New Directions in the Treatment of Psoriasis

According to the National Psoriasis Foundation, approximately 8 million Americans suffer from psoriasis and 125 million people worldwide are living with it. Psoriasis is not gender-specific and occurs in both adults and children, with the onset of symptoms occurring at any age.

It is not a contagious disease and cannot be transferred from one person to another through any type of physical contact. However, it can be genetic, with 1 in 3 adults having a relative who also has the disease, but this is not always the case. It is not uncommon for individuals suffering from other conditions such as heart disease, diabetes, and depression to also suffer from psoriasis.

Even though the disease can last a lifetime, patients can experience periods of  remission. However, certain aggravators such as serious infections, certain medications  or times of high stress can cause it to make a reappearance. Even some types of medications can cause symptoms to flare up again. 

Traditional Approaches to Treatment

There is currently no cure for psoriasis, but a variety of treatments can greatly reduce the effects of the disease and bring relief to people suffering from it. 

Phototherapy using ultraviolet light can be prescribed along with systemic drugs or topical ointments and creams that target the affected areas of the skin. 

For psoriatic arthritis, a drug called methotrexate can be prescribed in combination with one of the other skin treatments. Arthritic symptoms can also be alleviated by alternating hot or cold therapies, using assistive devices such as wrist and knee braces, and regular, gentle exercise.

New Approaches to Treatment

New approaches to the treatment of psoriasis are on the rise, especially those that target the moderate-to-severe cases of the disease which create ongoing disruption in patients' daily lives.

Since 2004, biologics have been rising in popularity as more dermatologists are discovering their efficacy in treating those moderate-to-severe cases of psoriasis and psoriatic arthritis that can often be difficult to keep under control.  And researchers are also beginning to study the possible cardioprotective benefits that TNF-alpha inhibitors might offer patients.

Biologics do not target the entire immune system as traditional therapies do. Instead, they work by targeting specific parts of a patient's immune system by blocking the action of a specific cell or they block a protein. 

Biologics 

There are now 10 FDA-approved biologic drugs  that are available to dermatologists for treating psoriasis. Biologics are not a pill or cream a patient uses at home. Instead, they are administered through an injection or an IV infusion in a medical setting. 

They are most often prescribed for those individuals suffering from moderate-to-severe psoriasis that does not respond to more traditional therapies. To determine the best course of treatment using biologics, dermatologists need to consider three main aspects of the disease:

• The type(s) of psoriasis involved
• The affected areas of the body
• Comorbidities that are impacting the disease

Once these factors are assessed, an entire picture of a patient's disease emerges, making it easier to determine how to treat it effectively with the different biologics available. 

Sometimes a patient's symptoms will respond well to just one biologic drug. However, for difficult cases, a combination of several drugs used over a specific timeframe yields better results. 

While biologics continue to show promise as an ongoing form of treatment, there is still more research required. Currently, there are no identifying biomarkers that can help dermatologists know which biologic treatment is best-suited for an individual patient's symptoms.

Another factor to consider is the patient's health insurance. Not all biologics are covered under every plan. The treating physician will need to be aware of what a patient's insurance will and will not cover. If the company will not agree to the physician's request for a biologic drug to be covered, the plan of treatment will need to be adjusted.

Comorbidities

Psoriasis accompanied by associated physical conditions which, in the past, were not always recognized as being related to the disease. 

conditions such as psoriatic arthritis, depression, cardiovascular disease, and metabolic syndrome all fall into this category. The approach to treatment becomes a balancing act as each condition can not only be affected by psoriasis but also have an impact on the severity of the psoriatic symptoms.

Talking with patients to determine if any other medical conditions exist allows the dermatologist to more quickly see how they are impacting the patient's psoriasis symptoms. Understanding the bigger picture of a patient's medical history gives dermatologists a better perspective on determining which course of treatment to pursue to alleviate a patient's symptoms. 

Learning the extent to which a patient suffers from additional comorbidities also allows the dermatologist to partner with any other physicians already involved in that patient's care. This type of partnership lets a dermatologist design a plan of treatment that works in conjunction with those prescribed by other physicians rather than one that conflicts and ends up creating more stress for the patient.

Conclusion
Psoriasis is certainly a challenging condition to treat. Severe-to-moderate cases often do not respond to traditional treatments like creams and light therapy, leaving patients and physicians feeling frustrated.

The development of biologics now offers exciting opportunities to not only control the disease, but keep it in remission longer. Combining biologics with the ongoing research of how comorbidities can impact disease symptoms is giving dermatologists a wider perspective of a patient’s psoriasis on multiple levels. And by partnering with other physicians and their knowledge of the patient’s comorbidities, dermatologists are able to treat patients with greater specificity.

As the positive research continues to create more information and new insights into how to deal with this frustrating disease, dermatologists are able to offer a better quality of life for millions of psoriasis sufferers.