As someone living with plaque psoriasis, you have many treatment options. Most people start with topical treatments, such as corticosteroid creams or ointments, or phototherapy, before progressing to systemic medications.
Systemic medications work inside the body, attacking the physiological processes that cause psoriasis. In contrast, topical treatments work on the symptoms of psoriasis at the site of outbreak on the skin.
Systemic treatments are for people with moderate to severe plaque psoriasis. Typically, these drugs fall into one of two groups: biologics and oral treatments. Currently, biologics are only given by intravenous (IV) infusion or injection. Oral medications are available in pill, liquid, and alternative injectable forms.
Here’s what you need to know about topical, injectable, and oral medications for plaque psoriasis.
Topical treatments are applied directly to your skin. They’re usually the first treatment your doctor will prescribe if you have mild to moderate psoriasis. If your symptoms are severe, your doctor may prescribe a topical treatment along with an oral or injectable.
Corticosteroid ointments or creams are one of the most common topical treatments. They work by reducing the swelling and itchiness caused by your psoriasis. The strength of the corticosteroid ointment depends on the location of your psoriasis.
You shouldn’t apply strong creams to sensitive areas, like your face. Your doctor will decide what is best for your condition.
Other than steroids, your doctor may recommend topical retinoids. These come from vitamin A and can reduce swelling. But they can also make you more sensitive to sunlight, so you’ll need to remember to apply sunscreen.
Phototherapy, or light therapy, is another topical treatment option. This treatment involves exposing skin to ultraviolet light on a regular basis. It’s typically given under a doctor’s supervision at an office or clinic. It can also be given at home with a phototherapy unit.
Tanning beds are not recommended because they emit a different type of light that doesn’t effectively treat psoriasis. It also increases the risk melanoma by 59 percent, according to the American Academy of Dermatology and the World Health Organization.
Biologics are different from traditional drugs because they’re made from biological cells or components. Traditional drugs are made from chemicals in a laboratory and are far less complex.
Biologics are also different because they target specific parts of the immune system, rather than impacting the immune system as a whole. They do this by blocking the action of a specific immune cell that plays a major role in developing psoriasis or psoriatic arthritis.
There are several biologics on the market designed for the treatment of psoriasis. Some are also prescribed for psoriatic arthritis. The drugs are categorized by the specific component of the immune system they target.
Tumor necrosis factor alpha (TNF-alpha) cell inhibitors include:
- certolizumab pegol (Cimzia)
- etanercept (Enbrel)
- adalimumab (Humira)
- golimumab (Simponi)
- infliximab (Remicade)
Interleukin 12, 17, and 23 protein inhibitors include:
- ustekinumab (Stelara)
- secukinumab (Cosentyx)
- ixekizumab (Taltz)
- brodalumab (Siliq)
- guselkumab (Tremfya)
T cell inhibitors include:
- abalecept (Orencia)
These biologics are all given by injection or IV infusion. People taking these medications typically administer the injection themselves at home. Infliximab (Remicade), by contrast, is given through an IV infusion by a healthcare provider.
These biologics typically work by stopping certain proteins that cause inflammation. Because they tackle the immune system, they can cause some serious side effects like infection.
Biosimilars are a new type of biologic drug. They’re modelled after biologics already approved by the U.S. Federal Drug Administration (FDA). Biosimilars are highly similar to the biologic drugs on which they’re based, but give patients a more affordable option. The FDA standards ensure that biosimilars are safe and effective. Speak with your doctor about whether biosimilars are a good option for you.
According to a 2013 study of people with psoriasis, those taking injectable medications were highly satisfied with treatment because it was both effective and convenient. After an initial dosing period, injectable biologics are given on a more infrequent schedule. Depending on the specific medication, the time between doses may be as short as a week or as long as two to three months.
Oral medications have a much longer track record of treating psoriasis than biologics, but may not be as effective. These include cyclosporine, apremilast (Otezla), and acitretin (Soriatane). All of these drugs are taken by mouth in pill or liquid form. Methotrexate, another well-established treatment, can be taken orally or by injection.
All of these medications have serious side effects that you should discuss with your doctor. For example, cyclosporine increases the risk of infection and kidney problems. The risk is even greater with ongoing use. According to the Mayo Clinic, cyclosporine can’t be used for long periods of time because of these risks. Long-term use of methotrexate also increases the risk of serious side effects, such as liver damage.
Oral medications are typically taken once or twice daily. Methotrexate is the one exception. It’s taken with one weekly dose or divided into three doses over a 24-hour period. Unlike some biologics, there’s no need to take oral medications for psoriasis in a clinical setting. Those with a prescription can take the medicine at home on their own.
Apremilast is a new oral medication that works a bit differently from traditional drugs for psoriasis. According to the National Psoriasis Foundation, this medication acts upon molecules inside immune cells. It stops a certain enzyme that causes inflammation at the cellular level.
When deciding on a treatment plan for your plaque psoriasis, your doctor should take into account many different factors. In addition to how effective the treatment may be, they should discuss the potential risks of each drug with you.
Injectable treatments are typically more convenient for those with severe psoriasis. However, these drugs use newer technology and come with the risk of serious side effects.
Oral treatments also have potential side effects, but may be appropriate for people who prefer to take a pill rather than receive an injection.
Be sure to have an open conversation with your doctor before deciding on the right treatment for you. Together you and your doctor can determine the best way to manage your plaque psoriasis.