From the Guidelines
Treatment options for plaque psoriasis include topical therapies, phototherapy, and systemic medications, with selection based on disease severity. For mild to moderate cases, first-line treatments include topical corticosteroids (such as betamethasone or clobetasol), vitamin D analogs (calcipotriene), and combination products like Enstilar (calcipotriene/betamethasone dipropionate foam) 1. These are typically applied once or twice daily to affected areas for 2-4 weeks, with maintenance therapy as needed.
Treatment Options
- Topical corticosteroids:
- Class 1 (ultra-high potency) for thick, chronic plaques
- Class 2-5 (moderate to high potency) for initial therapy in adults
- Lower potency for face, intertriginous areas, and areas susceptible to steroid atrophy
- Vitamin D analogs: calcipotriene, calcipotriol, and calcitriol
- Combination products: Enstilar (calcipotriene/betamethasone dipropionate foam)
Systemic Treatments
- Oral medications:
- Methotrexate (starting at 7.5-15mg weekly)
- Cyclosporine (2.5-5mg/kg/day)
- Apremilast (Otezla, 30mg twice daily)
- Biologic therapies:
- TNF inhibitors (adalimumab, etanercept)
- IL-17 inhibitors (secukinumab, ixekizumab)
- IL-23 inhibitors (guselkumab, risankizumab)
- IL-12/23 inhibitors (ustekinumab)
Phototherapy
- Narrowband UVB (administered 2-3 times weekly)
- PUVA (psoralen plus UVA)
The following table summarizes the treatment options for plaque psoriasis:
| Treatment | Dosage | Frequency |
|---|---|---|
| Topical corticosteroids | Class 1-7 | Once or twice daily |
| Vitamin D analogs | Calcipotriene | Once or twice daily |
| Methotrexate | 7.5-15mg | Weekly |
| Cyclosporine | 2.5-5mg/kg | Daily |
| Apremilast | 30mg | Twice daily |
| Biologic therapies | Varies | Varies |
| Narrowband UVB | 2-3 times weekly | |
| PUVA | 2-3 times weekly |
Treatment selection should consider disease severity, affected body areas, comorbidities, patient preferences, and potential side effects 1. Regular monitoring for adverse effects is essential, particularly with systemic therapies.
According to the most recent guidelines, the recommended starting dose of etanercept is 50 mg taken as a self-administered subcutaneous injection twice weekly for 12 consecutive weeks 1. Similarly, ustekinumab is recommended as a monotherapy treatment option for use in adult patients with moderate-to-severe plaque psoriasis 1.
In conclusion is not allowed, so the text is ended here.
From the FDA Drug Label
HUMIRA is indicated for: ... Plaque Psoriasis (Ps) (1. 7): 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. To treat moderate to severe chronic (lasting a long time) plaque psoriasis (Ps) in adults who have the condition in many areas of their body and who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).
The treatment options for plaque psoriasis include:
- Systemic therapy: adalimumab (HUMIRA) is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy 2
- Phototherapy: treatment using ultraviolet light alone or with pills, adalimumab (HUMIRA) is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who may benefit from phototherapy 2
The following table summarizes the treatment options:
Treatment Option Description Systemic therapy Adalimumab (HUMIRA) for adult patients with moderate to severe chronic plaque psoriasis Phototherapy Treatment using ultraviolet light alone or with pills for adult patients with moderate to severe chronic plaque psoriasis
From the Research
Treatment Options for Plaque Psoriasis
The treatment options for plaque psoriasis can be categorized into several types, including:
- Topical treatments
- Light therapy
- Systemic treatments
- Biologics
Topical Treatments
Topical treatments are the mainstay of treatment for mild plaque psoriasis. The following are some of the commonly used topical treatments:
- Corticosteroids: potent and superpotent corticosteroids are effective in treating plaque psoriasis 3, 4, 5
- Vitamin D analogs: can be used alone or in combination with corticosteroids 3, 4, 6
- Calcineurin inhibitors: can be used to treat facial and intertriginous psoriasis 6
- Salicylic acid: can be used to increase the absorption of other topical treatments 6
- Coal tar: can be used to treat difficult psoriasis refractory to conventional treatment 6
Systemic Treatments
Systemic treatments are used to treat moderate to severe plaque psoriasis. The following are some of the commonly used systemic treatments:
- Methotrexate: a traditional agent used to treat psoriasis 7
- Acitretin: a traditional agent used to treat psoriasis 7
- Cyclosporine: a traditional agent used to treat psoriasis 7
- Apremilast: a phosphodiesterase 4 inhibitor used to treat moderate to severe plaque psoriasis 7
Biologics
Biologics are a new class of treatments that target specific molecules involved in the development of psoriasis. The following are some of the commonly used biologics:
- Tumor necrosis factor-alpha (TNF-α) inhibitors: etanercept, adalimumab, certolizumab, and infliximab 7
- Interleukin-12 and interleukin-23 (IL-12/23) inhibitors: ustekinumab 7
- Interleukin-17 (IL-17) inhibitors: secukinumab, ixekizumab, bimekizumab, and brodalumab 7
- Interleukin-23 (IL-23) inhibitors: guselkumab, tildrakizumab, risankizumab, and mirikizumab 7
Treatment Comparison
The following table compares the different treatment options for plaque psoriasis:
| Treatment | Efficacy | Safety | Convenience |
|---|---|---|---|
| Topical corticosteroids | High | Good | Convenient |
| Vitamin D analogs | High | Good | Convenient |
| Calcineurin inhibitors | Moderate | Good | Less convenient |
| Salicylic acid | Moderate | Good | Less convenient |
| Coal tar | Low | Fair | Less convenient |
| Methotrexate | High | Fair | Less convenient |
| Acitretin | High | Fair | Less convenient |
| Cyclosporine | High | Fair | Less convenient |
| Apremilast | High | Good | Convenient |
| Biologics | High | Good | Convenient |
Note: The efficacy, safety, and convenience of each treatment option may vary depending on the individual patient and the specific formulation of the treatment. 3, 4, 6, 5, 7