Psoriasis is an autoimmune condition that most commonly affects the skin and joints. A few different types of psoriasis are recognized, and we call the most common version of chronic plaque-type psoriasis. People with psoriasis often have red scaling plaques on their skin. These plaques can cover a very small portion of the skin or be very extensive. The most common areas involved are pressure points including the elbows, knees, low back, and scalp. Roughly 1/3 of patients with psoriasis in the skin will also have inflammation in the joints causing joint pain and/or stiffness. This is called psoriatic arthritis.
Psoriasis Treatments Part 2
Please refer to our recent blog for more information on this disease: https://www.midlandsderm.com/psoriasis-background-part-1-dermatologist-omaha/. Taking all of this into consideration including how psoriasis can impact a person’s quality-of-life, this disease has received intense medical scrutiny and research leading up to many advanced treatment options. Here we will focus on the treatments for psoriasis known as the injectable biologic medications. These have been in the process of development and evolution over the last 20 years and have greatly transformed how we treat more severe cases of psoriasis.
To understand the injectable biologic treatment options and understand future treatment developments for psoriasis, it’s important to have a very basic understanding of the effects such treatments can have on the immune system.
A good way to think of the immune system is to envision a lumbering giant. This giant is our bodyguard, with massive arms and legs. In many ways, it is a veritable Hercules. It travels with us and it helps fight off many of the evils that can affect our body including infection and cancer. With all the good it does, it can do bad things. Though it’s primary purpose is to defend us, sometimes that giant can turn against us. This is the case in psoriasis and other autoimmune diseases, where the immune system attacks our own tissues.
This lumbering giant (our immune system), must be controlled and in some cases weakened to minimize the harm it does to us in order to better control psoriasis.
Injectable Biologic Medications
The injectable biologic medications are some of the most well-researched medications for this purpose. The best dermatologists are well-versed in the evidence-based medicine clinical research surrounding these medications. At Advanced Dermatology of the Midlands, our dermatologists have been involved in developing successive generations of biologic drugs to treat psoriasis. In fact, in the field of Dermatology, we now have available what we would consider being the 3rd generation of biologic medications.
Back to the lumbering giant, think of the giant’s arms as being the areas that malfunction and cause psoriasis. This is a simplification that can make these medicines much easier to understand because there are numerous immune pathways leading up to psoriasis that is very intricate and complex.
Biologic Medications 3 Generations
Next, it is important to understand that biologic medications can be separated into 3 different generations based on how they work. The earlier the generation of the medicine, the higher up on the arm it works. Working higher up on the arms might give more potency in some ways but also more potential side effects.
The first-generation biologic medications work to restrain the entire arms of the giant. By doing this, these medicines (Humira, Enbrel, and Remicade) are effective at treating psoriasis and psoriatic arthritis. Yet given their more aggressive control of things they are also more likely to have side effects including infection. Remember, the more aggressively we control the giant (the immune system) the more off-shoot side effects we can see at times. These medications all block a chemical called TNF-α.
The second-generation biologic medicine is Stelara, and it is a bit more fine control, restraining the wrists of the giant. With this, we can see some great results controlling psoriasis, but not as much improvement in psoriatic arthritis (the joints). Stelara works to block two different chemicals, known as IL (Interleukin-a class of glycoproteins leukocytes for regulating immune responses) 12 and IL 23.
And finally, the third-generation biologic medications work to restrain individual fingers of the giant. Some of the fingers trigger psoriasis, some psoriatic arthritis, some trigger both. By this more articulate and fine control over the immune system, we can get some pretty amazing results for psoriasis with many fewer side effects including a much lower risk of infection. These medications include medications that selectively block the chemicals IL 23 or IL 17A. IL 23 blocking medications include Tremfya, Ilumya, and Skyrizi. Cosentyx, Taltz, Siliq are the IL17A blockers. All these medications can work very well to improve psoriasis. The IL 17A medications seem to also work well for psoriatic arthritis.
Advanced Dermatology of the Midlands | Best Dermatologist Omaha & Council Bluffs, IA | Board Certified Dermatologists
With many of these medications, we are seeing improvement in psoriasis that is out of this world. Some patients are achieving complete clearance of all of their spots of psoriasis. Though none of these treatments can yet be called a “cure” for this problem, they do enable us to achieve more in the treatment of psoriasis than ever before. Talk with your dermatology provider about your options, including their side effects. Biologic medications are primarily used for patients with psoriatic arthritis or more extensive moderate to severe skin psoriasis, in most cases covering 10% or more of their body surface. Remember, you have many choices and sometimes it takes trying a few of them to find the one that is best for you.
Please contact us to schedule a consultation. in any of our clinics in Omaha, Council Bluffs or the surrounding communities.
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