Orit Markowitz, MD, a board-certified dermatologist based in New York City, has been treating patients with psoriasis for over 17 years. And the biggest misconception among the patients that come through her office, she says, is that psoriasis is nothing more than a skin issue. “People think that the only thing they have to worry about is their skin, and that if it doesn’t really bother them that much, then they’re better off just dealing with it than treating it,” she says.

Instead of heading to a dermatologist for help, she’s seen people try to manage their psoriasis on their own. They may attempt to scrape or pumice away the typically thickened red scales. This not only makes things worse for vulnerable psoriatic skin, but it also completely ignores the root cause of the issue. “Psoriasis is a chronic disease that involves your immune system, and as with any chronic disease, you’re always going to need a 360-degree, holistic treatment,” says Dr. Markowitz.

Over the last few years, advances in psoriasis technology have made it significantly easier to find such treatments. Keep reading for the ones that Dr. Markowitz recommends.

What is psoriasis?

Before diving into the most effective treatments for psoriasis, it’s first important to understand what it actually is. Psoriasis is an overgrowth of the top layer of skin cells in the epidermis, brought about by an overactive immune system. The condition tends to be cyclical, the Mayo Clinic explains, flaring up for a few weeks or months before subsiding for a while. Common triggers include infections, cuts or burns, certain medications, and fragrances that are frequently found in beauty products.

Textbook examples usually feature a demarcated rash that has a silvery scaling. The most commonly affected areas are the elbows, knees, butt, scalp, and nails, which can vary in severity. The more severe your psoriasis gets, however, the more it can impact other systems in your body, which is why it’s critical to think of it as being much more than “just a skin issue,” says Dr. Markowitz. “If it impacts more than 10 percent of the surface area of your2:0 body, it can cause heart disease, heart attacks, and irreversible joint damage,” she says. “The reality is that once you have it, it’s a part of who you are, but the treatments can help you keep it under control and manage it.”

What are the psoriasis treatments that actually work?

Historically, treatments for psoriasis have ranged from “ineffective” to “dangerous” (think: intensive phototherapies and excessive exfoliation). Thanks to new innovations in technology, however, dermatologists agree that it’s a fortunate time for people who are suffering from psoriasis, because treatments are becoming more and more evolved. “The more innovative we get and the more technology we have, the better these holistic treatments are getting,” says Dr. Markowitz. “But not every patient has the same genetic markers of their psoriasis, so while the treatment needs to be 360, it also needs to be very tailored and customized.”

If you’re dealing with psoriasis (especially if it’s severe), you always want to work with a board-certified dermatologist to come up with your best course of action. Though psoriasis isn’t curable, there are treatments that she’s seen to be particularly effective when used under the guidance of a professional.

1. Biologics

“In terms of prescriptions, there are many medications and different formulations that are phenomenal for psoriasis,” says Dr. Markowitz. “When it becomes a bit more aggressive, or is starting to impact more systemic things like our heart and joint, there are a lot of systemic medications that decrease the inflammatory response.”

Among these are biologics, which use antibodies to suppress the immune system in the psoriatic pathway but won’t affect the rest of the body, so that there are minimal side effects. They work by halting the part of the immune system that’s responsible for causing a proliferation of skin cells and allow the rest of the immune system to function normally. They’re prescribed by a doctor, but administered via at-home injections (usually four times a year).

“With the newer medications for severe cases of any inflammatory disease—especially an inflammatory disease like psoriasis—it’s all about which parts of the pathway you’re blocking, and where you can block your body’s response to decrease the disease and all of the unwanted systemic side effects,” says Dr. Markowitz. “These newer medications are working further and further down that pathway, and the further down the pathway they work, the more specific response and lower side effects you’ll get.”

2. Light therapy

Unlike the dangerous PUVA therapies (incredibly intense phototherapies that derms now categorize as dangerous) that were used in the past, doctors are now prescribing something called narrowband UVB therapy. “It’s a completely different array of UV light that’s so much less harmful,” says Dr. Markowitz. A 2011 study found that this type of light therapy helps to suppress a part of the immune pathway that leads to skin overgrowth, and other research has found that it doesn’t come along with the same skin cancer risk that previous UV therapies had.

3. Topicals

If you have a mild case of psoriasis, Dr. Markowitz notes that there are certain over-the-counter topicals that can help make it more comfortable to live with. “Mild washes with oatmeal have been helpful, and coal tar shampoo can definitely help alleviate psoriasis,” she says. “There are also some alternative anti-inflammatories, like safflower oil, tea tree oil, and certain formulations of cannabis that can be helpful as well.” However, since these ingredients only target the skin element of psoriasis, it’s still important to check in with a  doctor such as a dermatologist, rheumatologist, or autoimmune specialist to make sure there’s nothing more serious happening beneath the surface.

4. Lifestyle changes

No matter what treatment plan your dermatologist prescribes, maintaining a healthy lifestyle is one of the most important things you can do to keep the symptoms of psoriasis at bay. Though lifestyle habits don’t cause psoriasis (if you’re genetically predisposed, it will show up on its own), things like binge drinking, smoking, and weight fluctuations are known to cause flare-ups.

“If my patients who have managed their psoriasis have a flare-up, my first questions to them are, ‘Are you under increased stress? Have you recently been eating less healthily than usual? Has your exercise routine changed?’ and the answer is inevitably always yes,” says Dr. Markowitz. “Decreased stress and a healthy lifestyle helps manage any chronic disease, including psoriasis, so ultimately you’ll see benefits if you have a healthy lifestyle.”

What is the future of psoriasis treatments?

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As treatments continue to improve, there’s even more innovation to get excited about. Dr. Markowitz is currently working on a study that uses non-invasive imaging to look at the nuanced changes that psoriasis medications bring about very early on in the process. This process will not only help dermatologists predict when and how much psoriasis will clear up on a given treatment plan, but it will also make it easier to tell when a treatment isn’t working so that the course of care can we switched up.

“These are all really innovative new ways to manage the disease,” says Dr. Markowitz. “We now have topicals, oral medications, and injectibles that we didn’t have in the past, and [treatment] can really get tailored to exactly what the patient needs.”

To learn more about psoriasis (and what derms say about treating it), check out the video below.

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