From the Guidelines
The treatment of psoriasis involves a stepwise approach based on disease severity, with topical treatments as the first line for mild psoriasis, phototherapy for moderate to severe psoriasis, and systemic medications or biologic therapies for severe cases or those unresponsive to previous treatments, as recommended by the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies 1.
Pathophysiology of Psoriasis
Psoriasis is a chronic inflammatory skin disease characterized by an overactive immune response, leading to rapid skin cell turnover and resulting in scaling, erythema, and plaque formation. The exact cause of psoriasis is unknown, but it is believed to involve a combination of genetic, environmental, and immune system factors.
Diagnosis of Psoriasis
Diagnosis of psoriasis is typically based on clinical presentation, medical history, and physical examination. The characteristic skin lesions of psoriasis, including red, scaly patches on the skin, are often sufficient for diagnosis. In some cases, a skin biopsy may be performed to confirm the diagnosis.
Treatment of Psoriasis
Treatment of psoriasis depends on the severity of the disease and the individual patient's needs. The following are some common treatment options:
- Topical treatments: corticosteroids, vitamin D analogs, retinoids, and calcineurin inhibitors, which are typically applied once or twice daily to affected areas for several weeks.
- Phototherapy: UVB light or PUVA (psoralen plus UVA) may be recommended for moderate to severe psoriasis, with treatments 2-3 times weekly for 2-3 months.
- Systemic medications: methotrexate, cyclosporine, or oral retinoids like acitretin, which are used for severe cases or those unresponsive to previous treatments.
- Biologic therapies: TNF inhibitors, IL-17 inhibitors, IL-23 inhibitors, and IL-12/23 inhibitors, which target specific immune pathways and are used for severe cases or those unresponsive to previous treatments. Some key points to consider when treating psoriasis include:
- Treatment selection depends on psoriasis type, severity, comorbidities, and patient preferences, often requiring combination approaches for optimal control 1.
- Lifestyle modifications, such as stress reduction, maintaining a healthy weight, avoiding alcohol, and moisturizing regularly, can help manage symptoms.
- The choice of vehicle for topical treatments can significantly alter the use and penetration of the medication, and therefore alter the efficacy 1.
- Phototherapy, including UVB and PUVA, is an essential therapeutic option for patients with psoriasis, and is efficacious, cost-effective, and generally lacks the systemic immunosuppressive properties of both traditional and biologic systemic therapies 1.
From the FDA Drug Label
HUMIRA is used: To treat moderate to severe chronic (lasting a long time) plaque psoriasis (Ps) in adults who have the condition in many areas of their body and who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills). The treatment of psoriasis is with HUMIRA, a Tumor Necrosis Factor (TNF) blocker, for moderate to severe chronic plaque psoriasis in adults.
- Key points:
- HUMIRA is used to treat moderate to severe chronic plaque psoriasis.
- It is used in adults who have the condition in many areas of their body.
- Patients may benefit from taking injections or pills (systemic therapy) or phototherapy. 2
From the Research
Pathophysiology of Psoriasis
- Psoriasis is a chronic inflammatory skin disease characterized by an abnormal immune response, keratinocyte proliferation, and angiogenesis 3, 4, 5
- The exact cause of psoriasis is unknown, but it is believed to involve a combination of genetic, environmental, and immune system factors 5
Diagnosis of Psoriasis
- Diagnosis is typically based on clinical presentation, medical history, and physical examination 3, 4, 5
- There are several types of psoriasis, including plaque, guttate, inverse, pustular, and erythrodermic psoriasis 5
Treatment of Psoriasis
- Treatment options vary depending on the severity and extent of the disease, as well as the patient's medical history and preferences 3, 4, 6, 5, 7
- Topical therapies, such as corticosteroids, vitamin D analogs, and retinoids, are commonly used for mild to moderate psoriasis 3, 4, 6, 5, 7
- Systemic therapies, such as methotrexate, acitretin, and cyclosporine, may be necessary for more severe cases 3, 4, 5
- Phototherapy, including ultraviolet B (UVB) and psoralen plus UVA (PUVA), can also be effective for moderate to severe psoriasis 3, 4, 5
- Combination therapy, using multiple treatments simultaneously or in rotation, may be beneficial for some patients 4, 6, 5, 7
Topical Treatments for Psoriasis
- Topical corticosteroids are a common first-line treatment for mild to moderate psoriasis 6, 5, 7
- Vitamin D analogs, such as calcipotriene, can be used alone or in combination with corticosteroids 3, 4, 6, 7
- Retinoids, such as tazarotene, can be used for stable plaque psoriasis, often in combination with other therapies 3, 6, 5
- Other topical treatments, including salicylic acid, coal tar, and anthralin, may be used for specific types of psoriasis or in combination with other therapies 6, 5, 7