What are the treatment options for psoriasis?

From the Guidelines

Treatment options for psoriasis include topical therapies, phototherapy, and systemic medications depending on severity, with the most recent guidelines from 2020 recommending a tailored approach based on individual patient needs and disease severity 1.

Overview of Treatment Options

• Topical therapies, such as vitamin D analogues and corticosteroids, are effective for managing limited disease and offer fewer significant adverse effects due to the lack of systemic exposure.
• Phototherapy or systemic treatments can be pursued for more extensive disease or when topical therapies are inadequate.
• Systemic treatments include oral medications like methotrexate, cyclosporine, and acitretin, which target the immune system or decrease keratinocyte hyperproliferation.
• Biologics targeting specific immune pathways, such as TNF inhibitors, IL-17 inhibitors, IL-23 inhibitors, and IL-12/23 inhibitors, are also effective options.

Specific Treatment Recommendations

• For mild to moderate cases, topical corticosteroids (like betamethasone or clobetasol) are first-line treatments, applied once or twice daily for 2-4 weeks.
• Vitamin D analogs such as calcipotriene can be used alone or combined with steroids.
• Topical retinoids (tazarotene) and calcineurin inhibitors (tacrolimus, pimecrolimus) are also effective for sensitive areas.
• For moderate to severe psoriasis, phototherapy using UVB light or PUVA (psoralen plus UVA) administered 2-3 times weekly for 8-12 weeks can clear plaques.
• Systemic treatments include oral medications like methotrexate (10-25mg weekly), cyclosporine (2.5-5mg/kg/day), and acitretin (25-50mg 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 for Treatment Selection

• Treatment selection depends on psoriasis severity, affected body areas, comorbidities, and patient preferences.
• Combination approaches often provide the best outcomes.
• The choice of vehicle can significantly alter the use and penetration of the medication and therefore alter the efficacy.
• Occlusion of topical medications can also alter the penetration, thereby varying the effectiveness.

From the FDA Drug Label

HULIO 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 option for psoriasis is adalimumab (HULIO), which is used to treat moderate to severe chronic plaque psoriasis in adults. Key points about this treatment include:

• It is used for adults with the condition in many areas of their body.
• Patients may benefit from taking injections or pills (systemic therapy) or phototherapy.
• Adalimumab (HULIO) is a Tumor Necrosis Factor (TNF) blocker 2.

From the Research

Treatment Options for Psoriasis

• Topical agents: Vit D, calcipotriol, corticosteroids, dithranol, and retinoids 3
• Systemic agents: methotrexate, cyclosporine 3
• Phototherapy: UV-B, Psoralen plus ultraviolet therapy, excimer laser 3
• Combination therapy: rotational therapy with UVB, PUVA, methotrexate, and etretinate 4
• Biologicals: Denilukin diftitox, Efalizumab, Alefacept, Ustekinumab, Etanercept 3, 5
• Herbal therapy: methanolic extracts of duzhong, yerba mate, linseed oil, fish oil, Indigo naturalis 3

Comparison of Treatment Options

• Ustekinumab was found to be superior to etanercept in treating moderate-to-severe psoriasis 5
• Rotational therapy may minimize long-term toxicity and allow effective treatments to be maintained for many years 4

Safety and Efficacy of Treatment Options

• Traditional systemic therapies, such as methotrexate and cyclosporine, have a well-documented array of toxicities, including end-organ toxicities 6
• Biologic therapies, such as alefacept and efalizumab, may increase the risk of malignancy 6
• Topical vitamin D analogues, such as calcitriol and calcipotriol, are generally well-tolerated and effective in treating psoriasis 7