From the Guidelines
Psoriasis treatment should be individualized based on the severity, location, and patient preferences, and may involve a combination of topical therapies, phototherapy, and systemic medications. For mild to moderate psoriasis, topical corticosteroids like betamethasone or clobetasol applied once or twice daily to affected areas for 2-4 weeks can be effective 1. Vitamin D analogs such as calcipotriene can be used alone or combined with steroids. For scalp psoriasis, medicated shampoos containing salicylic acid or coal tar are effective.
Treatment Options
- Topical corticosteroids: betamethasone or clobetasol
- Vitamin D analogs: calcipotriene
- Medicated shampoos: salicylic acid or coal tar
- Phototherapy: UVB light 2-3 times weekly for 2-3 months
- Systemic medications: methotrexate, biologics such as adalimumab, secukinumab, or oral medications like apremilast
Moderate to severe cases may require phototherapy (UVB light) 2-3 times weekly for 2-3 months 1. For severe or widespread psoriasis, systemic medications like methotrexate (starting at 7.5-15mg weekly), biologics such as adalimumab (40mg every other week), secukinumab (300mg monthly), or oral medications like apremilast (30mg twice daily) may be necessary 1. These treatments work by reducing inflammation, slowing skin cell growth, and modulating the immune system that drives psoriasis.
Lifestyle Modifications
- Maintaining a healthy weight
- Avoiding triggers like stress and alcohol
- Regular moisturizing
Lifestyle modifications including maintaining healthy weight, avoiding triggers like stress and alcohol, and regular moisturizing are important complementary approaches 1. Treatment should be individualized based on psoriasis type, severity, location, and patient preferences.
From the FDA Drug Label
CLINICAL PHARMACOLOGY The corticosteroids are a class of compounds comprising steroid hormones secreted by the adrenal cortex and their synthetic analogs. In pharmacologic doses, corticosteroids are used primarily for their anti-inflammatory and/or immunosuppressive effects Topical corticosteroids such as clobetasol propionate are effective in the treatment of corticosteroid-responsive dermatoses primarily because of their anti-inflammatory, antipruritic, and vasoconstrictive actions. Following repeated nonocclusive application in the treatment of scalp psoriasis, there is some evidence that clobetasol propionate topical solution has the potential to depress plasma cortisol levels in some patients
Psoriasis treatment with clobetasol propionate topical solution is effective due to its anti-inflammatory, antipruritic, and vasoconstrictive actions.
- The treatment can be used for scalp psoriasis.
- However, systemic absorption of the topical corticosteroid can produce reversible HPA axis suppression and other adverse effects in some patients 2.
- Careful patient supervision is recommended as treatment with corticosteroids can exacerbate the disease or provoke the pustular form of psoriasis in rare instances 2.
From the Research
Psoriasis Treatment Overview
- Psoriasis is a systemic inflammatory disease associated with increased risk of comorbidities, such as psoriatic arthritis, Crohn's disease, malignancy, obesity, and cardiovascular diseases 3
- Treatment regimens for psoriasis patients should be tailored to meet the specific needs based on disease severity, the impact on quality of life, the response to previous therapies, and the presence of comorbidities 3
Topical Treatments
- Topical corticosteroids are an essential tool for treating inflammatory skin conditions such as psoriasis and atopic dermatitis 4
- Topical corticosteroids can work safely and effectively in patients who are pregnant or lactating 4
- Ultrapotent topical corticosteroids, such as clobetasol propionate, are the mainstay of psoriasis treatment, used either alone or in combination with a topical vitamin D analog 5
- Newer formulations of clobetasol propionate, such as spray, foam, lotion, and shampoo, may provide improved convenience and acceptance in many patients with similar efficacy, safety, and tolerability as traditional ointment and cream formulations 5
Systemic Treatments
- Biologics, such as inhibitors to tumor necrosis factor α (TNF-α), are an option for first-line treatment of moderate to severe plaque psoriasis due to their efficacy and acceptable safety profiles 6
- Other biologics, such as those that inhibit cytokines like IL-12, IL-13, IL-17, and IL-23, are also approved for the treatment of psoriatic arthritis 6
- Oral treatments, including traditional agents like methotrexate, acitretin, and cyclosporine, as well as advanced small molecules like apremilast, are also available for treating psoriasis 6
- Combination therapy, such as combining etanercept with traditional agents, can enhance efficacy and allow drug sparing, potentially resulting in faster treatment responses and permitting safe transitioning from one systemic agent to another 7
Treatment Considerations
- The risk of adverse effects from topical corticosteroids increases with prolonged use, large area of application, higher potency, occlusion, and application to areas of thinner skin such as the face and genitals 4
- Correct patient application is critical to successful use of topical corticosteroids, and patients may be taught application using the fingertip unit method 4
- Treatment adherence is likely to be a far more important determinant of success than small differences in drug delivery, especially in actual clinical use as opposed to the well-controlled environment of clinical trials 5