From the Guidelines
Plaque psoriasis can be effectively treated with a combination of topical, systemic, and lifestyle approaches, with the most recent guidelines recommending the use of biologics such as etanercept or adalimumab for moderate to severe cases 1. For mild to moderate cases, start with topical corticosteroids like betamethasone or clobetasol applied once or twice daily to affected areas for 2-4 weeks. These reduce inflammation and slow skin cell growth.
- Calcipotriene (a vitamin D analog) can be used alone or combined with steroids as in products like Enstilar or Taclonex.
- For maintenance, calcineurin inhibitors like tacrolimus may be used on sensitive areas.
- Salicylic acid preparations help remove scales before applying other medications. For more extensive disease,
- phototherapy with UVB light 2-3 times weekly for 8-12 weeks
- or systemic medications like methotrexate (starting at 7.5-15mg weekly)
- or biologics (adalimumab, secukinumab, or ustekinumab)
- or oral apremilast may be necessary. Keeping skin moisturized with fragrance-free emollients, avoiding triggers like stress and alcohol, and gentle removal of scales with warm baths containing colloidal oatmeal can complement medical treatment. Regular follow-up is important to monitor treatment efficacy and potential side effects, as recommended by the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics 1. The combination of topical agents with biologics, such as the addition of an ultrahigh potency topical corticosteroid to standard dose etanercept, can be beneficial for the treatment of moderate to severe psoriasis 1. It is also important to consider the potential for tachyphylaxis to topical corticosteroids and other topical agents, and to use innovative rotational and combination strategies to maintain long-term efficacy and minimize risks 1. Traditional systemic therapies, such as methotrexate and cyclosporine, can also be effective for the treatment of psoriasis, but may have more significant side effects and require closer monitoring 1.
From the FDA Drug Label
1.7 Plaque Psoriasis HUMIRA is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate HUMIRA should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician [see Warnings and Precautions (5)].
Treatment of Psoriasis Plaque: Adalimumab (HUMIRA) is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis.
- The recommended dosage for plaque psoriasis is not explicitly stated in the provided text, but the dosage for other conditions is provided.
- Key Considerations:
- HUMIRA should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician.
- Patients should be candidates for systemic therapy or phototherapy, and other systemic therapies should be medically less appropriate. 2
From the Research
Psoriasis Plaque Treatment Options
- Topical corticosteroids, such as clobetasol propionate, are commonly used to treat mild to moderate plaque psoriasis 3, 4, 5, 6
- Vitamin D analogues, like calcitriol and calcipotriol, can be used alone or in combination with topical corticosteroids to treat plaque psoriasis 3
- Biologics, such as etanercept, adalimumab, and ustekinumab, can be used to treat moderate to severe plaque psoriasis, and may be combined with conventional systemic agents or phototherapy 4, 7
Treatment Efficacy and Safety
- Studies have shown that topical corticosteroids, such as clobetasol propionate, can be effective in treating plaque psoriasis, with response rates ranging from 30-90% 4, 6
- The combination of biologics with conventional systemic agents or phototherapy may improve treatment outcomes, but more research is needed to determine the optimal treatment strategies 7
- Safety profiles of topical corticosteroids and biologics vary, with common adverse events including skin irritation, erythema, and pruritus 4, 6
Treatment Modalities and Regimens
- Topical corticosteroids can be used in various formulations, including creams, ointments, and sprays, and may be applied once or twice daily 5, 6
- Maintenance treatment with topical corticosteroids or biologics may help prolong remission and improve treatment outcomes 6, 7
- The optimal treatment regimen for plaque psoriasis may depend on individual patient factors, such as disease severity and treatment history 3, 7