From the Guidelines
The best treatment for psoriasis typically involves a stepwise approach, starting with topical treatments for mild to moderate cases, and progressing to phototherapy, systemic medications, or biologics for more severe cases, as recommended by the most recent guidelines 1.
Treatment Approach
The treatment approach for psoriasis depends on the severity and type of psoriasis. For mild to moderate cases, topical treatments are the first line, including:
- Corticosteroids (such as betamethasone or clobetasol)
- Vitamin D analogs (calcipotriene)
- Retinoids (tazarotene) These should be applied directly to affected areas once or twice daily as prescribed.
Phototherapy and Systemic Medications
For moderate to severe psoriasis, phototherapy using UVB light 2-3 times weekly for 2-3 months may be effective. When these options fail, systemic medications like:
- Methotrexate (starting at 7.5-15mg weekly)
- Cyclosporine (2.5-5mg/kg/day)
- Biologics such as adalimumab (Humira, 40mg every other week), etanercept (Enbrel, 50mg twice weekly initially), or ustekinumab (Stelara, weight-based dosing) may be necessary.
Lifestyle Modifications
Lifestyle modifications including maintaining a healthy weight, avoiding alcohol, managing stress, and using moisturizers regularly can complement medical treatments. Regular follow-up with a dermatologist is essential to monitor treatment effectiveness and potential side effects, as highlighted in the guidelines 1.
Key Considerations
It is essential to consider the individual patient's needs, preferences, and circumstances when selecting a treatment approach, as emphasized in the guidelines 1. The choice of vehicle for topical treatments can significantly alter the use and penetration of the medication, and therefore alter the efficacy 1. Additionally, the use of biologic therapies has emerged as a valuable treatment option for patients with severe disease, as discussed in the guidelines 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.
The best treatment for psoriasis is systemic therapy or phototherapy, and adalimumab (HUMIRA) is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for these therapies. The recommended dosage for plaque psoriasis is an 80 mg initial dose, followed by 40 mg every other week starting one week after the initial dose 2.
- Key points:
- Adalimumab (HUMIRA) is a TNF blocker.
- Indicated for moderate to severe chronic plaque psoriasis.
- Recommended dosage: 80 mg initial dose, followed by 40 mg every other week.
From the Research
Treatment Options for Psoriasis
The treatment for psoriasis depends on the severity of the disease. For mild to moderate forms of psoriasis, topical therapy is often used, which includes:
- Corticosteroids
- Vitamin D3 analogs
- Retinoids
- Tars
- Anthralin
- Keratolytics
- Topical immunomodulators 3 Topical corticosteroids are effective in reducing inflammation and slowing down skin cell growth, and their mechanisms of action involve the inhibition of multiple pro-inflammatory genes and the induction of anti-inflammatory genes 4.
Systemic Treatment for Severe Psoriasis
For severe forms of psoriasis, systemic treatment is often necessary, which includes:
- Conventional preparations such as methotrexate, cyclosporin, and acitretin
- Biological preparations such as inhibitors of TNF-alpha (etanercept, adalimumab, infliximab) and the monoclonal antibody against IL 12/23 ustekinumab 5 Systemic therapy provides a significant benefit to patients with severe psoriasis, and biological preparations are more effective than conventional medications, which are often limited by severe side-effects and generally less tolerated than biological treatments 5.
Combination Therapy
Combination therapy, such as adding a superpotent corticosteroid like clobetasol propionate spray 0.05% to a stable regimen of biologic treatment, can be effective in obtaining additional clearing of plaques in patients with moderate to very severe plaque psoriasis 6. However, the risk of malignancy associated with psoriasis treatments, including phototherapy, traditional systemic therapies, and biologic therapies, should be considered, and appropriate patient counseling and selection, as well as clinical follow-up, are necessary to maximize safety with these agents 7.
Key Considerations
When choosing a treatment for psoriasis, it is essential to consider the individual patient's needs and expectations, and to tailor the treatment choice accordingly 3, 4. The decision to add a topical agent to a stable biologic treatment regimen should be based on the patient's response to treatment and the presence of any adverse effects 6.