Psoriasis: Selecting the Right Treatment

Psoriasis continues to be a common skin condition, affecting 8 million Americans (which is about 2-3% of the population). Each year, about 150,000 new people hear the diagnosis of “psoriasis” from their doctors; after which they will then navigate a long list of treatment options. Although many patients start out with topical treatments, it’s not uncommon for systemic (oral or injected medications) to be prescribed, especially for moderate or severe psoriasis.

Unfortunately, a substantial number of patients report that they don’t consider their current treatment plan to be optimal. This feedback comes from a health and wellness survey of 22,050 adults (of which 1,264 had psoriasis or psoriatic arthritis) that was recently published.

Results showed that 14.6% of patients with psoriasis reported using systemic therapy and 58.5% of psoriatic arthritis patients reported systemic therapy use. Of the patients in this study, one-third of those with severe symptoms had never discussed systemic treatment with their physicians. This indicates that many psoriasis patients seem to be not receiving optimal treatment; in fact, many survey respondents even noted dissatisfaction with their current treatment.

The researchers of this study are not suggesting that every one of these patients should be switched to systemic treatment; but rather that more open discourse about treatment options would better determine the best treatment for each patient.

Interestingly, in another study, a different group of researchers took a look at patients with moderate psoriasis and noted that optimal treatment is also missing the mark in this group. It’s important to remember that even moderate psoriasis can seriously impact quality of life.

In this study of 136 patients with moderate plaque psoriasis, treatment with the systemic medication Otezla (apremilast) was effective at resolving symptoms according to skin examinations and a quality of life index, though the year-long follow up.

Researchers of both studies highlight the same take-away message: the importance of considering optimal treatment for psoriasis patients and specifically considering systemic treatments, even for those with less severe cases. 


Tveit KS, Duvetorp A, Østergaard M, et al. Treatment use and satisfaction among patients with psoriasis and psoriatic arthritis: results from the NORdic PAtient survey of Psoriasis and Psoriatic arthritis (NORPAPP) [published online]. J Eur Acad Dermatol Venereol doi: 10.1111/jdv.15252

Gold LS, Bagel J, Lebwohl M, et al. Efficacy and safety of apremilast in systemic- and biologic-naive patients with moderate plaque psoriasis: 52-week results of UNVEIL. Journal Drugs Derm February 2018.