From the Guidelines
Psoriasis treatment should typically involve a stepwise approach, starting with topical treatments for mild to moderate cases, and progressing to phototherapy, systemic medications, and biologic therapies for more severe or resistant cases, as recommended by the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care 1. When considering treatment options, it's essential to weigh the benefits and risks of each therapy. Topical treatments, such as vitamin D analogues and corticosteroids, are often effective for limited disease and have fewer significant adverse effects due to the lack of systemic exposure. However, for more extensive disease, phototherapy or systemic treatments may be necessary. Some key points to consider when treating psoriasis include:
- Topical treatments, such as corticosteroids and vitamin D analogs, should be applied once or twice daily to affected areas for 2-4 weeks, with maintenance therapy as needed.
- Phototherapy using UVB light 2-3 times weekly for 10-12 weeks can be effective for moderate to severe cases.
- Systemic medications like methotrexate, cyclosporine, or oral retinoids may be prescribed when topical treatments and phototherapy fail.
- Biologic therapies targeting specific inflammatory pathways, such as TNF inhibitors, IL-17 inhibitors, IL-23 inhibitors, or IL-12/23 inhibitors, are highly effective for severe or resistant cases. Lifestyle modifications, such as maintaining a healthy weight, reducing stress, avoiding alcohol, and moisturizing regularly, can complement medical treatments and help prevent flares. According to the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care, these treatments work by reducing inflammation and normalizing skin cell turnover, which addresses the underlying immune dysregulation causing the rapid skin cell production and inflammation characteristic of psoriasis 1.
From the FDA Drug Label
HUMIRA is a tumor necrosis factor (TNF) blocker 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. 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.
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. 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
Psoriasis Treatment Options
- Topical treatments combining corticosteroids and vitamin D analogues are well-established first-line treatments for mild-to-moderate psoriasis 3
- Biologics are directed at more specific targets, have a better safety profile, are better tolerated, and are more effective than conventional systemic agents for moderate-to-severe psoriasis 4
- Treatment regimens should be tailored to meet the specific needs of each patient based on disease severity, impact on quality of life, response to previous therapies, and presence of comorbidities 5
Treatment Approaches
- A stepped-care approach can be used, with mild disease treated with topical therapies, and more extensive disease treated with phototherapy or step 3 agents such as acitretin, cyclosporine, and methotrexate 6
- Biologic agents have dramatically improved the treatment of psoriasis, with 11 FDA approved options available, each with unique merits and demerits 7
Considerations for Treatment
- Patient identification, treatment decision making, topical treatment outcomes, and optimising patient adherence are important considerations for general practitioners when treating psoriasis 3
- The presence of comorbidities, such as psoriatic arthritis, Crohn's disease, malignancy, obesity, and cardiovascular diseases, can impact the decision to use one therapy over another 5