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.
Your doctor will choose a treatment based on how severe your disease is, other medical conditions you may have, how well the treatment works for you, as well as your concerns about cost and convenience.
Doctors tend to use a step-by-step approach. They start by prescribing milder creams and phototherapy. If those don't work, they move on to meds that affect your whole body.
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.
You can get phototherapy 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
As researchers learn more about psoriasis, you can expect new medicines to become available. For now, the FDA has approved drugs that treat different types of the disease.
Biologics that treat both plaque psoriasis and psoriatic arthritis are:
- Adalimumab (Humira)
- Etanercept (Enbrel)
- Infliximab (Remicade)
- Secukinumab (Cosentyx)
- Ustekinumab (Stelara)
Another medication used in treating both psoriasis and psoriatic arthritis is apremilast (Otezla). It isn’t a biologic, but it does helps your immune system fight inflammation.
Drugs approved for plaque psoriasis are:
- Brodalumab (Siliq)
- Ixekizumab (Taltz)
If you need treatment for psoriatic arthritis, your doctor may suggest one of these FDA-approved drugs:
- Certolizumab (Cimzia)
- Golimumab (Simponi)
More Psoriasis Medications on the Way
Researchers are testing new drugs to see how well they treat psoriasis and to make sure they're safe. These experimental medicines include:
- Tildrakizumab, an injectable anti-inflammatory for psoriasis
- Abatacept, an injectable drug for psoriasis that turns down the immune system
- CF101 and FP187, anti-inflammatory drugs taken by mouth for psoriasis
- Tofacitinib (Xeljanz), an anti-inflammatory taken by mouth for psoriasis and psoriatic arthritis
- LAS41008, LEO 90100, and M518101 are topical treatments.
- Calcipotriene foam (Dovonex, Sorilux), a topical vitamin D drug that's being tested for children ages 2-17. (It's already available for people 18 and older.)
- Daclizumab, a medication now used to prevent rejection problems after a renal transplant, but researchers are testing to treat severe psoriasis
- Paclitaxel, a cancer drug that's now being studied for treatment of severe psoriasis
People with psoriasis now have many treatment choices. 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. The more targeted the treatment, the greater the chance it will work and with fewer side effects, Heffernan says. This kind of tailored approach would be a huge advance.