Dermatologists at NYU Langone understand that psoriasis may affect the way you feel about your appearance. If topical medications and light therapy have not been successful in clearing your skin, your doctor may prescribe medication that is taken by mouth or injected. New medications, including those called biologics, may slow an overactive immune system’s production of skin cells and prevent psoriasis lesions from forming.
If you have psoriatic arthritis, medications taken by mouth or injection may relieve stiffness and pain in the joints, as well as minimize the appearance of lesions on the skin. If your NYU Langone dermatologist suspects that you have psoriatic arthritis, he or she may refer you to a rheumatologist, a doctor who specializes in arthritis, for additional care.
The decision to start treatment is one that you and your dermatologist make based on the location and type of lesions, how much of your body is affected, and how significantly psoriasis affects your daily life.
Some medications carry a risk of serious side effects that your doctor can discuss with you before moving forward with treatment. Over time, your doctor may adjust the type and dosage of medication to maximize its effectiveness and minimize the possibility of side effects.
If psoriasis symptoms are resistant to topical corticosteroids, or if a lesion is located in the scalp or another area that’s hard to treat topically, your dermatologist may inject a corticosteroid solution directly into the lesion. An injected corticosteroid may take effect more quickly than topical treatment to reduce itching, redness, and swelling.
You receive the injection in the doctor’s office and may get more than one during an appointment. The doctor monitors the concentration given, as well as the total amount over time to avoid side effects. Most of the time, local anesthesia is not necessary and the injections cause little discomfort.
Biologic medications, commonly called biologics, block a specific immune system response that leads to inflammation, which causes the overproduction of skin cells. A slowed rate of skin cell growth means that fewer new psoriasis lesions form.
Although research in this area is still in the early stage, recent evidence suggests that people with psoriasis treated with a biologic medication had lower levels of inflammation throughout the body, which led to improvements in their overall health such as a reduced risk of having a heart attack. Biologics are often part of a long-term treatment plan for people with psoriasis.
Current biologics are administered by injection into the skin; your doctor may teach you or a family member to give the injections at home. Some are injected weekly, and others every other week. The frequency of the injections depends on the type of medication.
Some biologics are injected at longer intervals, usually at three months, and are usually administered by your dermatologist in the office.
Occasionally, a dermatologist recommends biologics that are given by intravenous (IV) infusion. NYU Langone has infusion centers in both Manhattan and Brooklyn. To perform this procedure, a nurse inserts a slim, flexible tube called a catheter into a vein in the arm. Infusion usually takes about an hour.
Immunomodulators suppress or regulate certain aspects of the immune system that affect the overproduction of skin cells. By slowing the rate at which skin cells multiply and accumulate on the skin surface, these medications may prevent the development of new lesions.
There are several types of immunomodulators that your dermatologist may discuss as treatment options. Most of these are available as pills taken by mouth once a day. Other medications may be injected, either by a dermatologist in a doctor’s office or by yourself at home.
It may take three to six months for an immunomodulator to start working. During this time, your doctor may recommend topical medication or phototherapy to help you manage psoriasis symptoms. He or she also monitors how well the medication is working in periodic follow-up visits. If this medication alleviates your symptoms, therapy may continue for years.