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 PSORIASIS Psoriasis is a complex, chronic, multifactorial, inflammatory disease that involves hyperproliferation of the keratinocytes in the epidermis, with an increase in the epidermal cell turnover rate. Environmental, genetic, and immunologic factors appear to play a role. The disease most commonly manifests on the skin of the elbows, knees, scalp, lumbosacral areas, intergluteal clefts, and glans penis. In up to 30% of patients, the joints are also affected. Treatment is based on surface areas of involvement, body site(s) affected, the presence or absence of arthritis, and the thickness of the plaques and scale.(1) SYMPTOMS

The signs and symptoms of psoriasis can vary depending on the type of psoriasis you have. The 5 most common symptoms of psoriasis include: 

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Rashes or patches of red, inflamed skin, often covered with loose, silver-colored scales. In severe cases, the plaques will grow and merge into one another, covering large areas. Itchy, painful skin that can crack or bleed. Small areas of bleeding where the involved skin is scratched. Problems with your fingernails and toenails, including discoloration and pitting. The nails may also begin to crumble or detach from the nail bed. Scaly plaques on the scalp.(2)

TYPES OF PSORIASIS PLAQUE PSORIASIS Plaque psoriasis is the most common form of the disease and appears as raised, red patches covered with a silvery white buildup of dead skin cells. These patches or plaques most often show up on the scalp, knees, elbows and lower back. They are often itchy and painful, and they can crack and bleed. GUTTATE Guttate [GUH-tate] psoriasis is a form of psoriasis that appears as small, dot-like lesions. Guttate psoriasis often starts in childhood or young adulthood, and can be triggered by a strep infection. This is the second-most common type of psoriasis, after plaque psoriasis. About 10 percent of people who get psoriasis develop guttate psoriasis INVERSE

Inverse psoriasis shows up as very red lesions in body folds, such as behind the knee, under the arm or in the groin. It may appear smooth and shiny. Many people have another type of psoriasis elsewhere on the body at the same time. PISTILUR

Pustular [PUHS-choo-lar] psoriasis in characterized by white pustules (blisters of noninfectious pus) surrounded by red skin. The pus consists of white blood cells. It is not an infection, nor is it contagious. Pustular psoriasis can occur on any part of the body, but occurs most often on the hands or feet.

ERYTRODERMIC

Erythrodermic [eh-REETH-ro-der-mik] psoriasis is a particularly severe form of psoriasis that leads to widespread, fiery redness over most of the body. It can cause severe itching and pain, and make the skin come off in sheets. It is rare, occurring in 3 percent of people who have psoriasis during their life time. It generally appears on people who have unstable plaque psoriasis.

Psoriasis can show up anywhere—on the eyelids, ears, mouth and lips, skin folds, hands and feet, and nails. The skin at each of these sites is different and requires different treatments. Light therapy or topical treatments are often used when psoriasis is limited to a specific part of the body. However, doctors may prescribe oral or injectable drugs if the psoriasis is widespread or greatly affects your quality of life. Effective treatments are available, no matter where your psoriasis is located.

Scalp Scalp psoriasis can be very mild, with slight, fine scaling. It can also be very severe with thick, crusted plaques covering the entire scalp. Psoriasis can extend beyond the hairline onto the forehead, the back of the neck and around the ears.

Face Facial psoriasis most often affects the eyebrows, the skin between the nose and upper lip, the upper forehead and the hairline. Psoriasis on and around the face should be treated carefully because the skin here is sensitive.

Hands, Feet and Nails Treat sudden flares of psoriasis on the hands and feet promptly and carefully. In some cases, cracking, blisters and swelling accompany flares. Nail changes occur in up to 50 percent of people with psoriasis and at least 80 percent of people with psoriatic arthritis.

Genital Psoriasis The most common type of psoriasis in the genital region is inverse psoriasis, but other forms of psoriasis can appear on the genitals, especially in men. Genital psoriasis requires careful treatment and care.

Skin Folds Inverse psoriasis can occur in skin folds such as the armpits and under the breasts. This form of psoriasis is frequently irritated by rubbing and sweating. SIGNS AND SYMPTOMS

Worsening of a long-term erythematous scaly area Sudden onset of many small areas of scaly redness Recent streptococcal throat infection, viral infection, immunization, use of antimalarial drug, or trauma Pain (especially in erythrodermic psoriasis and in some cases of traumatized plaques or in the joints affected by psoriatic arthrit Pruritus (especially in eruptive, guttate psoriasis) Afebrie (except in pustular or erythrodermic psoriasis, in which the patient may have high fever)

Dystrophic nails, which may resemble onychomycosis Long-term, steroid-responsive rash with recent presentation of joint pain Joint pain (psoriatic arthritis) without any visible skin findings(3) ETHIOLOGY

Psoriasis involves hyperproliferation of the keratinocytes in the epidermis, with an increase in the epidermal cell turnover rate. The cause of the loss of control of keratinocyte turnover is unknown. However, environmental, genetic, and immunologic factors appear to play a role. ENVIRONMENTAL FACTORS Many factors besides stress have also been observed to trigger exacerbations, including cold, trauma, infections (eg, streptococcal, staphylococcal, human immunodeficiency virus), alcohol, and drugs (eg, iodides, steroid withdrawal, aspirin, lithium, beta-blockers, botulinum A, antimalarials). One study showed an increased incidence of psoriasis in patients with chronic gingivitis. Satisfactory treatment of the gingivitis led to improved control of the psoriasis but did not influence longterm incidence, highlighting the multifactorial and genetic influences of this disease.[11] Hot weather, sunlight, and pregnancy may be beneficial, although the latter is not universal. Perceived stress can exacerbate psoriasis. Some authors suggest that psoriasis is a stress-related disease and offer findings of increased concentrations of neurotransmitters in psoriatic plaques. GENETIC FACTORS Patients with psoriasis have a genetic predisposition for the disease. The gene locus is determined. The triggering event may be unknown in most cases, but it is likely immunologic. The first lesion commonly appears after an upper respiratory tract infection. Psoriasis is associated with certain human leukocyte antigen (HLA) alleles, the strongest being human leukocyte antigen Cw6 (HLA-Cw6). In some families, psoriasis is an autosomal dominant trait. Additional HLA antigens that have shown associations with psoriasis and psoriatic subtypes include HLA-B27, HLAB13, HLA-B17, and HLA-DR7.[12] A multicenter meta-analysis confirmed that deletion of 2 late cornified envelope (LCE) genes, LCE3C and LCE3B, is a common genetic factor for susceptibility to psoriasis in different populations.[13] Obesity is another factor associated with psoriasis. Whether it is related to weight alone, genetic predisposition to obesity, or a combination of the 2 is not certain. Onset or worsening of psoriasis with weight gain and/or improvement with weight loss is observed.

IMMUNOLOGY FACTORS Evidence suggests that psoriasis is an autoimmune disease. Studies show high levels of dermal and circulating TNF-α. Treatment with TNF-α inhibitors is often successful. Psoriatic lesions are associated with increased activity of T cells in the underlying skin. Psoriasis is related to excess T-cell activity. Experimental models can be induced by stimulation with streptococcal superantigen, which cross-reacts with dermal collagen. This small peptide has been shown to cause increased activity among T cells in patients with psoriasis but not in control groups. Some of the newer drugs used to treat severe psoriasis directly modify the function of lymphocytes. Also of significance is that 2.5% of those with HIV develop worsening psoriasis with decreasing CD4 counts. This is paradoxical, in that the leading hypothesis on the pathogenesis of psoriasis supports Tcell hyperactivity and treatments geared to reduce T-cell counts help reduce psoriasis severity. This finding is possibly explained by a decrease in CD4 T cells, which leads to overactivity of CD8 T cells, which drives the worsening psoriasis. The HIV genome may drive keratinocyte proliferation directly. HIV associated with opportunistic infections may see increased frequency of superantigen exposure leading to similar cascades as above mentioned. Guttate psoriasis often appears following certain immunologically active events, such as streptococcal pharyngitis, cessation of steroid therapy, and use of antimalarial drugs. PATHOPHYSIOLOGY Psoriasis is a complex, multifactorial disease that appears to be influenced by genetic and immunemediated components. This is supported by the successful treatment of psoriasis with immunemediating, biologic medications The pathogenesis of this disease is not completely understood. Multiple theories exist regarding triggers of the disease process including an infectious episode, traumatic insult, and stressful life event. In many patients, no obvious trigger exists at all. However, once triggered, there appears to be substantial leukocyte recruitment to the dermis and epidermis resulting in the characteristic psoriatic plaques. Specifically, the epidermis is infiltrated by a large number of activated T cells, which appear to be capable of inducing keratinocyte proliferation. This is supported by histologic examination and immunohistochemical staining of psoriatic plaques revealing large populations of T cells within the psoriasis lesions. One report calculated that a patient with 20% body surface area affected with psoriasis lesions has around 8 billion blood circulating T cells compared with approximately 20 billion T cells located in the dermis and epidermis of psoriasis plaques. Ultimately, a ramped-up, deregulated inflammatory process ensues with a large production of various cytokines (eg, tumor necrosis factor-α [TNF-α], interferon-gamma, interleukin-12). Many of the clinical features of psoriasis are explained by the large production of such mediators. Interestingly, elevated levels of TNF-α specifically are found to correlate with flares of psoriasis. One study adds further support that T-cell hyperactivity and the resulting proinflammatory mediators (in this case IL-17/23) play a major role in the pathogenesis of psoriasis.

Key findings in the affected skin of patients with psoriasis include vascular engorgement due to superficial blood vessel dilation and altered epidermal cell cycle. Epidermal hyperplasia leads to an accelerated cell turnover rate (from 23 d to 3-5 d), leading to improper cell maturation. Cells that normally lose their nuclei in the stratum granulosum retain their nuclei, a condition known as parakeratosis. In addition to parakeratosis, affected epidermal cells fail to release adequate levels of lipids, which normally cement adhesions of corneocytes. Subsequently, poorly adherent stratum corneum is formed leading to the flaking, scaly presentation of psoriasis lesions, the surface of which often resembles silver scales. Conjunctival impression cytology demonstrated a higher incidence of squamous metaplasia, neutrophil clumping, and nuclear chromatin changes in patients with psoriasis.(1) DIAGNOSIS

There are no special blood tests or tools to diagnose psoriasis. A dermatologist (doctor who specializes in skin diseases) or other health care provider usually examines the affected skin and determines if it is psoriasis. Doctor may take a piece of the affected skin (a biopsy) and examine it under the microscope. When biopsied, psoriasis skin looks thicker and inflamed when compared to skin with eczema. Doctor also will want to learn about your family history. About one-third of people with psoriasis have a family member with the disease. PSORIASIS IN CHILDREN Every year, roughly 20,000 children under 10 years of age are diagnosed with psoriasis. Sometimes it is misdiagnosed because it is confused with other skin diseases. Symptoms include pitting and discoloration of the nails, severe scalp scaling, diaper dermatitis or plaques similar to that of adult psoriasis on the trunk and extremities. Psoriasis in infants is uncommon, but it does occur. Only close observation can determine if an infant has the disease. Some young people report the onset of psoriasis following an infection, particularly strep throat. One-third to one-half of all young people with psoriasis may experience a flareup two to six weeks after an earache, strep throat, bronchitis, tonsillitis or a respiratory infection. Areas of skin that have been injured or traumatized are occasionally the sites of psoriasis, know as the “Koebner [keb-ner] phenomenon.” However, not everyone who has psoriasis develops it at the site of an injury.

TREATMENT BIOLOGICS Biologic drugs, or "biologics," are given by injection (shot) or intravenous (IV) infusion (a slow drip of medicine into your vein). A biologic is a protein-based drug derived from living cells cultured in a laboratory. While biologics have been used to treat disease for more than 100 years, modern-day techniques have made biologics much more widely available as treatments in the last decade. Biologics are different from traditional systemic drugs that impact the entire immune system. Biologics, instead, target specific parts of the immune system. The biologics used to treat psoriatic disease block the action of a specific type of immune cell called a T cell, or block proteins in the immune system, such as tumor necrosis factor-alpha (TNF-alpha), interleukin 17-A, or interleukins 12 and 23. These cells and proteins all play a major role in developing psoriasis and psoriatic arthritis. QThe following are biologics approved for psoriatic disease. Some are approved for psoriasis, psoriatic arthritis.

Tumor necrosis factor-alpha (TNF-alpha) inhibitors

Cimzia (certolizumab pegol), Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab), Simponi (golimumab) and Simponi Aria (golimumab) are drugs that block TNF-alpha. TNF-alpha is a cytokine, or a protein, that prompts the body to create inflammation. In psoriasis and psoriatic arthritis, there is excess production of TNFalpha in the skin or joints. That leads to the rapid growth of skin cells and/or damage to joint tissue. Blocking TNF-alpha production helps stop the inflammatory cycle of psoriatic disease.

Interleukin 12 and 23 (IL-12/23) inhibitors Stelara (ustekinumab) works by selectively targeting the proteins, or cytokines, interleukin-12 (IL-12) and interleukin 23 (IL-23). Interleukins-12/23 are associated with psoriatic inflammation.

Interleukin 17 (IL-17) inhibitors Cosentyx (secukinumab), and Taltz (ixekizumab) block a cytokine, or protein, called interleukin17 (IL-17), which is involved in inflammatory and immune responses. Siliq (brodalumab) blocks the receptor of this cytokine, IL-17 receptor A (IL-17 RA) through which IL-17 mediates the inflammatory and immune responses. There are elevated levels of IL-17 in psoriatic plaques. By interfering with IL-17 signaling, Cosentyx, Siliq and Taltz interrupt the inflammatory cycle of psoriasis. This can lead to improvement in symptoms for many people who take it.

T cell inhibitors Orencia (abatacept) targets T cells in the immune system. T cells are a type of white blood cell that is involved in the inflammation in psoriasis and psoriatic disease. Orencia inhibits T cells from becoming activated to reduce inflammation.

Interleukin 23 (IL-23) inhibitors Tremfya (guselkumab) and Ilumya (tildrakizumab-asmn) work by targeting interleukin 23 (IL-23). This cytokine is linked with inflammation in psoriasis and psoriatic arthritis. Tremfya and Ilumya work to reduce psoriatic symptoms and slow disease progression.

Traditional Systemic Medications Systemic medications are prescription drugs that work throughout the body. They are usually used for individuals with moderate to severe psoriasis and psoriatic arthritis. Systemic medications are also used in those who are not responsive or are unable to take topical

medications or UV light therapy.

Systemic psoriasis drugs are taken by mouth in liquid or pill form or given by injection. Systemics have been used for more than 10 years.

Acitretin (Soriatane) Cyclosporine

Methotrexate Off-label systemics

Topical Treatments Topical treatments—medications applied to the skin—are usually the first line of defense in treating psoriasis. Topicals slow down or normalize excessive cell reproduction and reduce psoriasis inflammation.

There are several effective topical treatments for psoriasis. While many can be purchased over the counter (OTC), others are available by prescription only. Corticosteroids, or just "steroids," are the most frequently used treatment for psoriasis. They are referred to as anti-inflammatory

OTC topicals come in many different forms. Two active ingredients, salicylic acid and coal tar, are approved by the FDA for the treatment of psoriasis. There are other products that contain substances such as aloe vera, jojoba, zinc pyrithione and capsaicin, which are used to moisturize, soothe, remove scale or relieve itching.

Learn more about topical treatments 

OTC topicals

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Topical non-steroid

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Topical steroids

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Seal of Recognition products

Phototherapy Phototherapy or light therapy, involves exposing the skin to ultraviolet light on a regular basis and under medical supervision. Treatments are done in a doctor's office or psoriasis clinic or at home with phototherapy unit. The key to success with light therapy is consistency.

Learn about different types of light therapy. 

Ultraviolet light B (UVB)

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Sunlight

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Psoralen + UVA (PUVA)

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Laser Treatments

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Tanning beds

Ultraviolet light B (UVB)

UVB phototherapy Present in natural sunlight, ultraviolet B (UVB) is an effective treatment for psoriasis. UVB penetrates the skin and slows the growth of affected skin cells. Treatment involves exposing the skin to an artificial UVB light source for a set length of time on a regular schedule. This treatment is administered in a medical setting or at home. There are two types of UVB treatment, broad band and narrow band. The major difference between them is that narrow band UVB light bulbs release a smaller range of ultraviolet light. Narrow-band UVB is similar to broad-band UVB in many ways. Several studies indicate that narrow-band UVB clears psoriasis faster and produces longer remissions than broad-band UVB. It also may be effective with fewer treatments per week than broad-band UVB. During UVB treatment, your psoriasis may worsen temporarily before improving. The skin may redden and itch from exposure to the UVB light. To avoid further irritation, the amount of UVB administered may need to be reduced. Occasionally, temporary flares occur with low-level doses of UVB. These reactions tend to resolve with continued treatment. UVB can be combined with other topical and/or systemic agents to enhance efficacy, but some of these may increase photosensitivity and burning, or shorten remission. Combining UVB with systemic therapies may increase efficacy dramatically and allow for lower doses of the systemic medication to be used.

UVB treatment is offered in different ways. This can include small units for localized areas such as the hands and feet, full body units or handheld units. Some UVB units use traditional UV lamps or bulbs, and others use LED bulbs.

Home UVB phototherapy Treating psoriasis with a UVB light unit at home is an economical and convenient choice for many people. Like phototherapy in a clinic, it requires a consistent treatment schedule. Individuals are treated initially at a medical facility and then begin using a light unit at home. It is critical when doing phototherapy at home to follow a doctor's instructions and continue with regular check-ups. Home phototherapy is a medical treatment that requires monitoring by a health care professional. All phototherapy treatments, including purchase of equipment for home use, require a prescription. Some insurance companies will cover the cost of home UVB equipment. Vendors of home phototherapy equipment often will assist you in working with your insurance company to purchase a unit.

Sunlight Although both UVB and ultraviolet light A (UVA) are found in sunlight, UVB works best for psoriasis. UVB from the sun works the same way as UVB in phototherapy treatments. Short, multiple exposures to sunlight are recommended. Start with five to 10 minutes of noontime sun daily. Gradually increase exposure time by 30 seconds if the skin tolerates it. To get the most from the sun, all affected areas should receive equal and adequate exposure. Remember to wear sunscreen on areas of your skin unaffected by psoriasis. Avoid overexposure and sunburn. It can take several weeks to see improvement. Have your doctor check you regularly for sun damage. Some topical medications can increase the risk of sunburn. These include tazarotene, coal

tar, Elidel (pimecrolimus) and Protopic (tacrolimus). Individuals using these products should talk with a doctor before going in the sun. People who are using PUVA or other forms of light therapy should limit or avoid exposure to natural sunlight unless directed by a doctor.

Psoralen + UVA (PUVA) Like UVB, ultraviolet light A (UVA) is present in sunlight. Unlike UVB, UVA is relatively ineffective unless used with a light-sensitizing medication psoralen, which is administered topically or orally. This process, called PUVA, slows down excessive skin cell growth and can clear psoriasis symptoms for varying periods of time. Stable plaque psoriasis, guttate

psoriasis, and psoriasis of the palms and soles are most responsive to PUVA treatment. The most common short-term side effects of PUVA are nausea, itching and redness of the skin. Drinking milk or ginger ale, taking ginger supplements or eating while taking oral psoralen may prevent nausea. Antihistamines, baths with colloidal oatmeal products or application of topical

products with capsaicin may help relieve itching. Swelling of the legs from standing during PUVA treatment may be relieved by wearing support hose.

Laser Treatments

Excimer laser The excimer laser—recently approved by the Food and Drug Administration (FDA) for treating chronic, localized psoriasis plaques—emits a high-intensity beam of ultraviolet light B (UVB). The excimer laser can target select areas of the skin affected by mild to moderate psoriasis, and research indicates it is a particularly effective treatment for scalp psoriasis. Researchers at the University of Utah, for example, reported in The Journal of Drugs in Dermatology that in a small series of patients, laser treatment, combined with a topical steroid, cleared scalp psoriasis that resisted other treatment. Individual response to the treatment varies. It can take an average of four to 10 sessions to see results, depending on the particular case of psoriasis. It is recommended that patients receive two treatments per week, with a minimum of 48 hours between treatments. There is not yet enough long-term data to indicate how long the improvement will last following a course of laser therapy.

Tanning beds Some people visit tanning salons as an alternative to natural sunlight. Tanning beds in commercial salons emit mostly UVA light, not UVB. The beneficial effect for psoriasis is attributed primarily to UVB light. National Psoriasis Foundation does not support the use of indoor tanning beds as a substitute for phototherapy performed with a prescription and under a doctor's supervision. Read more on the Psoriasis Foundation position on indoor tanning

beds » The American Academy of Dermatology, the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention all discourage the use of tanning beds and sun lamps. Indoor tanning raises the risk of melanoma by 59 percent, according to the American Academy of Dermatology and the World Health Organization. In May 2014, the FDA reclassified sunlamps (which are used in tanning beds and booths) from Class I (low risk) to Class II (moderate risk) products. The FDA can exert more regulatory control over Class II products, according to a press release on the FDA website. The ultraviolet radiation from these devices can damage the skin, cause premature aging and increase the risk of skin cancer.

LIFE STYLE MODIFICATIONS

Life with Psoriasis Living with psoriasis has unique challenges. The good news is health care providers are becoming more aware of the impact psoriasis can have on a person's quality of life. Researchers are focused more now than ever on finding solutions to those challenges.

Learn coping strategies for the most common lifestyle concerns for people with psoriasis.

Stress Reduction Stress is a common trigger for a psoriasis flare. At the same time, a psoriasis flare can cause stress. Learn how to manage stress effectively »

Managing Itch The itch of psoriasis may have a bigger impact on quality of life than the visible effect of the disease. Learn how you can help manage itch »

Relationships It can be difficult talking to friends and family about your psoriasis and how it affects your life. Psoriasis may impact your relationships, but it doesn't need to control them. Learn how to manage psoriasis–and your relationships »

Depression People with psoriasis are more likely to become depressed. It's important to look for symptoms of depression and seek treatment if you need it. Learn how to cope with depression »

Work Working with psoriasis and psoriatic arthritis can be challenging. You may need to take time off for doctor appointments or ask for changes to your work environment. Learn more about how to manage your disease in the workplace »

Personalized Support NPF’s Patient Navigation Center provides personalized guidance for people living with psoriasis and psoriatic arthritis. Learn more about our free and confidential services RECENT ADVANCES IN PSORIASIS

New Oral Treatments New oral treatment are small molecule medicines that are taken by mouth. Unlike earlier pills used for psoriasis and psoriatic arthritis, these new oral treatments selectively target molecules inside immune cells. By adjusting the complicated processes of inflammation within the cell, these treatments correct the overactive immune response that causes inflammation in people with psoriasis and psoriatic arthritis, leading to improvement in redness and scaliness as well as joint tenderness and swelling.

Otezla (apremilast) Otezla treats psoriasis and psoriatic arthritis by regulating inflammation within the cell. It inhibits an enzyme known as phosphodiesterase 4 (PDE4). This enzyme controls much of the inflammatory action within cells, which can affect the level of inflammation associated with psoriatic disease.

used Otezla is available as a 30-milligram (mg) tablet. The first five days is a start period, where the dosage will gradually increase until the recommended dose of 30 milligrams twice daily is reached. Otezla is meant to be taken continuously to maintain improvement.

risks There have been rare reports of: 

Gastrointestinal problems, including diarrhea, nausea and vomiting

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Depression

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Weight decrease

Common side effects In clinical trials, the most common side effects were diarrhea, nausea, headache and upper respiratory infection.

Using Otezla with other treatments Otezla can be used with other treatments such as phototherapy or topicals. It has been shown to be safe and effective when taken with methotrexate. Talk to your health care provider about whether using any other treatments with Otezla is right(2)

Biologics

They're medicines made from substances found in living things. Doctors inject these lab-made proteins or antibodies into your skin or

bloodstream. Once inside the body, the drug blocks part of your altered immune system that adds to psoriasis. In general, biologics work on psoriasis because they:  Curb T cells (a form of white blood cell)  Block a substance called tumor necrosis factor-alpha (TNF-alpha), one of the main messenger chemicals in the immune system  Stop a family of your immune system's chemical messengers called interleukins  Bind to proteins that cause inflammation The patches and plaques of psoriasis come after an interaction between your skin cells and white blood cells. Biologics interfere with TNF-alpha or T cells, or they target interleukins. This short-circuits that unhealthy link. This will ease your inflammation. You'll have less growth of thick, scaly skin, too. Biologic medicines approved by the FDA to treat moderate to severe psoriasis include: Adalimumab (Humira), a TNF-alpha-blocking antibody  Adalimumab-adbm (Cyltezo), a biosimilar to Humira  Brodalumab (Siliq), a human antibody against interleukins  Certolizumab pegol (Cimzia), a TNF-alpha blocker  Etanercept (Enbrel), a TNF-alpha blocker  Etanercept-szzs (Erelzi), a biosimilar like Enbrel  Guselkumab (Tremfya), an antibody against interleukins  Infliximab (Remicade), a TNF-alpha blocker  Ixekizumab (Taltz), an antibody that binds to inflammation-causing proteins/interleukins  Secukinumab (Cosentyx), a human antibody against interleukins Ustekinumab (Stelara), a human antibody against interleuins 

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Biologics are good at treating psoriasis. In clinical trials, each of the drugs lowered psoriasis activity by at least 75% in many people. There are some drawbacks, though. Biologics can be expensive. Though they're safe for most people, they could raise your chances of infection, cancer, and other complications. Your doctor will need to keep close tabs on you to make sure you stay healthy. Apremilast (Otezla)

Apremilast is a drug you take by mouth that's approved to treat psoriatic arthritis and plaque psoriasis in adults. It curbs phosphodiesterase-4 (PDE-4), an enzyme that controls inflammation. Side effects include diarrhea, nausea, and headache. Some people in studies who took the drug lost weight. If you use the medicine, it's recommended that you check your weight regularly.(3) 1.Medscape 2.National psoriasis foundation 3.webmd

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proves Quality of Life

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