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Treatment Goals

In 2016, the National Psoriasis Foundation issued the first U.S. treatment goals for doctors to use when they talk to and evaluate people with psoriasis. Three months after you start a new drug, the guidelines say, psoriasis should cover 1% or less of your body’s surface area (about the size of your palm). To reach this milestone, your doctor may need to change or modify your treatments along the way. You might hear him call this process “treat to target.”

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Protein Targets

The drug ustekinumab (Stelara) has been used to treat psoriasis since 2009. It blocks two proteins related to inflammation: interleukin-12 (IL-12) and interleukin-23 (IL-23). But recent studies show that IL-12 may actually protect skin cells from a different inflammatory protein, IL-17. Some scientists say it may not help to attack IL-12. Targeting IL-23 and IL-17, they say, might get better results.

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IL-17 Blockers

A new injectable drug that blocks the activity of IL-17 proteins was approved in 2016. Ixekizumab (Taltz) got the OK for treatment of moderate to severe psoriasis after 80% of people in clinical trials improved when taking it. The drug cleared symptoms for almost half the people who tried it. That’s a success rate other psoriasis drugs haven’t been able to match. It joins fellow IL-17 inhibitor secukinumab (Cosentyx), which was approved to treat psoriasis in 2015.

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IL-23 Blockers

More traditional psoriasis treatments, like adalimumab (Humira), block the inflammatory protein TNF-alpha. But three drugs on the horizon take aim at another protein, IL-23, instead. It’s still in clinical trials, but the injectable IL-23 blocker guselkumab improved psoriasis better than adalimumab. Similar drugs risankizumab and tildrakizumab are also in the works.

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Gene-Based Gels

A gel known as AST-005 proved safe for people with psoriasis in a small, phase I clinical trial. The potential new drug is based on a technology called spherical nucleic acid. It uses microscopic spheres of genetic material to stop your body from making TNF-alpha. Larger and longer studies are needed, but experts say this could be a first step toward new treatment options.

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Turmeric

Most natural psoriasis remedies have no scientific research to support their use. One exception is the bright yellow spice turmeric. Its main ingredient, curcumin, can block the protein TNF-alpha, which triggers psoriasis inflammation. Turmeric can be mixed into food or taken as a supplement. It might be useful as a gel treatment, too.

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Sleep

If you have psoriasis, you may not sleep well. But it isn’t clear whether pain and itching keep you awake or if a lack of shut-eye brings on skin problems. Scientists believe both may be true. That means people with psoriasis could be trapped in a vicious cycle. Research is under way to explore how sleep quality and your body’s natural rhythms affect psoriasis and other skin diseases.

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Weight Loss

Weight loss surgery can ease psoriasis and psoriatic arthritis symptoms if you’re obese. Losing extra pounds can lower levels of harmful inflammation throughout your body, researchers say. That’s one of the main causes of psoriasis flare-ups. Those who lost the most after surgery showed the biggest improvements in their skin disease.

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Depression

People with psoriasis may be twice as likely to have depression as those who don’t. The link is complex: Pain and embarrassment from the skin disease can lead to sadness and isolation. But doctors also think stress and depression can trigger psoriasis symptoms. Using biologic drugs to treat psoriasis could treat your disease and boost your mood.

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Meds and Light Therapy

If your psoriasis doesn’t get better with standard treatments, your doctor might try biologic drugs with phototherapy -- exposure to a specific type of ultraviolet light, This pairing could work better than either one alone. This mix hasn’t been as safe and effective as solo treatments over the long term, but some doctors are prescribing it on a short-term basis.

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Smoking

Not only is it a psoriasis trigger, but lighting up can also worsen flare-ups and make your treatments less effective. Scientists are still looking into the many links between smoking and psoriasis, but they’re sure of one thing: Kicking the habit can help you manage the disease better. 

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Heart Disease

The disease has long been tied to a higher risk of heart problems. Psoriasis -- especially a severe case -- makes you more likely to have inflammation in your blood vessels. You may also have a greater chance of a burst in your abdominal aorta, the major blood vessel that runs through the center of your body. Studies suggest that psoriasis and internal inflammation are linked.

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Bone Loss

People with psoriasis are more likely to get osteoporosis, especially men. Scientists may know why. It seems that high levels of IL-17 proteins can block new bone cells from forming. The good news? Psoriasis drugs that block IL-17, like ixekizumab and secukinumab, may help clear up skin and keep your bones healthy. 

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Healing Genes

A recent study found that the gene GRHL3, which helps grow skin before birth, also helps your body heal psoriasis lesions. Researchers are now studying whether people with psoriasis have a genetic change that weakens GRHL3’s effects and if there’s a way to boost its healing powers.

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Safer Treatments

Scientists have found a protein called Rac1, which goes to work when your skin is damaged (like from a cut or scrape). It also switches on during an infection, like strep throat. Both can trigger psoriasis if your genes make you more likely to get it. Doctors think that “turning off” Rac1 could help fight flare-ups. This could lead to treatments that are easier on your immune system than today’s biologic drugs.

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Sources | Medically Reviewed on 10/30/2017 Reviewed by Stephanie S. Gardner, MD on October 30, 2017

SOURCES:

National Psoriasis Foundation: “Can't sleep? Psoriasis, psoriatic arthritis may be to blame,” “Depression,” “Healing power of a protein could help psoriasis,” “Herbs/Natural Remedies,” “Link found between osteoporosis and psoriasis, psoriatic arthritis,” “Moderate to Severe Psoriasis and Psoriatic Arthritis: Biologic Drugs,” “The link between psoriatic disease and mental illness,” “Treat to Target,” “Trial drug shows small target can improve psoriasis.” 

Journal of the American Academy of Dermatology: “From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis.”

Nature Communications: “IL-12 protects from psoriasis from skin inflammation.”

The New England Journal of Medicine: “A Phase 2 Trial of Guselkumab versus Adalimumab for Plaque Psoriasis,” “Phase 3 Trials of Ixekizumab in Moderate-to-Severe Plaque Psoriasis.”

News release, University of Zurich.

News release, Northwestern University Feinberg School of Medicine.

News release, FDA.

ClinicalTrials.gov: “BI 655066 (Risankizumab) Compared to Placebo and Active Comparator (Ustekinumab) in Patients With Moderate to Severe Chronic Plaque Psoriasis,” “Sleep, Circadian Rhythm & Skin Health.”

News release, Nasdaq.

Science: “Spherical RNA therapy shows promise against psoriasis in first human trial.”

Iranian Journal of Pharmaceutical Research: “Topical Turmeric Microemulgel in the Management of Plaque Psoriasis; A Clinical Evaluation.”

American College of Rheumatology: “Clinical Improvements in Psoriasis and Psoriatic Arthritis with Surgical Weight Loss.”

NYU Langone Medical Center: “Psoriasis & Psoriatic Arthritis Symptoms Curbed by Bariatric Surgery.”

JAMA Dermatology: “Psoriasis and the Risk of Depression in the US Population.”

Lancet: “Etanercept and clinical outcomes, fatigue, and depression in psoriasis: double-blind placebo-controlled randomised phase III trial.”

Psoriasis: Targets and Therapy: “Combining biologic and phototherapy treatments for psoriasis: safety, efficacy, and patient acceptability.”

The Biochemical Journal: “Psoriasis mutations disrupt CARD14 autoinhibition promoting BCL10-MALT1-dependent NF-κB activation.”

Arteriosclerosis, Thrombosis, and Vascular Biology : “Nationwide Study on the Risk of Abdominal Aortic Aneurysms in Patients With Psoriasis,” “Severity of Psoriasis Associates With Aortic Vascular Inflammation Detected by FDG PET/CT and Neutrophil Activation in a Prospective Observational Study.”

Journal of Dermatology: “Psoriasis and bone mineral density: implications for long-term patients.”

Science Translational Medicine: “Chronic skin inflammation leads to bone loss by IL-17–mediated inhibition of Wnt signaling in osteoblasts.”

News release, Spanish National Cancer Research Centre.

The Journal of Clinical Investigation: “A GRHL3-regulated repair pathway suppresses immune-mediated epidermal hyperplasia,” “RAC1 activation drives pathologic interactions between the epidermis and immune cells.”

News release, Stanford Medicine.

Reviewed by Stephanie S. Gardner, MD on October 30, 2017

This tool does not provide medical advice. See additional information.

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.