When you're living with moderate-to-severe plaque psoriasis, it’s important to find a treatment that works well for you. This is the most common form of the disease, but finding the right treatment can still be a challenge. And it can be stubborn -- coming back when you think it’s under control. If your medications aren't managing your symptoms as well as you’d like, you may want to talk to your doctor about the newer, state-of-the-art treatments you'll find in this guide.
You may have already tried several traditional psoriasis therapies. These usually include:
- Corticosteroid creams
- Nonsteroid creams and ointments like vitamin D analogs, retinoids, coal tar, anthralin, or calcineurin inhibitors
- Phototherapy, which uses ultraviolet light to treat psoriasis
In severe cases, doctors may recommend medications that tamp down your immune system, like methotrexate or cyclosporine, or an oral retinoid like acitretin (Soriatane).
Doctors have relied on these therapies for a long time. And while they can be effective for many people, they don't always provide lasting relief. It can also be tough to apply creams and ointments consistently. Moderate-to-severe plaque psoriasis covers more than 3% of your skin, and it may be in places that are tough to reach.
It’s understandable to feel frustrated about finding an effective treatment, but advanced treatments are available that could improve your symptoms with a new approach to managing plaque psoriasis.
While you apply many of the older psoriasis treatments directly to your skin, the newer treatments usually work systemically, meaning from inside your body. They may be in pill form, injections, or an infusion that goes directly into your bloodstream. There is also a new type of topical treatment that works differently from older topicals.
What Are the Newest Treatments for Psoriasis?
The newer prescription medicines that treat psoriasis affect specific parts of the immune system and include:
These medications are “targeted therapies,” which means they block a particular type of protein molecule that can overstimulate the immune system. They can reduce inflammation and plaque formation. These medications can become less effective over time in some people, so you may get them along with traditional medicines such as topicals or methotrexate to boost their effectiveness.
Understanding how these newer medicines work, how you take them, and what their potential side effects or drawbacks may be can help you have an informed discussion about your treatment with your doctor.
As you and your doctor create an effective treatment plan, think about:
- The severity of your psoriasis
- How you prefer to get treatment, such as by injection or pill
- Underlying health conditions
- How well your previous treatments have worked
What Are IL Inhibitors?
IL stands for “interleukin,” which refers to a group of immune system proteins. Interleukins signal other cells to grow and divide, but sometimes they tell the body to start an inflammation response when it might not be necessary. IL inhibitors target interleukin proteins to stop that incorrect response. By blocking interleukins, IL inhibitors can cut down on the inflammatory processes that lead to the development of psoriasis symptoms.
IL inhibitors are biologics, like TNF inhibitors. This refers to the fact that they are made from human or animal cells, which are then duplicated in a laboratory. You get these medicines the same way, by an injection or by IV infusion at a health care facility.
There’s also a topical IL inhibitor called tapinarof topical (Vtama) that comes as a cream you apply to your skin. It activates certain receptors in the skin called aryl hydrocarbon receptors (AhR). AhR receptors help the skin handle harmful environmental or chemical exposure and play a role in immune response.
Learn more about IL inhibitors for moderate-to-severe psoriasis.
What Are JAK Inhibitors?
JAK stands for Janus kinase, a protein in your body that helps control immune system activity. JAK inhibitors work by blocking the activity of Janus kinase proteins. This helps reduce the overactive immune response that leads to psoriasis.
JAK inhibitors are relatively new in the treatment of psoriasis. Only one has been approved by the FDA, deucravacitinib (Sotyktu). It is different from the JAK inhibitors used to treat psoriatic arthritis and has a lower risk of serious side effects. One of those psoriatic arthritis medicines, tofacitinib (Xeljanz), may also help treat moderate-to-severe plaque psoriasis symptoms.
You usually take a JAK inhibitor as a pill. You typically take it once or twice a day, depending on your doctor's instructions. You might choose JAK inhibitors if other treatments haven't worked well for you or if you prefer a pill over injections or infusions.
Learn more about JAK inhibitors for moderate-to-severe psoriasis.
What Are PDE Inhibitors?
PDE stands for phosphodiesterase, which is an enzyme in your body. Enzymes are a particular kind of protein that speed up processes in the body. In people with psoriasis, PDE is overactive and contributes to inflammation and rapid skin cell growth.
PDE inhibitors work by blocking this enzyme. This helps lower inflammation and slow down the rapid growth of skin cells.
There are two PDE inhibitors used to treat psoriasis. One, apremilast (Otezla), is a pill. The other, roflumilast (Zoryve), is a topical cream that you apply directly to your skin.
You might choose PDE inhibitors if:
- Other treatments haven’t worked well for you.
- You prefer taking a pill or using a topical cream over getting injections or infusions.
Learn more about PDE inhibitors for moderate-to-severe psoriasis.
What Are TNF Inhibitors?
TNF stands for “tumor necrosis factor.” TNF is one of the proteins found within the cells of your immune system. If your body makes too much TNF, it causes your immune system to overreact and can lead to psoriasis.
TNF inhibitors stop your body from making too much TNF. They can slow or stop inflammation and the rapid growth of skin cells. You may have fewer and less severe psoriasis patches. TNF inhibitors can also help prevent joint damage from psoriasis.
You may hear TNF inhibitors referred to as “monoclonal antibodies.” This means they’re made from human or animal tissue and only affect their target. They act like the antibodies already in our systems, which are a kind of protein that fights infection.
You get TNF inhibitor treatments in one of two ways. You can give yourself a shot in the skin of your thigh or belly using a small needle. You can also get them by IV infusion, in which the medicine goes directly into your bloodstream through a small needle and tube placed in a vein in your arm. With this method, you’ll typically need to go to a health care facility called an infusion center.
TNF inhibitors were the first of the psoriasis treatments to target the immune system. Doctors have been prescribing them for more than 20 years, and they are often more affordable than other biologics.
Sometimes doctors even recommend them as a first treatment, though they are more commonly given when other therapies aren’t working well. But TNF inhibitors don't work for everyone, and they can become less effective over time. In those cases, your doctor can switch you to another biologic or give you other medications along with them.
Learn more about TNF inhibitors for moderate-to-severe psoriasis.
Things to Consider When Choosing a Treatment
When deciding on a treatment for moderate-to-severe psoriasis with your doctor, bear in mind that each treatment category brings its own set of benefits, side effects, and other considerations.
Here are five key things to bear in mind:
Severity, location, and type of psoriasis
For severe cases of psoriasis, biologics are powerful and tend to be effective and quick-acting. The location of your skin plaques may also help to guide your treatment choice. If you have psoriasis on your scalp, nails, or genitals, you may want to choose a systemic medication rather than a topical, which can be difficult or unpleasant to apply. If you have a type of psoriasis other than plaque psoriasis, it can affect which medication might work best.
How you take your medication
How you receive these medications can vary. You can discuss your preferences and the options with your doctor. These include self-injections, IV infusions, pills, and topicals.
Treatment for recurring psoriasis
It’s common for psoriasis to come back, even after treatment. You and your doctor will want to look at how your condition responded to therapies you tried before as you look for one that’s effective for you now. It’s not uncommon to need to switch treatment routines for moderate to severe psoriasis, sometimes more than once.
Potential side effects
Different medications can cause different side effects. Some are minor, such as redness or itch at the injection site. Biologics may make you feel queasy or give you a headache. They can also raise your risk of infection and could reactivate a disease you’ve had in the past, such as TB or hepatitis B. Compare possible side effects, both minor and more serious, that may happen with any given drug. It’s important that you weigh the risks vs. the benefits of the treatment option you choose. Certain psoriasis treatments not only address skin symptoms but are also effective in treating joint issues such as discomfort or possible joint damage.
Coexisting conditions
Many people with psoriasis have related conditions such as psoriatic arthritis.
Talk to your doctor about these things so you can make an informed decision about your treatment plan. Some of these treatments can be costly, so make sure you understand what your out-of-pocket expenses could be. State of the art psoriasis treatments offer options that can not only manage your psoriasis effectively, but also align with your health needs and lifestyle.