From jewishlink.news
By Dr. Alex Doctoroff
Psoriasis is a chronic autoimmune skin condition that affects millions of people worldwide. It causes red, scaly and often itchy patches on the skin. Psoriasis is not contagious. Psoriasis can have a profound impact on a person’s physical comfort, self-esteem and overall quality of life. Though there is currently no cure for psoriasis, treatment options have expanded significantly in recent years, giving patients a wider range of choices that are safer, more effective and easier to use than ever before.
Depending on the extent of skin involvement and how much it interferes with daily life, psoriasis is generally classified as mild, moderate or severe. Mild psoriasis typically affects less than three percent of the body and tends to be more localized, such as patches on the elbows or scalp. Moderate psoriasis may cover more skin or affect areas that interfere with everyday activities or cause significant emotional distress. Severe cases involve more widespread skin involvement, or the presence of psoriatic arthritis, which causes joint pain and stiffness. Each level of severity requires a different approach to treatment, and recent advancements are helping to tailor these options more precisely to individual needs.
For those with mild psoriasis, topical treatments are usually the first line of defence. For decades, corticosteroid creams and ointments have served as the primary therapy. These drugs help reduce inflammation and calm overactive immune responses but can cause side effects like skin thinning when used long term. Additional topicals like vitamin D analogues and calcineurin inhibitors have offered steroid-free alternatives for sensitive areas. In recent years, however, there has been a push to develop even safer, more sustainable options for topical therapy.
Two major breakthroughs in this area include tapinarof and roflumilast. Tapinarof is a non-steroidal cream approved in 2022 that targets the skin’s immune signalling through a pathway called the aryl hydrocarbon receptor. It offers strong results with a low risk of side effects. Roflumilast, another newer agent, inhibits an enzyme involved in inflammation and is particularly useful for sensitive areas such as the scalp or body folds. Both of these treatments represent a new era of steroid-free topical management, giving patients options that are effective and safe for continuous use.
In addition to topical treatments, Xtrac laser is a valuable treatment option, which we routinely use. The benefit of Xtrac is that after the treatment is completed, a long-term remission (seven to 12 months) is usually possible. For those patients who have widespread involvement with psoriasis, but are unwilling or unable to use biologic treatments (more on biologics later), narrowband ultraviolet B (UVB) phototherapy is one of the most effective methods.
As psoriasis becomes more widespread or difficult to manage with topicals alone, treatment often escalates to systemic options—medications that work throughout the body. Traditionally, oral medications like methotrexate and cyclosporine were used to manage moderate to severe psoriasis. While effective for some, these drugs carry serious side effects risks, such as liver or kidney toxicity, and require frequent blood tests to monitor for complications.
In recent years, however, newer oral treatments have emerged that offer similar or better results with fewer risks. One of the most exciting developments is the introduction of deucravacitinib, a once-daily pill that works by selectively inhibiting a molecule involved in the immune response known as TYK2. Unlike older systemic drugs, deucravacitinib has a more targeted mechanism and a favorable safety profile, making it an attractive option for patients who prefer pills over injections. This reflects a broader trend in psoriasis care toward personalized treatment—choosing the right therapy for the right patient at the right time.
For people with severe psoriasis, particularly those with joint involvement or very widespread skin symptoms, biologic therapies have become the gold standard. Biologics are advanced medications that work by blocking specific parts of the immune system that are overactive in psoriasis. Instead of suppressing the entire immune response like older drugs, biologics act on precise targets, such as certain interleukins or inflammatory proteins, allowing for more effective treatment with fewer side effects.
The most common misconception I have to address with patients is the notion that biologics are toxic or immunosuppressive. This notion is not correct. Biologics do not generate toxicity for internal organs, such as liver or kidneys, like older oral medications did. And they certainly are not immunosuppressive, like older medications were. I think of biologics more like immunomodulators: they decrease body
mediators, which are elevated, without lowering one’s immune system as a whole.
There are several classes of biologics, each targeting a different pathway in the immune system. Earlier biologics focused on tumour necrosis factor-alpha, a general inflammatory protein, while newer agents have shifted toward more specific targets like interleukin-17 and interleukin-23. These newer biologics, such as risankizumab, guselkumab and ixekizumab, have shown remarkable success in clinical trials, with many patients achieving clear or nearly clear skin. Injections are typically spaced out every few weeks to months, and many patients report significant improvements in both symptoms and quality of life.
One of the most exciting trends in the biologic space is the rise of IL-23 inhibitors. These medications have become particularly popular due to their long-lasting effects, high success rates and relatively low risk of side effects. Patients on IL-23 blockers often need only four to six injections per year after an initial loading period, making them convenient and less disruptive to daily life. These therapies are now often considered as first-line options for patients beginning biologic treatment.
Cost and accessibility remain a concern, but the introduction of biosimilars—less expensive versions of brand-name biologics—has begun to lower barriers. Biosimilars are now available for some of the most widely used biologics, offering similar efficacy at a reduced price, and their presence is expected to grow in the coming years. This is a significant step forward in making advanced treatment more widely available to people with severe disease.
The overall message is one of hope. Psoriasis may still be a lifelong condition, but managing it has never been more achievable. Today, patients have access to a wide spectrum of therapies—from innovative topicals and smart light treatments to powerful biologics and targeted oral medications. With regular follow-up, an individualized care plan and open communication with a dermatologist, many people can now live free from the discomfort and stigma of uncontrolled psoriasis. Whether your disease is mild and manageable or severe and persistent, the options available today offer real possibilities for relief, recovery and long-term remission.
Dr. Alex Doctoroff is dual board certified in dermatology and Mohs Surgery. He is the past president of the New Jersey Dermatological Society and a clinical assistant professor of dermatology at Columbia University Medical Center and New York Presbyterian Hospital.
No comments:
Post a Comment