New treatments for psoriasis are available, and more advanced options may be approved for use soon.
These include steroid-free topicals, targeted biologics and oral medications, and smartphone-powered light treatments you can use at home.
Biologics are advanced drugs that block specific cells or proteins made by your immune system that cause inflammation in psoriasis.
Today, 11 biologics are approved to treat psoriasis. Recent ones block a cytokine, or protein, called interleukin-23 (IL-23) that’s linked to psoriasis inflammation. Some research shows that IL-23 blockers clear up skin for more people with psoriasis than other biologics with similar side effects.
IL-23 drugs available now for psoriasis include:
- Guselkumab (Tremfya)
- Risankizumab-rzaa (Skyrizi)
- Tildrakizumab-asmn (Ilumya)
New biologic treatments are in clinical trials now, including another IL-23 blocker called mirikizumab, and bimekizumab, which targets and blocks two different cytokines -- IL-17A and IL-17F.
Two biologics already available block IL-17A -- ixekizumab (Taltz) and secukinumab (Cosentyx). A newer biologic, brodalumab (Siliq) targets an IL-17A receptor. Bimekizumab would be the first biologic to target IL-17F.
Both mirikizumab and bimekizumab showed improvements in psoriasis in recent clinical trials. These drugs are given as a shot. They may be available to use as soon as 2021.
With several biologics for psoriasis already available, you may wonder why we need more. Not every biologic works for everyone. Even if your current biologic clears your skin now, these drugs may not work as well for you over time. With more biologics available, you’ll have other options to try.
JAK and TYK2 Blockers
New oral medicines are being studied for psoriasis treatment too. These drugs help block connections in your immune system called signaling pathways. They cut off the communication channel that causes inflammation.
Tofacitinib (Xeljanz) is a Janus kinase (JAK) inhibitor that’s approved to treat psoriatic arthritis, and it’s being studied as a treatment for psoriasis too. It helps block two signaling pathways, JAK1 and JAK3. You take either one or two pills each day. In clinical trials, people taking tofacitinib had some improvement in their skin, and they had few side effects.
BMS-986165 is an oral medication to be taken once daily. It helps block tyrosine kinase 2 (TYK2), another signaling pathway linked to psoriasis inflammation. A clinical trial found BMS-986165 helped clear skin plaques. But three people in the trial had serious side effects, and one person developed melanoma, a serious skin cancer, a few months later. This drug is still in clinical trials, and more research is needed to know if it’s safe to use.
Topicals are creams that you rub into your skin to clear up mild to moderate psoriasis plaques. Some topicals are used along with oral or biologic drugs for psoriasis.
Many topical psoriasis treatments contain steroids, which can cause side effects like thinning skin or easy bruising. Over time, absorbing steroids through your skin can damage blood vessels and internal organs.
Two new topicals being studied for psoriasis are steroid-free:
Tapinarof blocks a protein called aryl hydrocarbon receptor (AHR) that’s linked to psoriasis inflammation. You would use it once a day anywhere on your skin where you have plaques. A small clinical trial showed good results for the medication. The people in the trial tolerated the treatment well. Larger clinical trials are needed.
HAT1 is another steroid-free topical agent being studied to treat psoriasis skin plaques. It’s an herbal cream derived from plants. In a recent clinical trial, HAT1 worked well and was well-tolerated by people with mild to moderate plaque psoriasis.
Ultraviolet (UV) light therapy is used to treat psoriasis plaques with or without topical creams. Phototherapy devices that emit UVB rays are considered safe, but you have to go to your doctor’s office for treatments two or three times a week for 10 to 12 weeks before it starts working.
Handheld phototherapy devices you can use at home can help with plaques and are convenient, but people with more severe psoriasis may need up to 60 treatments to see changes. Some people don’t stick with their at-home treatments or feel unsure about getting the right dose of light.
A new smartphone-guided home phototherapy device is in clinical trials. The handheld device lets your doctor guide your treatment through an app on your smartphone.
On the days you need light treatments, your doctor sends a reminder. They also send instructions on light duration and dose to the device, and they guide you through the whole treatment. Results are sent back to your doctor, and you can go over them together.
Most people who were part of a small trial found it effective, safe, and convenient, and they stuck with their treatments.