What is the best treatment for psoriasis?

From the Guidelines

The most effective treatment for psoriasis is a stepwise approach, starting with topical treatments such as calcipotriene and hydrocortisone, and progressing to phototherapy, systemic medications, and biologic therapies as needed, with the goal of reducing morbidity, mortality, and improving quality of life. When considering treatment options, it is essential to prioritize the most recent and highest quality studies, such as the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures 1. For mild to moderate psoriasis, topical treatments are the first line, including:

• Corticosteroids (such as betamethasone or clobetasol)
• Vitamin D analogs (calcipotriene)
• Retinoids (tazarotene) These are applied directly to affected skin once or twice daily until improvement occurs. The use of combination treatments with vitamin D analogues and potent topical corticosteroids from 3 to 52 weeks is more effective than either agent alone for the treatment of psoriasis 1. For moderate to severe cases, phototherapy using UVB light or PUVA (psoralen plus UVA) may be recommended, typically administered 2-3 times weekly for several months. When these options are insufficient, systemic medications like methotrexate (starting at 7.5-15mg weekly), cyclosporine (2.5-5mg/kg/day), or oral retinoids (acitretin 10-50mg daily) may be prescribed, as outlined in the guidelines of care for the management of psoriasis and psoriatic arthritis 1. For severe or resistant psoriasis, biologic therapies targeting specific immune pathways are highly effective, including:
• TNF inhibitors (adalimumab, etanercept)
• IL-17 inhibitors (secukinumab, ixekizumab)
• IL-23 inhibitors (guselkumab, risankizumab)
• IL-12/23 inhibitors (ustekinumab) These treatments work by reducing inflammation and normalizing skin cell growth, as psoriasis results from an overactive immune response causing rapid skin cell turnover, and have been shown to be effective in improving quality of life for patients with psoriasis 1. Lifestyle modifications like stress reduction, maintaining a healthy weight, avoiding alcohol, and moisturizing regularly can complement medical treatments and help manage flare-ups. Ultimately, the best treatment for psoriasis will depend on the individual patient's needs and circumstances, and should be determined in consultation with a healthcare professional.

From the FDA Drug Label

HUMIRA is 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. The best treatment for psoriasis is not explicitly stated in the provided drug labels, but adalimumab (HUMIRA) is indicated for the treatment of moderate to severe chronic plaque psoriasis in adults who are candidates for systemic therapy or phototherapy.

• The decision to use adalimumab should be made on a case-by-case basis, considering the individual patient's condition and medical history.
• It is essential to consult the FDA drug label and other relevant medical resources to determine the most appropriate treatment for a specific patient with psoriasis 2, 2.

From the Research

Treatment Options for Psoriasis

• Topical corticosteroids are the mainstay of treatment for mild to moderate psoriasis, and can be used in combination with other agents such as salicylic acid, vitamin D analogues, and tazarotene 3
• Combination therapy with topical corticosteroids and vitamin D analogues can provide an improvement in psoriasis within 2 weeks, reaching a maximal improvement after 4 weeks in the majority of patients 4
• The combination of potent corticosteroids with calcipotriol is an efficacious and safe treatment option, with two-compound products being a practical solution 4
• Combination therapies are widely used by physicians, and adjunctive topical therapies used with other antipsoriatic regimens have been demonstrated to provide many clinical benefits 5

Combination Therapy

• Combination therapy plays an important role in the treatment of psoriasis, with various combinations of topical, UV-light, and systemic therapies being used 6
• Not every combination provides additive or synergistic effects, and some combinations may be contraindicated 6
• Data on the benefit-risk assessment of combination therapies is limited, but current knowledge is summarized in published literature 6
• Topical therapies such as vitamin D analogs and corticosteroids can be combined with phototherapy or systemic agents to enhance treatment efficacy 7, 5

Topical Therapies

• Topical corticosteroids are commonly used as polytherapy and combination therapy with other agents 3
• New, innovative products such as sprays, foams, and nail lacquers provide opportunities to tailor treatment for individuals, promoting patient adherence to medications 3
• Topical retinoids, calcineurin inhibitors, and vitamin D analogues are also used as first-line topical treatments for chronic plaque psoriasis 4