From the Guidelines
Psoriasis treatment options include topical therapies, phototherapy, and systemic medications based on disease severity, with the most recent guidelines recommending a personalized approach to treatment. For mild to moderate psoriasis, topical treatments are first-line, including corticosteroids (such as betamethasone or clobetasol), vitamin D analogs (calcipotriene), retinoids (tazarotene), and calcineurin inhibitors (tacrolimus) 1. These are typically applied once or twice daily to affected areas.
Key Considerations
- For moderate to severe psoriasis, phototherapy using UVB light or PUVA (psoralen plus UVA) may be administered 2-3 times weekly for several months 1.
- Systemic treatments include oral medications like methotrexate (7.5-25 mg weekly), cyclosporine (2.5-5 mg/kg/day), and acitretin (10-50 mg daily) 1.
- Biologic therapies target specific immune pathways and include TNF-alpha inhibitors (adalimumab, etanercept), IL-17 inhibitors (secukinumab, ixekizumab), IL-23 inhibitors (guselkumab, risankizumab), and IL-12/23 inhibitors (ustekinumab) 1.
Treatment Selection
- Treatment selection depends on psoriasis severity, affected body areas, comorbidities, and patient preferences.
- Most treatments require regular monitoring for side effects, and combination therapy is often used to enhance efficacy while minimizing toxicity.
- Newer oral options include apremilast and JAK inhibitors, which may be considered for patients who have failed or are intolerant to traditional systemic therapies 1. The most recent guidelines recommend a personalized approach to treatment, taking into account the individual patient's disease severity, medical history, and lifestyle 1.
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 current treatment options for psoriasis include:
- Systemic therapy
- Phototherapy
- TNF blockers such as adalimumab, as indicated in the drug label 2 and 2. Key points to consider when treating psoriasis:
- The treatment should be chosen based on the severity of the disease and the patient's medical history.
- The goal of treatment is to reduce signs and symptoms, inhibit the progression of structural damage, and improve physical function.
- It is essential to carefully evaluate the patient's condition and medical history before starting treatment with a TNF blocker like adalimumab.
From the Research
Current Treatment Options for Psoriasis
The treatment of psoriasis is mainly based on anti-inflammatory and/or anti-hyperproliferative agents 3. The current treatment options for psoriasis include:
- Topical treatments, such as corticosteroids, vitamin D derivatives, tazarotene, anthralin, tacrolimus, and pimecrolimus 4
- Systemic treatments, such as methotrexate, cyclosporine, and acitretin 3, 5
- Biologic agents, such as TNF antagonists (etanercept, adalimumab, and infliximab) and the anti-p40 IL12/23 agent ustekinumab 3
- Phototherapy, including ultraviolet B (UVB) phototherapy, psoralen plus ultraviolet A (PUVA), and narrowband UVB (NB-UVB) 6, 5, 7
Phototherapy for Psoriasis
Phototherapy is a mainstay in the treatment of psoriasis and is available as psoralen plus UVA (PUVA), broadband UVB (BB-UVB), and narrowband UVB (NB-UVB) 7. NB-UVB is considered the first-line treatment for extensive plaque type psoriasis 7. The typical regimens for NB-UVB involve dosing 3 times per week for at least 3 months 7.
Topical Therapies for Psoriasis
Topical treatments for psoriasis include corticosteroids, vitamin D derivatives, tazarotene, anthralin, tacrolimus, pimecrolimus, and newer formulations of tar 4. The choice of vehicle and patient adherence to medication are key factors for a treatment to be effective 4. New drugs and vehicles, such as calcipotriene and betamethasone dipropionate (Cal/BD) fixed combination foam, continuously enhance the treatment landscape for psoriasis 4.
Combination Therapies for Psoriasis
Combination therapies, such as the use of NB-UVB with adjunctive topical treatments (e.g., emollients, calcipotriene, corticosteroids, retinoids, and tar) or systemic agents (e.g., methotrexate, mycophenolate mofetil, and cyclosporine), can be effective for psoriasis treatment 6. However, the duration of the combined treatment should be kept to a minimum and patients need to be closely monitored 6.