 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:

 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, HLA-
B13, 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 T-
cell 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 immune-
mediated components. This is supported by the successful treatment of psoriasis with immune-
mediating, 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 flare-
up 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 TNF-
alpha 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 interleukin-
17 (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
 Topical non-steroid
 Topical steroids
 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)

 Sunlight
 Psoralen + UVA (PUVA)
 Laser Treatments
 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

 Depression
 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

 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

HELPS CONTROL SYMPTOMS AND REDUCE DISEASE.

Jain's Cow Urine Therapy has proved effective in controlling the infections, swelling,
rashes, bleeding or pus discharge, itching and other symptoms in various skin infections
and diseases.

IT HELPS CONTROL SYMPTOMS AND REDUCE DISEASE.

 proves Quality of Life

 Helps reduce drug dependency.

  recurrence chances