Advances in Psoriasis Treatment: What’s New For Mild, Moderate and Severe Disease

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.

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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. 

https://jewishlink.news/advances-in-psoriasis-treatment-whats-new-for-mild-moderate-and-severe-disease/ 

Psoriasis Medication Side Effects

From everydayhealth.com 

Major advancements in psoriasis treatments in the past two decades have given people living with the autoimmune condition a wide range of options for controlling symptoms. There are more than a dozen systemic treatments alone, which include some of the newer medications like Janus kinase (JAK) inhibitors.

But psoriasis treatments include many “old-school” medications as well, mainstays of therapy that have been around for decades. The one thing that all these options have in common? Side effects, which can range from mild to bothersome, and in some cases, a risk of serious adverse events.

Keep reading to learn what you need to know about the most common side effects from the most used psoriasis treatments.

Topical Corticosteroids and Skin Side Effects

Topical corticosteroids are among the most commonly prescribed treatments for psoriasis because they reduce inflammation, redness, and irritation, says Susan Massick, MD, an associate professor of dermatology at the Ohio State University in Columbus.

But if they’re used too frequently or for too long, they can cause skin atrophy, or thinning of the skin, says Dr. Massick.

Topical corticosteroid overuse can also lead to:

• Noticeable blood vessels (telangiectases)
• Hypopigmentation (light-coloured skin)
• Easier bruising
• Delayed wound healing
• Acne breakouts
• Stretch marks (striae)

“This can happen with low-potency topical steroids when used for prolonged periods of time, or with higher-potency topical steroids when applied in more sensitive areas, such as the face, armpits, groin, or genitals, or if used for prolonged periods of time,” she says.

Massick recommends working with your medical provider to limit the length of treatment to short-term or intermittent use and avoid prolonged or continuous treatment times.

“Your dermatologist will tailor what type of topical steroid depending on how severe your disease is and what areas need to be treated, with lower-potency topical steroids reserved for the delicate areas of the face, armpits, breasts, and genital areas, and with higher-potency topical steroids more appropriately reserved for places like your arms, legs, hands, feet, and trunk — and not to be used on the face,” says Massick.

Vitamin D Analogues and Sun Sensitivity

Medications like calcipotriene (also called calcipotriol), a synthetic form of vitamin D, are often paired with topical steroids to treat psoriasis. They’re generally well tolerated and don’t directly cause sun sensitivity, though using sun protection and wearing protective clothing and a hat are precautions worth taking, according to Massick.

You should also avoid sunlamps and tanning beds while using topical vitamin D analogues.

Retinoids and Skin Irritation

In psoriasis, keratinocytes (the type of cell that makes up most of the epidermis, the outermost layers of the skin) build up faster than normal, leading to the thick patches on the skin known as plaques.

Topical retinoids such as tazarotene (Fabior, Tazorac, Avage) treat psoriasis by reducing the overproduction of keratinocytes; promoting normal differentiation, or maturation, of keratinocytes; and exerting anti-inflammatory effects.

But patients do notice signs of skin sensitivity like redness, dryness, peeling, and irritation, especially when first starting treatment, says Massick.

“I recommend starting low and slow: Start with using the product two to three times a week to get acclimated to any potential irritation, and then increase the frequency as long as you’re not experiencing skin irritation,” she says.

Topical retinoids increase sun sensitivity, meaning you’ll sunburn more easily, so it’s important to practice excellent sun protection when using a topical retinoid: Stay out of the sun as much as possible, and apply sunscreen before going outside.

Coal Tar and Skin Irritation

Topical coal tar has been used to treat psoriasis for decades. Indeed, it may be the first known therapy for psoriasis, with use dating back to 1900. It is used less frequently today because newer treatments come with fewer side effects and less hassle, says Massick. 

“While coal tar can reduce inflammation by slowing the rapid skin cell turnover — the hallmark of plaque psoriasis — it also has a very pungent smell and can stain clothing, bedding, and towels,” she says.

Coal tar can also cause skin irritation in some people, especially when used in higher concentrations or on sensitive skin, says Massick.

For people who find that coal tar is a good way to manage psoriasis, they can limit skin irritation by using a lower concentration or using it on alternating days.

Biologic Medications and Infection Risks

Psoriasis is an autoimmune disease; the immune system is triggered and activated as if there were harmful invaders attacking the body. Sometimes topical therapies aren’t enough to control inflammation, and systemic therapies — drugs that address the root cause — are needed.

“Biologic medications target specific components of the immune system’s response and inflammatory cascade that trigger the psoriasis inflammatory pathway. These medications can block specific targets, such as IL-17, IL-23, and TNF alpha, all of which play key roles in psoriasis,” explains Massick.

Because these medications work by suppressing part of your immune system, they are considered immunosuppressants, she says.

Any suppression of your immune system can increase your risk of infection in general.

“This includes infections such as the typical upper respiratory viral and bacterial infections, such as influenza (flu) and COVID-19, and, in rare cases, more serious infections like tuberculosis,” says Massick. 

“Prior to starting therapy with any of the biologics, your doctor will screen you for chronic infections, including HIV, tuberculosis exposure, and hepatitis B and C, and will continue to monitor you during your treatment course,” she says.

JAK Inhibitors and Blood Clots

JAK inhibitors are oral drugs that can help with chronic inflammatory conditions, including psoriasis.

“These are the new kids on the block, one of the newer classes of medications that are effective in chronic inflammatory conditions, such as eczema and psoriasis. JAK inhibitors work by targeting specific inflammatory signalling pathways within cells that lead to inflammation,” says Massick.

While JAK inhibitors have been shown to be effective, they do carry potential serious risk of internal, or systemic, side effects, including increased risk of infection, bone marrow changes with low white counts, blood clots, heart-related events, and increased risk of cancer, she says. Not every patient will experience these side effects; some risks can depend on an individual's medical history and risk factors, says Massick.

As a class, JAK inhibitors have a black box warning that includes an increased risk of blood clots. Studies have shown that the risk is higher in people with other risk factors for clotting, and the risk is higher in people who take higher doses.

“A blood clot, such as a deep venous thrombosis (DVT), can cause swelling or pain where the clot forms, most commonly in the lower legs, developing as localized calf redness, swelling, and pain. If the clot travels to the lungs, this can cause a pulmonary embolism, causing shortness of breath and much more severe complications,” she says. A pulmonary embolism is a medical emergency.

Because of this risk, prescribing JAK inhibitors requires careful consideration to ensure that the severity of psoriasis outweighs the potential risk of these more serious side effects, says Massick.

JAK Inhibitors and Skin Cancer

“JAK inhibitors are associated with increased risk of non-melanoma skin cancers particularly in conjunction with other risk factors for skin cancer like age, fair skin, and history of skin cancers and sunburns,” says Massick.

The data has been mixed, but some studies have shown an increased risk of skin cancers in people taking JAK inhibitors for autoimmune conditions, including psoriasis.

“In terms of counselling, I do choose very carefully who I will offer these treatment options to and have frank discussions regarding potential side effects and long-term effects of these newer systemic therapies. While efficacious in terms of disease control, they are not without their risks,” says Massick.

The Takeaway

• Psoriasis treatments can control symptoms, but each treatment has potential side effects to weigh against benefits.
• Topicals like corticosteroids, vitamin D analogues, retinoids, and coal tar mainly cause skin issues such as irritation, thinning, or staining, which can often be managed by adjusting the dosage.
• Biologics and JAK inhibitors target immune pathways for stronger control but can raise the risk of serious infections; JAK inhibitors may also increase blood clot and cancer risk in certain people.
• Work with your dermatologist to choose, monitor, and adjust your psoriasis treatments to balance effective symptom control with safety.
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• https://www.everydayhealth.com/skin-conditions/psoriasis-medication-side-effects/
  

How Are Injections Used to Treat Psoriasis?

From healthcentral.com

Learn about potential benefits, drawbacks, and which treatments delivered via a shot may be right for managing severe symptoms 

Psoriasis is a full-body, autoimmune condition that often appears on the skin as dry, flaky patches, referred to as plaques. It can sometimes be managed with topical treatments, but more severe cases often required advanced therapies such as biologic medications. Biologics used to treat psoriasis are often given by injections, either at home or in a clinical setting. Depending on your insurance, biologics can be an expensive choice of treatment but may also be well worth the cost.

Most experts agree: Biologics have been a game changer for psoriasis treatment, says Kurt Ashack, M.D., a dermatologist at Dermatology Associates of West Michigan in Grand Rapids, MI. “Biologics last in the body for longer, and that keeps the psoriasis at bay for much longer,” he says. Wondering exactly what biologics are and how injections for psoriasis work? Our experts break it all down here, including how injections have become a new standard level of care for those with moderate to severe psoriasis.

                                                                  GettyImages/Catherine Falls Commercial

What Are Biologics?

Not long ago, traditional medications used to treat psoriasis impacted the entire immune system. Biologic medications are different from those older medications, quieting only a portion of the immune system that is overactive because of psoriasis. The Food and Drug Administration has approved at least 11 different biologics to treat psoriasis. At least one of the medications, infliximab, requires an infusion (through an IV) but the others can be received by an injection. “The injections aren’t very painful, and they range from one shot a month to 4 shots a year,” says Dr. Ashack.

According to the National Psoriasis Foundation, the biologics that are used to treat psoriatic disease block proteins in the immune system including tumour necrosis factor-alpha (TNF-alpha), interleukins 12 and 23, and interleukin 17. Let’s take a closer look at each.

TNF-Alpha Inhibitors

According to the journal Clinical Immunology, more than a million people worldwide have been treated with tumour necrosis factor-alpha (TNFα) inhibitors for a variety of conditions including rheumatoid arthritis, inflammatory bowel disease, and psoriatic disease. TNF-alpha inhibitors help reduce pro-inflammatory cytokines that increase inflammation through several pathways. Blocking the TNF-alpha production helps stop the inflammation related to psoriatic disease. Some of the TNF-alpha inhibitors approved for psoriasis include:

• Cimzia (certolizumab pegol)

• Enbrel (etanercept)

• Humira (adalimumab)

• Remicade (infliximab)

• Simponi (golimumab)

• Simponi Aria (golimumab)

IL-12/23 Inhibitors

“This injectable biologic works by selectively targeting the proteins, or cytokines, interleukin 12 (IL-12) and interleukin 23 (IL-23),” says Adam Kaye, Pharm.D., a clinical professor of pharmacy at the University of the Pacific in Stockton, CA. Stelara (ustekinumab) is the biologic that is approved for psoriasis and targets both the IL-12 and IL-23 pathways, he says. “When patients take this biologic, they will take an initial dose subcutaneously (under the skin), followed by a second dose at week four, then every 12 weeks after the initial dosing,” he explains. Interleukins 12/23 are associated with psoriasis inflammation.

IL-17 Inhibitors

Interleukin 17 is also associated with psoriatic disease. According to Kaye, there are several approved IL-17 inhibitors used to treat psoriasis including:

• Cosentyx (secukinumab)

• Taltz (ixekizumab)

• Siliq (brodalumab)

The latest in this class to be approved is Bimzelx (bimekizumab-bkzx). Kaye says the most common adverse effects of this class of medication is infection risk. Each of the IL-medications for psoriasis are taken subcutaneously by injection, explains Kaye.

IL-23 Inhibitors

Kaye says there are three main interleukin 23 inhibitors used for psoriasis: Tremfya (guselkumab), Ilumya (tildrakizumab), and Skyrizi (risankizumab). These biologics are used for both psoriasis and psoriatic arthritis. According to the National Psoriasis Foundation, IL-23 inhibitor medications can treat psoriatic disease and also help slow psoriatic disease progression. According to Kaye, a common adverse effect of IL-23 inhibitors is an increased risk of infection.

Does Methotrexate Treat Psoriasis?

Methotrexate, approved in 1972 for psoriasis treatment, is still prescribed in some circumstances, especially if cost is an issue. Methotrexate is usually taken as a pill and works more broadly compared to the biologic medications to dampen an overactive immune system. According to the American Academy of Dermatology Association, most patients who are prescribed methotrexate, see less symptoms from psoriasis in four to six weeks. However, according to Kaye, methotrexate isn’t for everyone, because it comes with potentially serious side effects. “Methotrexate is a medication with well-known pulmonary and liver risks that clinicians are well aware of and know they need to monitor for,” he explains.

Possible Medication Side Effects

Dr. Ashack says that while all immunosuppressant medications can make you an easier target for infections, your immune system takes less of a hit on a biologic as compared to methotrexate. “The targeted therapies for psoriasis like Skyrizi and Tremfya are so specific to psoriasis that the body does not utilize this pathway for a lot of other things like fighting off infections,” he says. Still, “biologics do cause an increased risk in infection, but they are much safer than older therapies like methotrexate.”

Kaye agrees and says that the newer targeted medication side effects can be subtle, but something to still be aware of. The need to avoid infections due to immunosuppressive therapies is a basic philosophy that should be shared with patients by the prescriber when biologic therapy begins, he adds.

Other Treatment Options

Especially for mild psoriasis, there are other treatment options to try before biologics. Topical therapies such as moisturizing lotion, steroid cream, medicated shampoo, vitamin D ointment, and retinoid cream are all effective options for some people with milder forms of the disease, per the Cleveland Clinic.

But if you have more severe psoriasis, or your psoriasis isn’t improving with your existing treatment, it may be time to talk to your dermatologist about a new approach. “Injectable biologics often make the psoriasis melt away so that you don’t have to use your topical therapy anymore, or if so, very little,” Dr. Ashack reports.

Bottom Line on Psoriasis Injections

In recent years, new medications called biologics have been approved to treat moderate to severe psoriasis. These medications target different specific parts of the immune system. Because they are so targeted, they are often very effective and avoid suppressing your entire immune system.

These medications are usually taken several times a year by injection. While effective, biologic medications can be unaffordable for some. While biologics are more targeted, they still have potential side effects, and you will need to maintain close communication with your provider when taking a biologic medication. According to the American Academy of Dermatology Association, if you are prescribed a biologic, you should contact your doctor if you have any side effects, stop taking the medication, have difficulty with the injection, or plan to become pregnant.

https://www.healthcentral.com/condition/psoriasis/psoriasis-injections?ap=nl2060&rhid=67ec2b8321f52bf01b0cca01&mui=&lid=141093361&mkt_tok=NTQxLUdLWi0yNDMAAAGaROz36BjyJ8WYxwi4iTV0lfhMzwiZ2LGE5Ie4izo9xiksy5oA0-w0hbnHFJrb50i63E4ka80xZtmK2GO3LZFCsIN2KlYzD_YX2bnUIEWbLQDZ6ZA

More than a skin-deep problem

From thestar.com.my

There’s a greater need for psoriasis awareness and more support for its patients

KUALA LUMPUR: Kenderick Lee was 24 and carving out a successful career in the corporate world when a diagnosis of the skin disease psoriasis somewhat stopped him in his tracks.

What started merely as a scalp issue ended up affecting his way of walking.

“I was diagnosed with pustular psoriasis which developed into psoriatic arthritis as I had already problems concerning arthritis, so all of these issues sort of combined and left me limping,” he said.

Psoriasis is an autoimmune disease that causes a rash with itchy, scaly patches, usually affecting the knees, elbows and scalp. It is not contagious, but there is no cure.

During the early stages after his diagnosis, Lee lost many of his friends.

“As a young person going through a chronic condition and just starting a career, it was such a chaotic time.

“There were friends who left me. I believe there should be some awareness about the condition so more people are educated about it,” he added.

Still, he has gained “gems” who stood by him.

“I found those who remained by my side,” said Lee, who is in the insurance sector.

Lee, now 35, has found refuge in a treatment called biologics.

“I have been receiving biologics for nine years,” he said, adding that it has enabled him to pursue regular, daily activities such as exercising.

Raising awareness: Sofia (left) with sponsors during the World Psoriasis Day 2024 event at KL Gateway Mall in Kuala Lumpur. — ART CHEN/The Star

Biologics are derived from natural proteins found in living cells. Commonly injected into patients every month, they work by targeting the underlying cause of psoriasis – excessive skin cell growth due to an overactive immune system.

The treatment, however, does not come cheap.

Lee pays about RM38,000 a year for the monthly injections. He hopes the government could consider subsidising the treatment for those relying on biologics.

“I am part of a programme in which my treatments are subsidised, which works well for me,” said Lee, who was present at an event on Saturday to mark World Psoriasis Day.

According to the US-based National Psoriasis Foundation, World Psoriasis Day is held annually on Oct 29 to honour “the 125 million people worldwide who face life with the challenges and frustrations of psoriasis and psoriatic arthritis”.

Dr Azura Mohd Affandi, the Health Ministry’s National Head of Dermatology Subspeciality, said biologics can ease psoriasis symptoms by as much as 90% to 100%.

Based on the Malaysian Psoriasis Registry for 2020-2022, there is a slight male predominance in psoriasis patients.

Dr Azura, who is also the head of the Dermatology Department at Hospital Kuala Lumpur, said the registry is voluntary.

From 2007-2022, it has registered 28,795 psoriasis patients, with 93.6% being adults and 6.4% under the age of 18.

“The number of affected patients is actually higher,” Dr Azura said.

Another study published based on data collected from Johor Baru revealed a prevalence rate of 0.34% of the population.

Given Malaysia’s 34 million population, she estimated that around 117,884 people in the country may be affected by the condition.

Psoriasis Association Malaysia interim president Sofia Lovi Ramasany said biologics should be made more accessible for psoriasis patients in the country.

She hopes the government would look into making biologics more available as fewer than 400 patients have access to it.

“Another pressing matter to highlight is the rare psoriasis type, which is the generalised pustular psoriasis. It can be life threatening if it’s not being treated promptly.

“People like us are not just prone to skin issues but also psoriatic arthritis where it will impact our joints and mobility.

“We need support from the government and community to have a transformation where the condition is understood and supported.“Patients who are diagnosed with psoriasis are also likely shunned from society and this could negatively impact their mental health as well,” she said.

https://www.thestar.com.my/news/nation/2024/11/11/more-than-a-skin-deep-problem 

What Are Biologics? And How Do They Treat Psoriasis?

From batonrougeclinic.com

Here’s what you need to know before deciding if this type of drug is right for you

Have you noticed a lot of advertisements for medications that treat psoriasis lately? Many of these drugs are biologics. Although not new, biologics are one of the fastest-growing drug categories in the U.S. – and they don’t just treat psoriasis. They also treat other diseases. If you have psoriasis, you may be wondering what these drugs do and the side effects they may have.

Here are answers to common questions about using biologics in the treatment of psoriasis:

What are biologics?

These drugs are developed from living organisms (human or animal) and target specific parts of the immune system to treat disease. They may also be referred to as biological response modifiers or biological agents.

What kind of diseases do biologics treat?

Biologics treat psoriasis, which is an autoimmune disorder that affects the skin. They also treat other autoimmune diseases such as psoriatic arthritis, rheumatoid arthritis and Crohn’s disease, as well as some cancers.

How do you take biologics?

These medicines are given as an injection or an infusion into a vein. Depending on the drug, you’ll need to take it anywhere from twice a week to once every three months.

How do biologics work when treating psoriasis?

These drugs target the part of the immune system that is overactive in people who have psoriasis and psoriatic arthritis. They block reactions that cause inflammation and other skin-related symptoms including redness, scaliness, itchiness, dryness and pain. They also help stop joint pain, stiffness and swelling in people with psoriatic arthritis. Biologics are powerful drugs but are only used for moderate to severe psoriasis when other treatments have failed due to the potential for serious side effects.

What are the side effects of biologics?

The most common side effects are mild and may include infusion or injection site reactions, such as redness, swelling, pain or itching. You may also have a headache, nausea or stomach upset. One of the biggest concerns about biologics is that they may raise your risk of infection because they weaken your immune system. There may be other side effects as well.

Are biologics an effective psoriasis treatment?

For people with moderate to severe forms of the disease, biologics may be the most effective treatment available. The drugs tend to be more effective if you take them continuously, rather than starting and stopping treatment. But sometimes a biologic may become less effective over time. If this happens, using another biologic may work better.

What should I do if I’m interested in taking a biologic?

If you have moderate to severe psoriasis or psoriatic arthritis, talk with your doctor about the benefits and risks before deciding if biologics are right for you. You’ll need to have some medical tests done before it can be determined if it’s safe to take these drugs, including blood and tuberculosis tests. Other tests may also need to be performed. You’ll also need to have some tests done periodically while you’re on the medication.

https://batonrougeclinic.com/what-are-biologics-and-how-do-they-treat-psoriasis/ 

The Path to Biologics: Finding a Psoriatic Arthritis Treatment That Works for Me

From bezzypsa.com

By Laura Todd Carns

I was 19 when I started noticing patches on my elbows. I thought it was just really dry skin but, despite moisturizing, the patches grew.

A few years later, a doctor finally identified these patches and the ones that had sprung up on my knees as psoriasis.

At the time, I knew nothing about psoriasis. I had no idea that it was an autoimmune disease. I saw it as nothing more than a cosmetic nuisance.

Years later, when my joints began to ache, it didn’t occur to me that my pain could be related to this skin condition.

Psoriatic arthritis (PsA) is inflammatory arthritis closely related to psoriasis. Approximately 7.4 million Americans have psoriasis, 10 to 20 percent of whom will eventually develop PsA, according to the Centres for Disease Control and Prevention.

Most people who develop PsA already have skin symptoms, although some people develop symptoms of arthritis before skin is visibly affected.

In my case, I first noticed stiffness in my hands and pain in the joints of my feet. The pain and stiffness were worse when I first woke up and tended to improve through the day.

These were not symptoms that dramatically affected my ability to get through my day, and so I largely ignored them.

Seeking answers for joint pain

Eventually, I went to a rheumatologist to figure out what was going on.

PsA is typically diagnosed by first ruling out other conditions, such as rheumatoid arthritis, Lyme disease, and other issues that cause joint pain.

That rheumatologist told me, “You’re young, your symptoms are mild. I wouldn’t worry about it too much.”

He prescribed ibuprofen and told me to come back when it got worse.

A few years later when my symptoms were worsening, I sought advice from a different rheumatologist. This doctor took the opposite approach.

After listening to my history for less than 5 minutes, she declared that I needed to start more aggressive treatment immediately.

With no discussion of pros and cons, she shooed me out the door with a prescription for methotrexate — an injectable drug that’s commonly used in the treatment of psoriasis.

I did some research, got freaked out, and ditched both the prescription and the doctor.

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Coming to terms with biologics

Eventually, the psoriasis that I’d always seen as a mild nuisance had spread enough to affect my self-esteem.

I was a middle school teacher at the time, and my students were constantly saying things like, “Wow, Mrs. Carns, is that poison ivy? What happened to you?”

I made an appointment with a new dermatologist to see what advances there might have been in psoriasis therapies.

This new doctor felt the pockets of fluid in the knuckles of my hand and asked if I’d ever considered using biologics.

The treatment of an autoimmune disease often involves some mechanism for suppressing the body’s immune system. The trick is to suppress only the part of the immune system that is overreacting, leaving the rest of it functioning normally.

This is where the so-called “biologic” treatments come in. These treatments are able to target, with greater and greater specificity, the unwanted immune response.

I told the dermatologist how the rheumatologist’s suggestion of methotrexate had scared me off, and she listened patiently to my concerns.

I was in my early 40s and I was worried about starting a medication that I might have to continue for the rest of my life. Plus, the idea of suppressing my immune system, on purpose, was deeply unsettling.

What my doctor explained to me, however, was that my relative youth was itself an argument for addressing not just my symptoms, but the progression of the disease.

While I may have felt the discomfort was manageable at the time, eventually, PsA was likely to cause irreversible joint damage. This could lead to increasing levels of disability.

Still relatively young and mobile, I had the opportunity to stop or slow the disease before that damage occurred. This was the argument that finally convinced me.

Facing my fear of injections

Once I’d decided to go on biologics, however, I had to confront the delivery method.

One of the drawbacks of biologics, for many, is that they are delivered via injection — and most people self-inject at home. This prospect was daunting to me, to say the least.

Thankfully, I was able to enrol in a patient support program run by the pharmaceutical company, and a nurse came to my house and taught me how to do the injections.

At first, I felt a lot of anxiety leading up to injection day. Over time, through some trial and error, I’ve found a routine that works for me.

I make sure to remove the injection pens from the fridge at least 15 minutes before administering. I use ice to numb the area and squeeze (or “chunk up”) the injection site with my other hand.

With my current medication, I have a choice between the front of my thighs or my abdomen as injection sites. I’ve found injecting into the abdomen to be significantly less painful because the tissue there is fattier. I’ve never been so grateful for a soft belly!

The life changing benefits of finding a treatment that works

I’ve now been on biologic treatment for over 4 years and have a wonderful rheumatologist who works with my dermatologist to coordinate treatment.

My doctors check my blood work every few months, and so far I haven’t had any negative side effects.

There have, however, been some benefits I wasn’t expecting.

Until I started using biologics, I didn’t realize that the fatigue I was experiencing, which worsened considerably during flares of my joint symptoms, was related to my PsA.

It was something I had gotten so used to, I didn’t notice until it was gone.

This is often the case for people with chronic illnesses. We become accustomed to feeling a certain way and forget what “normal” even felt like.

If you look closely while I’m standing in the sunlight, you may notice a slight difference in the pigmentation of my arms and legs in the places once covered by large psoriasis plaques. There is no other visual clue that I am a person with psoriasis.

As for the PsA, my hands are sometimes still stiff in the morning, and the joints in my toes ache a bit during cold and rainy weather.

In addition to my medication, I try to keep my joints limber and muscles strong with yoga and other weight-bearing exercises.

A recent set of X-rays confirmed that my primary goal of treatment has been successful: There was no indication of joint damage whatsoever.

In the end, I’m glad I found a team of doctors who listened to my concerns and took me seriously.

I’m also glad I was able to overcome my fears and begin treatment, improving my quality of life both today and, hopefully, for decades to come.

https://www.bezzypsa.com/discover/managing-psa/health-the-path-to-biologics-finding-a-psoriatic-arthritis-treatment-that-works-for-me/?slot_pos=article_1&utm_source=Sailthru%20Email&utm_medium=Email&utm_campaign=psoriasis&utm_content=2023-12-12&apid=39239719&rvid=058431b717dcfa59c0cdd27cd0a9313769e8b3dd4ad59d88efd0ded7ddb4774e&utm_term=Psoriasis