What to Expect From Your Psoriasis Medications

From healthcentral.com

There may be no cure for PsO, but top derms say there are many effective ways to treat this chronic skin condition 

If you’ve recently received a diagnosis of psoriasis (PsO), chances are you’re anxious to resolve your symptoms—the sooner, the better. The chronic skin condition, which causes your skin cells to grow too quickly, leads to inflammation that triggers itchy plagues, rash, and swollen, hot skin. Symptoms can range from mildly irritating to excruciating due to many factors, including the severity of your PsO and your overall health.

The good news? “The treatment options for psoriasis have continued to grow and expand and only get better,” says Aaron Farberg, M.D., a double board-certified dermatologist and dermatologic surgeon, in Dallas, TX. Since “no two cases are alike, every patient deserves an individualized treatment plan,” adds Allison K. Truong, M.D., a board-certified dermatologist specializing in psoriasis at Cedars Sinai in Los Angeles. So, having a range of treatment options for PsO to choose from is important.

Although you may feel like you’re alone with psoriasis, you’re definitely not—125 million people worldwide, or 3% of the total population, live with PsO, according to the National Psoriasis Foundation. It’s also normal to have lots of questions about the current PsO treatment options available. To help you better understand what to expect from your meds and how well you can anticipate today’s treatments working for you, we asked three leading dermatologists who specialize in psoriasis to clear up the confusion about treatment efficacy, potential benefits, and possible side effects.

Real Progress Has Been Made In Treating PsO

No one wants to live with psoriasis, but if you’re going to get a diagnosis of this s is that there are plenty of treatment options to help keep this skin condition under control, according to Dr. Farberg. Here’s why:

Improved PsO Understanding

Over the last few decades, researchers have made significant progress in understanding the genetics, immunology, and even associated comorbidities of PsO (which can include type 2 diabetes, Crohn’s disease, high blood pressure, and cardiovascular disease). Growing academic insight has led to the development of more effective PsO treatments with better efficacy, as well as a decade’s worth of research on PsO medications that enables physicians to “understand the safety profile and nuances in using these treatments clinically,” says Dr. Farberg. Such information can be particularly helpful when discussing treatment options with PsO patients with comorbidities, since the best treatment plan addresses a person’s entire health profile.

Biologics Can Treat PsO

There are now 13 FDA-approved biologics for the treatment of PsO, the newest of which hit the market in 2023. These agents are particularly useful for treating moderate psoriasis in which 3% to 10% of your body is affected, to severe cases, says Dr. Truong. They are also effective in treating psoriatic arthritis (PsA), a related inflammatory condition that affects roughly 30% of people living with PsO.

These newer, more effective drugs give people with both conditions more options for treatment, as well as the possibility of reducing the number of drugs they need to take. “Ideally, we can keep things simple with one maintenance medication,” says Christopher Sayed, M.D., a board-certified dermatologist in Chapel Hill, NC, of this approach. “However, there is sometimes a need to add topical treatments for a few stubborn areas, or layer on a second treatment in severe cases.”

New Topical PsO Treatments

Calcineurin inhibitors have been prescribed for years to treat PsO topically. However, Dr. Truong is particularly excited about two additional steroid-free options that recently hit the market: a phosphodiesterase-4 inhibitor (PDE4 inhibitor) that helps reduce levels of inflammation in the body and decreases symptoms such as pain, redness, and swelling, and a cream that works by activating the aryl hydrocarbon receptors and appears to slow the rapid build-up of skin cells and relieve inflammation.

Just like calcineurin inhibitors, neither option poses the same risks as long-term steroid use do, which can cause atrophy (or thinning) of the skin, and tachyphylaxis, in which medication suddenly becomes less effective. “Topical steroids still work best at calming down the inflammation quickly,” she explains, but these “newer topical agents and topical calcineurin inhibitors” can be “utilized as maintenance therapy” between flares or on smaller patches of skin that are particularly difficult to treat, versus the whole body.

Oral Medications for PsO

A new oral PDE4 inhibitor and an oral immunosuppressant that works by reducing the activity of your immune system have come onto the scene recently. Like biologics, they target widespread inflammation and are especially effective in people with moderate to severe PsO. What’s more, they’re taken in pill form—great news for those who have “needle phobia or are not responding to current available treatments,” says Dr. Truong. PDE4 inhibitors also treat PsA, which may reduce the need for multiple medications to manage both conditions.

Alternative Treatment Options for PsO

Beyond Rx medication for PsO, you can also try other approaches to help calm flaring symptoms.

Phototherapy exposes your skin to ultraviolet (UVA and UVB) rays at a dermatologist’s office, or even via a special in-home unit. This method can help shrink PsO patches and plaques and prevent new ones from forming, says Dr. Truong.

Lifestyle factors such as avoiding smoking, reducing stress, maintaining a healthy body mass index (BMI), sleeping well, and eating an anti-inflammatory diet can all help keep your symptoms under control and even prevent flares, she adds.

Side Effects and Possible Contraindications

When deciding on a treatment plan with your doctor, make sure to discuss side effects of the medications you’re considering, advises Dr. Truong. “The right individualized treatment plan often comes down to what side effects a patient might be willing to tolerate,” she explains.

Additionally, be sure to mention any comorbidities that you have. (Certain PsO meds are contraindicated for inflammatory bowel disease, for example.) And don’t forget to discuss your reproductive plans. If you wish to become pregnant in the near future, your physician will be mindful of the safety data that’s available for specific medications when making treatment recommendations.

You’ll also want to be aware of what your insurance company’s policies are on covering PsO treatments. Some providers, for example, only cover biologics once other treatments have failed to work. By partnering with your doctor and discussing all of your options, says Dr. Farberg, you’ll be able to come up with the best PsO possible treatment plan for you.

Can PsO Treatments End Your Symptoms?

Clear skin is within reach, says Dr. Sayad. Although, he adds, it’s important to know that there may be a trial-and-error period as your dermatologist works to find the medication (or combination of meds) that will deliver optimal results.

“Often, we can get patients’ [skin] completely clear with limited or no side effects,” he explains. “It’s not always possible, but we have a range of options now and rarely settle for less than 75% to 90% improvement.”

Does a Flare Mean That Your Treatment Stopped Working?

Not necessarily, says Dr. Farberg, who advises talking to your dermatologist about your symptoms and then together deciding on the best next steps.

“Small flares [while on your current treatment plan] can sometimes occur and be temporary,” notes Dr. Sayed. “We can often add a topical medicine for a few resistant areas. If it’s not possible to regain satisfactory improvement within a few months, I’ll usually consider making a bigger change.”

If a medication has stopped working altogether, “I get to assure my patients and say, ‘Don’t worry. I have several other options in my back pocket’,” due to the number of treatments available today, adds Dr. Farberg.

Additional Targeted PsO Treatments Are on the Horizon

Currently, Dr. Farberg is spearheading a research project that he hopes will reduce, or entirely eliminate, the trial-and-error process that some people with psoriasis must undergo to find the right treatment plan. With support from Castle Biosciences Inc., researchers are studying how gene expression profiling may help physicians better identify how to treat PsO, as well as other inflammatory diseases including atopic dermatitis. Results are expected to be reported in early 2025.

The bottom line: Psoriasis is a chronic illness for which there is no cure, but there are many treatment options available today, with more under review for the future, says Dr. Farberg. “We’ll always have a treatment that we can turn to in order to help alleviate, if not eliminate entirely, [your] psoriasis symptoms.”

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