If you have psoriasis, a disease that causes raised, red plaques and silvery scales on the skin, you may be wondering if biologics are right for you. While many of today’s drugs are made by combining chemicals to create new compounds, biologics are grown, often with the help of living cells. They work by targeting specific proteins to tamp down an overactive immune system. Currently, 11 different biologics are FDA approved as psoriasis treatments.
Biologic therapy can improve psoriasis symptoms dramatically — many people achieve clear or nearly clear skin. Given by injection or infusion, they also tend to have fewer side effects than older psoriasis medications that shut down more of the immune system.
It’s a quality-of-life question
Mild cases don’t require a biologic. “Mild psoriasis means that once in a while, your symptoms are a minor annoyance,” said Dr. John Minni, a board-certified dermatologist at Water’s Edge Dermatology who is also board certified in family practice. If that’s true for you, a topical cream such as a corticosteroid or retinoid may be all you need.
You may be a good candidate for a biologic, however, if you have moderate to severe psoriasis. “Basically, that’s anyone whose psoriasis gets in the way of their daily life,” said Dr. Minni. “If your symptoms bother you every day, you should see a dermatologist who is comfortable prescribing biologics and ask about that option.”
Biologics may also be the best type of medication for you if:
- You have psoriasis in hard-to-treat areas, such your scalp, nails or genitals
- You also have psoriatic arthritis, a chronic inflammatory disease that damages both joints and skin
- Your current treatment isn’t working well for you
An under-prescribing problem
Although the first biologic for psoriasis was approved more than 15 years ago, some people who could benefit from these drugs still aren’t offered the option. One reason, according to Dr. Minni: Doctors who don’t specialize in treating skin conditions (and even some who do) may not fully appreciate the physical and emotional effects of psoriasis. “Sometimes primary care doctors just see a skin rash and prescribe a cream,” he said.
The severity of psoriasis is often calculated as a percentage of skin affected. At Water’s Edge Dermatology, doctors also consider how the disease affects the patient’s life.
“I focus less on numbers and more on whether my patient is happy with the results of their current treatment. If they’re not, it’s time to discuss biologics,” said Dr. Minni.
Benefits that are more than skin deep
Some people with psoriasis — about 20% to 30% — also have or will have psoriatic arthritis. Biologics are often the best treatment option for psoriatic arthritis, according to Dr. Minni.
“Considering biologics for people with psoriatic arthritis is very important because some of these medicines can help prevent disabling joint damage,” he said. “This is especially important for people who are diagnosed with psoriatic arthritis at younger ages and have years to either add to or prevent damage.”
Psoriasis and psoriatic arthritis increase the risk for other serious conditions, including heart disease, diabetes and depression. Biologics may lower some of these risks.
Powerful medications with fewer side effects
As with many medications that reduce immune system activity, most biologics can increase the risk of infection. They may also very slightly increase the risk of certain cancers. But they spare patients the side effects commonly seen with some other psoriasis drugs.
Methotrexate, for example, can cause liver and lung damage along with mouth sores, vomiting and fatigue. Cyclosporine can damage the kidneys and cause high blood pressure, and treatment guidelines advise against long-term use because of these and other risks. Neither drug is safe for use by women who are pregnant or planning to become pregnant.
The risks and benefits of different biologics vary. Before deciding on the best one for you, your doctor should consider your medical history and current health, including any other conditions you have.
“We have a whole smorgasbord of biologic options now, and if a patient has certain risks, we can usually find a safe option for them,” said Dr. Minni. “I tell my patients that it’s very rare for me to have to stop a biologic because of side effects.”
He noted that biologic treatment options continue to expand for patients of all ages.
“The FDA recently approved a biologic for children with psoriasis who are as young as 6,” said Dr. Minni. “We now have the ability to treat people in a wide spectrum of age groups with these very safe medicines.”
Article Written By: Emily Delzell, a freelance health and medical journalist based in Birmingham, Alabama.
Medical Review By: John Minni, DO
