Psoriasis Treatment Options
- For many people with psoriasis, topical treatments fail to really alleviate symptoms. A host of new therapies that work in a more systemic way (as pills or shots) are now on the market as potentially more effective options.
- Beloved singer/songwriter and actress LeAnn Rimes, 40, was diagnosed with psoriasis when she was 2 years old. But she’s found ways to manage her symptoms.
- Psoriasis, in general, is a condition that can cause the development of red, itchy patches on the skin.
- Symptoms associated with psoriasis include red patches of skin covered with silvery scales, small scaling spots, dry, cracked skin that may bleed or itch, itching, burning, or soreness, thickened or ridged nails and swollen or stiff joints. If you ever start to notice red, scaly spots on your body, one of our experts recommends you see a dermatologist right away.
- For patients with newly diagnosed or very mild psoriasis, topical treatments (like ointments or creams you rub on your skin) may be enough to treat outbreaks. If the condition is more widespread, your doctor may recommend phototherapy (which uses light to treat the condition) or systemic treatments, which can be taken orally or through an IV and treat the body as a whole.
- A newer option for people with moderate to severe plaque psoriasis is called SOTYKTU™ (deucravacitinib). This oral medication can help people find relief with potential side effects than ever before.
It’s unclear exactly what treatments Rimes is or isn’t using right now, but we know she’s tried many different options over the years. Making her diet and overall health a priority and identifying triggers for her symptoms were a big part of what helped her manage flare-ups, according to an interview with the National Psoriasis Foundation (NPF), but we know she’s also found injections that have worked for her.Read More
LeAnn Rimes’ Psoriasis JourneyLeAnn Rimes was diagnosed with psoriasis earlier than most at age 2. By the time she was six, about 80 percent of Rimes’ body was covered in painful red spots, according to an article she wrote for Glamour. Rimes did everything she could to hide her condition from the world and find treatment that worked. Eventually, she discovered an injectable treatment in her 20s that kept her skin clear, but the stress of the COVID-19 pandemic brought her symptoms to the surface again.
“All hell broke loose in the world—and inside of me, as I’m sure it did for so many other people amid this pandemic,” she wrote. “Stress is a common trigger for psoriasis, and with so much uncertainty happening, my flare-ups came right back.”
Since then, the beloved singer has decided to own her psoriasis and share details about her journey to educate about the chronic condition.
She even did a nude photoshoot for the Glamour article that put her psoriasis on full display.
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“When you finally allow yourself to step outside of what you’ve been caging in, the whole world opens up. There’s freedom in even just putting one foot outside the door,” she wrote. “I hope anyone who also kept themselves small has the courage to step outside of that cage.
“When we allow ourselves not to be held in, our lives come back to us.”
Understanding LeAnn Rimes’ Condition: Psoriasis
Now that we’ve taken a look at LeAnn Rimes’ psoriasis journey, let’s take a step back and understand the condition more fully. Psoriasis, in general, is a condition that affects up to 3.2 percent of the U.S. population, according to the American Academy of Dermatology. It can cause the development of red, itchy patches on the skin. But there are many different types of the disease with plaque psoriasis being the most common.
“Psoriasis is a chronic, auto-immune skin condition where you have red, scaly patches on the skin,” Dr. Saakshi Khattri, a dermatologist/rheumatologist at Mount Sinai Health System, previously told SurvivorNet. “It is a chronic condition, which can ebb and flow. You can have good days and bad days.”
People with psoriasis are often asymptomatic, but uncomfortable outbreaks can happen. That being said, psoriasis patches can vary in how they look on the skin. You might have a few spots with scaling similar to dandruff or rashes covering a large portion of your body. The most common places to see psoriasis patches are the lower back, elbows, knees, legs, soles of feet, scalp, face and palms.
“Some patients report itching [or a] burning sensation, but that doesn’t tend to be the norm. It certainly can happen,” Dr. Khattri explained. “Then if you have psoriasis in the genital area, it can feel uncomfortable just because it’s in a very sensitive part of the body. But for the most part, it tends to be asymptomatic.”
Symptoms associated with psoriasis include:
- Red patches of skin covered with silvery scales
- Small scaling spots
- Dry, cracked skin that may bleed or itch
- Itching, burning, or soreness
- Thickened or ridged nails
- Swollen or stiff joints
If you ever start to notice red, scaly spots on your body, Dr. Khattri recommends you see a dermatologist right away so you get get a proper diagnosis and the proper care you need.
Psoriasis is a chronic disease that does not have a cure, but there are many different ways to help manage symptoms. Treatment for the disease also varies but the three main categories include topical treatments like ointments or creams you can rub on the skin, phototherapy which uses UVB light to treat the disease and systemic treatments like drugs that target parts of the immune system you can take orally or through an IV. Like we said before, it’s unclear what kind of treatments/management techniques LeAnn Rimes has turned to, but whatever they are have helped her reclaim her psoriasis journey.
“When I see a psoriasis patient, I first determine the extent of their condition. If it’s fairly localized, I’m able to treat the patient with topical therapy by itself,” says Dr. Linda Stein Gold, Director of Clinical Research in the Department of Dermatology at Henry Ford Health in Detroit. “But if they have a more widespread condition, topicals alone are not practical.”
Topicals are most often recommended for newly diagnosed patients, or those with mild psoriasis. This first-line treatment is applied directly to your affected skin area with either lotion, cream, or foam. They work by reducing inflammation and slowing down, or putting the brakes on excessive immune cell production.
- Topical steroids. Corticosteroid ointments or creams are the most common treatment for psoriasis flareups and can reduce swelling, redness and itching. Steroid medications come in different strengths that range from strong to less potent. Low strength versions can be bought over-the-counter (OTC), but you’ll need a prescription for stronger steroids. Since prescription-strength steroids can have side effects such as burning or thinning of your skin, you should avoid using them on sensitive areas of your body such as your face, genitals or armpits.
- Topical non-steroids. Your doctor might suggest a non-steroidal topical treatment. These medications include synthetic vitamin D3 (Calcipotriol) and Vitamin A, calcium inhibitors, retinoids, salicylic acid (scalp and shampoo solutions), as well as coal tar and anthralin. Side effects include skin drying, rash, peeling and in some cases, a worsening of your psoriasis.
Phototherapy (light therapy) will not cure your condition, but it can reduce the size, itchiness and the appearance of psoriasis. Light therapy works by exposing the skin to ultraviolet light on a regular basis and slowing down the excess growth of skin cells, which reduces plague formation. Under medical supervision, you can receive light therapy at your healthcare provider’s office, a designated phototherapy unit, or at home.
Your psoriasis should improve within two to four weeks. But keep in mind that everyone’s skin reacts differently. Although the benefit of treatment varies from patient-to-patient, average remission time is three to 12 months. The possible side effects include mild sunburn, a stinging or itching sensation, an increased likelihood of cold sores (this is more likely if you’ve had them before), as well as premature aging of the skin. Your risk of getting skin cancer also increases with long-term exposure to light therapy.
Systemic Treatments like LeAnn Rimes’
Systemic treatments may be suggested by your healthcare provider if your psoriasis is more persistent and topicals or phototherapy are not helping your condition.
Systemic treatments are not just aimed at the affected skin area, but work throughout your body and are taken orally or by injection or intravenously. “We find that systemic, particularly biologic agents are highly safe and effective,”
says Dr. Stein Gold.
Oral/Intravenous or Injected Medications:
- Methotrexate. (Taken orally by pills or liquid form, intravenously or by injection) Approved by the FDA more than four decades ago, this classic systemic treatment works as an immunosuppressant that inhibits fast dividing cells. It’s typically delivered as one dose or divided into three dosages over a 24-hour period. The most common side effects are fatigue, nausea, and headaches.
- Apremilast (Otezia). (Taken orally by pill or in liquid form) This medication treats psoriasis and psoriatic arthritis by regulating inflammation within the cell and inhibiting an enzyme known as phosphodiesterase 4 (PDE4). This is the enzyme that controls much of the inflammatory action within cells, which can affect the level of inflammation associated with psoriasis. Side effects include nausea, diarrhea, headache and upper respiratory tract
- Cyclosporine. (Taken orally by pill or liquid form) This fast-acting medication is aimed at severe, difficult to manage and acute flares. Because of the drug’s potential for serious side effects including kidney issues and high blood pressure, it isn’t prescribed as a long-term treatment.
- Biologics. (Administered by injection or IV transfusion) Unlike other systemic medications, biologics only target specific parts of the immune system and are exclusively injected or delivered through transfusion. The biologics used to treat psoriasis work by blocking the action of a specific type of immune cell called a T-cell. Or, they block proteins in the immune system that play a big part in psoriasis. Although biologic medications are administered either intravenously or by injection, they are not a one-shot deal. Treatments often need to continue as long as the medication is working. Biologics have another downside: they can increase your risk of infection such as a fever, cough, or flu-like symptoms. If you’re taking a biologic and you are experiencing a side effect, contact your healthcare provider right away.
- There are several different types of biologics available to treat psoriasis, including:
- TNF-Alfa Inhibitors (Enbrel, Humira, Cimzia, Remicade, and Simponi)
- IL- 17 Inhibitors (Cosentyx, Siliq, and Talz)
- IL-23 Inhibitors (Ilumya, Skyrizi, Tremfya)
- IL12/IL23 Inhibitors (Stelara)
- T-Cell Inhibitors (Orencia)
- There are several different types of biologics available to treat psoriasis, including:
“You can help your doctor make more informed decisions regarding your treatment by sharing information about your condition and your medical history,” Dr. Stein Gold said. “For example, whether you have a history of heart disease, IBS, MS or prior cancers and if you have arthritis or a history of infections including TB or hepatitis.”
A Newer Option
On top of the medications listed above, there is also a newer option for people with moderate to severe plaque psoriasis called SOTYKTU. SOTYKTU, or deucravacitinib, is an FDA-approved oral medication that has less potential side effects and “box warnings” compared to existing drugs on the market.
“So deucravacitinib is a pill that blocks an enzyme called TYK2, which is responsible for the generation of certain cytokines that play a key role in the development of psoriasis,” Dr. Mark G. Lebwohl, Dean of Clinical Therapeutics at the Kimberly and Eric J. Waldman Department of Dermatology at the Icahn School of Medicine at Mount Sinai, told SurvivorNet. “So by blocking TYK2, they reduce those cytokines and psoriasis improves. It is remarkable in that it is a pill that has biologic type efficacy.
“There are two other pills that are quite effective, Cyclosporine (Gengraf, Neoral, SandIMMUNE) and Methotrexate (Trexall), but they have a lot of side effects and a lot of box warnings… Deucravacitinib has no box warnings, and very good efficacy—similar to biologics. Great efficacy without having to worry about side effects as much as you do with the other drugs.”
When talking about this exciting newer option, Dr. Lebwohl made sure to emphasize the importance of treating plaque psoriasis in general.
“Untreated plaque psoriasis can damage interior organs, not just the skin, not just psychological,” Dr. Lebwohl said. “Patients with bad psoriasis have an increase in heart attacks, increase in a form of arthritis called psoriatic arthritis, and it affects may other organs as well.
“So, if patients have symptoms of psoriasis, they should not be ignored, they should be treated.”
Contributing: Robin Westen