PracticalDermatology

The way that dermatologists treat psoriasis has changed dramatically since the advent of biologic drugs in the late 1990s, and the innovations keep on coming.

Lindsey A. Bordone, MD, a dermatologist in the Department of Dermatology at Columbia University Medical Center in New York City, talked to Practical Dermatology® magazine about what has changed and how it has affected the care of patients with psoriasis and the trajectory of the disease.

What’s new in psoriasis care?

Lindsey A. Bordone, MD: There seems to be a new psoriasis medication every year. Guselkumab (Tremfya, Janssen), tildrakizumab (Ilumya, Sun Pharmaceuticals), and Risankizumab (Skyrizi, AbbVie) are all new drugs that work on IL-23. For patients who are not responding to TNF inhibitors, these new medications expand the arena of treatment beyond what ustekinumab (Stelara, Janssen) had offered in targeting IL-12/23.

What is coming down the pipeline?

Dr. Bordone: Tofacitinib citrate (Xeljanz, Pfizer) has now been approved for psoriatic arthritis and offers a new treatment for patients who failed injectable biologics and/or apremilast (Otezla, Amgen).

What is possible today for psoriasis patients given new therapies?

Dr. Bordone: Psoriasis now is completely changed from what it was 20 years ago.Twenty years ago patients walked around covered in psoriasis plaques and with crippling joint disease due to severely limited treatment options. It would be very unusual to see a person with extensive psoriasis at the pool or beach these days, whereas in the past it was a much more common sighting.

Can blocking inflammation prevent long-term consequences of psoriasis?

Dr. Bordone: Reducing inflammation through systemic psoriasis medications has been shown to decrease a patient’s risk of chronic diseases, such as heart disease and stroke. There is a lot of data to back this up, and many publications have come out in the last several years showing the importance of looking at psoriasis as a systemic condition rather than just a skin disease.

What role do laser and light therapies have in treating psoriasis at your practice?

Dr. Bordone: Light and lasers can help certain patients with psoriasis. In reality, light treatment is a challenge for patients who have a busy schedule, since it often requires going to a doctor’s office for treatment at least twice per week. A home phototherapy unit can be used, but this is sometimes difficult in a place like NYC where even closet space is hard to come by. Also, phototherapy doesn’t induce significant periods of remission in patients and does not address the internal inflammation that leads to heart disease and stroke. Overall, in the right patient with limited skin disease, it can be a great treatment. <