From the Guidelines
Psoriasis treatment should prioritize topical therapies for mild to moderate cases, with systemic medications and phototherapy reserved for more severe cases, as supported by the most recent guidelines 1.
Overview of Psoriasis Treatment
Psoriasis is a chronic autoimmune skin condition characterized by red, scaly patches that can appear anywhere on the body. The goal of treatment is to reduce inflammation and slow skin cell growth.
Treatment Approach
- For mild to moderate cases, topical therapies like corticosteroids (such as betamethasone or clobetasol), vitamin D analogs (calcipotriene), or combination products (Enstilar, Taclonex) are recommended, applied once or twice daily to affected areas for 2-4 weeks, then tapered as improvement occurs 1.
- For moderate to severe psoriasis, phototherapy (UVB light) 2-3 times weekly for 8-12 weeks or systemic medications may be necessary, with options including methotrexate (starting at 7.5-15mg weekly), biologics like adalimumab (Humira, 40mg every other week), secukinumab (Cosentyx, 300mg monthly), or oral medications like apremilast (Otezla, 30mg twice daily) 1.
Lifestyle Modifications
Lifestyle modifications are also important, including:
- Moisturizing regularly
- Avoiding triggers like stress and alcohol
- Maintaining a healthy weight
- Avoiding scratching affected areas
Special Considerations
- Erythrodermic psoriasis, a severe form of the disease, requires a distinct approach, with systemic treatments like oral cyclosporine (3-5 mg/kg/d) or methotrexate (subcutaneously) considered for rapid response 1.
- Patient preferences and individual needs should be taken into account when developing a treatment plan, with consideration of factors like body location, lesion thickness, and degree of erythema 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.
Psoriasis Treatment: Adalimumab (HUMIRA) is indicated for the 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 2.
- Key Points:
- Indicated for moderate to severe chronic plaque psoriasis
- For adult patients who are candidates for systemic therapy or phototherapy
- When other systemic therapies are medically less appropriate 2 also supports the use of adalimumab for plaque psoriasis.
From the Research
Psoriasis Treatment Options
- Topical treatments are the mainstream treatment for mild-to-moderate psoriasis, with first-line treatments including vitamin D derivatives and corticosteroids 3
- Topical treatments combining corticosteroids and vitamin D analogues are well-established first-line treatments in mild-to-moderate psoriasis 4
- Other topical treatments for psoriasis include tazarotene, anthralin, tacrolimus, pimecrolimus, and newer formulations of tar 5
Phototherapy for Psoriasis
- Ultraviolet (UV) B phototherapy is most appropriate for patients with >10% affected body surface area who have not responded to topical treatments 6
- Narrowband UVB (NB-UVB) and targeted phototherapy are effective treatment options for psoriasis, with a good safety profile for long-term use 6
- NB-UVB can be used in combination with adjunctive topical treatments such as emollients, calcipotriene, corticosteroids, retinoids, and tar 6
Systemic and Biologic Treatments for Psoriasis
- Biologics are an option for first-line treatment of moderate to severe plaque psoriasis, with inhibitors to tumor necrosis factor α (TNF-α) including etanercept, adalimumab, certolizumab, and infliximab 7
- Other biologics inhibit cytokines such as the p40 subunit of the cytokines IL-12 and IL-13, IL-17, and the p19 subunit of IL-23 7
- Oral treatments for psoriasis include traditional agents such as methotrexate, acitretin, cyclosporine, and the advanced small molecule apremilast, which is a phosphodiesterase 4 inhibitor 7
Patient Adherence and Treatment Outcomes
- Patient adherence to topical treatment can be a major difficulty, and keeping the treatment regimen simple and using new and sophisticated treatment vehicles can improve treatment outcomes 5
- Addressing patient preferences about treatments and concerns about treatment-related toxicities and managing their expectations are key factors for effective treatment 5
- The selection of the most appropriate vehicle for topical treatments is of major importance, improving adherence to the treatment and frequently impaired by the complexities of topical therapeutic choices 3