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The Latest in Psoriasis Treatment

Medically Reviewed by Stephanie S. Gardner, MD on May 20, 2021

Research on psoriasis touches every aspect of the disease, including the role of nutrition, weight loss, the body’s microbiome, and treatments.

More Fit, Less Psoriasis?

While some researchers focus their attention on coming up with new psoriasis treatments, others look at ways to avoid this skin disorder. One promising avenue of prevention centers on fitness.

Studies find that exercise, especially when it’s intense, might help reduce the chance of getting psoriasis. People who are less fit seem to have a higher risk for the disease. Although the link needs to be explored further, it may be about how exercise can lower chronic inflammation, a hallmark of psoriasis and many other conditions.

Gut Bugs and Your Skin

You're far from alone in your body. You share it with trillions of bacteria, fungi, and other tiny bugs, most of which live in your gut. Scientists call this miniature community the "microbiome." This is natural, and having your inner environment in balance may be a key to good health.

Some of the bugs in your microbiome make fatty acids that control inflammation. (But not the “essential” fatty acids that you can get only from food and supplements). They also help to keep your immune system response under control. Researchers are now studying whether drugs made from helpful bacteria called probiotics might prove to be an effective psoriasis treatment.

Psoriasis, Weight, and Nutrition

No single diet or food will treat or prevent psoriasis. And you can get this condition at any size. Still, there are some signs that nutrition and weight do affect it -- just as they affect many other conditions.

Body fat fuels inflammation. Doctors have known for a while that losing weight (if you're overweight) can reduce psoriasis symptoms and help your medicines work better at clearing your skin. The open question is: What's the best way to lose weight?

In studies, people with psoriasis who trimmed off as little as 5% of their weight by following a low-calorie diet had clearer skin.

The traditional Mediterranean diet can also help lower inflammation, with foods like fish, fruit, vegetables, nuts, and olive oil. Researchers are looking at whether that might help make psoriasis less severe.

One small, short study offered a very low-calorie keto diet, followed by 6 weeks of a traditional Mediterranean diet. All the people in the study were overweight or obese and had psoriasis but weren’t taking medication for it. They lost weight, and their psoriasis improved. It’s not clear if that was because of the weight loss, the types of food they ate, or both things. More research will be needed to see exactly what worked.

New Era of Psoriasis Treatment

In the 1960s and '70s, new info about how the immune system -- your body's defense against germs -- plays a role in psoriasis led to several new treatments. Drugs like corticosteroids, cyclosporine, and methotrexate became mainstays for managing the disease. For the next few decades, though, advances in treatment slowed down.

Thanks to recent progress in research, that's history.

Scientists studying other autoimmune diseases found new insights about the immune system. It turns out that some of the problems in those conditions are active in psoriasis, as well.

The new info brought treatments that target specific areas of your immune system. Called biologics, these drugs launched a new era of psoriasis treatment. New biologic therapies work well to treat psoriasis, and other new treatments are close to FDA approval.

Biologics

They're medicines made from substances found in living things. Doctors inject these lab-made proteins or antibodies into your skin or bloodstream. Once inside the body, the drug blocks part of your altered immune system that adds to psoriasis.

In general, biologics work on psoriasis because they:

  • Curb T cells (a form of white blood cell)
  • Block a substance called tumor necrosis factor-alpha (TNF-alpha), one of the main messenger chemicals in the immune system
  • Stop a family of your immune system's chemical messengers called interleukins
  • Bind to proteins that cause inflammation

The patches and plaques of psoriasis come after an interaction between your skin cells and white blood cells. Biologics interfere with TNF-alpha or T cells, or they target interleukins. This short-circuits that unhealthy link. This will ease your inflammation. You'll have less growth of thick, scaly skin, too.

Biologic medicines approved by the FDA to treat moderate to severe psoriasis include:

  • Adalimumab (Humira), a TNF-alpha-blocking antibody
  • Adalimumab-adbm (Cyltezo), a biosimilar to Humira
  • Brodalumab (Siliq), a human antibody against interleukins
  • Certolizumab pegol (Cimzia), a TNF-alpha blocker
  • Etanercept (Enbrel), a TNF-alpha blocker
  • Etanercept-szzs (Erelzi), a biosimilar like Enbrel
  • Guselkumab (Tremfya), an antibody against interleukins
  • Infliximab (Remicade), a TNF-alpha blocker
  • Ixekizumab (Taltz), an antibody that binds to inflammation-causing proteins/interleukins
  • Risankizumab-rzaa (SKYRIZI), an antibody against interleukins
  • Secukinumab (Cosentyx), a human antibody against interleukins
  • Ustekinumab (Stelara), a human antibody against interleukins

Biologics are good at treating psoriasis. In clinical trials, each of the drugs lowered psoriasis activity by at least 75% in many people.

There are some drawbacks, though. Biologics can be expensive. Though they're safe for most people, they could raise your chances of infection, cancer, and other complications. Your doctor will need to keep close tabs on you to make sure you stay healthy.

Apremilast (Otezla)

Apremilast is a drug you take by mouth that's approved to treat psoriatic arthritis and plaque psoriasis in adults. It curbs phosphodiesterase-4 (PDE-4), an enzyme that controls inflammation.

Side effects include diarrhea, nausea, and headache. Some people in studies who took the drug lost weight. If you use the medicine, it's recommended that you check your weight regularly and watch out for signs of depression.

WebMD Medical Reference

Sources

SOURCES:

American Academy of Dermatology Association: "What Should I Eat If I Have Psoriasis?"

FDA: "FDA approves new psoriasis drug Taltz,” "FDA approves Amjevita, a biosimilar to Humira." 

Harvard Medical School: "Preventing psoriasis with exercise."

International Journal of Molecular Sciences: "Recent Advances in Psoriasis Research; The Clue to Mysterious Relation to Gut Microbiome," "The Role of Gut Microbiome in Psoriasis: Oral Administration of Staphylococcus aureus and Streptococcus danieliae Exacerbates Skin Inflammation of Imiquimod-Induced Psoriasis-Like Dermatitis."

Journal of the American Academy of Dermatology: “New psoriasis treatments based upon a deeper understanding of the pathogenesis of psoriasis vulgaris and psoriatic arthritis: a personal appraisal of their use in practice.”

Nature: “Pathogenesis and therapy of psoriasis.”

Medicine (Baltimore): "Association between physical activity and risk of prevalent psoriasis."

Journal of Clinical Investigation: “Recent insights into the immunopathogenesis of psoriasis provide new therapeutic opportunities.”

Nutrition: "Aggressive weight-loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: A proof-of-concept, single-arm, open-label clinical trial."

PLoS One: "Cardiorespiratory fitness in late adolescence and long-term risk of psoriasis and psoriatic arthritis among Swedish men."

Current Pharmaceutical Design: “Advances in Therapy for Psoriasis: An Overview of Infliximab, Etanercept, Efalizumab, Alefacept, Adalimumab, Tazarotene, and Pimecrolimus.”

University of Washington: "The Human Microbiome."

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