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Psoriasis Awareness Month: Treating Psoriasis

By Rosanna Sutherby, PharmD

August 12, 2020

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August is Psoriasis Awareness Month. According to a recent study, 7.4 million adults in the United States are living with psoriasis. It affects women and men equally and typically begins between the ages of 15 and 25.

Psoriasis is not only a health problem. This condition can also affect your self-esteem and interfere with your social interactions. Fortunately, you do not have to live with the discomfort and embarrassment of psoriasis flare-ups. Advancements in psoriasis treatment make it possible to effectively manage your symptoms and significantly improve your quality of life.

What Is Psoriasis?

Psoriasis is an autoimmune disease that affects your skin. If you have an autoimmune disease, your immune system, which normally protects your body from infection, instead attacks healthy cells.

Psoriasis causes red, itchy patches of skin that are covered with thick scales. These patches are the result of skin cells that grow abnormally quickly. The most commonly affected areas are the knees, elbows, trunk, or scalp; however, psoriasis can occur on any part of the body.

Although no cure exists for psoriasis, several forms of treatment can alleviate symptoms and improve your quality of life. The goal of psoriasis treatment is to slow cell growth and remove scaly skin.

The type of treatment that you receive for psoriasis depends on the severity of your symptoms and how you respond to treatment. The following are methods of psoriasis treatment commonly used today:

Topical treatment
Light therapy
Oral systemic medications
Biologics or targeted treatment
Oral targeted treatment

Topical Treatments for Psoriasis

Topical treatments are medications applied to the affected skin. Topical treatments for psoriasis are available as creams, ointments, lotions, gels, foams, sprays, or shampoos. Common topical medications used to treat psoriasis include the following:

Corticosteroids: Corticosteroids are the most commonly used medications to treat mild to moderate psoriasis. Your doctor may use a mild steroid, such as hydrocortisone, for sensitive areas like your face or skin folds. More potent steroids, such as triamcinolone, (Acetonide, Trianex) or clobetasol (Temovate), can be used on less sensitive skin or areas that are difficult to treat.
Vitamin D analogs: Synthetic vitamin D products, such as calcipotriene (Dovonex, Sorilux) and calcitriol (Vectical), may be used alone or combined with corticosteroids. They work by slowing down the growth of skin cells.
Retinoids: Drugs in this category include tazarotene (Tazorac, Avage).
Calcineurin inhibitors: Medications in this class, including Elidel (pimecrolimus) and Protopic (tacrolimus), help reduce plaque buildup.

Light Therapy for Psoriasis

Light therapy may be used alone or in combination with other therapies to treat moderate to severe psoriasis. Your doctor may recommend controlled amounts of exposure to natural sunlight or artificial light. Ultraviolet B (UVB) rays can slow the growth of skin cells.

Oral Systemic Treatment for Psoriasis

If topical products or light therapy does not adequately control your psoriasis, your doctor may prescribe oral medications. Commonly prescribed oral medications for psoriasis include the following:

Acitretin (Soriatane)
Methotrexate (Trexall)
Cyclosporine (Gengraf, Neoral)

Biologics or Targeted Therapy for Psoriasis

The newest advancements in psoriasis treatment include biologic medications. These medicines are cytokines, or proteins, that are made from living cells and target specific pathways that promote inflammation. They work by blocking immune system cells, such as T cells, or proteins, such as tumor necrosis factor-alpha (TNF-alpha), interleukin 17-A (IL-17A), or interleukins 12 and 23 (IL-12/23). Blocking these cells and proteins that are responsible for inducing the inflammatory process that promotes rapid cell growth in psoriasis helps reduce the cycle of inflammation.

Biologics are typically used in people with moderate to severe psoriasis who have not seen improvement with other treatments. Many people who use biologics notice an improvement in their symptoms within weeks.

Be sure to ask your doctor if biologics are safe for you. These drugs must be used with caution because they can suppress your immune system and increase your risk of infection.

Injectable biologics used to treat psoriasis include the following:

TNF-alpha inhibitors

Cimzia (certolizumab pegol)
Enbrel (etanercept)
Humira (adalimumab)
Remicade (infliximab)
Simponi (golimumab)

IL-12/23 and IL-23 inhibitors

Stelara (ustekinumab)
Ilumya (tildrakizumab-asmn)
Skyrizi (risankizumab-rzaa)
Tremfya (guselkumab)

IL-17 inhibitors

Cosentyx (secukinumab)
Taltz (ixekizumab)
Siliq (brodalumab)

T-cell inhibitor

Orencia (abatacept)

New Oral Targeted Treatment for Psoriasis

Researchers have developed other treatments for psoriasis that selectively target immune cells in a way that is similar to biologics. However, these new drugs are smaller molecules and are available as tablets that can be taken orally.

These medications are typically taken daily and continuously, if well tolerated, to keep your psoriasis symptoms under control.

Oral targeted treatments for psoriasis include the following:

Otezla (apremilast)
Xeljanz (tofacitinib)

Be sure to talk to your doctor or pharmacist about the possible side effects and risks of taking these medications.

Biosimilars and the Future of Psoriasis Treatment

Although biologics offer significant advantages in psoriasis treatment, their high cost may be a barrier to access. Drug manufacturers have developed products called biosimilars to increase the availability and reduce the cost of effective therapy for patients with psoriasis.

Biosimilars are similar to biologic drugs on the market, but they are not exact replicas. To be approved by the FDA, biosimilars must be highly similar to the compared product, treat the same conditions, work in the same way, and come in the same form and dosages.

The following are currently FDA-approved biosimilars for psoriasis treatment:

Amjevita (adalimumab-atto) is biosimilar to Humira
Cyltezo (adalimumab-adbm) is biosimilar to Humira
Erelzi (Etanercept-szzs) is biosimilar to Enbrel
Inflectra (infliximab-dyyb) is biosimilar to Remicade
Renflexis (infliximab-abda) is biosimilar to Remicade

Further research is currently underway to develop and introduce other biosimilars in the future. These drugs can offer savings for some of the expensive psoriasis therapies.

If you are concerned about the cost of your psoriasis medicine, be sure to compare prescription prices before heading to a pharmacy near you. A free Rx savings card can help you save as much as 80% off your prescription psoriasis medication.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://www.jaad.org/article/S0190-9622(13)01268-1/fulltext

https://www.wellrx.com/health-conditions/about/health-condition/psoriasis/~default/

https://www.psoriasis.org/research/science-of-psoriasis/immune-system#:~:text=Researchers%20agree%20that%20psoriatic%20disease,by%20an%20overactive%20immune%20system.

https://magazine.medlineplus.gov/article/psoriasis-on-the-road-to-discovery

https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845

https://www.wellrx.com/HYDROCORTISONE/drug-information/

https://www.wellrx.com/TRIAMCINOLONE%20ACETONIDE/drug-information/

https://www.wellrx.com/CLOBETASOL%20PROPIONATE/drug-information/

https://www.wellrx.com/CALCIPOTRIENE/drug-information/

https://www.wellrx.com/CALCITRIOL/drug-information/

https://www.wellrx.com/TAZAROTENE/drug-information/