From the Guidelines
Psoriasis vulgaris should be treated based on its severity, with mild cases managed with topical corticosteroids and vitamin D analogs, and moderate to severe cases potentially requiring phototherapy or systemic medications like methotrexate or biologics, as recommended by the joint AAD-NPF guidelines of care 1.
Treatment Approach
The treatment of psoriasis vulgaris depends on the severity of the disease, which can be assessed using the Psoriasis Area Severity Index (PASI) score, taking into account the total body surface area (BSA) involved, as well as the intensity of redness, scaling, and plaque thickness 1.
- For mild cases (<3% BSA), first-line treatment includes topical corticosteroids like betamethasone valerate 0.1% cream applied twice daily for 2-4 weeks, along with vitamin D analogs such as calcipotriene 0.005% ointment.
- Moisturizers should be used regularly to reduce scaling and improve barrier function.
- For scalp involvement, medicated shampoos containing coal tar or salicylic acid can help remove scales.
Systemic Therapies
For moderate to severe cases (≥3% BSA), treatment options may include:
- Phototherapy (narrowband UVB treatments 2-3 times weekly for 10-12 weeks)
- Systemic medications like methotrexate (starting at 7.5-15mg weekly)
- Biologics such as adalimumab (40mg every other week)
- Oral phosphodiesterase-4 inhibitors like apremilast (30mg twice daily), as outlined in the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies 2.
Lifestyle Modifications
Lifestyle modifications are also crucial in managing psoriasis, including stress reduction, maintaining a healthy weight, avoiding alcohol, and identifying trigger factors, as these can help alleviate symptoms and improve quality of life. The pathogenesis of psoriasis involves dysregulated immune responses, particularly the activation of T-cells and the release of inflammatory cytokines such as TNF-alpha, IL-17, and IL-23, which is why targeting these pathways with biologics can be effective for severe cases 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. The answer to the question about Psoriasis vulgaris is that adalimumab (SQ) 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 3.
- The dosage for plaque psoriasis is an 80 mg initial dose, followed by 40 mg every other week starting one week after initial dose.
- Key points to consider when treating psoriasis vulgaris with adalimumab include the potential for serious infections and malignancies.
From the Research
Psoriasis Vulgaris Treatment Options
- Psoriasis is an inflammatory skin condition that affects approximately 2% of people worldwide 4
- Treatment options for psoriasis include: + Topical treatments + Systemic treatments + Biologic agents + Phototherapy
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 4
- Narrowband UVB (NB-UVB) and targeted phototherapy are effective treatment options for psoriasis 4, 5
- NB-UVB can be used in combination with adjunctive topical treatments such as emollients, calcipotriene, corticosteroids, retinoids, and tar 4
- The combination of NB-UVB phototherapy and etanercept has a synergistic effect for clearing plaque-type psoriasis previously unresponsive to etanercept and NB-UVB phototherapy alone 5
Topical Treatments for Psoriasis
- Clobetasol propionate emollient 0.05% is a effective treatment for patients with dry, scaly, corticosteroid-responsive dermatoses such as psoriasis 6
- Clobetasol propionate spray 0.05% can be used as add-on therapy to a stable regimen of biologic treatment in patients with moderate to very severe plaque psoriasis 7
Combination Therapy for Psoriasis
- The combination of adalimumab and narrowband UVB light phototherapy is a effective treatment option for patients with moderate to severe psoriasis 8
- The combination of NB-UVB phototherapy and biologic agents such as etanercept and adalimumab can be used to treat patients with moderate to severe psoriasis 5, 8