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Advances in Psoriasis Treatments

Reviewed by Stephanie S. Gardner, MD on November 09, 2020

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

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.

Continued

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.

Injection Tips for Moderate to Severe PsoriasisShots are a great option for people who have moderate to severe psoriasis. Find out what you should know.106

[MUSIC PLAYING]

JOSEPH PAYNE: There are

multiple treatment options

for patients

with moderate to severe plaque

psoriasis.

And for some patients,

injections are the best method.

If your disease is greater

than approximately 5%

of your body's surface,

and, certainly, if it's

beyond say 10%,

this is something that you

should definitely

be entertaining as an option.



These medicines are kind

of tinkering

with your immune system

slightly.

You should be thinking about,

is this going to make

my immune system function

in a way

other than how it's supposed to?



The things that we're really

concerned about is infection

risk.

It is something that you just

kind of have to watch in terms

of the either number, frequency,

duration, or severity.

For the most part, we're talking

about bacterial infections,

things like staph infections,

urinary tract infections.

But you also have

mycobacterial infections

like tuberculosis.



For most people, they're not

going to notice any difference

in the number of infections

that they see.

We recommend to patients who

either have immune disorders

or perhaps they are in the midst

of battling a cancer to not

be on these biologic medicines,

and so we try to find

other alternatives.



The medicines do such a good job

of keeping things under control,

the patients sometimes feel as

though they're cured.

So my advice would be, stay

on schedule

with their injections,

regardless of how well

their psoriasis is responding.

Joseph R. Payne, MD<br>Dermatologist, Dermatology Association of Atlanta /delivery/aws/cd/e8/cde8310b-bbf3-3325-aec3-56b31c0132bf/funded-expert-feature-psoriasis-injection-tips_,4500k,2500k,1000k,750k,400k,.mp412/11/2019 12:00:0018001200photo of psoriasis on hands/webmd/consumer_assets/site_images/article_thumbnails/video/psoriasis_injection_tips_video/1800x1200_psoriasis_injection_tips_video.jpg091e9c5e81dcfa58

Topicals

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.

Phototherapy

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.

Safe Sunlight Therapy for PsoriasisThe sun's rays can help clear or prevent patches of psoriasis, but it's important to make sure you get the right amount for your skin.62

SPEAKER: Sunlight therapy can

improve your psoriasis if you do

it safely.

First, you need to get

a sunlight diet that works

for you.

Ask your doctor what's best.

Because depending on your skin

color, you could need to sun

anywhere from 5 to 40 minutes

each session.

You might also need

several sessions a week,

if not daily,

to make it effective.



Use sunscreen on all exposed

skin, even psoriasis patches.

Products with broad spectrum

and a minimum of 7% zinc

work best.

Opt for brands that are made

for sensitive skin.

Stay away from fragrance

or irritants.

And sunburns should be avoided

as they can make flare-ups

worse.



Treatment is the same

for all skin colors.

But if you have darker skin,

sunning might make spots I'm

even in certain areas.

Talk to your doctor

or consider alternatives

to avoid uneven skin tone.



Doctors advise against the use

of tanning beds

because it's too tough

to control

the light, and prolonged

exposure to UV radiation

ups your risk of skin cancer.

Need more fine tuning?

Ask your doctor for a sunlight

plan that works for you.



[MUSIC PLAYING]

Mayo Clinic: "Psoriasis."<br>The Psoriasis and Psoriatic Arthritis Alliance: "Psoriasis and the sun."<br>The National Psoriasis Foundation: "Taking Care of Your Skin in Summer."<br>American Academy of Dermatology Association: "Can You Get Psoriasis If You Have Skin of Color?"<br>The National Psoriasis Foundation: "Phototherapy."/delivery/aws/89/b9/89b92f29-6cba-4e05-8ac7-729b540b0b75/091e9c5e820746b0_funded-vo-feature-how-to-safely-sun-to-help-with-psoriasis_,4500k,2500k,1000k,750k,400k,.mp411/20/2020 12:00:0018001200photo of woman applying sunscreen/webmd/consumer_assets/site_images/article_thumbnails/video/how_to_get_sun_safely_with_psoriasis_video/1800x1200_how_to_get_sun_safely_with_psoriasis_video_alt.jpg091e9c5e820746b0
WebMD Medical Reference

Sources

SOURCES:

National Psoriasis Foundation: “What’s Next?” “Biologics,” “Steroids.”

Dermatology Online Journal: “A novel ultraviolet B home phototherapy system: Efficacy, adherence, tolerability, and satisfaction.”

American Academy of Dermatology Association: “Psoriasis Treatment: Biologics.”

Acta Dermato-Venereologica: “Psoriasis and Treatment: Past, Present, and Future Aspects.”

The Lancet: “Comment on ‘Risankizumab compared with adalimumab in patients with moderate-to-severe plaque psoriasis (IMMvent): a randomised, double-blind, active-comparator-controlled phase 3 trial.”

Versus Arthritis: “What Is Tofacitinib?”

The New England Journal of Medicine: “Phase 2 Trial of Selective Tyrosine Kinase Inhibition in Psoriasis.”

Journal of the American Academy of Dermatology: “Phase 2, randomized dose-finding study of tapinarof (GSK2894512 cream) for the treatment of plaque psoriasis.”

Clinical and Experimental Dermatology: “Efficacy and safety of HAT1 compared with calcipotriol in the treatment of patients with mild to moderate chronic plaque psoriasis: results from an open-label randomized comparative pilot clinical study.”

Institute for Living: “Phototherapy for Psoriasis.”

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