Which Medication for Psoriasis Is Right for You?
Medically reviewed by Lindsay Cook, PharmD
Several viable treatment options are available for psoriasis, including topical creams, oral medications, and phototherapy. Prescription medication is often necessary to help you reach remission. Medications are prescribed depending on the type of psoriasis you have.
This article discusses the various types of psoriasis medications, how they work, and how to decide which is best for you.
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Oral Psoriasis Medication
Oral medications are often used in people with moderate or severe psoriasis, psoriatic arthritis, and those who do not respond to topical treatments.
How They Work
Oral medications are taken by mouth and, once broken down in the stomach, move through the small intestine, traveling through the intestinal wall and into the bloodstream.In the case of oral medications for psoriasis, they are sent to the area in the body affected by psoriasis.
Types
There are several different types of oral psoriasis medications, each with a different mechanism of action, as follows:
Retinoids: Oral retinoids are thought to limit skin cell multiplication.
Immunosuppressants: These medications suppress the action of the immune system to decrease inflammation in the affected area.
Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs can be prescribed or purchased over the counter (OTC) and work by reducing inflammation.
Disease-modifying antirheumatic drugs (DMARDs): DMARDs limit inflammation on a cellular level by decreasing the action of an inflammatory enzyme called PDE4 (phosphodiesterase).
Janus kinase (JAK) inhibitors: Janus kinase is a part of the immune system that aids in the immune process that causes psoriasis. By inhibiting it, the immune system overreaction is hindered.
Tyrosine kinase 2 (TYK2) inhibitors: TYK2 inhibitors are JAK inhibitors that block the TYK2 protein and the cellular signals to help reduce the immune system's overreaction.
Side Effects
Different drugs have different side effects. When taken orally, side effects can include:
Retinoids | Hair loss, dry mouth, chapped lips, dry skin, dry eyes, gum bleeding, nosebleeds, increased sensitivity to light, nail changes and peeling fingers, depression, thoughts of self-harm, new aggression, headaches, joint pain, a decrease in night vision, elevated liver enzymes, changes in the levels of fat in the blood |
Immunosuppressants | Headaches, a decrease in kidney function, high blood pressure, high cholesterol, excessive hair growth, skin sensitivity, gum growth, flu symptoms, upset stomach, tiredness, pain in the joints, muscles, or bones, liver damage or scarring, feeling a tingling sensation in the limbs |
NSAIDs | Gastrointestinal bleeding, ulcers, high blood pressure, congestive heart failure, stroke, salt retention, swelling in tissues, kidney disease |
DMARDs | Sores, redness, and swelling in the mouth, vomiting, nausea, appetite loss, fatigue, increased risk of severe infections, increased risk of lymphoma, increased risk of liver or kidney disease |
JAK inhibitors | Headaches, diarrhea, joint stiffness, pain in the extremities, cough, sinusitis, upper abdominal pain, fever, back pain, increased risk for infections, high blood pressure, liver inflammation or damage, kidney impairment, increased risk for cancerous tumors, weight gain, urinary tract infections, depression, alopecia, fatigue, increased hunger, insomnia, dizziness, constipation, itchy skin, joint swelling |
TYK2 inhibitors | Rash, fatigue, diarrhea, liver inflammation or damage, interstitial lung disease, nail changes |
Who Should Use Them?
Oral medications are much stronger than other types, such as creams or ointments. Oral medication is typically reserved for people with increasingly severe psoriasis or those that have tried other prescription topicals without any relief from symptoms.
Who Should Avoid Oral Psoriasis Medications?
Avoiding certain types of medications will depend on a person’s current level of health and any other conditions they may have. People with an increased risk of infection, those with bowel or stomach disorders, and those with liver or kidney disease may not be good candidates for oral psoriasis medications. These drugs should also be avoided by pregnant people, those planning to become pregnant, and people currently breastfeeding.
Related: Does Psoriasis Go Away?
Prescription Topical Treatments for Psoriasis
Topical creams, ointments, and emollients applied directly to the skin are often the first-line therapy for people with psoriasis. If the drugs given as topicals can control the disease, then no further treatment is usually sought.
How They Work
Topicals are applied directly to the affected area. They are absorbed by the skin and reduce inflammation that causes the rash in psoriasis to form.
They can also hinder the action of skin cell turnover by reducing the number of new skin cells produced by the body. These medications are most effective for people with mild to moderate disease.
Types
There are several types of drugs used topically for psoriasis, including:
Corticosteroids: Corticosteroids reduce inflammation in the skin while slowing down how quickly skin cells are produced. Typically, they come in solutions, ointments, creams, or shampoos for people with scalp psoriasis.
Vitamin D analogs: While rare, vitamin D analogs can also be used to treat psoriasis. They work by reducing cell turnover.
Calcineurin inhibitors: For people with psoriasis in sensitive areas such as the groin, calcineurin inhibitors will be used. They come in creams and ointments and work by reducing the action of the immune system to clear up symptoms.
Dithranol and coal tar: Dithranol and coal tar were once mainstay treatments but are rarely used. They reduce the number of new skin cells produced by the body.
Side Effects
While topicals are highly effective, they also come with the risk of side effects. Side effects can include:
Corticosteroids | Itching, rash, thinning skin, burning in the area, skin redness and irritation, changes in skin color, swollen blood vessels in the area the cream or lotion was applied, worsened psoriasis |
Vitamin D analogs | Skin irritation, burning, itching, swelling, peeling of the skin, dryness, and redness |
Calcineurin inhibitors | Skin irritation, burning, itching, and redness where the cream was applied, increased risk for allergic contact dermatitis, infection reactivation, acne, facial flushing after drinking alcohol, inflamed hair follicles |
Dithranol and coal tar | Skin staining, acne, increased sensitivity to the sun, skin irritation |
Who Should Use Them?
Topicals are the first-line therapy, so often, many people who develop psoriasis will begin their therapy with this medication. Healthcare providers usually start with the mildest treatments and work their way up to stronger ones if they are not helping.
What Is the Most-Used Topical for Psoriasis?
While there are several different topical options, the first choice is often corticosteroids because they are generally safe and effective. However, they should be avoided if:
You have a skin infection.
You have other skin conditions, such as rosacea or acne.
You have open sores (ulcers) in the area where the cream is to be applied.
Learn More: How Psoriasis Is Treated
Biologics and Biosimilars
Biologics are the most potent medication available to treat psoriasis and other inflammatory conditions. They are administered through an injection or intravenously (through an IV).
How They Work
Biologics work by targeting the specific area of the immune system that’s causing psoriasis symptoms. It does so by blocking inflammatory reactions in the body that drive psoriasis development.
The proteins in the immune system blocked by biologics are:
Tumor necrosis factor-alpha (TNF-alpha)
Interleukin 17-A
Interleukins 12 and 23
Types
Brands of biologics that can be used to treat psoriasis include:
Bimzelx (bimekizumab-bkzx)
Cimzia (certolizumab pegol)
Cosentyx (secukinumab)
Enbrel (etanercept)
Humira (adalimumab)
Ilumya (tildrakizumab)
Remicade (infliximab)
Siliq (brodalumab)
Simponi (golimumab)
Skyrizi (risankizumab)
Stelara (ustekinumab)
Taltz (ixekizumab)
Tremfya (guselkumab)
Can Children with Psoriasis Use Biologics?
Some biologics also treat children with psoriasis. They include:
Etanercept for those 4 and older
Ustekinumab for those 6 and older
Secukinumab for those 6 and older
Side Effects
While biologics are generally considered safe, there are some side effects to be aware of, including:
Skin reactions where the injection is administered
Flu-like symptoms following a dose
Headaches
Who Should Use Them?
Biologics are often used for people with moderate to severe cases of psoriasis or for those with both psoriasis and psoriatic arthritis.
They can also be used in people who haven’t found relief from their symptoms after using topical and oral medications.
Biologics and Risk of Severe Infection
Because biologics hinder the action of the immune system, people taking them are at an increased risk of developing severe infections. Some factors that can increase this risk include:
Older age
Diabetes
Smoking or chewing tobacco products
History of infections
How Long Does Treatment Take?
The length of treatment depends on the medication and the therapy results. However, since there is no cure for psoriasis, many people will have to treat their condition on an ongoing basis.
The length of time each treatment typically lasts before a person can expect results is:
Oral medications: Different oral medications come with varying timelines. Some oral medications can improve psoriasis in as little as four weeks, while others could take as long as 24 weeks.
Topicals: One to two weeks after treatment starts
Biologics: 10 to 16 weeks after beginning treatment
Goals of Psoriasis Treatment
The main goal of psoriasis treatment is to manage the disease. Medical providers aim to help people with the disorder achieve skin clear of plaques or rash while allowing them to return to their daily activities that were compromised during flare-ups. They want to help people with psoriasis live without having to cope with the impact that psoriasis can have on their work, social life, and other obligations.
Treating Psoriasis Without Prescription Medication
While many people with psoriasis need prescription medication, mild cases may benefit from other forms of therapy.
Nonprescription Treatment
Several OTC options exist for people with mild psoriasis. They include:
Creams and ointments that contain hydrocortisone
Gentle and scent-free oils or moisturizers
Products that contain salicylic acid to soften the scales that form in psoriasis
Light Therapy
Phototherapy, or light therapy, is another effective nondrug treatment that can be used for mild to moderate cases of psoriasis. Light therapy is done by exposing the affected area of the skin to ultraviolet rays. It works by slowing down the overproduction of skin cells.
In some cases, light therapy will be combined with an agent known as psoralen. Psoralen makes the skin more sensitive to light, thus, allowing the ultraviolet (UV) light to penetrate the skin better.
Self-Care Tips
People with psoriasis should develop a self-care routine to help manage their condition regardless of the type of medication they are on or the therapy they’re receiving. Some tips for managing psoriasis include:
Avoiding skin injuries like cuts or bug bites
Consistently applying sunscreen to ensure you don’t get a sunburn
Not scratching or picking at the area
Applying cold compresses to help with itching and irritation
Applying lotion throughout the day and before bed
Identifying and avoiding triggers such as stress
Possible Psoriasis Triggers
Other than stress, psoriasis can be triggered by other things, such as:
A cold and dry climate
Skin injuries, such as a sunburn
Drinking alcohol in excess
Smoking
Certain medications
Learn More: Is Psoriasis Hereditary?
How to Find the Right Treatment
Finding the proper psoriasis treatment can be a case of trial and error. That is because not everyone will respond to the medications similarly. To find the right treatment for you, meet with your healthcare provider and discuss your options.
They will be aware of your case, health history, and the severity of your condition. Since topical medications are often the start of treatment, healthcare providers will likely prescribe one of those first to see if you see results in a specific time frame. If not, they will move on to more potent medications.
Summary
Psoriasis is an incurable skin disorder that must be managed for life. Due to the differences in severity and location of psoriasis, various types of drugs are available to you if you develop the condition.
Topical, oral, and biologic medications for psoriasis all have their own side effects and upsides. Starting with topical medications is typically the beginning of therapy, but there is hope if they don’t work. Your healthcare provider will choose the right type of medication, depending on your case.
Read the original article on Verywell Health.
