three types of light therapy available for treating severe psoriasis. These include.

Ultraviolet B (UVB) Therapy. UVB therapy is ideal for patients who have had no success from creams and lotions. In this, your body is exposed to UVB light from a lightbox. The light goes into the skin and is said to slow down the growth of the skin cells. It is recommended that this is performed only under the guidance of a professional dermatologist or doctor. Potential side effects can include redness, skin irritation, itching or burning sensation, sunburn, dry skin, increased risk of skin cancer, and blisters.

PUVA Therapy (Photochemotherapy). PUVA therapy uses a drug known as psoralen that increases the skin’s sensitivity to light. Once the skin has become more sensitive to absorbing the light, it is then exposed to ultraviolet A light. The light then slows down the growth of skin cells. Side effects of this treatment include nausea, redness, itching, freckles, burns, blisters, and an increased risk of skin cancer.

Laser Treatment. In this treatment, a thin beam of laser targets the areas affected by psoriasis, without affecting the nearby skin. Side effects may include scarring, bruising, blistering, and/or redness.

Biological Response Modifier Drugs

Biological response modifier drugs or biologics are the latest forms of treatment for many immune system-based diseases. These are protein-based drugs that are either injected or given through IV infusion. These medications target certain parts of the immune system and block the proteins that are responsible for the development of psoriasis.

Biologics are equally effective as a standalone treatment and even more effective when used with other treatments.


Every person responds differently to a certain treatment because everyone has a different experience with psoriasis. If you have severe psoriasis then a combination treatment plan could be a good option for you and your doctor would be the best person to guide you further on this. Always remember that you should never begin or stop any medications or treatments without consulting your doctor.


  1. Mayo Clinic. (2021). Psoriasis. https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840

  2. National Psoriasis Foundation. (n.d.). About Psoriasis. https://www.psoriasis.org/about-psoriasis

  3. American Academy of Dermatology Association. (n.d.). Psoriasis: Diagnosis and Treatment. https://www.aad.org/public/diseases/psoriasis/treatment

  4. National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2021). Psoriasis. https://www.niams.nih.gov/health-topics/psoriasis

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:September 7, 2023

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