What are the treatment options for psoriasis?

From the Guidelines

Psoriasis treatment options include topical therapies, phototherapy, and systemic medications based on disease severity. For mild to moderate psoriasis, topical corticosteroids (like betamethasone or clobetasol) are typically first-line treatments, applied once or twice daily for 2-4 weeks. Vitamin D analogs such as calcipotriene can be used alone or combined with steroids. Calcineurin inhibitors (tacrolimus, pimecrolimus) work well for sensitive areas like the face. For moderate to severe cases, phototherapy using UVB light 2-3 times weekly for 2-3 months may be effective. Systemic treatments include oral medications like methotrexate (starting at 7.5-15mg weekly), cyclosporine (2.5-5mg/kg/day), and apremilast (30mg twice daily). Biologics targeting specific immune pathways include TNF inhibitors (adalimumab, etanercept), IL-17 inhibitors (secukinumab, ixekizumab), IL-23 inhibitors (guselkumab, risankizumab), and IL-12/23 inhibitors (ustekinumab) 1. These treatments work by reducing inflammation and normalizing skin cell growth, as psoriasis results from an overactive immune response causing rapid skin cell turnover. Treatment selection depends on psoriasis severity, affected body areas, comorbidities, and patient preferences, often requiring combination approaches for optimal management.

Some key considerations in treatment selection include:

• The use of topical therapies as first-line treatments for mild to moderate psoriasis
• The potential for phototherapy to be effective in moderate to severe cases
• The role of systemic medications, including biologics, in treating moderate to severe psoriasis
• The importance of considering patient preferences and comorbidities in treatment selection

According to the most recent guidelines, the treatment of psoriasis should be tailored to the individual patient's needs, taking into account the severity of the disease, affected body areas, and patient preferences 1. This approach can help to optimize treatment outcomes and improve patient quality of life. In addition, the use of biologics has been shown to be effective in treating moderate to severe psoriasis, and may be considered as a treatment option for patients who have not responded to other therapies 1.

Overall, the treatment of psoriasis requires a comprehensive approach that takes into account the individual patient's needs and preferences. By considering the full range of treatment options, including topical therapies, phototherapy, and systemic medications, healthcare providers can help patients to achieve optimal treatment outcomes and improve their quality of life.

From the FDA Drug Label

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.

The treatment options for psoriasis include systemic therapy or phototherapy. Adalimumab (SQ) is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for these therapies. Key points to consider:

• Systemic therapy may be used for patients with moderate to severe psoriasis.
• Phototherapy may be used for patients with moderate to severe psoriasis.
• Adalimumab (SQ) is a tumor necrosis factor (TNF) blocker that can be used to treat plaque psoriasis 2.

From the Research

Treatment Options for Psoriasis

• Topical treatments are the mainstream treatment for psoriasis, especially for mild to moderate disease, and include corticosteroids, vitamin D analogues, topical retinoids, and calcineurin inhibitors 3, 4
• Combinations of first-line topical treatments, such as potent and superpotent corticosteroids with vitamin D analogues, can provide significant improvement in psoriasis symptoms within 2-4 weeks 3
• Phototherapy, including psoralen plus UVA (PUVA), broadband UVB (BB-UVB), and narrowband UVB (NB-UVB), is a safe and effective treatment strategy for psoriasis, with NB-UVB being the first-line treatment for extensive plaque type psoriasis 5
• Biologic agents, such as tumor necrosis factor inhibitors, ustekinumab, interleukin-17 inhibitors, and interleukin-23 inhibitors, are available for moderate-to-severe psoriasis and offer unique benefits and limitations for treatment 6, 7
• Treatment recommendations should be personalized based on disease severity, comorbid conditions, and patient-related factors, and may involve the use of biologic treatment algorithms 6, 7

Special Considerations

• Patients with comorbid conditions, such as psoriatic arthritis, multiple sclerosis, congestive heart failure, inflammatory bowel disease, hepatitis B, and latent tuberculosis, require special consideration when selecting a treatment option 6, 7
• Pediatric patients, patients with coronavirus 2019 (COVID-19), and pregnant and breastfeeding patients with psoriasis also require individualized treatment recommendations 7