As someone living with plaque psoriasis, you have many treatment options. Most people start with topical medications, such as corticosteroids, 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. At present, biologics are only given by intravenous (IV) infusion or injection. Oral medications are available in pill, liquid, and sometimes injectable form.
Biologics (injectable psoriasis treatments)
Biologics are different from conventional drugs because they’re made from biological cells or components. Traditional drugs are made from chemicals in a laboratory and are far less complex.
There are several biologics on the market designed for the treatment of psoriasis. Some are also prescribed for psoriatic arthritis. secukinumab (Cosentyx), etanercept (Enbrel), adalimumab (Humira), ustekinumab (Stelara), brodalumab (Siliq), ixekizumab (Taltz), and guselkumab (Tremfya) are all given by injection. 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. The exact side effects and precautions depend on the type of medication you take for plaque psoriasis.
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. These include cyclosporine, apremilast (Otezla), and acitretin (Soriatane), all of which are taken by mouth in pill or liquid form. Methotrexate, another well-established treatment, is 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 psoriasis. However, they 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 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.