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. He's a dermatologist with Central Dermatology in St. Louis. That's led to "a marked improvement in successful treatments."
To describe his battle against psoriasis, Alan Eisenberg likes to quote John Paul Jones, the famed Revolutionary War mariner: “I have not yet begun to fight.”
For six years, the Portland, Ore., resident has been trying treatments for his skin condition. Methotrexate helped his nails, but didn’t cure the skin outbreaks. He says the prescription drug Enbrel worked for six months, then lost its effect. Another drug gave him hives. Yet another worked better, but put him at risk of infections. He had...
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 more powerful medication.
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 drugs 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 you have to be your own best advocate with your physician and the insurance company."
Developments in Topical Treatments and Phototherapy
In recent years, scientists have found new ways to deliver topical psoriasis treatments. Sprays, foams, and shampoos, as well as more advanced gels and ointments, treat larger or more sensitive areas. They're easier, safer, and more effective than older drugs.
Phototherapy is now 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 combines ultraviolet A (UVA) light with a drug called psoralen, which makes the skin more sensitive to light.
State-of-the-Art Biologic Medications
Some of the biggest advances have been in biologic drugs. They're made from living cells, and they target certain parts of your 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're exciting not only because they offer good control, but also because they've 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.