From the Guidelines
Psoriasis is treated with a combination of topical, systemic, and lifestyle approaches depending on severity, with the most recent guidelines recommending high-potency topical steroids and topical vitamin D analogs for all grades of psoriasis, as well as narrow-band UVB phototherapy for moderate cases 1. For mild to moderate cases, start with topical corticosteroids like clobetasol or betamethasone applied once or twice daily to affected areas for 2-4 weeks, followed by maintenance therapy.
- Vitamin D analogs such as calcipotriene can be used alongside steroids or alternated with them.
- For scalp psoriasis, medicated shampoos containing salicylic acid, coal tar, or ketoconazole used 2-3 times weekly can help. Moderate to severe cases may require:
- Phototherapy (UVB light treatments 2-3 times weekly for 8-12 weeks)
- Systemic medications like methotrexate (starting at 7.5-15mg weekly) 1
- Biologics (such as adalimumab, etanercept, or ustekinumab) 1
- Oral retinoids Lifestyle modifications are important for all patients:
- Moisturize daily with fragrance-free products
- Avoid known triggers like stress and alcohol
- Maintain a healthy weight
- Avoid scratching or picking at plaques Psoriasis is an autoimmune condition causing rapid skin cell turnover, so treatments aim to reduce inflammation, slow cell growth, and remove scales while managing symptoms. The choice of treatment should be based on the individual patient's needs and preferences, as well as the severity of their disease, with consideration of the potential benefits and risks of each treatment option 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. 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.
Treatment of Psoriasis: Adalimumab (SQ) is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis. The recommended dosage is an initial dose of 80 mg, followed by 40 mg every other week starting one week after the initial dose 2.
- Key Points:
- Indicated for moderate to severe chronic plaque psoriasis
- Initial dose: 80 mg
- Maintenance dose: 40 mg every other week
- Starting one week after the initial dose
From the Research
Treatment Options for Psoriasis
- Topical agents, such as corticosteroids, vitamin D analogs, and keratolytics, are commonly used to treat mild psoriasis 3
- For moderate to severe psoriasis, biological agents like ustekinumab, adalimumab, infliximab, and etanercept may be prescribed 4
- Topical clobetasol propionate, an ultrapotent corticosteroid, can be used alone or in combination with other treatments, and is available in various formulations, including spray, foam, lotion, and shampoo 5
Efficacy and Safety of Treatments
- The addition of clobetasol propionate spray 0.05% to a stable regimen of biologic treatment has been shown to be effective in achieving additional clearing of plaques in patients with moderate to very severe plaque psoriasis 6
- However, the use of topical corticosteroids, including clobetasol propionate, can be associated with adverse events, such as erythema, peeling, dryness, and stinging 6
- Biological agents have been compared in terms of their efficacy, and while some may be more effective than others, they can be considered clinical equivalents for the treatment of psoriasis, with the choice depending on their relative safety profiles, individual contra-indications, and cost effectiveness 4
Importance of Treatment Adherence
- Adherence to treatment is a crucial factor in the management of psoriasis, and using a treatment regimen that is simple and acceptable to the patient can improve treatment outcomes 7, 5
- Newer formulations of topical agents, such as clobetasol propionate, may provide improved convenience and acceptance for patients, leading to better adherence and outcomes 5