Psoriasis Treatments from a Dermatologist

Many people with psoriasis notice an improvement in their skin after they have been in the sunshine. The use of the sun’s rays has been used to treat psoriasis for over a century, however, of the many different ultraviolet rays emitted by the sun, only UVA and UVB are helpful to people with psoriasis. Ultraviolet light reduces inflammation in the skin, which is why it can be effective for psoriasis and other inflammatory skin conditions.

There are two different types of ‘UV’ therapy that are used to treat psoriasis. Narrowband UVB (also known as ‘TL-01’, after the type of bulb used) uses the UVB part of the spectrum, and is often used to treat guttate or plaque psoriasis. The other type of ‘UV’ therapy is known as PUVA, and is a combination of the UVA part of the spectrum and a chemical called psoralen (this is where the ‘p’ in PUVA comes from). UVA light is not useful in treating psoriasis on its own, and so psoralen is needed to make the skin more sensitive to it. PUVA might be used if UVB therapy has not worked, and can be particularly effective for psoriasis on the hands and feet, due to being better at penetrating thicker plaques of psoriasis.

Remember - using a sunbed at a gym, salon or spa is not the same has having UV therapy in a hospital setting. Hospital-based UV treatment uses only the specific part of the spectrum that is useful to treat skin conditions. This is not the case on a sunbed, where a much broader spectrum is used. Many sunbeds use mostly, or entirely, UVA light, which is ineffective for treating psoriasis without the added psoralen. Therefore, using sunbeds means taking on the risks of UV exposure, without much of the benefit to psoriasis.

UV treatment in hospital is very carefully controlled – a Dermatologist will tailor the right amount of UV for each individual, and monitor the results. If a person uses sunbeds or an at-home lamp in addition to this, it makes it difficult to ensure they are receiving the correct dose for them.

Click here for more information on the different types of UV therapy, regimes, side effects and risks.

Systemic medicines affect the entire body (or 'system') rather than just targeting one area, as with topicals (creams and ointments) or UV therapy.

Systemics are able to be prescribed by a Dermatologist for moderate to severe psoriasis which has not successfully responded to topical treatments or UV therapy, or for those who cannot have more cycles of UV therapy. Some systemics can also be used to treat psoriatic arthritis. If the first systemic treatment does not have acceptable results, or if the individual can’t carry on taking it due to side effects or other safety concerns, a second systemic will usually be tried.

The systemics that are most commonly used to treat psoriasis in the UK are Methotrexate, Ciclosporin and Acitretin.

Click here for more information on Methotrexate, its dosing regime and side effects.

Click here for more information on Ciclosporin, its dosing regime and side effects.

Click here for more information on Acitretin, its dosing regime and side effects.

Otezla (also known by its non-commercial name, apremilast) is a systemic medication that can be used to treat  moderate to severe psoriasis and psoriatic arthritis.

Click here for more information on Otezla, its dosing regime and side effects.

Skilarence (also known by its non-commercial name, dimethyl fumarate) is a fumaric acid medication that can be used to treat severe psoriasis.

Click here for more information on Skilarence, its dosing regime and side effects.

Biologic medications are specifically designed to mimic chemicals that are naturally found within the human body, and act to correct something that is going wrong. A well-known biologic treatment (that is not used for psoriasis) is Insulin, which is taken by diabetics.

The National Institute for Health and Care Excellence (NICE) has issued guidelines for when biologics can be prescribed. NICE recommends that Adalimumab (Humira, Amgevita, Hulio, Hyrimoz and Imraldi), Enbrel (etanercept), Stelara (ustekinumab), Cosentyx (secukinumab), Kyntheum (brodalumab), Taltz (ixekizumab), Tremfya (guselkumab), Cimzia (certolizumab pegol), Skyrizi (risankizumab) and Ilumetri (tildrakizumab) can be prescribed for people with severe psoriasis who have not responded to systemic treatments such as PUVA, methotrexate, ciclosporin and acitretin. People can also be prescribed these biologics if the mentioned systemics cause side effects which means the person should not take them, or if the person has another condition or medication which means that they should not take the other systemic treatments. Remicade (Infliximab) can be offered for the treatment of very severe plaque psoriasis if the psoriasis has not responded to other systemic treatments such as PUVA, methotrexate or ciclosporin.

If you would like more information on a specific biologic medication, please use the links below:

Click here for more information on Adalimumab, its dosing regime and side effects

Click here for more information on Cimzia, its dosing regime and side effects

Click here for more information on Cosentyx, its dosing regime and side effects.

Click here for more information on Enbrel, its dosing regime and side effects.

Click here for more information on Ilumetri, its dosing regime and side effects.

Click here for more information on Kyntheum, its dosing regime and side effects.

Click here for more information on Skyrizi, its dosing regime and side effects.

Click here for more information on Stelara, its dosing regime and side effects.

Click here for more information on Taltz, its dosing regime and side effects.

Click here for more information on Tremfya, its dosing regime and side effects.

Click here for more information on Remicade, its dosing regime and side effects.

BADBIR

Biologics are still fairly recent treatments for psoriasis, and long-term safety data is still being compiled.

In order to help collect long-term safety data on biologic medications, your Dermatologist should recommend that you join the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). BADBIR confidentially monitors those using biologics for psoriasis – particularly from the point of view of short and longer-term safety and side effects -  in order to see if there are any differences between the biologics and older psoriasis treatments, and to see if anything can be learnt.

For more information please visit www.badbir.org or speak to your Dermatologist.