What are the treatment options for psoriasis?

From the Guidelines

Psoriasis treatment should typically involve a combination of topical medications, phototherapy, and systemic treatments depending on severity, with the most recent guidelines from the American Academy of Dermatology recommending a stepped approach to care 1. When considering treatment options, it's essential to assess the severity of the disease and the impact on the patient's quality of life. For mild to moderate psoriasis, topical corticosteroids like betamethasone or clobetasol can be effective, applied once or twice daily to affected areas for 2-4 weeks. Vitamin D analogs such as calcipotriene can be used alone or combined with steroids. Some key points to consider when treating psoriasis include:

• Topical therapies may be sufficient for limited disease, but phototherapy or systemic treatments may be necessary for more extensive or severe cases 1.
• Systemic medications like oral methotrexate, biologics, or oral apremilast can be effective for moderate to severe cases, but require careful monitoring and consideration of potential side effects 1.
• Lifestyle modifications, such as maintaining a healthy weight, avoiding triggers, and using moisturizers regularly, can also improve symptoms and quality of life.
• Regular follow-up with a dermatologist is crucial to monitor treatment efficacy and potential side effects, and to adjust the treatment plan as needed 1. The most effective treatment approach will depend on the individual patient's needs and circumstances, and should be guided by the most recent and highest-quality evidence available 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.

Treatment for Psoriasis: 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

Treatment Options for Psoriasis

• Topical therapies, such as corticosteroids, vitamin D analogues, calcineurin inhibitors, and keratolytics, are the mainstay of treatment for mild psoriasis 3
• Phototherapy, including narrowband UV-B phototherapy, is also used to treat mild to moderate psoriasis 4, 3
• Systemic treatments, such as methotrexate, acitretin, and cyclosporine, are used for moderate to severe psoriasis 4, 5, 3
• Biologic agents, including inhibitors of tumor necrosis factor α (TNF-α), IL-12/23, and IL-17, are used for severe or unremitting cases of psoriasis, especially those with psoriatic arthritis 4, 3

Selection of Treatment

• The selection of treatment depends on the severity of the disease, as well as the patient's specific characteristics, such as age, lifestyle, and preferences 4, 6
• The treating physician should be aware of the management possibilities, advantages, and side effects of each treatment option 4
• A non-systematic literature review can provide information on the current treatment methods for psoriasis, including their indications, posology, and common side effects 4

Special Considerations

• Paediatric and pregnant patients require special consideration when selecting a treatment for psoriasis 4
• The use of acitretin in psoriasis has been established, and guidelines have been developed for its use, including its pharmacological properties, indications, and contraindications 5
• Topical treatments combining corticosteroids and vitamin D analogues are well-established first-line treatments for mild to moderate psoriasis 6