In 2016, the National Psoriasis Foundation issued the first U.S. treatment goals for doctors to use when they talk to and evaluate people with psoriasis. Three months after you start a new drug, the guidelines say, psoriasis should cover 1% or less of your body’s surface area (about the size of your palm). To reach this milestone, your doctor may need to change your treatments along the way. You might hear him call this process “treat to target.”
The drug ustekinumab (Stelara) has been used to treat psoriasis since 2009. It blocks two proteins related to inflammation: interleukin-12 (IL-12) and interleukin-23 (IL-23). But recent studies show that IL-12 may actually protect skin cells from a different inflammatory protein, IL-17. Some scientists say it may not help to attack IL-12. Targeting IL-23 and IL-17, they say, might get better results.
A new injectable drug that blocks the activity of IL-17 proteins was approved in 2016. Ixekizumab (Taltz) got the OK for treatment of moderate to severe psoriasis after 80% of people in clinical trials improved when taking it. The drug cleared symptoms for almost half the people who tried it. That’s a success rate other psoriasis drugs haven’t been able to match. It joins fellow IL-17 inhibitor secukinumab (Cosentyx), which was approved to treat psoriasis in 2015.
More traditional psoriasis treatments, like adalimumab (Humira), block the inflammatory protein TNF-alpha. But three drugs on the horizon take aim at another protein, IL-23, instead. It’s still in clinical trials, but the injectable IL-23 blocker guselkumab improved psoriasis better than adalimumab. Similar drugs risankizumab and tildrakizumab
are also in the works.
A gel known as AST-005 proved safe for people with psoriasis in a small, phase I clinical trial. The potential new drug is based on a technology called spherical nucleic acid. It uses microscopic spheres of genetic material to stop your body from making TNF-alpha. Larger and longer studies are needed, but experts say this could be a first step toward new treatment options.
Most natural psoriasis remedies have no scientific research to support their use. One exception is the bright yellow spice turmeric. Its main ingredient, curcumin, can block the protein TNF-alpha, which triggers psoriasis inflammation. Turmeric can be mixed into food or taken as a supplement. It might be useful as a gel treatment, too.
If you have psoriasis, you may not sleep well. But it isn’t clear whether pain and itching keep you awake or if a lack of shut-eye brings on skin problems. Scientists believe both may be true. That means people with psoriasis could be trapped in a vicious cycle. Research is under way to explore how sleep quality and your body’s natural rhythms affect psoriasis and other skin diseases.