Psoriasis Treatment Options: Creams, Ointments and Other Treatments
The treatments that work for plaque psoriasis, the order NICE recommends them in, and when to see a specialist.
Part of our psoriasis guide.
Get urgent help first. Call 999 or go to A&E if your skin suddenly becomes red and inflamed over most of your body, or you have widespread pus-filled spots, especially with a fever, chills or feeling very unwell. These can be signs of erythrodermic or generalised pustular psoriasis, which are emergencies. See a GP soon if you have painful, swollen joints. Online treatment isn't suitable in these situations.
Key fact: most plaque psoriasis is treated first with a potent steroid and a vitamin D treatment such as calcipotriol, used for up to 4 weeks. Emollients are used every day alongside, and stronger treatments are offered if creams don't work.
Adults only online, and not in pregnancy or breastfeeding. Access Doctor's online psoriasis service is for adults aged 18 and over, and can't supply treatment if you're pregnant or breastfeeding: your GP or midwife can help. Children with psoriasis should see their GP.
The main psoriasis treatments at a glance
| Treatment | What it does | Typical use |
|---|---|---|
| Emollients | Soften scale, reduce dryness and itch, help other treatments work. | Every day, even when the skin is clear. |
| Potent steroid (Betnovate, Elocon) | Calms inflammation quickly. | Once a day for up to 4 weeks, then a 4-week break. |
| Vitamin D (calcipotriol) | Slows skin cell growth and flattens plaques. | Once or twice a day; can be used long term. |
| Combined steroid and vitamin D (Enstilar, Dovobet) | Both actions in one product. | Once a day. Enstilar: up to 4 weeks. Dovobet gel: up to 4 weeks on the scalp, 8 weeks on the body. |
| Very potent steroid (Dermovate) | The strongest steroid. | Short courses only, usually under specialist advice. |
| Coal tar | Reduces scale and inflammation. | Once or twice a day; messy and smelly. |
| Light therapy, tablets, injections | Treat widespread or stubborn psoriasis. | Dermatologist-led, through the NHS. |
The NICE treatment steps for plaque psoriasis
NICE guidance (CG153) sets out a step-by-step approach for plaque psoriasis on the trunk, arms and legs in adults. Each step lasts long enough to see whether it works before moving on.
1
Start: potent steroid plus vitamin D, up to 4 weeks
Apply a potent steroid once a day and a vitamin D treatment such as calcipotriol once a day, at different times (one in the morning, one in the evening).
2
If not clear: vitamin D twice a day, up to 8 weeks
Stop the steroid and use the vitamin D treatment twice a day.
3
If still not controlled after 8 to 12 weeks
Options are a potent steroid twice a day for up to 4 weeks, coal tar once or twice a day, or a combined steroid and vitamin D product such as Enstilar or Dovobet once a day for up to 4 weeks.
4
If creams aren't working
A GP can refer you to a dermatologist for light therapy, tablets or injections. See tablets, injections and light therapy.
Breaks between steroid courses: NICE advises aiming for a break of 4 weeks between courses of potent or very potent steroids, and not using a potent steroid continuously on the same area for more than 8 weeks (4 weeks for a very potent steroid), to lower the risk of skin thinning and other side effects. Vitamin D or coal tar can be used during the break.
Steroid creams and ointments
Steroids are the quickest way to calm red, inflamed plaques. Potent steroids such as betamethasone (Betnovate) and mometasone (Elocon) are the usual choice for the body. The very potent steroid clobetasol (Dermovate) is reserved for thick, stubborn plaques, and the BNF advises using it for psoriasis only under specialist supervision. Steroids work well in the short term, but psoriasis often returns when they are stopped, which is why they're combined with vitamin D.
Our guide to steroid creams for psoriasis explains how to use them safely, and our steroid cream strengths guide explains the UK potency names.
Vitamin D treatments
Calcipotriol is a man-made form of vitamin D. It slows down the fast skin cell growth of psoriasis and is not a steroid, so it isn't limited by steroid side effects such as skin thinning, although there is a weekly maximum (100g a week for the ointment). It can irritate the skin at first, so it isn't used on the face or in skin folds. See our calcipotriol guide.
Combined steroid and vitamin D: Enstilar and Dovobet
Enstilar foam and Dovobet gel contain calcipotriol and betamethasone together, so they're applied once a day instead of using two products. They're licensed for plaque psoriasis in adults. Enstilar is used for up to 4 weeks at a time; Dovobet gel for up to 4 weeks on the scalp and up to 8 weeks on the body. Enstilar can also be used twice a week to keep psoriasis away once it has cleared. Read our Enstilar foam guide and our Dovobet gel guide.
Coal tar and dithranol
Coal tar has been used for psoriasis for over a century. It reduces scaling and inflammation, but it smells, stains and can make the skin more sensitive to sunlight. Dithranol is mainly used in hospital now, as the main cream form was discontinued. Our guide to coal tar and dithranol explains when they're used.
Emollients and skin care
Emollients (medical moisturisers) don't clear psoriasis on their own, but they reduce scale, dryness, cracking and itch, and help other treatments soak in. Use them generously every day and as a soap substitute. Apply them at least 30 minutes before or after other treatments. Emollients soak into clothing and bedding, which then catches fire more easily, so keep away from flames. See our emollients guide for how much to use.
Treatment for the face, folds, scalp, hands and nails
- Face, ears and eyelids: a mild or moderate steroid for no more than 2 weeks at a time. See psoriasis on the face.
- Skin folds and genitals: mild steroids for short courses; strong treatments irritate. See inverse psoriasis.
- Scalp: shampoos, lotions and gels made for the scalp. See scalp psoriasis treatment.
- Hands and feet: thicker skin often needs stronger treatment. See hands and feet.
- Nails: hard to treat with creams. See nail psoriasis.
Need treatment for psoriasis on your body?
Our GPhC-registered pharmacist independent prescribers can assess your psoriasis online and, if suitable, prescribe a steroid, Enstilar or Dovobet. Adults 18 and over. Dispensed from our UK pharmacy. Approved before 3pm, Monday to Friday? Dispatched the same day, by Royal Mail Tracked 48, Tracked 24 or Special Delivery guaranteed by 1pm next working day: you choose.
Start Psoriasis Consultation →How our online service supplies psoriasis treatment: adults 18 and over, not for the face, genitals or skin folds. Enstilar, Dovobet and other psoriasis-only treatments need psoriasis already diagnosed by a GP or dermatologist. Enstilar and Dovobet: one pack per order, supplied as a course of up to 4 weeks, on no more than 30% of the body. Betnovate and Elocon: up to 3 × 30g or 1 × 100g, for a 4-week course followed by a 4-week break. Dermovate only if you have been prescribed it before. Widespread psoriasis, joint pain or psoriasis that hasn't responded to treatment is referred to your GP.
When you need a specialist
See your GP if your psoriasis covers a large area, affects your nails, face, hands, feet or genitals badly, hasn't improved after the steps above, is affecting your mood or quality of life, or if your joints are painful. A dermatologist can offer narrowband UVB light therapy, tablets such as methotrexate, and biologic injections.
UK safety and reporting side effects
Prescription psoriasis treatments are only supplied after a GPhC-registered pharmacist independent prescriber reviews your consultation, including where your psoriasis is, how much skin it covers and what you have used before. Always read the patient information leaflet. Since 2024, UK steroid packs show their strength on the front (mild, moderate, strong or very strong). The MHRA advises using topical steroids for the shortest time needed, and to tell a healthcare professional if your skin flares badly after you stop a steroid you have used for a long time, which can be a topical steroid withdrawal reaction.
If you think you've had a side effect, tell your pharmacist or doctor. You can also report it to the MHRA through the Yellow Card scheme.
Psoriasis treatments from Access Doctor
Following an online consultation, our prescribers can supply the treatments below where suitable, as part of our psoriasis treatment service.
Vitamin D + potent steroid · Rx
Enstilar Foam
Calcipotriol with betamethasone in a spray foam, once a day for up to 4 weeks. For diagnosed plaque psoriasis.
View product →Vitamin D + potent steroid · Rx
Dovobet Gel
Calcipotriol with betamethasone, for the scalp and for mild to moderate plaque psoriasis on the body.
View product →Potent steroid · Rx
Betnovate Ointment
The greasier form, better for thick, dry or scaly plaques.
View product →Potent steroid · Rx
Elocon Ointment
Once-daily mometasone in an ointment base, for dry, thick plaques.
View product →Frequently Asked Questions
What is the most effective treatment for psoriasis?
For most plaque psoriasis, a potent steroid combined with a vitamin D treatment such as calcipotriol works best, either as two products or as one combined product such as Enstilar or Dovobet. For widespread or stubborn psoriasis, light therapy, tablets or biologic injections from a dermatologist are more effective.
How long does psoriasis treatment take to work?
Steroids usually start to help within 1 to 2 weeks. Vitamin D treatments take longer, often 4 to 8 weeks for the full effect. NICE suggests reviewing treatment after about 4 weeks for steroids and 8 weeks for vitamin D.
Can I use a steroid cream for psoriasis every day?
Yes, during a course: potent steroids are usually applied once a day for up to 4 weeks. NICE advises aiming for a 4-week break before the next course, and not using a potent steroid continuously on the same area for more than 8 weeks. Vitamin D or coal tar can be used during the break.
Why does psoriasis come back after treatment?
Treatment clears the patches, but it doesn't change the underlying tendency to psoriasis, so flares can return, especially after stopping a steroid. Vitamin D treatments, twice-weekly Enstilar and daily emollients can help keep the skin clear for longer.
Do I need to see a dermatologist for psoriasis?
Not usually. Most psoriasis is managed with treatments a GP or pharmacist prescriber can supply. You may need a dermatologist if your psoriasis is widespread, hasn't responded to treatment, affects your joints, or badly affects your quality of life.
References
- NICE. Psoriasis: assessment and management (CG153). nice.org.uk
- NICE Clinical Knowledge Summaries. Psoriasis. cks.nice.org.uk
- Joint Formulary Committee. British National Formulary: psoriasis (treatment summary). bnf.nice.org.uk
- Enstilar 50 micrograms/g + 0.5 mg/g cutaneous foam: summary of product characteristics. medicines.org.uk
- MHRA. Emollients: new information about risk of severe and fatal burns with paraffin-containing and paraffin-free emollients. 2018. gov.uk
- MHRA. Topical corticosteroids: information on the risk of topical steroid withdrawal reactions. Drug Safety Update, September 2021. gov.uk
Medical disclaimer: This article is for information only and isn’t medical advice. Prescription psoriasis treatments need a clinical consultation before they can be supplied. If your skin is red all over, you have widespread pus spots, a fever or you feel unwell, seek medical advice the same day. In a medical emergency, call 999.