From the Guidelines
The best starting treatments for psoriasis typically begin with topical therapies, such as calcipotriene or tacalcitol ointment combined with hydrocortisone, which have been shown to be efficacious for the treatment of facial psoriasis 1.
Topical Therapies
For mild to moderate psoriasis, the following topical therapies are recommended:
- Corticosteroid creams and ointments like betamethasone or clobetasol, applied once or twice daily to affected areas for 2-4 weeks
- Vitamin D analogues such as calcipotriene (Dovonex) can be used alone or combined with steroids, applied twice daily
- For scalp psoriasis, medicated shampoos containing salicylic acid or coal tar, used 2-3 times weekly, help remove scales
- Moisturizers should be applied daily to reduce dryness and scaling
Systemic Therapies
For more widespread cases, the following systemic therapies may be prescribed:
- Phototherapy (UVB light treatments) 2-3 times weekly for 8-12 weeks
- Oral medications like methotrexate (starting at 7.5-15mg weekly) or biologics such as adalimumab or ustekinumab might be considered
- These treatments work by reducing inflammation and slowing skin cell growth, addressing the underlying causes of psoriasis—an overactive immune system that accelerates skin cell production
Lifestyle Modifications
Lifestyle modifications including stress reduction, avoiding skin trauma, and maintaining a healthy weight can also improve treatment outcomes. The use of combination treatments with vitamin D analogues and potent topical corticosteroids from 3 to 52 weeks is more effective than either agent alone for the treatment of psoriasis 1. In a 52-week study with 828 patients, 69% to 74% of patients in the group treated with calcipotriene 0.005% plus betamethasone 0.064% once or twice daily achieved clear or almost clear status compared with 27% of the patients treated with vehicle control (P < .001) 1. Combining separate vitamin D and corticosteroid preparations into specific easy-to-follow regimens can be used to reduce both the adverse effects of topical corticosteroids and the cost for some patients 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.
The best starting treatment for psoriasis mentioned in the label is adalimumab (SQ) with a dose of 80 mg initial dose, followed by 40 mg every other week. However, it's essential to consider that the label indicates adalimumab is for patients who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate 2.
- Key points:
- Indication: Moderate to severe chronic plaque psoriasis
- Dosage: 80 mg initial dose, followed by 40 mg every other week
- Candidate patients: Those who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate
From the Research
Treatment Options for Psoriasis
- Topical treatments, systemic treatments, biologic agents, and phototherapy are all treatment options for psoriasis 3, 4
- The selection of treatment depends on the knowledge and experience of the treating dermatologist and the specific characteristics of each patient 4
First-Line Treatments
- Topical therapies are generally the first line of management for mild to moderate forms of psoriasis 4
- Clobetasol propionate foam 0.05% is a safe and effective treatment for plaque-type psoriasis on scalp and nonscalp areas 5
- Newer formulations of clobetasol propionate, such as spray, foam, lotion, and shampoo, may provide improved convenience and acceptance for patients 6
Phototherapy
- Phototherapy is a mainstay in the treatment of psoriasis and is available as psoralen plus UVA (PUVA), broadband UVB (BB-UVB), and narrowband UVB (NB-UVB) 7
- Narrowband UVB (NB-UVB) is more effective than BB-UVB and safer than PUVA 7
- NB-UVB phototherapy is considered the first-line treatment for extensive plaque type psoriasis 7