Psoriasis

Symptoms

• Plaque Psoriasis: The most common form, characterized by dry, raised, red skin lesions (plaques) covered with silvery scales.
• Guttate Psoriasis: Appears as small, water-drop-shaped, scaling lesions on the trunk, arms, legs, and scalp.
• Inverse Psoriasis: Shows up as bright red, shiny lesions that appear in skin folds.
• Pustular Psoriasis: Characterized by white pustules (blisters of noninfectious pus) surrounded by red skin.
• Erythrodermic Psoriasis: The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely​ ​.

Treatment

• Topical Treatments: These include creams and ointments applied directly to the skin, which can help reduce inflammation and decrease the turnover of skin cells. These include steroid and non-steroid topicals.
• Light Therapy: This involves exposing the skin to ultraviolet light regularly and under medical supervision.
• Systemic Medications: Used for more severe cases, these drugs affect the entire body by slowing cell turnover and reducing inflammation. They can be taken orally or injected. These include methotrexate, cyclosporine, acitretin, and mycophenolate mofetil, and are not used much anymore due to the safety and effectiveness of biologics making them virtually obsolete.
• Biologics: A newer class of drugs with a 25+ year track record, biologics are advanced medications that target specific parts of the immune system responsible for the inflammation that contributes to psoriasis symptoms and plaque development. These treatments are typically recommended for moderate to severe psoriasis and are especially beneficial for those who have not responded well to traditional therapies. Here’s an overview of the types of biologics used to treat psoriasis:

Types of Biologics

• TNF-alpha Inhibitors: These drugs can help reduce inflammation by blocking the tumor necrosis factor-alpha (TNF-alpha) protein in the immune system. Common examples include etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira).
• Interleukin Blockers: These target the immune system’s interleukins, which are key drivers of inflammation associated with psoriasis. Interleukin blockers work by specifically targeting certain cytokines in the immune system, reducing their ability to trigger inflammation and cell turnover, which are hallmarks of psoriasis. By blocking these cytokines, these drugs help to reduce the scaling and thickness of psoriatic plaques, alleviate associated pain and itching, can significantly improve the skin’s appearance and can stop the progression of psoriasis in the joints.
• IL-12/23 Blockers
  • Ustekinumab (Stelara): This drug targets interleukins 12 and 23, two cytokines involved in inflammatory and immune responses. Ustekinumab is approved for the treatment of moderate to severe plaque psoriasis and can be administered at home through subcutaneous injection.
•  IL-17 Blockers
  • Secukinumab (Cosentyx) and Ixekizumab (Taltz) and (Bimzelx): These medications specifically target interleukin-17A, a pro-inflammatory cytokine that plays a crucial role in the pathogenesis of psoriasis. They are effective in reducing the signs and symptoms of psoriasis and are also used for psoriatic arthritis.
•  IL-23 Blockers
  • Guselkumab (Tremfya), Tildrakizumab (Ilumya), and Risankizumab (Skyrizi): These newer agents target interleukin-23, another key cytokine involved in the inflammatory process of psoriasis. They have shown high efficacy in clearing psoriatic lesions and are administered via injection.

Benefits

• Targeted action: These drugs have a targeted mechanism of action, which may result in fewer systemic side effects and improved tolerability compared to older systemic treatments.
• Improved skin clearance: Many patients achieve significant or complete clearance of their psoriasis symptoms.
• Quality of life improvement: With effective symptom management, patients often report an improved quality of life.

Monitoring and Follow-up

Regular monitoring for side effects, effectiveness, and potential infections is necessary for patients on these treatments. It’s essential to have ongoing follow-up to ensure the therapy remains effective and safe.