Psoriasis Treatments Get More Personalized

New oral medications targetting the immune system offer new hope to patients with psoriasis and psoriatic arthritis

If you have psoriasis and/or psoriatic arthritis, the future is looking up. The more scientists learn about psoriasis, the more therapeutic options are becoming available for patients with this disease. Targetted treatments are now becoming the norm, making your care more personalized.

“As we better understand the disease, researchers know more about what specific factors to target in order to develop effective treatments,” said Melinda L. McCord, MD, a dermatologist at the US Food and Drug Administration (FDA).

The treatment for psoriasis has changed from the previous gradual step-by-step approach. Today, doctors seek to optimize treatment from the first visit—whether with phototherapy or systemic therapies—based on the specific needs of each patient.

“Tomorrow’s treatments will become even more personalized because the drugs in development now are targeting different aspects of the immune system,” Dr. McCord noted in a release from the FDA.

Personalized Medicine and Psoriasis

Psoriasis is an immune system disorder that affects approximately 7.5 million Americans. Psoriasis is   characterized by inflammation and the rapid overproduction of skin cells, creating scaling, pain, swelling, heat, and redness. 

Traditional treatments of  for psoriasis include:

  • Medicines applied to the skin (topical treatment)
  • Light treatment (phototherapy)
  • Drugs taken by mouth or injection (systemic therapy)

There is no cure for psoriasis, so the main goals of treatment are to reduce inflammation and to stop the skin cells from growing so quickly, noted the FDA.

"In the past, doctors treated psoriasis using a step-wise approach. Patients with mild to moderate psoriasis would start with topical therapies and, if they did not respond well to that, move on to other treatments, such as systemic therapy or phototherapy," noted the FDA. "This approach called for treating people with moderate to severe psoriasis with phototherapy or traditional systemic therapies—drugs such as methotrexate and cyclosporine—before offering them biologic therapies (a type of treatment that works with your immune system)."

That strategy has changed to a more patient-specific approach. Today, patients and their doctors can choose a treatment based on its effectiveness, the severity of their disease, lifestyle considerations, risk factors, and associated diseases (co-morbidities).

Two recently approved biologic product target enzymes and antibodies that produce inflammation and overproduction of skin cells. These include apremilast, marketed as Otezla, and ustekinumab (Stelara). Otezla has been referred to as a “small-molecule” drug because it targets specific molecules within your immune cells, something that couldn’t be achieved with earlier forms of oral medications for psoriatic arthritis.

Team Approach to Treatment

Dr. McCord recommends a team approach to treating psoriasis—patients, families and their health care providers need to work together to address the multiple diseases that may occur in association with psoriasis, including the risk of developing metabolic syndrome (the occurrence of obesity, high blood pressure, high cholesterol and diabetes in one patient), lymphoma, heart disease and/or depression. “We do not completely understand the relationship of these co-morbidities to psoriasis, but it is an area of active research,” she noted.

Because psoriasis is a chronic disease with no cure, patients may need to use treatments for a long time. Many therapies approved by FDA have been evaluated for extended time periods.

Psoriasis has environmental and genetic components. It is more common in adults and can run in families. What triggers it? A virus? Bacteria? Stress? Other environmental factors? “We just don’t know,” said Dr. McCord.

"The good news is that patients can treat some of the signs and symptoms of psoriasis with simple measures. For example, regular use of moisturizers may improve the itching and scaling. Reducing or limiting tobacco use and alcohol consumption may decrease the number of flares of psoriasis. Lifestyle changes—such as maintaining a healthy weight and being physically active—may help lessen or prevent the development of associated diseases."

Dr. McCord advises patients to seek treatment early from a doctor experienced with the disease. A dermatologist can provide patients with the correct diagnosis and information to manage the disease. “If you are diagnosed and treated early, you may avoid the pitfalls of ineffective and inappropriate therapy,” she adds.

Some patients become easily discouraged about treatments, but newer therapies may make them more comfortable. That’s why Dr. McCord recommends that  patients should investigate treatment options early and educate themselves about their condition. Even if patients have a mild case of psoriasis and decide they don’t want a particular treatment option, there are ways they can decrease their symptoms.

“Psoriasis has a great emotional impact on some patients. But it doesn’t have to, given the right care and treatment,” she says.


Updated on: 06/18/20
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The Empowered Patient's Guide to Psoriatic Arthritis