The potential of biologic therapy in the treatment of psoriasis

Q&A - 17TH AUGUST 2021

To mark Psoriasis Awareness Month, consultant dermatologist Dr Wanda Robles of Dr Haus Dermatology provides a quick guide to this chronic skin condition and outlines the promising advances being made through the application of biologic therapy

What is psoriasis?
Psoriasis is an inflammatory skin condition that causes red, flaky patches of skin. These patches typically appear on your elbows, knees, lower back and scalp and even sometimes affect the joints.

If you have psoriasis, the process through which skin cells are replaced is much faster than usual, taking just a few hours rather than the typical 21-28 days. When all these skin cells accumulate, they form raised ‘plaques’ on the skin. In Caucasian skin, these are typically red, itchy and flaky, while in darker skin tones the patches can appear darker.

What causes psoriasis?
Some people have a family history of the condition, but others don’t. Flare-ups can be triggered by a range of factors such as stress or anxiety, skin injuries, hormonal changes or certain types of infections or medications.

Dr Wanda Robles of Dr Haus Dermatology

Dr Wanda Robles of Dr Haus Dermatology

What is biologic therapy?
Biologic therapy uses proteins that are designed to stimulate or restore the ability of the body’s immune system to fight infection and disease. Our bodies naturally produce these substances – known as biological response modifiers – but usually in very small amounts. With the help of technology, though, they can be administered in larger amounts to treat conditions such as cancer, Crohn’s disease and rheumatoid arthritis.

In the treatment of psoriasis, the biologic therapy can be used to block the activity of cytokines, which regulate the response of the immune system. It is the cytokines contained in psoriatic plaques that trigger the redness, thickening and inflammation of the skin. The therapy targets this area to prevent the rapid skin cell growth seen in psoriasis.

There are a number of biologic drugs that can be used by dermatologists for the treatment of psoriasis, particularly when conventional treatments have failed. These include secukinumab and more recently ixekizumab, which can be injected under the skin of the stomach, thighs or outer upper arms.

How well does biologic therapy work?
Although biologic therapy has existed for many years, we are still in the early stages of developing and applying it to clinical practice. At Dr Haus Dermatology, I have seen some very good improvement in patients with psoriasis when using biologic therapy.

Are there any risks involved with this treatment?
As with any treatment, there are downsides. Biologic therapy affects the immune system, so while you are undergoing treatment, it could make your immune system weaker at fighting infections and diseases. This would, of course, be closely monitored by the overseeing doctor.

How invasive is the treatment?
The treatment itself is minimally invasive and is administered through injection without the need for surgery. The dosage and frequency vary depending on the patient and their condition. Doctors may suggest one dose per week as an initial treatment for the first five weeks and then it can usually be reduced to once a month afterwards. Again, this depends on each case and some patients may only require one treatment per month.