From the Guidelines
Psoriasis treatment should prioritize a combination of topical medications, phototherapy, and systemic treatments, with a focus on biologics such as adalimumab, etanercept, or ustekinumab for moderate to severe cases, as they have been shown to be effective in reducing inflammation and improving quality of life 1.
Treatment Options
The treatment of psoriasis depends on the severity of the disease. For mild to moderate cases, topical corticosteroids like betamethasone or clobetasol can be used, applied once or twice daily to affected areas for 2-4 weeks. Vitamin D analogs such as calcipotriene can be used alongside steroids or alternated with them. Coal tar preparations and salicylic acid can help remove scales.
Systemic Treatments
For moderate to severe cases, phototherapy using UVB light 2-3 times weekly for 6-8 weeks may be effective. When these approaches are insufficient, systemic medications like methotrexate (starting at 7.5-15mg weekly), cyclosporine (2.5-5mg/kg/day) may be prescribed. However, biologics such as adalimumab, etanercept, or ustekinumab are preferred due to their targeted mechanism of action and improved safety profile compared to traditional systemic therapies 1.
Lifestyle Modifications
Lifestyle modifications including maintaining a healthy weight, reducing stress, avoiding alcohol, and moisturizing regularly can help manage symptoms. Psoriasis is an autoimmune condition where skin cells multiply too quickly, causing raised, scaly patches, so treatments aim to slow cell growth and reduce inflammation.
Key Considerations
- The treatment of psoriasis should be individualized, taking into account the severity of the disease, patient preferences, and potential side effects of treatments.
- Biologics have emerged as a valuable treatment option for moderate to severe psoriasis, offering improved efficacy and safety compared to traditional systemic therapies 1.
- Regular monitoring and follow-up are essential to adjust treatment plans and minimize potential side effects.
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.
The treatment option for psoriasis is adalimumab (HUMIRA), which is a TNF blocker. The recommended dosage for adult patients with moderate to severe chronic plaque psoriasis is an 80 mg initial dose, followed by 40 mg every other week starting one week after the initial dose 2.
From the Research
Treatment Options for Psoriasis
The treatment options for psoriasis include:
- Topical therapy
- Phototherapy
- Systemic therapy
- Combination of two or more of these therapies 3
Systemic Treatment
Systemic treatment with conventional and biological preparations is indicated for severe forms of psoriasis. Conventional preparations include:
- Methotrexate
- Cyclosporin
- Acitretin
- Narrow-band ultraviolet B phototherapy Biological preparations include:
- Inhibitors of TNF-alpha (etanercept, adalimumab, infliximab)
- Monoclonal antibody against IL 12/23 (ustekinumab) 4
Phototherapy
Phototherapy is used to treat moderate and severe forms of psoriasis. Two types of phototherapy are:
- Narrowband UVB (NB-UVB)
- Psoralen plus UVA phototherapy (PUVA) NB-UVB is more commonly prescribed due to fewer contraindications and side effects 5
Comparison of Treatment Options
Studies have compared the efficacy of different treatment options, including:
- Methotrexate and narrow-band ultraviolet B for the treatment of plaque-type psoriasis, which showed similar efficacy and recurrence rates 6
- Infliximab + methotrexate, acitretin, etanercept, and adalimumab, which showed significant reductions in PASI score and BSA index 4
Considerations for Treatment
Treatment strategy should be tailored to each patient, considering factors such as: