What are the treatment options for psoriasis?

From the Guidelines

Psoriasis treatment options include topical therapies, phototherapy, and systemic medications based on disease severity, with the goal of reducing inflammation and normalizing skin cell growth to improve morbidity, mortality, and quality of life. 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 1. 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.

Treatment Options

• Topical therapies:
  • Corticosteroids
  • Vitamin D analogs
  • Calcineurin inhibitors
• Phototherapy:
  • UVB light 2-3 times weekly for 2-3 months
• Systemic treatments:
  • 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

Considerations

• Treatment selection depends on psoriasis severity, affected body areas, comorbidities, and patient preferences, often requiring combination approaches for optimal management 1
• The choice of vehicle can significantly alter the use and penetration of the medication and therefore alter the efficacy 1
• Occlusion of topical medications can also alter the penetration, thereby varying the effectiveness 1

Recent Guidelines

• The most recent guidelines from the American Academy of Dermatology recommend a stepped approach to treatment, starting with topical therapies and progressing to phototherapy and systemic treatments as needed 1
• Biologic therapies have emerged as a valuable treatment option for patients with moderate to severe psoriasis, offering a targeted approach to treatment with potentially fewer side effects than traditional systemic therapies 1

From the FDA Drug Label

HUMIRA is a tumor necrosis factor (TNF) blocker 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. Plaque Psoriasis or Adult Uveitis (2.5): Adults: 80 mg initial dose, followed by 40 mg every other week starting one week after initial dose.

Treatment Options for Psoriasis:

• Adalimumab (HUMIRA) is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis.
• The recommended dosage for plaque psoriasis is an initial dose of 80 mg, followed by 40 mg every other week starting one week after the initial dose.
• HUMIRA can be used in patients who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate 2.
• Key Points:
  • Indicated for moderate to severe chronic plaque psoriasis
  • Initial dose: 80 mg
  • Maintenance dose: 40 mg every other week
  • Can be used for systemic therapy or phototherapy

From the Research

Treatment Options for Psoriasis

• Topical corticosteroids are a mainstay of topical therapy for psoriasis, but their use requires careful consideration of potency, duration, and potential side effects such as skin atrophy and adrenal suppression 3, 4
• Topical corticosteroids are classified by strength and the risk of adverse effects, and their application should be guided by the fingertip unit method to ensure correct dosage 4
• Combination therapy with methotrexate and narrowband UVB phototherapy has been shown to provide more rapid clinical improvement compared to narrowband UVB monotherapy in the treatment of chronic plaque-type psoriasis 5
• Biologics, such as inhibitors of tumor necrosis factor α (TNF-α), IL-12/23, and IL-17, are effective treatments for moderate to severe plaque psoriasis and are recommended as first-line treatment options by the American Academy of Dermatology-National Psoriasis Foundation guidelines 6
• Oral treatments, including traditional agents such as methotrexate, acitretin, and cyclosporine, as well as advanced small molecules like apremilast, are also available for the treatment of psoriasis 6
• Narrowband UV-B phototherapy is a commonly prescribed light therapy for the treatment of plaque psoriasis 6
• Combination treatment of biologics with conventional systemic agents or phototherapy is used in daily clinical practice, with methotrexate being the most commonly used concomitant treatment, although the frequency and type of combination treatments vary across registries 7

Treatment Considerations

• The choice of treatment depends on the severity of the disease, with topical agents being the mainstay of treatment for mild psoriasis and biologics being recommended for moderate to severe plaque psoriasis 6
• Patients with psoriasis should be monitored for comorbidities, such as psoriatic arthritis, cardiometabolic diseases, and depression, and treated accordingly 6
• The potential side effects and risks associated with each treatment option should be carefully considered and discussed with the patient 3, 4, 7, 6