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A former patient of mine had psoriasis symptoms that were so severe they couldn’t work or drive due to thick, painful plaques on their hands. I prescribed a biologic therapy—a medication that targets a specific part of the immune system. Six weeks later, the patient was 100% clear and a completely different person.
Today, experiences like this aren’t unique. Because of the advancements in psoriasis research, the ability to be 90-100% clear when using newer medications is very achievable. In the past, our expectations for clearance were much lower. Today, we have so many wonderful options that are much more effective and can truly change a person’s quality of life.
How to treat psoriasis—and options to avoid.
The three main types of psoriasis treatment include:
- Topical therapy—a cream or ointment you apply directly to the affected area. This approach is better suited for patients with early localized psoriasis or mild symptoms.
- Light therapy—regular exposure to ultraviolet light, which can be done at our outpatient dermatology clinic or at home using a special unit. Not many facilities have light boxes on site, but we have a full-body machine that patients can use multiple times each week. I often recommend this approach to patients with moderate to severe symptoms for whom biologic therapies are not an option and topical therapy is not feasible.
- Biologic therapy—often recommended for patients with moderate to severe psoriasis. These injectable medications target a specific part of the immune system to help decrease inflammation.
A decade ago, we were limited to only a few options for biologic therapy. Now we have nearly 11 choices available, thanks to a tremendous amount of research on psoriasis causes and triggers. Because these new medications effect only one part of the immune system instead of its entirety, they are safer and have fewer side effects.
Newer biologics include Cosentyx®, Taltz®, Tremfya®, Skyrizi®, and Siliq®. These have all come to market in the past several years. They are highly effective with long-lasting results, and generally very well tolerated.
Patients often seek complementary and alternative therapies, but we don’t have robust data pointing to their success. Furthermore, many supplements and herbal remedies are not regulated by the U.S. Food and Drug Administration (FDA). So, you can’t be sure that the product you get is what you’re expecting. It’s better to stick to what we know is effective and helpful instead of experimenting and potentially making things worse.
Some studies do show a benefit to turmeric supplements which can offer anti-inflammatory benefits. Other than that, meditation, weight loss, and stress relief methods have been shown to be helpful.
A holistic approach.
At MedStar Health, we evaluate each patient thoroughly, taking all their medical conditions into consideration and discussing how the disease affects their life.
Our collaborative team approach allows us to work closely with rheumatology because many people with psoriasis also have psoriatic arthritis—joint pain, swelling, and stiffness that can intermittently flare up damage the joints. Approximately 30% of patients with even mild psoriasis have psoriatic arthritis, as reported by the National Psoriasis Foundation.
Increasingly clearer is the connection between the skin and mental health. Stress can make skin diseases worse, particularly in psoriasis. The COVID-19 pandemic, for example, triggered many psoriasis flare-ups, and we continue to see more links between psoriasis and depression.
This is why, in addition to medical therapy, we often recommend behavioral therapy. Stress relief techniques, such as yoga, meditation, and exercise, are an important part of a holistic psoriasis treatment plan.
As we are learning more about psoriasis, we have realized that this is a systemic inflammatory condition that goes beyond the skin and joints. Patients with psoriasis are also at increased risk for heart disease, high blood pressure, diabetes, high cholesterol, and fatty liver disease. So, it’s also important to see your regular primary care physician for routine health screenings.
Another challenge many psoriasis patients face is insurance coverage. We understand how many hurdles there can be to accessing therapies, so we work closely and carefully with our patients to help facilitate insurance approval. We have nurses dedicated to making this process easier for patients and to help provide biologic injection training for patients to do their treatments at home.
The research continues.
- Two new biologic therapies, Bimekizumab and Mirikizumab, are currently in clinical trials to determine whether they are effective and/or fast-acting for psoriasis clearance.
- A new oral therapy, BMS-986165, is a daily pill and may not require bloodwork monitoring. Current oral therapies on the market—methotrexate and Otezla®—are not as effective as biologic therapies. Methotrexate requires bloodwork monitoring and can be harmful to the liver over the long term.
- A new steroid-free topical agent, Tapinarof, seems to be very effective in early clinical trials.
Skin diseases can fluctuate over time. Psoriasis might start mild, but it can progress and affect other areas where it didn’t show up initially. Seek care at the first sign of symptoms for a better chance of skin clearance.