Topical therapies are commonly used for mild-to-moderate psoriasis and as “add-on” care for more extensive disease. Peak Skin Center often focuses on balancing effectiveness with long-term skin comfort, especially on sensitive areas.

Topical corticosteroids

Topical steroids calm psoriasis by suppressing inflammatory signaling in the skin and slowing the rapid turnover of skin cells within plaques. Many people notice softer plaques and less itching within 1–2 weeks, with more visible flattening over 2–4 weeks. Common side effects include burning or irritation early on, and with prolonged or frequent use, thinning of the skin, stretch marks, and visible small blood vessels.

Vitamin D analogs (calcipotriene)

Vitamin D analogs help normalize skin cell growth and reduce inflammation, which can gradually thin plaques and decrease scaling. Improvement typically becomes noticeable in 2–6 weeks, with continued gains over several months when used consistently. Common side effects include mild irritation or dryness; overuse on large areas can rarely affect calcium balance, so dosing guidance matters.

Topical retinoids (tazarotene)

Tazarotene is a vitamin A derivative that helps psoriasis by influencing gene expression involved in keratinocyte growth and inflammation, which can reduce plaque thickness and scaling. Effects often begin in 2–4 weeks and continue to build through 8–12 weeks. Common side effects include irritation, peeling, and increased sun sensitivity, so it is often paired with moisturizers or other topicals.

Calcineurin inhibitors (tacrolimus, pimecrolimus)

These non-steroidal anti-inflammatory creams are often used off-label for psoriasis on the face, eyelids, groin, or skin folds, where steroids can cause more side effects. They work by reducing T-cell–driven inflammation in the skin. Improvement is often seen in 2–6 weeks. Common side effects include temporary burning or stinging at application, especially during the first week.

Keratolytics (salicylic acid, urea)

Keratolytics loosen thick scale and help topical medications penetrate plaques more effectively by breaking down the outer layer of compacted skin cells. Softer scale can be seen within 1–2 weeks, with continued plaque improvement when combined with anti-inflammatory therapy. Side effects may include irritation, dryness, and sensitivity, particularly if used too aggressively.

Steroid-sparing anti-inflammatory creams (tapinarof, roflumilast)

Tapinarof (an aryl hydrocarbon receptor modulator) and roflumilast (a PDE-4 inhibitor) are non-steroidal prescriptions that reduce inflammatory pathways involved in plaque formation and scaling. Many individuals begin to notice changes in redness and plaque texture within 2–6 weeks, with further improvement over 8–12 weeks. Common side effects can include application-site burning or irritation; tapinarof may cause folliculitis-like bumps in some cases.

When psoriasis is extensive, affects high-impact areas, or does not respond adequately to topicals alone, systemic therapy may be appropriate. At Peak Skin Center, Dr. Thomas Knackstedt considers overall health, other medications, pregnancy potential, and monitoring needs when selecting an oral or systemic option.

Apremilast

Apremilast is an oral PDE-4 inhibitor that reduces inflammatory cytokine activity associated with psoriasis. Symptom improvement is often noticed in 4–8 weeks, with fuller responses over 12–16 weeks. Common side effects include diarrhea, nausea, headache, and weight loss; mood changes are uncommon but should be discussed in advance.

Methotrexate

Methotrexate reduces psoriasis by dampening overactive immune cell activity that drives chronic inflammation and rapid skin cell turnover. Improvement is commonly seen within 4–8 weeks, and it can be especially helpful when psoriatic arthritis is present. Common side effects include nausea, fatigue, and elevated liver enzymes; blood count and liver monitoring are routine, and alcohol intake may need to be limited.

Cyclosporine

Cyclosporine suppresses T-cell–mediated immune activity and can work quickly for severe flares. Effects may appear within 2–4 weeks, which is why it is often used for short-term control rather than long-term maintenance. Common side effects include high blood pressure, kidney strain, and increased infection risk, so close monitoring is essential.

Acitretin

Acitretin is an oral retinoid that helps normalize keratinocyte growth and reduce thick scaling, often benefiting pustular or very hyperkeratotic psoriasis. Improvement typically takes 6–12 weeks. Common side effects include dry lips and skin, hair thinning, and elevated triglycerides; it is not used in people who could become pregnant due to strict pregnancy-related safety precautions.

TYK2 inhibitors

TYK2 inhibitors reduce signaling involved in psoriasis inflammation, particularly pathways related to IL-23 and downstream cytokines. Many patients notice improvement within 4–8 weeks, with stronger responses by about 12–16 weeks. Common side effects can include upper respiratory infections, headache, and acne-like eruptions in some individuals, and lab monitoring may be recommended depending on the medication.

Biologics are injectable or infused therapies that target specific immune pathways known to drive psoriasis. Peak Skin Center commonly considers biologics for moderate-to-severe psoriasis, difficult-to-treat locations, or when systemic control is needed to reduce inflammation burden. Dr. Thomas Knackstedt typically coordinates baseline screening, including infection risk assessment, before treatment begins.

TNF-alpha inhibitors (adalimumab, etanercept, infliximab)

TNF-alpha inhibitors reduce broad inflammatory activity that contributes to plaque formation and joint inflammation. Many people see meaningful improvement in 4–12 weeks, with continued clearing over several months. Common side effects include injection-site reactions and increased susceptibility to infections; screening for tuberculosis is standard.

IL-17 inhibitors (secukinumab, ixekizumab, brodalumab, bimekizumab)

IL-17 inhibitors work by blocking a key cytokine that drives plaque inflammation and rapid skin cell turnover, often producing fast and robust skin clearance. Improvement can begin within 2–6 weeks, with strong results commonly seen by 12–16 weeks. Common side effects include upper respiratory infections, injection-site reactions, and a higher risk of yeast infections; some are used cautiously in people with inflammatory bowel disease.

IL-23 inhibitors and IL-12/23 inhibitors (guselkumab, risankizumab, tildrakizumab, ustekinumab)

These biologics target upstream signals that sustain psoriasis over time, which can lead to durable control with relatively infrequent dosing schedules. Improvement often becomes noticeable within 4–8 weeks, with peak responses around 12–24 weeks depending on the medication. Common side effects include injection-site reactions and mild respiratory infections; screening for infections is part of safe prescribing.