From healthcentral.com
From topical ointments to light therapy and systemic meds, these are your options for managing this chronic skin disease
We’ve come a long way from the days of messy creams and sticky tars for plaque psoriasis treatment. With a new understanding of the cause of psoriasis related to a malfunctioning immune system, treatments are now often focused on targeting the inflammation before it even begins to wreak havoc on the skin. There is no cure for psoriasis, but there are many targeted treatments available that can reduce inflammation and help your skin recover back to its pre-psoriasis state.
Topical Treatments for Plaque Psoriasis
Kurt Ashack, M.D., a dermatologist and assistant professor at the Michigan State University College of Human Medicine in East Lansing, Michigan, says that even with newer, systemic medications, topic treatments still play a major role in psoriasis treatment. “Topical treatments are where I start off therapy with every patient who has a manageable number of plaques without psoriatic arthritis,” he says. Fortunately, there are numerous topical treatments available:
Over-the-Counter (OTC) Topical Nonsteroidals
There are many psoriasis treatments available over the counter (a.k.a. without a doctor’s prescription). According to the American Academy of Dermatology Association, these products work best if you have very mild psoriasis. Some of these treatments include:
Anti-itch medication: Calamine Lotion (calamine), Aveno Skin Relief, Gold Bond among others (menthol)
Coal tar: Neutrogena T-Gel Therapeutic Shampoo, MG217 Psoriasis Medicated Conditioning Shampoo, among others
Moisturisers: CeraVe Psoriasis Cream, Curél Hydra Therapy Itch Defense, Dermarest Psoriasis Medicated Treatment Gel, among others
Salicylic acid: Neutrogena T/Sal, Salicyn and Keralyt
Prescription Topical Steroids
While some steroids (a.k.a. corticosteroids) can be purchased over the counter, others require a prescription. How they are available depends on the strength of the medicine. Steroids are divided into seven different classes, with class I considered the most potent and class VII considered the lowest potency. Even topical steroids come with potential side effects, so only the lowest strength is available over the counter and stronger concentrations will need a doctor’s prescription. You can find topical steroids in different formulations such as ointments, creams, lotions, gels, and foams. Some of the prescription topical steroids include:
Bryhali, Lexette, Ultravate (halobetasol)
Celestone Soluspan (betamethasone)
Clobevate, Clobex, Cormax, among others (clobetasol)
Prescription Topical Non-Steroids
Just as there are newer classes of oral medications available for psoriasis treatment, there are also newer classes of topical non steroid medications. They include:
Anthralins: Drithocreme, Psoriatec, Zithranol, among others
Calcineurin inhibitors: Elidel (pimecrolimus), Protopic (tacrolimus)
Hydrocarbon receptor antagonists: VTAMA (Tapinarof)
Phosphodiesterase-4 (PDE4) inhibitors: ZORYVE (Roflumilast)
Vitamin A derivatives: Duobril (halobetasol propionate) Soriatane (acitretin), Tazorac (tazarotene)
Vitamin D analogs: Dovonex (calcipotriene), Enstilar (calcipotriene and betamethasone dipropionate), Taclonex (calcipotriene and betamethasone dipropionate), Vectical (calcitriol)
Systemic Treatments for Plaque Psoriasis
As the understanding of psoriasis as a whole-body disease came into focus, so did new choices of skin treatment that worked from the inside out. However, along with those systemic therapies came an increased patient concern around potential new side effects. George Han, M.D., dermatologist at Lenox Hill Hospital in New York City, says he frequently talks with his patients about their side-effect concerns.
“I think the best way to go about tackling side effect questions is to address both the rational concerns and the irrational ones, but separately,” he says. “For the former, we can address rational concerns about treatments with data.” That includes results from clinical trials—most of the medications have at least four to five years of highly scrutinized data, as well as registrational data collected after medicines come to market, Dr. Han explains. “For our newer classes of medicines, the IL-17 and IL-23 inhibitors, thankfully, the safety profiles look very good,” he says. “For example, some medications feature a side-effect profile that is within 1% to 2% of the placebo, at which point it’s hard to say that any side effects are actually due to the medication.”
There are a few specific concerns that are valid. “The IL-17 inhibitor class does have the potential to make inflammatory bowel disease (such as Crohn’s disease) worse, and TNF alpha inhibitors have a slightly higher risk in terms of potential infections and non-melanoma skin cancer,” says Dr. Han. “Outside of these specifics, though, there is no strong data to support our modern treatments having a high risk for any major issues.”
Biologic Treatments for Plaque Psoriasis
The U.S. Food and Drug Administration (FDA) has approved the following biologics to treat adults with psoriasis:
Cimzia (certolizumab pegol)
Cosentyx (secukinumab)
Enbrel (etanercept)
Humira (adalimumab)
Ilumya (tildrakizumab)
Remicade (infliximab)
Siliq1 (brodalumab)
Skyrizi (risankizumab)
Stelara (ustekinumab)
Taltz (ixekizumab)
Tremfya (guselkumab)
Other Systemic Treatments
Beyond biologics, there are other medications for psoriasis that work throughout the body. Some are more traditional disease modifying antirheumatic medications (DMARDs) and others fall into newer classes of treatments.
DMARD: Rheumatrex, Trexall, Otrexup (methotrexate), Arava (leflunomide)
Immunosuppressant: Gengraf, Neoral, Sandimmune (cyclosporine)
PDE-4 Inhibitor: Otezla (apremilast
JAK Inhibitor: Xeljanz and Xeljanz XR (tofacitinib)
Off-Label Systemic Drugs
Sometimes a provider will prescribe a medication that has not been FDA-approved to treat the condition, but it is still known to work well. This is a perfectly legal practice under a doctor’s supervision. Some of the off-label medications for psoriasis include:
Arava (leflunomide)
Azasan (azathioprine)
Cellcept, Myhibbin (mycophenolate mofetil)
Envarsus XR, Prograf, Astagraf XL (tacrolimus)
Fumaderm (fumaric acid esters)
Hydrea, Droxia (hydroxyurea)
Sulfasalazine (sulfasalazine)
Tabloid (6-thioguanine)
Phototherapy for Plaque Psoriasis
Phototherapy is a type of psoriasis treatment that uses light to help slow the rapidly growing skin cells. There are a variety of light treatments available including:
Ultraviolet Light B (UVB)
UVB therapy involves exposing the impacted skin to one of two types of UVB lights: broad band and narrow band. This treatment usually happens in a doctor’s office for a set length of time over a set schedule, usually two to three times a week, according to the American Academy of Dermatology Association.
Ultraviolet Light A (UVA) and Psoralens
This type of light therapy involves taking medication (psoralens) prior to the therapy to make the skin more sensitive to sunlight. UVA light penetrates deeper into the skin than UVB light and is often used for more severe psoriasis, according to the Mayo Clinic.
Sunlight
Both UVB and UVA are found in sunlight, however, using sunlight to treat psoriasis is not recommended for everyone, advises the National Psoriasis Foundation. Some medications can increase the risk of sunburn, so it is important to check with your provider about how much sun exposure is safe for your skin.
Talking With Your Doctor About Treatment
Even if you have mild psoriasis, appearing on less than 3% of your body, this can still indicate significant inflammation in the body. Whole body inflammation could lead to other diseases, such as cardiovascular disease. That’s why treating your psoriasis is so important. Fortunately, newer classes of medication are quite effective and have a good safety profile. The key is to work closely with your provider to find a treatment that goes along with your lifestyle and helps you feel your best.
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