Researchers have learned a lot more in recent years about psoriasis and the role the immune system plays in this condition. These new discoveries have led to safer, more targeted, and more effective psoriasis treatments.

Despite all of the therapies available, studies show that many people receiving treatment for psoriasis are dissatisfied with their treatment or only modestly satisfied.

If you’re looking to change treatments because your current one is no longer effective or you’re having side effects, it’s a good idea to learn as much as possible about the latest options.

Biologics are made from substances found in living things, such as proteins, sugars, or nucleic acids. Once in the body, these medications block a part of the immune system that contributes to your psoriasis symptoms.

Biologics interfere with the following:

  • tumor necrosis factor alpha (TNF-alpha), which is a protein that promotes inflammation in the body
  • T cells, which are white blood cells
  • interleukins, which are cytokines (small inflammatory proteins) involved in psoriasis

This interference helps ease inflammation.

Risankizumab-rzaa (Skyrizi)

Risankizumab-rzaa (Skyrizi) was approved by the Food and Drug Administration (FDA) in April 2019.

It’s intended for people with moderate to severe plaque psoriasis who are candidates for phototherapy (light therapy) or systemic (body-wide) therapy.

Skyrizi works by blocking the action of interleukin-23 (IL-23).

Each dose consists of two subcutaneous (under the skin) injections. The first two doses are spaced 4 weeks apart. The rest are given once every 3 months.

The main side effects of Skyrizi are:

  • upper respiratory infections
  • reactions at the injection site
  • headache
  • tiredness
  • fungal infections

Certolizumab pegol (Cimzia)

The FDA approved certolizumab pegol (Cimzia) as a psoriasis treatment in May 2018. It had previously been approved to treat conditions like Crohn’s disease and psoriatic arthritis (PsA).

Cimzia treats moderate to severe plaque psoriasis in people who are candidates for phototherapy or systemic therapy. It works by targeting the protein TNF-alpha.

The drug is given as two subcutaneous injections every other week.

The most common side effects of Cimzia are:

  • upper respiratory tract infections
  • rash
  • urinary tract infections (UTIs)

Tildrakizumab-asmn (Ilumya)

Tildrakizumab-asmn (Ilumya) was FDA-approved in March 2018. It’s used to treat plaque psoriasis in adults who are candidates for phototherapy or systemic therapy.

The drug works by blocking IL-23.

Ilumya is given as subcutaneous injections. The first two injections are spaced 4 weeks apart. From then on, injections are given 3 months apart.

The main side effects of Ilumya are:

  • reactions at the injection site
  • upper respiratory infections
  • diarrhea

Guselkumab (Tremfya)

Guselkumab (Tremfya) was FDA-approved in July 2017. It’s used to treat moderate to severe plaque psoriasis in people who are also candidates for phototherapy or systemic therapy.

Tremfya was the first biologic to target IL-23.

The first two starter doses are given 4 weeks apart. Afterward, Tremfya is given as a subcutaneous injection every 8 weeks.

The more common side effects include:

  • headache
  • upper respiratory infections
  • reactions at the injection site
  • joint pain
  • diarrhea
  • stomach flu

Brodalumab (Siliq)

Brodalumab (Siliq) was FDA-approved in February 2017. It’s intended for people who meet the following criteria:

  • have moderate to severe plaque psoriasis
  • are candidates for phototherapy or systemic therapy
  • their psoriasis doesn’t respond to other systemic therapies

It works by binding to the IL-17 receptor. The IL-17 pathway plays a role in inflammation and is involved in the development of psoriasis plaques.

In clinical trials, participants treated with Siliq were more likely than those who received a placebo to have skin that was considered clear or nearly clear.

Siliq is administered as an injection. If your doctor prescribes the drug, you’ll receive one injection a week for the first 3 weeks. Afterward, you’ll receive one injection every 2 weeks.

Like other biologics, Siliq increases your risk for infection. The label for this drug also has a black box warning about a higher risk of suicidal thoughts and behavior.

People with a history of suicidal behavior or depression should be monitored when taking brodalumab.

Ixekizumab (Taltz)

Ixekizumab (Taltz) was FDA-approved in March 2016 to treat adults with moderate to severe psoriasis. It’s intended for people who are candidates for phototherapy, systemic therapy, or both.

Taltz targets the protein IL-17A.

It’s an injectable drug. You’ll receive two injections on your first day, injections every 2 weeks for the next 3 months, and injections every 4 weeks for the remainder of your treatment.

The approval was based on the results of multiple clinical studies with a total of 3,866 participants. In those studies, most people taking the drug achieved skin that was clear or almost clear.

The more common side effects of Taltz include:

  • upper respiratory infections
  • reactions at the injection site
  • fungal infections

Biosimilars aren’t exact replicas of biologics. Instead, they’re reverse-engineered to produce similar results as biologics.

Like generic drugs, biosimilars are made once the original biologic goes off patent. The advantage of biosimilars is that they often cost a lot less than the original product.

Biosimilars for psoriasis include the following:

Biosimilars to adalimumab (Humira)

  • adalimumab-adaz (Hyrimoz)
  • adalimumab-adbm (Cyltezo)
  • adalimumab-afzb (Abrilada)
  • adalimumab-atto (Amjevita)
  • adalimumab-bwwd (Hadlima)

Biosimilars to etanercept (Enbrel)

  • etanercept-szzs (Erelzi)
  • etanercept-ykro (Eticovo)

Biosimilars to infliximab (Remicade)

  • infliximab-abda (Renflexis)
  • infliximab-axxq (Avsola)
  • infliximab-dyyb (Inflectra)

The Remicade biosimilar Inflectra was the first psoriasis biosimilar to receive FDA approval. It was approved in April 2016.

Inflectra and Renflexis, another Remicade biosimilar, are the only ones currently available for purchase in the United States. This is primarily because the patents held by the biologics’ manufacturers have yet to expire.

Topical treatments, or ones you rub onto your skin, are often the first treatments doctors recommend for psoriasis. They work by reducing inflammation and slowing excess skin cell production.

Halobetasol propionate-tazarotene lotion, 0.01%/0.045% (Duobrii)

In April 2019, the FDA approved halobetasol propionate-tazarotene lotion, 0.01 percent/0.045 percent (Duobrii) for the treatment of plaque psoriasis in adults.

Duobrii is the first lotion to combine a corticosteroid (halobetasol propionate) with a retinoid (tazarotene). The anti-inflammatory corticosteroid clears plaques, while the vitamin A–based retinoid limits the excess growth of skin cells.

Duobrii is applied once a day to affected areas of skin.

The main side effects are:

  • pain at the application site
  • rash
  • folliculitis, or inflamed hair follicles
  • wearing away of the skin where the lotion is applied
  • excoriation, or skin picking

Halobetasol propionate foam, 0.05% (Lexette)

Halobetasol propionate foam, 0.05 percent is a topical corticosteroid that the FDA first approved, as a generic, in May 2018. In April 2019, it became available under the brand name Lexette.

It’s used to treat plaque psoriasis in adults. Its goal is to clear up the skin.

Twice a day, the foam is applied in a thin layer and rubbed into the skin. Lexette can be used for up to 2 weeks.

The most common side effects of Lexette are pain at the application site and headache.

Halobetasol propionate lotion, 0.01% (Bryhali)

Halobetasol propionate lotion, 0.01 percent (Bryhali) was approved by the FDA in November 2018. It’s intended for adults with plaque psoriasis.

Some of the symptoms it helps address are:

  • dryness
  • flaking
  • inflammation
  • plaque buildup

Bryhali is applied daily. The lotion can be used for up to 8 weeks.

The most common side effects include:

  • burning
  • stinging
  • itching
  • dryness
  • upper respiratory tract infections
  • high blood sugar

Betamethasone dipropionate spray, 0.05% (Sernivo)

In February 2016, the FDA approved betamethasone dipropionate spray, 0.05 percent (Sernivo). This topical treats mild to moderate plaque psoriasis in people ages 18 and older.

Sernivo helps relieve psoriasis symptoms like itching, flaking, and redness.

You spray this corticosteroid medicine onto the skin twice a day and gently rub it in. It can be used for up to 4 weeks.

The most common side effects are:

  • itching
  • burning
  • stinging
  • pain at the application site
  • skin atrophy

A few psoriasis drugs that were previously only available for adults have recently been FDA-approved to treat children too.

Calcipotriene foam, 0.005% (Sorilux)

In 2019, the FDA expanded its approvals for a form of vitamin D called calcipotriene foam, 0.005 percent (Sorilux). It’s used for the treatment of plaque psoriasis of the scalp and body.

In May, it received approval for use in children ages 12 to 17 years old. The following November, it was approved to treat plaque psoriasis of the scalp and body in children as young as 4 years old.

Sorilux helps slow abnormal skin cell growth in psoriasis. This foam is applied to affected areas of the skin twice a day for up to 8 weeks. If symptoms don’t improve after 8 weeks, consult your doctor.

The most common side effects are redness and pain at the application site.

Calcipotriene-betamethasone dipropionate foam, 0.005%/0.064% (Enstilar)

In July 2019, the FDA approved calcipotriene-betamethasone dipropionate foam, 0.005 percent/0.064 percent (Enstilar) for use in adolescents between 12 and 17 years old. It’s intended for people with plaque psoriasis.

Calcipotriene slows down skin cell growth, while betamethasone dipropionate helps decrease inflammation.

The foam is applied daily for up to 4 weeks.

The most common side effects include:

  • itching
  • folliculitis
  • rash with raised red bumps or hives
  • worsening psoriasis

Calcipotriene-betamethasone dipropionate topical suspension, 0.005%/0.064% (Taclonex)

In July 2019, calcipotriene-betamethasone dipropionate topical suspension, 0.005 percent/0.064 percent (Taclonex) was also FDA-approved for use in 12- to 17-year-olds with plaque psoriasis of the body.

The topical suspension had previously been FDA-approved for 12- to 17-year-olds with plaque psoriasis of the scalp. A Taclonex ointment had previously been FDA-approved for adolescents and adults with plaque psoriasis.

Taclonex topical suspension is applied daily for up to 8 weeks. For 12- to 17-year-olds, the maximum weekly dosage is 60 grams (g). The maximum weekly dosage for adults is 100 g.

The most common side effects include:

  • itching
  • burning
  • irritation
  • redness
  • folliculitis

Ustekinumab (Stelara)

In October 2017, the FDA approved ustekinumab (Stelara) for adolescents 12 years old and up. It can be used for young people with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy.

The approval came after a 2015 study found that the drug significantly cleared the skin after 3 months. In terms of skin clearance and safety, results were similar to those seen in adults.

Stelara blocks two proteins that are key to the inflammatory process, IL-12 and IL-23.

It’s given as a subcutaneous injection. Dosing is based on body weight:

  • Adolescents who weigh less than 60 kilograms (132 pounds) get 0.75 milligrams (mg) per kilogram of weight.
  • Adolescents who weigh between 60 kg (132 lbs.) and 100 kg (220 lbs.) get a 45-mg dose.
  • Adolescents who weigh more than 100 kg (220 lbs.) get 90 mg, which is the standard dose for adults of the same weight.

The first two doses are given 4 weeks apart. After that, the drug is given once every 3 months.

The most common side effects are:

  • colds and other upper respiratory tract infections
  • headache
  • tiredness

Etanercept (Enbrel)

In November 2016, the FDA approved etanercept (Enbrel) to treat chronic moderate to severe plaque psoriasis in children 4 to 17 years old who are candidates for phototherapy or systemic therapy.

Enbrel has been approved to treat adults with plaque psoriasis since 2004 and to treat children with juvenile idiopathic arthritis (JIA) since 1999.

This injectable drug works by reducing the activity of TNF-alpha.

A 2016 study of nearly 70 children ages 4 to 17 years old found that Enbrel was safe and kept working for up to 5 years.

Each week, children and teens receive 0.8 mg of the drug per kilogram of their body weight. The maximum dose their doctor will prescribe is 50 mg per week, which is the standard dose for adults.

The most common side effects are reactions at the injection site and upper respiratory tract infections.

Other drugs are nearing FDA approval.

Bimekizumab

Bimekizumab is an injectable biologic drug that’s being tested as a treatment for chronic plaque psoriasis. It works by blocking IL-17.

Bimekizumab is currently in phase III studies. So far, research has shown it to be safe and effective.

In the BE SURE clinical trial, bimekizumab was more effective than adalimumab (Humira) at helping people attain at least a 90 percent improvement in scores used to measure disease severity.

Calcipotriene-betamethasone dipropionate cream, 0.005%/0.064% (Wynzora)

In 2019, a new drug application was submitted to the FDA for Wynzora. Wynzora is a once-daily cream that combines calcipotriene and betamethasone dipropionate.

In a phase III study, Wynzora was more effective at clearing the skin after 8 weeks than Taclonex topical suspension and cream.

Wynzora has the advantage of being nongreasy, which the study participants found to be more convenient.

JAK inhibitors

JAK inhibitors are another group of disease-modifying drugs. They work by targeting pathways that help the body make more inflammatory proteins.

They’re already used to treat:

  • psoriatic arthritis
  • rheumatoid arthritis
  • ulcerative colitis

A few are in phase II and phase III trials for moderate to severe psoriasis. Ones being studied for psoriasis are the oral drugs tofacitinib (Xeljanz), baricitinib (Olumiant), and abrocitinib. A topical JAK inhibitor is also under investigation.

So far, studies have found JAK inhibitors to be effective for psoriasis. They’re about as safe as existing biologic drugs. One advantage is that they come in pill form and don’t have to be given as injections.

The studies performed so far have been short term. Additional research is needed to know whether JAK inhibitors continue to be effective over longer periods of time.

Staying informed about the newest options for treating psoriasis is crucial to managing your condition.

There isn’t a one-size-fits-all therapy for psoriasis. It’s likely you’ll have to try out many different treatments before you find one that works best for you and doesn’t cause side effects.

New discoveries in psoriasis happen all the time. Make sure to talk to your doctor about new treatment options.