What You Should Know About Psoriasis
Psoriasis is a chronic disorder affecting approximately 2-3% of the world's population. Though it comes in several variants, it is known as an "auto-immune" disease. Specifically, it is a disease where one's immune system is targeting the body's white blood cells known as lymphocytes. Lymphocytes are essential because they play a crucial role in what is known as our "Acquired Immune System."
The immune system is responsible for protecting the body from harmful bacteria, viruses, and other pathogens. People who have psoriasis are known to have an overactive immune system, which can cause inflammation within the body leading to psoriasis on the skin and even pain within the joints.
Typically, it is seen on the body to such areas as elbows and knees but can appear on the scalp, hands, feet, and even the genitalia. Unfortunately, it can be quite distressing as it is uncomfortable and can also cause itching, bleeding, and emotional distress. The disease can progress and cause discomfort and pain to the joints. Inflammation to the joints is known as psoriatic arthritis.
Psoriasis Diagnosis and Treatment
It’s essential to get an early diagnosis and treatment for optimal control. With a diagnosis of psoriasis, regular visits to a dermatologist are vital for close monitoring, especially if joints start to become affected. Early treatment is critical to prevent permanent damage that could potentially lead to disability.
Over-the-counter options such as weak topical steroids, tars, and salicylic acids, often, are often not enough for the management of the disease. Many prescription treatments are available for psoriasis, and providers choose them based on the severity of the symptoms. With mild cases, topical first-line therapy, such as corticosteroids and Vitamin D3 analogs, is a great option.
Still, topical second-line treatment, such as calcineurin inhibitors, can also be introduced depending on the response and treatment areas. Topical prescription-strength compounds that may include tars, Anthralin, and tazarotene may help manage the skin disease as well. Sometimes, a combination of treatments is best as some prescriptions should not be used in gentle areas such as the face, groin, and skin folds.
Unfortunately, with someone experiencing moderate-to-severe psoriasis, it can be quite challenging to only treat with topical medications (even prescriptions as mentioned above). Phototherapy and systemic agents should be introduced when someone has a more extensive disease — fortunately, these systemic treatment options for patients can make a life-changing difference.
Your dermatologist will discuss with you the many systemic treatments available in regards to selecting the right treatment option for you. Systemic treatments can have risks, and one should always consider the risk versus benefit when moving forward with this option as the goal is to control the disease from worsening, especially to the joints.
Up to 30% of patients with cutaneous disease have psoriatic arthritis. The distal finger joints (the first joint under the fingernail) are most commonly affected and, unlike plaque psoriasis, are typically seen asymmetrically.
A common sign seen on the fingers and toes is known as "sausage" digits when the joints are inflamed, making movement more difficult and painful. Other joints such as elbows, knees, and hips can also be affected.
Known Prescription Treatments for Psoriasis
Most of the following medications are expensive in cost but manufacturers do often offer a payment assistance program or savings alternative. Below is a list of the brand name drugs listed along with their savings programs.
|Prescription Drug Manufacturer Assistance
|Otezla Support Plus
|Remicade Care Path
|Humira Savings Card
Remicade and Humira
TNF-alpha inhibitors, such as Remicade and Humira, are administered via IV fusion or Subcutaneous injectionThese two 'biologic' prescriptions focus on inhibiting the T-cell inflammatory cytokine known as TNF-alpha, which is overactive with psoriasis. Specifically, these prescriptions suppress the immune system, which can cause an increased risk of infections and other conditions. Because they focus on specific cytokines, they are proven to help not only with the skin but joint pain as well, and the benefit of taking them can outweigh the risk. For best results, they should be ongoing for the management of psoriatic disease. Compliance is essential for the full efficacy of the drug. Annual blood tests are usually required.
Cosentyx and Taltz
Interleukin targeted treatment options, such as Cosentyx and Taltz, are newer generation subcutaneous administered biologic psoriasis treatments that hone in on specific cytokines known as Interleukins. They slow down the cascade of inflammatory events that lead to skin disease and joint pain of psoriasis. Like other biologics, annual laboratory monitoring is usually necessary.
Methotrexate and Soriatane
Other prescription treatment options come in pill form and have been used for many years for psoriasis either with or without joint involvement. These are known as Methotrexate and Soriatane. If you're a woman of child-bearing age, consult your doctor before using these medications. There is a potential of increased side effects, especially to the liver. For this reason, many patients are not candidates for either of these options. Patients need continued monitoring of liver enzymes as well as other labs, which may be inconvenient. Methotrexate is considered as an adjunct when traditional psoriasis prescriptions, such as biologics, are not providing relief, especially with joint involvement.
The cost of methotrexate without insurance starts at $21.21* for 2.5mg and 30 tablets using an RxSaver coupon.
A newer generation oral option is known as Otezla, which is also an immunosuppressant. The mechanism of action focuses on decreasing the inflammatory response caused by psoriasis, specifically an inhibitor of phosphodiesterase 4 (PDE4) within cells. Though not studied in women of child-bearing potential, this is a popular option due to no laboratory testing being needed before and during treatment. However, depression, as well as other side effects, are possible. As always, an extensive past medical history is necessary for all prescriptions before initiating treatment.
Considerations for Psoriasis
As a provider, when a patient with psoriasis is evaluated, an extensive past medical history is important to be recorded. If you are a woman planning to conceive, it should be something you inform your provider as certain medications should not be prescribed if you become pregnant. It is best to make your provider aware of any and all past treatments attempted along with what worked and what didn’t.
Also, discuss if any exacerbating factors are triggering your psoriasis such as stress, diet, medications, tobacco, and even alcohol. You may even want to keep a journal documenting such things making your condition worse.
Remember, anything that can lower your immune system can be contraindicated in people using a systemic treatment, so make sure you are taking good care of your health inside and out.
Lowest online price at national pharmacy chains Costco, CVS, RiteAid, Walgreens and Walmart as of 01/21/2021. Prices vary by location and pharmacy, see RxSaver.com for actual pricing in your area.
Renata Block, MMS, PA-C
Renata Block, MMS, PA-C, has been practicing in Dermatology in Chicago since 2003. She is a strong patient advocate, and gives back to her community by providing educational resources about skincare to create public awareness.
The information on this site is generalized and is not medical advice. It is intended to supplement, not substitute for, the expertise and judgment of your healthcare professional. Always seek the advice of your healthcare professional with any questions you may have regarding a medical condition. Never disregard seeking advice or delay in seeking treatment because of something you have read on our site. RxSaver makes no warranty as to the accuracy, reliability or completeness of this information.
If you are in crisis or you think you may have a medical emergency, call your doctor or 911 immediately.
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