Speak Clearly: Perspectives on Psoriasis

Overview of Psoriasis Treatment Options

People experience psoriasis differently – there isn’t one answer for everyone. Your physician will consider different factors when setting up your treatment plan, including the severity of your psoriasis and its impact on your daily life.

For people with mild psoriasis, the signs and symptoms are typically controlled with topical treatments, creams or ointments that you apply to your skin, or phototherapy, exposing your skin to natural or artificial UV light.^1,2

However, nearly 25 percent of people living with psoriasis are considered to have moderate to severe psoriasis, meaning more than 10 percent of the skin’s surface is affected.^3,4 In this case, systemic treatments are usually recommended. These medications work on the entire body, and often act on the immune system to ease psoriasis symptoms over large areas of the body. ⁵ They can include oral medication, taken by mouth in a liquid or pill form, or biologics, injectable medicines that target specific components of the immune system to reduce inflammation.^5-7

With the wealth of information available online about psoriasis treatments, there are some common misconceptions around systemic treatments that we want to correct.

Myth #1: Psoriasis is just a skin condition

Fact: Yes, the signs and symptoms of psoriasis largely appear on your skin, but it actually starts beneath the skin in the cells. Psoriasis is caused when the immune system does not function properly; it is an immune-mediated condition.⁸ The release of certain inflammatory cells, called cytokines, activates the rapid production of skin cells. This overproduction continues as inflammatory cells generate in the skin, causing a cycle of inflammation leading to psoriasis plaques forming on the skin. ^9-12

Systemic treatments work beneath the skin to stop the immune system from overproducing cytokines that eventually lead to psoriasis. Some focus on suppressing the immune system altogether or acting as an anti-inflammatory to reduce the rapid production of skin cells, while others target specific parts of the immune system to stop the cycle of inflammation.^5-7

Myth #2: Systemic treatments should only be used as a last resort for patients with very severe disease

Fact: Systemic treatments are available for people with moderate to severe psoriasis, especially for patients who are not responsive or are unable to take other management options.

Just because one treatment option may not work for you right away, doesn’t mean they all won’t. Treatments are constantly changing, and that's why it's important to discuss your goals, symptoms, and all possible treatment options with your doctor to help you avoid long-term effect of the physical and psychological burden.

The medical community uses a tool called cumulative life course impairment (CLCI) to measure the ongoing effects of chronic diseases like psoriasis. CLCI assesses the repercussions of living with the disease, factoring physical, psychological and emotional wellbeing, and how this can accumulate and interfere with an individual’s full potential over time if their psoriasis is not controlled. The impact of CLCI varies depending on circumstance, but the negative effects can increase over time.¹³

That’s why is important that you work with your doctor to find the optimal treatment plan for you that gives you the best chance to achieve clear skin.

Myth #3: We don’t know the long-term effects of systemic treatments

Fact: Systemic medicines have been approved for more than 10 years by regulatory authorities, including the European Medicines Agency and U.S. Food and Drug Administration.¹⁴ There have been many studies evaluating systemic treatments and they are recommended in clinical guidelines issued by professional dermatology organizations, including the European Academy of Dermatology and Venereology, the American Academy of Dermatology and other national dermatology organizations globally.^3,15-18

Research around the management of psoriasis is always advancing as healthcare providers seek to have a deeper understanding of the immune system and the complex nature of immune-mediated diseases like psoriasis.

You and your doctor should discuss what plan of care may be best for you based on the severity of your psoriasis, medical history and your lifestyle. Don’t be afraid to ask questions. Just because something did not work for someone else, does not mean that it is not right for you. Be confident that together with your doctor, you can take control of your psoriasis.

Learn how you can start the conversation with your doctor about the best management plan for you here.

What psoriasis myths we will clear up next? Check back soon for the next Clearing Up post.           

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References:

1. British Association of Dermatologists. Topical treatments for psoriasis. August 2017. Available at: http://www.bad.org.uk/shared/get-file.ashx?id=123&itemtype=document. Accessed on April 13, 2020.
2. British Association of Dermatologists. Phototherapy. July 2018. Available at: http://www.bad.org.uk/shared/get-file.ashx?id=175&itemtype=document. Accessed on April 13, 2020.
3. Pathirana, D., et al. European S3-Guidelines on the systemic treatment of psoriasis vulgaris. JEADV. October 2009. 23(2)5-70. DOI: 10.1111/j.1468-3083.2009.03389.
4. Statistics. National Psoriasis Foundation website. Available at: https://www.psoriasis.org/content/statistics. Accessed April 13, 2020.
5. British Association of Dermatologists. Treatments for moderate to severe psoriasis. January 2017. Available at: http://www.bad.org.uk/shared/get-file.ashx?id=124&itemtype=document. Accessed on April 13, 2020.
6. British Association of Dermatologists. Fumaric Acid Esters. May 2018. Available at: http://www.bad.org.uk/shared/get-file.ashx?id=84&itemtype=document. Accessed on April 13, 2020.
7. National Health Service. Treatment –Psoriasis. May 2018. Available at: https://www.nhs.uk/conditions/psoriasis/treatment/. Accessed April 13, 2020.
8. National Psoriasis Foundation. The Immune System and Psoriasis. June 2016. Available at https://www.psoriasis.org/researchers/science-of-psoriasis/immune-system. Accessed on April 13, 2020.
9. Hawkes JE, et al. J Allergy Clin Immunol. 2017;140(3):645-653.
10. Kim J, Krueger JG. Dermatol Clin. 2015;33(1):13-23.
11. Gaffen SL, et al. Nat Rev Immunol. 2014;14(9):585-600.
12. Cai Y, et al. Cell Mol Immunol. 2012;9(4):302-309.
13. Ros S, Puig L, Carrascosa JM. Cumulative Life Course Impairment: The Imprint of Psoriasis on the Patient’s Life. Actas Dermosifiliogr. 2014;105:128–134.
14. Rich SJ, Bello-Quintero CE. Advancements in the treatment of psoriasis: role of biologic agents. J Manag Care Pharm. 2004 Jul-Aug;10(4):318-25.
15. Menter A, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. JAAD. April 2019. 80(4): 1029–1072.
16. Gisondi P, et al. Italian guidelines on the systemic treatments of moderate‐to‐severe plaque psoriasis. JEADV. May 2017. 34(5):774–790.
17. Amatore F, et al. French guidelines on the use of systemic treatments for moderate‐to‐severe psoriasis in adults. JEADV. March 2019. 33(3):464–483.
18. National Institute for Health and Care Excellence. Psoriasis: assessment and management. September 2017. https://www.nice.org.uk/guidance/cg153. Accessed on April 27, 2020. 

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