Breaking the Silence on Psoriasis
Psoriasis is a chronic, immune-mediated inflammatory skin disorder characterised by the rapid proliferation of keratinocytes, resulting in thickened, scaly, and erythematous plaques. It is a non-contagious condition with a multifactorial origin involving genetic predisposition, environmental triggers, and immune system dysregulation.
Psoriasis symptoms and causes
The most common form, plaque psoriasis (psoriasis vulgaris), typically presents as well-demarcated, silvery-scaly lesions, predominantly over the scalp, elbows, knees, and lower back. Other clinical variants include guttate, inverse, pustular, and erythrodermic psoriasis, each with distinct morphological and clinical features. Psoriasis follows a relapsing-remitting course and may significantly impair quality of life due to physical discomfort, visible disfigurement, and associated psychosocial stress. In up to 30% of cases, it is with psoriatic arthritis, a seronegative inflammatory arthropathy.
The disease is also linked with systemic comorbidities such as metabolic syndrome, cardiovascular disease, insulin resistance, and depression, highlighting its status as a systemic inflammatory condition rather than a disease limited to the skin. Although without a cure, treatment strategies aim to reduce inflammation, control skin cell turnover, and manage associated symptoms. These include topical therapies, phototherapy, systemic immunosuppressants, and recently targeted biologic agents that modulate specific immune pathways involved in the disease process.
What are biologic therapies, and how do they differ from conventional treatments for psoriasis?
Biologic therapies are advanced, targeted treatments derived from living organisms or their components. In psoriasis treatment, these treatments block key immune pathways that drive inflammation and rapid skin cell turnover.
Key Characteristics of Biologic Therapies:
- Target specific cytokines (e.g. TNF-α, IL-17, IL-23) involved in the psoriatic immune response
- Administered via injection or intravenous infusion
- Used mainly for moderate to severe psoriasis or in cases unresponsive to conventional treatments
Differences from Conventional Treatments:
- Mechanism of Action
- Biologics: Selectively inhibit specific immune system molecules
- Conventional: General immune suppression (e.g. methotrexate, cyclosporine) or symptom control (e.g. topical corticosteroids)
- Precision
- Biologics: Highly targeted, leading to fewer off-target effects
- Conventional: Broad action, often associated with more systemic side effects.
- Onset and Duration
- Biologics: May show significant improvement within weeks; long-lasting control with regular use
- Conventional: Often slower onset; may require continuous use for maintenance.
- Safety and Monitoring
- Biologics: Require screening for infections (e.g. TB) before initiation; generally safer for long-term use under supervision
- Conventional: Can affect liver, kidneys, and blood counts; frequent monitoring needed
- Use in Comorbid Conditions
- Biologics: Also effective for psoriatic arthritis and other inflammatory diseases
- Conventional: Limited benefit beyond skin symptoms
Biologic therapies have revolutionised the management of psoriasis by offering more effective and safer long-term options, especially for patients with extensive or treatment-resistant disease.
What are the main targets of these new biologics?
Main targets of new biologic therapies for psoriasis:
- TNF-alpha
- A key substance in the body that causes inflammation
- Blocking it helps reduce redness, swelling, and scaling of the skin
- IL-17
- A protein that tells skin cells to grow too fast and causes thick, scaly patches
- Biologics that block IL-17 can quickly clear the skin
- IL-23
- A messenger that keeps the immune system overactive in psoriasis
- Blocking it helps stop the cycle of flare-ups and skin damage
These biologics work by calming down specific parts of the immune system rather than suppressing it entirely. This process makes them more effective and safer than older medicines for long-term use.
How effective are these new biologics compared to older treatments?
The new biologic therapies for psoriasis are significantly more effective than older treatments, especially for moderate to severe cases.
Comparison of Effectiveness:
- Faster Skin Clearance
- New biologics often clear 75–90% of skin lesions within 12–16 weeks
- Older treatments like methotrexate or cyclosporine take longer and offer lower clearance rates.
- Longer Lasting Results
- Many patients maintain clear skin for months or years with regular use of biologics.
- Conventional treatments often require frequent adjustments or may lose effectiveness over time.
- Higher Patient Satisfaction
- Biologics improve quality of life, reduce itching, and restore confidence.
- Patients report fewer side effects compared to traditional drugs.
- Better Safety Profile
- Targeted action reduces risks to the liver, kidneys, and blood cells.
- Conventional treatments need frequent monitoring and can harm organs with long-term use.
Examples:
- Secukinumab and Ixekizumab (IL-17 blockers) often show skin clearance rates above 85%
- Guselkumab and Risankizumab (IL-23 blockers) provide long-term control with fewer injections.
- In contrast, older drugs like methotrexate clear skin in only about 40–60% of patients and may cause serious side effects.
In short, new biologics offer quicker relief, better skin outcomes, and improved safety, especially for those with stubborn or widespread psoriasis.
How quickly do patients respond to these therapies, and how long do the effects last?
Patients typically begin to show clinical improvement within two to four weeks of initiating biologic therapy for psoriasis. Most achieve significant skin clearance, especially when treated with IL-17 inhibitors such as secukinumab or ixekizumab, which shows a rapid onset of action by twelve to sixteen weeks. Even after consistent administration, biologics maintain therapeutic effects over extended periods.
IL-23 inhibitors like guselkumab and risankizumab provide durable disease control, often requiring dosing only once every eight to twelve weeks. Long-term clinical trials confirm sustained efficacy for over three to five years. Symptoms usually return gradually over several weeks or months. However, resuming treatment typically restores disease control effectively without adverse outcomes after the discontinuation of therapy.
What are the side effects or risks associated with the newer biologics?
Newer biologics for psoriasis are generally well-tolerated, but they carry risks and potential side effects due to their impact on the immune system.
The most common side effects include injection site reactions such as redness, swelling, or mild pain. Some patients may experience upper respiratory infections like sore throat, nasal congestion, or cough, as these drugs slightly lower the body’s immune defences.
More serious but less common risks include an increased chance of infections like tuberculosis or fungal infections, especially in those with a weakened immune system. Patients require screening for latent infections before starting therapy. In rare cases, biologics may trigger inflammatory bowel disease or worsen existing conditions.
Some biologics, particularly IL-17 inhibitors, may slightly increase the risk of fungal skin infections like candida. Though uncommon, allergic reactions such as rash, itching, or difficulty breathing can occur and may require drug discontinuation. Overall, newer biologics offer a favourable safety profile compared to older systemic treatments. However, proper medical screening and regular monitoring remain essential to minimise risks and ensure safe, long-term use.
Conclusion:
Psoriasis is a chronic, immune-mediated disorder of skin and overall health. An overactive immune response accelerates skin cell turnover, causing inflamed, scaly plaques. Drs recognise it as more than a dermatological issue, as it often coexists with systemic conditions such as psoriatic arthritis, cardiovascular disease, and depression.
Healthcare providers must diagnose psoriasis early, assess its severity, and tailor treatment based on individual needs. Advances in therapy, especially with targeted biologics, now offer patients improved symptom control and quality of life. Ongoing research continues to enhance our understanding of psoriasis and refine long-term management strategies.
With a proactive, patient-centred approach, clinicians can effectively manage psoriasis, reduce complications, and improve long-term outcomes.
.