Psoriasis treatment has come a long way in the past 10 years. That's welcome news for the 7.5 million Americans with this complex skin disease.
"Every year, we've had either a new medication or a new use for one of these medications," says Michael P. Heffernan, MD, with Central Dermatology in St. Louis. That's led to "a marked improvement in successful treatments."
Could one of the newer medications or a drug in the research pipeline help you? That may depend on how severe your psoriasis is. Many people can control the disease with medicine they apply to their skin, called topicals, or treatment with ultraviolet light, called phototherapy. Others need something more powerful.
Doctors tend to use a step-by-step approach to treatment. They start by prescribing milder creams and phototherapy. If those don't work, they move on to meds that affect your whole body.
"You'll often be asked to try older, less expensive medications before getting access to newer ones," Heffernan says. So if you want to try a new option sooner, let your doctor know. "You have to be your own best advocate with your physician and the insurance company," he says.
What's New in First-Line Treatments?
Topical psoriasis treatments like sprays, foams, and shampoos, as well as more advanced gels and ointments, now treat larger or more sensitive areas. They're safer and work better than older meds.
Phototherapy is available in a new form called narrow-band ultraviolet B (UVB) therapy. It's more focused than other light treatments and has a lower risk of skin cancer. Another approach, called PUVA photochemotherapy, combines ultraviolet A (UVA) light with a drug called psoralen, which makes your skin more sensitive to light.
State-of-the-Art Biologic Medications
Some of the biggest advances have been in this type of drug. Biologics are made from living cells, and they target certain parts of the immune system that play a role in psoriasis.
Heffernan says they're helpful if you have psoriasis on a large area of your skin, or symptoms that greatly affect your day-to-day life.
"Biologics have offered a new long-lasting form of treatment that has been life-changing for many patients," he says.
They've also filled certain blank spots in psoriasis care, Heffernan says. For example, they're safer for women who want to get pregnant than the older drugs. And many biologics treat psoriatic arthritis as well as the skin disease, he says.
Types of Biologic Drugs for Psoriasis
One type, called anti-TNF drugs, was made to treat rheumatoid arthritis. But researchers discovered that TNF, a protein, also plays a role in psoriasis and psoriatic arthritis.
Anti-TNF drugs that are approved for both of those conditions include:
- Adalimumab (Humira)
- Etanercept (Enbrel)
- Etanercept-szzs (Erelzi)
- Infliximab (Remicade)
Golimumab (Simponi) is approved only for psoriatic arthritis, a long-term condition that comes along with psoriasis and causes painful, swollen joints. Certolizumab (Cimzia) is also approved for psoriatic arthritis, along with other inflammatory diseases.
As researchers learned more about psoriasis, they made biologics specifically for the disease.
Ixekizumab (Taltz), secukinumab (Cosentyx), and ustekinumab (Stelara) target proteins that researchers believe cause the inflammation linked to the skin condition.
The more targeted the treatment, the greater the chance it will work and with fewer side effects, Heffernan says.
Another medication used in treating both psoriasis and psoriatic arthritis is apremilast (Otezla). It isn’t a biologic, but it does help your immune system fight inflammation.
More Psoriasis Medications on the Way
There's been a lot of progress, but scientists are working on many more drugs, too. A number of new medicines are being tested by researchers with large groups of people to see if they're safe and effective:
- Abatacept ( Orencia) is an injectable drug for psoriasis that turns down the immune system.
- Brodalumab in an injectable anti-inflammatory drug for psoriasis and psoriatic arthritis.
- Calcipotriene foam (Dovonex, Sorilux) is a topical vitamin D drug also for children ages 2-17.
- CF101 and FP187 are anti-inflammatory drugs taken by mouth for psoriasis.
- LAS41008, LEO 90100, and M518101 are topical treatments.
- Secukinumab (Cosentyx) has been FDA-approved for psoriasis but not yet for psoriatic arthritis.
- Tildrakizumab is an injectable anti-inflammatory for psoriasis.
- Tofacitinib (Xeljanz) is an anti-inflammatory taken by mouth for psoriasis and psoriatic arthritis.
People with psoriasis now have many treatment options. But the only way to know which ones will work best for you -- and which will cause side effects -- is to try them.
What's on the horizon, treatment-wise? With genetic studies, researchers say they hope to predict which medication will work best in your body. This kind of tailored approach would be a huge advance.