Today I am going to give you a quick overview of some of the most common prescription treatments for psoriasis and links so you can access more information.
Whoa, Healthy Scratch! Why just prescription drugs?
Hey, I get it. There are lots of alternative treatments that people are using to attack this disease. I just needed to start somewhere. Check out future posts for more about these alternative ways to manage your P.
Yeah, but I know all this stuff. Old news, Scratch.
Ok, rockstar fine maybe you know it all. Good for you.
But what if you don’t?
Are there new drugs on the market since you last talked to your Dr or Derm? Are there new drugs to consider for safety or efficacy reasons? You’re happy with 50% clearance but what if you could do better?
Rookie and veteran members of team P should regularly check in here and elsewhere and take a minute and review what’s available. You might be surprised at what you learn!
Here are the most commonly prescribed classes of drugs in Canada:
What are they?
- These are drugs applied directly on the skin
- Most common class of drugs prescribed for mild cases
- Can be made into creams, ointments, gels, lotions or sprays
Available types of topicals include:
- Vitamin D
- Vitamin A
- Coal tar
- Enstilar – an aerosol foam approved in October 2015 for once daily use up to 4 weeks. In 2 clinical trials of patients with primarily moderate or mild plaque psoriasis, 45% and 53.3% of patients achieved “Clear” or “Almost clear” skin at Week 4
Things to consider:
- Long term use of corticosteroids is not generally recommended – ask your doctor. If used longer than recommended it can thin your skin, cause redness (erythema), acne, difficulty healing wounds and even something called Red Skin Syndrome or Steroid Addiction.
- It is likely to be the cheapest of the prescription options
- This is usually performed in a doctor office but patients may obtain a unit to treat themselves at home
- Depending on your skin type (how prone you are to sunburn) these treatments can be quite quick to start – as little as less than a minute
Available types of phototherapy include:
- UVB – perhaps the most common
- PUVA – Psoralen + UVA. Psoralen is a topical or oral light sensitizing medication to increase the effectiveness of UVA treatment
- Excimer laser – a high intensity UVB laser that targets specific plaques
- Pulsed dye laser – a high intensity beam of yellow light that disrupts blood flow to affected areas
Things to consider
- Suntan beds do not replace medical phototherapy treatments! The National Psoriasis Foundation says indoor tanning increases your risk of devloping melanoma by 59%
- In order to be most effective you must receive consistent treatments throughout the week. This may pose a challenge with your work or school schedule
- Phototherapy treatments can be progressive (increasing radiation each week or visit). Speak up if you begin to feel discomfort to avoid getting a minor burn.
- Typically prescribed when the previous treatment methods have not been effective to manage your psoriasis and when at least 5-10% of your body
- They are called systemic because they treat your whole body, not just your skin.
- Systemic medications are chemical formulations. Generic options may be available
- Some systemic medications can have serious side effects so it is likely that your doctor will want regular blood tests and check ups
- Systemic medications may cost more than topical treatment
Available types of systemics include:
- Acitretin – sold under the brand name Soriatane. It’s made of vitamin A and has been effective in pustular psoriasis.
- Cyclosporine – also works to suppress the immune system
- Hydroxyurea – while not FDA approved as a psoriasis treatment, it has been prescribed by some doctors for many years. It is seen to have less side effects than some of the “stronger” systemics but is also less effective
- Methotrexate – high doses have been used to treat cancer. For psoriasis patients, the dosage is much lower. It has been effective at treating both psoriasis and psoriatic arthritis
- Apremilast – sold under the brand name Otezla, this medication was FDA approved in 2014 and works to shut down an enzyme in the immune system to improve psoriasis symptoms
Things to consider:
- Systemic medications may cost more than topical treatments
- Some systemic medications can have serious side effects so it is likely that your doctor will want regular blood tests and check ups. Over time methotrexate can damage liver and blood cells. Cyclosporine can affect your kidneys, blood pressure and cholesterol. Hydroxyurea has been linked to skin cancer and bone marrow problems.
- Many systemics pose pregnancy risks. For example, women and men both of must not intend to have children for at least 3 years after discontinuing Soriatane
- The newest form of psoriasis treatment
- They are said to have “fewer side effects than traditional systemic therapy”
Available types of biologics include:
- Adalimumab – Humira
- Certolizumab –Cimzia
- Etanercept – Enbrel
- Golimumab – Simponi
- Infliximab – Remicade
- Secukinumab – Cosentyx
- Ustekinumab – Stelara
- Ixekizumab – Taltz
Things to consider:
- Typically biologics are very expensive treatments – as much as $20,000 or more per year.
- It may be possible to participate in a clinical research trial and receive a biologic treatment for free, but the medication will be relatively unproven.
- Biologics affect the immune system so infections may become more frequent
- You will need to be tested for TB as that disease can be reactivated by certain biologic treatments
Links for more info:
- Canadian Dermatology Association on psoriasis treatment options (from 2009, written for a medical professional audience)
- Another (easier to read) link from the Canadian Dermatology Association on psoriasis
- WebMD on systemics and biologics
If what you are doing to treat your psoriasis is working for you then keep it up!
If, on the other hand, your psoriasis or joints are not well maintained or worsening then I would suggest that you consider the options losted above and talk with your doctor or dermatologist to see if it’s time to make a change.
With psoriasis, ignorance is rarely bliss. Ignoring it doesn’t make it go away. You deserve to shoot for more than just getting by. Don’t give up hope. See a doctor.
Maybe you will ultimately decide to tackle this in a different way like through modifying your diet or some other means. But make sure that you have spoken with a professional who can help you make that call. It might change your life.
Mr Healthy Scratch
(PS – If you can’t wait for my series on alternative treatments I mentioned at the top of this post, check out this handy page from psoriasis.org which will lead you to more information. As always, make sure that you consult a real professional to determine what treatment is best for you.)
(PPS – Know of a treatment I missed? See a mistake? Please let me know! I want to continue to add to this post to keep it current and helpful. Thanks for participating in passing on your first hand knowledge and expertise)