For mild cases of psoriasis, topical treatments—those applied to the skin—often work well. But if you have moderate to severe psoriasis, or if topicals just aren’t effective for you, don’t despair. Other good options are available, including traditional systemic treatments and newer drugs known as biologics.
As with all psoriasis treatments, not every one of these drugs will work on everyone with psoriasis. Sometimes a trial-and-error approach is necessary to find what is effective for you, notes Jerome Shupack, MD, dermatology professor and chief of the dermatopharmacology unit at New York University’s Langone Medical Center. “Often there is no one single medication that fits everyone. Treatment plans must be individualized,” he says.
Trying the Traditional Route
Traditional systemic treatments are prescription drugs that treat psoriasis by working throughout the body. You take them orally, in either liquid or pill form, or by injection. There are many systemic drugs available, including acitretin (Soriatane), cyclosporine (Gengraf, Neoral, Sandimmune, SangCya), and methotrexate (Rheumatrex, Trexall), to name just a few.
Biologics are protein-based drugs made from living cells grown in a laboratory. They are designed to target specific parts of your immune system. Although psoriasis creates a skin problem, it is actually caused by a disorder within your immune system. Immune disorders occur when the body mistakenly attacks itself, and biologics are designed to fight that internal chain of events.
Your doctor may try various biologic drugs. One group, called T-cell blockers, targets a type of white blood cell, known as a T-cell, found in the immune system. T-cells are essential because they help guard against infection and disease. When you have psoriasis, these T-cells are activated by mistake. In fact, they become so active that they set off other immune responses. As a result, your skin cells reproduce so quickly that your body is unable to shed them normally, and psoriasis plaques develop. Alefacept (Amevive) a T-cell blocker drug.
Other biologics block a type of protein called tumor necrosis factor-alpha (TNF-alpha). These drugs are named for the specific substances involved in the development of psoriasis that they are designed to fight.
“The biggest category is the tumor necrosis factor drugs,” says Dr. Shupack. “They work by targeting a substance that gets the inflammatory reaction going, and then it becomes self-sustaining. These drugs inhibit this response, and once you slow it down, the lesions can heal.”
Biologic drugs are given by injection or intravenous infusion. Because they suppress your immune system response, you will be at an increased risk of infection and should be closely watched by your doctor. If you are or could become pregnant or are nursing, these drugs probably aren’t right for you.
Biologics carry serious risks. Some of these drugs have been associated with other diseases, such as central nervous system disorders, blood diseases, and cancers including lymphoma, although their role in the development of these diseases is not yet understood. But if you haven’t been helped by other treatments and if your psoriasis is hurting your quality of life, you might want to consider them. Talk with your doctor about all the pros and cons to see whether one might be right for you.
Interview with Jerome Shupack, MD.
Psoriasis Severity, National Psoriasis Foundation.
Traditional Systemic Medications, National Psoriasis Foundation.
Moderate to Severe Psoriasis: Biologic Drugs, National Psoriasis Foundation.
Psoriasis, NationalInstitute of Arthritis and Musculoskeletal and Skin Diseases, NIH.
Psoriasis and Your Immune System, Psoriasis Connections.
Biologic Treatments for Plaque Psoriasis, Psoriasis Connections.