The Cutting Edge of Psoriasis Research

In 2020, the National Psoriasis Foundation along with the Journal of American Academy of Dermatology issued updated treatment guidelines for doctors to use when they treat psoriasis. Updated guidelines highlight biologics for target treatment, phototherapy, screening for other conditions, and other alternative therapies. You'll need to work closely with your doctor to find the right treatment plan.

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. In 2020, the FDA approved the drug for use in children ages 6-11 with moderate to severe plaque psoriasis. 

A new injectable drug that blocks the activity of IL-17 proteins was approved in 2017. Siliq (brodalumab) got the OK for the treatment of moderate to severe psoriasis. It joins fellow IL-17 inhibitors ixekizumab (Taltz) and secukinumab (Cosentyx), which were approved in 2016 and 2015, respectively.

A number of injectable biologic drugs take aim at the inflammatory protein IL-23 to improve lesions. New early-stage research has shown the first oral drug known as JNJ-2113 can significantly improve moderate to severe plaque psoriasis. Injectable IL-23 blockers like guselkumab and risankizumab work better than adalimumab. Another injectable drug, tildrakizumab, can work for up to 5 years.

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. In 2018, an early clinical trial found the gel is safe and tolerable in higher doses. But more research is needed.

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. Studies show it can be taken along with other psoriasis drugs, too.

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.

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. 

People with psoriasis may be twice as likely to have depression as those who don’t. The link is complex: Pain and embarrassment can lead to sadness and isolation. But doctors also think stress and depression can trigger psoriasis symptoms. Biologic drugs could help treat psoriasis and boost your mood. Studies have found females, children, and older adults are more likely to have depression.

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 is a good treatment plan for moderate to severe psoriasis when one therapy alone doesn't work. But experts aren't sure about long-term side effects. 

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. 

The disease has long been tied to a higher risk of heart problems. Severe psoriasis makes you more likely to have inflammation in your blood vessels. You're also at risk for the abdominal aorta, a major blood vessel in the center of your body, to burst. You also have higher odds of heart attack, stroke, or heart-related death. Studies suggest that psoriasis and internal inflammation are linked.

People with psoriasis are more likely to get osteoporosis, especially men. Smoking, drinking alcohol, and lack of exercise can also increase bone loss. 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. 

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.

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.