Patient leaflet based on NICE

REPORT: Dr M Morgan MB BS BSc July 2025

Latest Treatments for Psoriasis: A Patient Guide

What is Psoriasis?

Psoriasis is a chronic inflammatory skin condition that affects around 2 in 100 people in the UK1. It causes red, scaly patches on the skin that can be itchy or painful. While there is no cure, many effective treatments are available to control symptoms and improve quality of life1.

Treatment Approach

Treatment for psoriasis follows a step-by-step approach, starting with mild treatments and progressing to stronger ones if needed2. Most patients (about 90%) can be managed with topical treatments applied to the skin3.

TOPICAL TREATMENTS (Applied to Skin)

First-Line Treatments

Combination Treatments

• Calcipotriol with Betamethasone (Enstilar® foam, Dovobet® gel/ointment)3

• • Contains vitamin D analogue plus steroid
  • Applied once daily for 4 weeks maximum
  • Most effective first-line option
  • Shake foam well before use and note it's flammable

Individual Treatments

• Topical Steroids: Various strengths available4
• Vitamin D Analogues: Calcipotriol (Dovonex®)4
• Coal Tar Preparations: For thick plaques4
• Emollients: Essential for all Area Treatments**

Face, Groin, and Body Folds

• Mild-moderate steroids (hydrocortisone, clobetasone butyrate)3
• Topical Calcineurin Inhibitors (Protopic®, Elidel®) for steroid-free treatment5

• • Can be used safely on face and sensitive areas
  • May cause initial stinging that usually improves

Scalp

• Potent steroid scalp applications (Betacap®, Dermovate®)6
• Combination products available

PHOTOTHERAPY (Light Treatment)

UVB Therapy

• Narrow-band UVB light treatment2
• Usually 2-3 times weekly for 12-16 weeks
• No tablets required
• Available at specialist hospitals

PUVA Therapy

• Combines psoralen medication with UVA light7
• Whole Body PUVA: Tablets taken before light exposure
• Topical PUVA: Psoralen applied to skin or bath soaks8
• Usually 2 treatments per week for 8-15 weeks
• Reserved for more severe cases

SYSTEMIC TREATMENTS (Tablets/Injections)

Traditional Systemic Therapies

Methotrexate

• Weekly tablet treatment
• Requires regular blood monitoring9
• Effective for both skin and joint symptoms

Ciclosporin

• Daily capsules
• Maximum 2 years continuous use
• Quick-acting but requires monitoring

Dimethyl Fumarate

• Twice daily tablets
• Licensed for moderate-to-severe psoriasis10

New Oral Treatment

Deucravacitinib (Sotyktu®) - Latest Addition 202311

• First-in-class TYK2 inhibitor
• Once-daily oral tablet
• For moderate-to-severe psoriasis
• Available when other treatments have failed
• NICE approved for NHS use in England12

BIOLOGIC TREATMENTS (Injections)

Eligibility Criteria

Available for moderate-to-severe psoriasis when13:

• PASI score ≥10 AND DLQI >10
• Failed to respond to methotrexate, ciclosporin, or phototherapy
• OR contraindications/intolerance to these treatments

Treatment Classes

Anti-TNF Biologics (First-line options)10

• Adalimumab (biosimilar Amgevita®) - every 2 weeks
• Etanercept (biosimilar Benepali®) - weekly
• Certolizumab - safe in pregnancy

IL-17 Inhibitors (Highly effective)10

• Secukinumab - every 4 weeks after loading
• Ixekizumab - every 4 weeks after loading
• Brodalumab - every 8 weeks after loading
• Bimekizumab - latest addition, very effective

IL-23 Inhibitors (Long-lasting effects)10

• Guselkumab - every 8 weeks after loading
• Risankizumab - every 12 weeks after loading
• Tildrakizumab - every 12 weeks after loading

IL-12/23 Inhibitor

• Ustekinumab - every 12 weeks after loading

Administration and Monitoring

• Most biologics are self-injected at home
• Regular blood tests required initially14
• Specialist hospital initiation and monitoring

WHEN TO SEE YOUR DOCTOR

GP Referral to Dermatology Needed For:

• Extensive psoriasis (>10% body surface area)3
• Difficult-to-treat areas (face, hands, genitals, nails)
• Failure of topical treatment after 2-3 months
• Suspected psoriatic arthritis
• Diagnostic uncertainty

Emergency Referral Required For:

• Erythrodermic psoriasis - widespread redness covering most of body6
• Generalised pustular psoriasis - widespread pus-filled spots6

MONITORING AND SAFETY

Blood Tests

Regular monitoring required for:

• Methotrexate: Every 1-2 weeks initially, then monthly9
• Biologics: Every 3-6 months after stabilisation14
• Ciclosporin: Monthly blood pressure and kidney function

Infection Prevention

• Report any infections before treatment
• Annual flu vaccination recommended
• Avoid live vaccines while on immunosuppressants

LIFESTYLE CONSIDERATIONS

General Health

• Maintain healthy weight
• Stop smoking (especially important for some types)
• Limit alcohol intake
• Regular cardiovascular health checks

Skin Care

• Use emollients daily
• Avoid skin injury when possible
• Protect from excessive sun exposure during phototherapy

PATIENT SUPPORT

Helpful Organisations

• The Psoriasis Association: www.psoriasis-association.org.uk
• Psoriasis and Psoriatic Arthritis Alliance (PAPAA): www.papaa.org
• NHS Psoriasis Information: http://www.nhs.uk/conditions/psoriasis

Emergency Contacts

Contact your GP or dermatology department immediately if you develop:

• Widespread skin redness or burning
• High fever with skin changes
• Signs of serious infection

This leaflet provides general information only. Always discuss your individual treatment options with your healthcare team. Treatment recommendations may vary based on your specific circumstances, medical history, and response to previous therapies.

Last updated: July 2025

Based on current NICE guidelines and NHS treatment pathways

1. https://www.nhs.uk/conditions/psoriasis/
2. https://www.nhs.uk/conditions/psoriasis/treatment/
3. https://swlimo.southwestlondon.icb.nhs.uk/wp-content/uploads/SWL-guidelines-Management-of-Psoriasis-Final-V1-Oct24.pdf
4. https://www.nice.org.uk/guidance/cg153/ifp/chapter/initial-treatment-with-topical-medication
5. https://www.skinhealthinfo.org.uk/wp-content/uploads/2018/10/Topical-calcineurin-Inhibitors-PIL-2020.pdf
6. https://www.nottsapc.nhs.uk/media/1614/psoriasis.pdf
7. https://www.ouh.nhs.uk/media/xsuklale/99053puva.pdf
8. https://www.leedsth.nhs.uk/patients/resources/local-puva-treatment-using-topical-psoralen/
9. https://www.sps.nhs.uk/monitorings/methotrexate-monitoring/
10. https://www.hey.nhs.uk/wp/wp-content/uploads/2022/07/pathwayPsoriasis.pdf
11. https://www.pharmafocus.com/articles/bristol-myers-squibb-s-sotyktu-recommended-to-treat-adult-patients-with-psoriasis-on-the-nhs
12. https://www.psoriasis-association.org.uk/news/sotyktu
13. https://www.selondonics.org/wp-content/uploads/dlm_uploads/PSO-pathway-August-2024-FINAL.pdf
14. https://academic.oup.com/bjd/article/190/4/e47/7629904
15. https://rightdecisions.scot.nhs.uk/media/npumkf0g/715-psoriasis-treatment-with-biological-agents.pdf
16. https://www.london-dermatology-centre.co.uk/blog/psoriasis-research-latest-treatments/
17. https://www.uhd.nhs.uk/uploads/about/docs/our_publications/patient_information_leaflets/dermatology/Biologic-medications-for-dermatological-conditions.pdf
18. https://www.nice.org.uk/guidance/cg153
19. https://dermnetnz.org/topics/guidelines-for-the-treatment-of-psoriasis
20. https://www.bad.org.uk/pils/psoriasis-treatments-for-moderate-or-severe-psoriasis/
21. https://pathways.nice.org.uk/pathways/psoriasis
22. https://www.uhsussex.nhs.uk/wp-content/uploads/2022/09/Biologic-and-biosimilar-treatment-for-skin-conditions.pdf
23. https://www.dermatologytimes.com/view/psoriasis-therapies-in-2024-and-beyond
24. https://bnf.nice.org.uk/treatment-summaries/psoriasis/
25. https://www.northyorkshireandyorkformulary.nhs.uk/docs/BNF/10/Biolgics%20pathway%20for%20Psoriatic%20Arthritis%20June%202019%20(2).pdf
26. https://primarycare.northeastlondon.icb.nhs.uk/wp-content/uploads/2025/01/Psoriasis-HCD-pathway-NEL-V1.4_01.2025.pdf
27. https://cks.nice.org.uk/topics/psoriasis/
28. https://www.bucksformulary.nhs.uk/docs/Guideline_738FM.pdf
29. https://www.bath.ac.uk/announcements/a-cure-for-psoriasis-could-a-faulty-iron-hormone-in-the-skin-be-the-key/
30. https://cks.nice.org.uk/topics/psoriasis/management/
31. https://www.skinhealthinfo.org.uk/wp-content/uploads/2018/11/Psoriasis-Treatment-for-moderate-or-severe-psoriasis-updated-February-2021-Lay-reviewed-Feburary-2021.pdf
32. https://www.bad.org.uk/pils/psoriasis-topical-treatments/
33. https://www.medthority.com/news/2023/5/mhra-uk-approves-sotyktu-to-treat-moderate-to-severe-plaque-psoriasis.--bms.-
34. https://www.bad.org.uk/pils/psoriasis-an-overview/
35. https://scottishmedicines.org.uk/medicines-advice/deucravacitinib-sotyktu-full-smc2581/
36. https://www.hweclinicalguidance.nhs.uk/all-clinical-areas-documents/download?checksum=f44ee263952e65b3610b8ba51229d1f9
37. https://www.psoriasis-association.org.uk/leaflets-and-information-sheets
38. https://scottishmedicines.org.uk/media/7992/deucravacitinib-sotyktu-final-nov-2023-amended-011223-for-website.pdf
39. https://www.pcds.org.uk/files/pils/PIL-Psoriasis.pdf
40. https://www.cheshireandmerseysideformulary.nhs.uk/docs/files/deucravacitinib_psoriasis.pdf?UNLID=
41. https://www.lancashireandsouthcumbriaformulary.nhs.uk/docs/files/LSCMMG%20Psoriasis%20guideline%20v1.3.pdf?UNLID=65362811202562341136
42. https://patient.info/skin-conditions/psoriasis-leaflet
43. https://pmc.ncbi.nlm.nih.gov/articles/PMC9513929/
44. https://www.formularywkccgmtw.co.uk/media/2000/km-clinical-guideline-for-biologic-therapy-for-psoriasis-in-adults.pdf
45. https://www.psoriasis-association.org.uk/news/nice-approves-rinvoq-for-psoriatic-arthritis
46. https://cks.nice.org.uk/topics/psoriasis/how-up-to-date-is-this-topic/update/
47. https://primarycare.northeastlondon.icb.nhs.uk/wp-content/uploads/2023/06/NEL-Psoriasis-pathway-final-version.pdf
48. https://www.gov.uk/drug-safety-update/janus-kinase-jak-inhibitors-new-measures-to-reduce-risks-of-major-cardiovascular-events-malignancy-venous-thromboembolism-serious-infections-and-increased-mortality
49. https://swlimo.southwestlondon.icb.nhs.uk/wp-content/uploads/Janus-Kinase-JAK-inhibitors-and-MHRA-safety-update-v2.1.pdf
50. https://www.bucksformulary.nhs.uk/docs/Guideline_740FM.pdf
51. https://www.northyorkshireandyorkformulary.nhs.uk/docs/launcher.asp?docID=215
52. https://www.arthritis.org/diseases/more-about/tests-to-diagnose-and-track-psoriatic-arthritis
53. https://www.drugs.com/compare/protopic
54. https://www.newcastle-hospitals.nhs.uk/services/dermatology/patient-dermatology-information-leaflets/hand-and-or-foot-immersion-puva/
55. https://www.bad.org.uk/pils/topical-calcineurin-inhibitors/
56. https://www.hey.nhs.uk/patient-leaflet/28826/
57. https://eczema.org/information-and-advice/treatments-for-eczema/topical-calcineurin-inhibitors/
58. https://www.ouh.nhs.uk/media/wh2htnwc/99054puva.pdf
59. https://www.imperial.nhs.uk/our-services/dermatology/psoriasis
60. https://hexi.ox.ac.uk/psoriasis/psoriasis-topical-treatments-topical-calcineurin-inhibitors-eg-protopic-tacrolimus
61. https://www.royaldevon.nhs.uk/services/dermatology/dermatology-eastern-services/phototherapy/
62. https://www.myskindoctor.co.uk/psoriasis/
63. https://www.pcds.org.uk/clinical-guidance/topical-calcineurin-inhibitors
64. https://yourhealth.leicestershospitals.nhs.uk/library/csi/central-outpatients/447-having-whole-body-puva-phototherapy/file