Psoriasis
An immune condition that speeds up skin turnover: raised red patches with silvery scale on elbows, knees, scalp and back. Not contagious. It comes and goes, and treatment now works remarkably well.
The psoriasis ladder
Creams first, then light, tablets or injections for widespread or stubborn psoriasis. Give creams 4 weeks and bigger treatments about 3 months.
- Step 1 · Self-careMoisturise, quit smoking, less alcohol, healthy weightThe unglamorous basics that make every other treatment work better.
- Works
- Small trials: weight loss gives a modest extra improvement; moisturiser softens scale
- Cost
- About $10–25 a tub of moisturiser
- How long
- Daily, long term
- Watch for
- Long hot showers and harsh soaps dry skin out.
Moisturiser is boring. Boring works.
- Step 2 · PharmacyTar or salicylic acid shampoos and creamsSoften and lift scale, especially on the scalp.
- Works
- Small benefit; weaker than vitamin D or steroid creams in trials
- Cost
- About $15–30
- How long
- A few times a week; leave shampoo on 5–10 minutes
- Watch for
- Tar smells and stains. Salicylic acid can irritate.
Your bathroom may smell like fresh roadworks. Your scalp won’t mind.
- Step 3 · PrescriptionSteroid ointment or creamThe first treatment for most patches. Ointments suit thick scale; milder strengths on the face and skin folds.
- Works
- Clearly beats base cream in trials (stronger ones more so); most patches improve within 2–4 weeks
- Cost
- Under the $25 PBS co-payment, about $15–25 a tube
- How long
- Courses of up to 4 weeks, then breaks
- Watch for
- Skin thinning with long or strong use, especially on the face and folds.
Courses, not a lifestyle.
- Step 4 · PrescriptionCalcipotriol + betamethasone gel, foam or ointmentVitamin D and a steroid in one, once a day. Great for plaques and the scalp.
- Works
- About half are clear or almost clear after 4–8 weeks; beats either ingredient alone
- Cost
- $25 on the PBS ($7.70 concession)
- How long
- Daily for up to 4 weeks, then as needed or twice a week
- Watch for
- Irritation. Not for the face.
Once a day. A medicine that respects your schedule.
- Step 5 · ProcedureNarrowband UVB light therapyClinic sessions 2–3 times a week, through a dermatologist.
- Works
- About 6 to 7 in 10 clear or nearly clear
- Cost
- Often Medicare-covered, sometimes with a small gap per session
- How long
- Usually 15–25 sessions over 6–10 weeks
- Watch for
- Sunburn-like redness. Skin cancer risk rises with many courses.
Not a solarium. Those are banned for a reason.
- Step 6 · SpecialistTablets that calm the immune systemSuch as methotrexate, acitretin, ciclosporin, apremilast or deucravacitinib, for moderate to severe psoriasis.
- Works
- About 3 to 7 in 10 get a big improvement, depending on the medicine
- Cost
- Usually $25 or less per script on the PBS ($7.70 concession); some only via a dermatologist
- How long
- 2–4 months to judge; long term with check-ups
- Watch for
- Regular blood tests. Methotrexate and acitretin cause birth defects (acitretin: no pregnancy for 3 years after stopping).
The blood tests are the price of admission. Pay it.
- Step 7 · SpecialistBiologic injectionsFor severe psoriasis when other treatments haven’t worked.
- Works
- Newer ones get about 7 to 9 in 10 people mostly or completely clear
- Cost
- $25 per script on the PBS ($7.70 concession) if you meet the criteria, via a dermatologist
- How long
- Injections every 2–12 weeks; reviewed at about 3–4 months
- Watch for
- Infection risk. Screening for TB and hepatitis first.
The results are stunning. The PBS paperwork is the only sticky bit.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Vitamin D tabletsA 2023 trial found they didn’t improve psoriasis. The vitamin D that works comes in a tube (calcipotriol), not a capsule.
- Fish oil capsulesTrials are small and mixed, with no reliable benefit for skin. Expensive burps.
- Gluten-free dietOnly helps if you have coeliac disease or gluten antibodies. For everyone else it’s just pricier bread.
- Turmeric and curcuminSmall, low-quality studies. Great in a curry, unproven on your elbows.
- Aloe vera gelTrials are mixed, and one found it no better than a dummy treatment. Soothing, maybe; treatment, no.
What you can do
- Moisturise every day, ideally just after a short, warm shower. Use soap-free washes.
- For the scalp, leave medicated shampoo on for 5 to 10 minutes before rinsing.
- Quit smoking and cut back on alcohol: both make psoriasis worse.
- Avoid scratching and skin injuries, as new patches can form there.
- Tell your doctor about all your medicines, as some (such as lithium or beta blockers) can trigger flares.
See your GP if
- Psoriasis isn’t improving after 4 weeks of treatment
- Patches cover large areas, or affect the face, genitals, hands or feet
- Swollen, painful or stiff joints, or sore heels
- It’s affecting your sleep, mood or relationships
Go to the emergency department if most of your skin becomes red, hot and painful, or you get widespread pus spots with fever or feel unwell.
Some psoriasis tablets, including methotrexate and acitretin, cause birth defects, and steroid tablets can cause a severe flare when stopped. Tell your doctor if you’re pregnant or planning to be.
Common questions
Is psoriasis contagious?
No. It is an immune condition that speeds up skin cell growth, and it comes and goes over a lifetime.
What is the best cream for psoriasis?
Steroid ointments are the first treatment for most patches. A gel, foam or ointment combining calcipotriol and betamethasone, once a day for up to 4 weeks, is very effective for plaques and the scalp.
Can I get biologics for psoriasis on the PBS?
Yes, for severe psoriasis when other treatments haven’t worked, through a dermatologist if you meet the criteria. The cost is the usual PBS co-payment.
Is psoriasis linked to joint pain?
About 1 in 4 people with psoriasis also get psoriatic arthritis. See your GP for swollen, painful or stiff joints, or sore heels.
What causes psoriasis?
An overactive immune system makes skin cells grow too fast, building up into scaly plaques. Genes play a big part. Flares can be triggered by strep throat, stress, skin injury, smoking, alcohol and some medicines such as lithium.
Does psoriasis go away?
Psoriasis is usually long term and tends to come and go, with flares and quieter spells. It can’t be cured yet, but modern treatments clear or nearly clear the skin for many people.
Is it scalp psoriasis or dandruff?
Scalp psoriasis has thick, silvery scales on well-defined red patches that often spread past the hairline or behind the ears. Dandruff and seborrhoeic dermatitis cause finer, greasier, yellowish flakes. A GP can usually tell by looking.
Helpful resources
- National Psoriasis Foundation: Patient Navigation CenterFree one-on-one help with questions about psoriasis, finding care and living with it. US-based, open to all by online form.
- Arthritis Australia: Psoriatic arthritis information sheetPlain-English guide to the joint side of psoriasis, and what to do about it. Free PDF.
Evidence and more information
- Healthdirect: Psoriasis
- Australasian College of Dermatologists: Psoriasis
- Better Health Channel: Psoriasis
- Cochrane: Topical treatments for chronic plaque psoriasis
maladywise.com/psoriasis/