Psoriasis is a common chronic skin disease that is characterized by a faster-than-normal life cycle of skin cells. It results in the rapid buildup of cells on the skin surface. The extra cells of the skin cause formation of scales and itchy red patches that are sometimes painful. In many instances, psoriasis comes and goes, making it unpredictable.
Psoriasis usually affects the knees, scalp, and the elbows. However, it can also occur on the torso, soles of the feet, and palms. The major symptoms of psoriasis include red patches that are covered by thick silvery scales, scaling spots, itchiness, burning sensations, thick and ridged nails as well as swollen and stiff joints referred to as psoriatic arthritis.
Genetics and the immune system play a major role in the development of psoriasis. It is not curable but certain treatment options and medications can be used to control the symptoms and improve comfort of the patient. The main objective of treatment is slowing the rapid growth of skin cells.
Treatment Options
Drugs
1. Biological Drugs These are some of the newest drugs used in the management of psoriasis. They are derived from human and animal proteins and act by controlling and regulating the immune response of the body. Their activity involves reducing the concentration of Tumor Necrosis Factor (TNF), an agent that regulates the body’s immune responses. These are quite effective when compared to other medications.
Otezla is the brand name for apremilast. It is effective in the treatment of moderate to severe plaque psoriasis where phototherapy or systemic therapies are appropriate. It is also approved for treatment of adults suffering from psoriatic arthritis.
Enbrel is the trade name of etanercept. It has been approved by the U.S. F.D.A for treatment of psoriatic arthritis, plaque psoriasis, rheumatoid arthritis, ankylosing spondylitis and juvenile rheumatoid arthritis.
Taltz is a trade name of the ixekizumab. It is a humanized monoclonal antibody. Its effects are seen as a result of blocking interleukin 17 an action that reduces inflammation as seen in psoriasis. It is used in treatment of plaque psoriasis.
Cosentyx is the brand name for secukinumab. It is an immunosuppressant that acts by reducing the effects of interleukin 17, a chemical that causes inflammation. It is used in the treatment of moderate and severe plaque psoriasis, psoriatic arthritis and ankylosing spondylitis.
Stelara is the brand name for ustekinumab. It is considered a biologic which means it works inside the body and targets an overactive immune system.
Ilumya is the brand name of tildrakizumab-asmn. It is a subcutaneous injection that the FDA approved in 2018 for psoriasis treatment and is now being test for use for psoriatic arthritis.
Otrexup, also known as methotrexate, is another subcutaneous injection used for the treatment of psoriasis. It has other medical uses as well, commonly used or treatment of various cancers or of rheumatoid arthritis.
Skyrizi is the brand name for risankizumab, an IL-23 inhibitor. The FDA approved it in 2019, and it may be used for the treatment of psoriasis.
Even with their effectiveness in management of psoriasis, the biologic drugs have side effects that should be considered before initiating therapy. The patients using them should be monitored routinely to ensure they are not harmed by the side effects. Some of their side effects include increased risk to infections due to suppression of the immune system, worsening of Crohn’s disease, diarrhea, and nausea and vomiting.
2. Anti-Cancer Drugs
Anti cancer drugs act by reducing the rate of cell division. Rapid cell division and multiplication is seen with both cancer and psoriasis. By reducing the rate of skin cells division, anticancer drugs can reduce the symptoms and severity of psoriasis.
The most commonly used anticancer drugs in management of psoriasis are methotrexate and cyclosporine. These drugs regulate the immune system reducing the symptoms of psoriasis. Despite their effectiveness, these medications have serious side effects and the doctors need to monitor the patients who use them.
3. Oral Retinoids
These are drugs that contain vitamin-A like properties. They have mild effects of relieving symptoms of severe psoriasis. They also interfere with cell division and growth, which reduces the overgrowth of skin cells seen in psoriasis.
Due to their mode of action, they can cause abnormal cell division of fetal cells leading to birth defects. Therefore, childbearing age women who use these drugs are required to use birth control methods for up to three years afterwards to reduce the risks of getting pregnant and giving birth to children with birth defects.
4. Topical Creams
Steroid Based Creams: This is the mainstay of psoriasis treatment. They reduce the inflammation, relieve itchiness and block the over-production of cells seen in psoriasis. The stronger preparations are more effective but have more side effects as well.
Sorilux is a trade name for calcipotriene, a synthetic form of vitamin D3. It is a foam that users apply topically for the treatment of plaque psoriasis.
Calcipotriene/Calcitriol Ointments: Calcipotriene (Vitamin D) has shown effectiveness in treatment of psoriasis. This effectiveness is mainly seen when it is combined with topical corticosteroids. Due to side effects, it’s recommended to be used in limited amounts.
Coal-tar shampoos and ointments: They help in slowing the rapid growth of cells of the skin. They also alleviate the symptoms of psoriasis. Some of their side effects include folliculitis where pimple-like rashes are formed affecting the hair follicles.
Conclusion
These drugs have been used with different degrees of effectiveness. Different people may respond to different medications differently. Usage of these medications may be limited because of their side effects. The biological agents Otezla, Enbrel Cosentyx and Taltz are used in different forms of psoriasis. They are quite effective and act by modulating the immune system activities that lead to psoriasis.
