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Key takeaways
Psoriasis is a chronic autoimmune skin disease that causes rapid skin cell growth, leading to thick, scaly patches, and can be exacerbated by factors like stress and cold weather.
Biologics, a treatment option for moderate to severe psoriasis, work by targeting specific immune cells or proteins to interrupt the disease cycle, differing from traditional medications that affect the whole immune system.
Patients with psoriasis can remain on biologics indefinitely to manage their condition, with treatments administered via injection or IV infusion, and switching biologics may be necessary if effectiveness decreases.
While effective, biologics are expensive, potentially costing up to $30,000 annually without insurance, though financial assistance may be available through pharmaceutical co-pay programs and coupons.
If you’re dealing with dry, itchy skin patches that do not go away, you may need a dermatologist to determine if this inflammation is a rash, eczema, or psoriasis. August is National Psoriasis Awareness Month, a campaign to raise awareness about the skin disorder that affects more than 8 million Americans and 125 million people around the globe, according to the National Psoriasis Foundation (NPF).
What is psoriasis?
It’s a chronic autoimmune skin disease that speeds up the growth cycle of skin cells, according to the Centers for Disease Control and Prevention (CDC). Psoriasis causes thick, scaly, patches of either red or silver on white skin, and purple, gray, or dark brown patches on skin of color. It typically affects the elbows, knees, scalp, lower back, face, palms, and soles of the feet. Yet, it can also surface on the fingernails, toenails, and mouth.
The most common form of this skin disorder—affecting between 80% and 90% of people diagnosed with psoriasis—is plaque psoriasis, which is characterized by painful coin-sized raised patches (or plaques) that tend to crack and bleed, according to the American Academy of Dermatology (AAD).
“Psoriasis is thought to be caused by a genetic predisposition and abnormal immune system signaling that make skin cells grow too quickly, pile on top of one another, and lead to skin changes,” says Brendan Camp, MD, FAAD, a double board-certified dermatologist and dermatopathology specialist who practices at Medical Dermatology & Cosmetic Surgery in New York City.
Related: Is it just dry skin? Or could it be eczema? Or psoriasis?
The AAD states that while this skin disorder is not contagious, certain triggers can exacerbate symptoms and cause flare-ups, such as:
- Stress
- Skin injuries (for example, a deep cut or sunburn)
- Infection
- Certain prescription medications (for example, lithium and prednisone)
- Weather (usually cold temperatures and dry conditions)
- Tobacco
- Alcohol
Psoriasis can also lead to joint and back pain, stiffness, and swelling, a condition called psoriatic arthritis, says Stacy Chimento, MD, a board-certified dermatologist who practices at Riverchase Dermatology in Miami. “Unfortunately, psoriasis is a long-term, chronic condition with no known cure,” she explains—but there are ways to treat it.
Biologics for psoriasis
Over the past 10 years, biologics have become a promising treatment option for plaque psoriasis. They are an alternative to traditional medications, like topical creams and light therapy.
What are biologics?
“Biologic drugs are manufactured in a living system (such as microorganisms, plant, or animal cells), whereas conventional medications are a combination of specific chemical ingredients,” explains Dr. Chimento. “More specifically, biologics alter the immune system in a way that disrupts the disease cycle, unlike traditional drugs that work on your whole immune system.”
How do biologics work for psoriasis?
When it comes to the treatment of psoriasis, biologics are designed to block either the action of a specific immune cell (known as a T-cell) or proteins within the immune system, such as tumor necrosis factor-alpha (TNF-alpha), interleukin 17-A, or interleukins 12 and 23.
“In psoriasis, abnormal messaging by small proteins called cytokines stimulates skin cells to proliferate quickly,” says Dr. Camp. “Biologics block the messages from being received and quell the associated signs and symptoms of psoriasis.”
Why use biologics?
Healthcare providers will often prescribe biologics, a type of systemic medication, to patients with moderate to severe psoriasis—those who are assessed with 3% to 10% percent (or more) of the body being affected by the disease, says Dr. Chimento. “Even if psoriasis only affects a small part of your body, it can still be considered severe if it impacts your everyday life,” she continues. A physician may also suggest biologics if traditional medicines (including topical creams, corticosteroids, cyclosporine, and retinoids) failed to manage the symptoms.
How long do you stay on biologics for psoriasis?
Biologic treatments are administered by intravenous (IV) infusion at a doctor’s office or injection (either self-injection or given by your healthcare provider). “Since psoriasis is a chronic condition, patients can typically stay on a biologic indefinitely to control it,” says Dr. Camp. “Also, taking a biologic continuously is more effective than stopping and starting it as this may cause the medication to lose its efficacy.” In the event where one biologic becomes less effective, a doctor would likely prescribe a different brand.
What are the risks of biologics?
Both Dr. Camp and Dr. Chimento point out that because biologic medications suppress the immune system, patients may be more susceptible to serious infections. “In extremely rare cases, the adverse effects can be life-threatening, including bacterial infections such as tuberculosis, pneumonia, or staph and fungal infections,” adds Dr. Chimento. In fact, it’s imperative to be tested for tuberculosis prior to starting a biologic, and patients who take this class of drugs should not receive live vaccines, Dr. Camp says.
Popular biologic medications for psoriasis
These are a few of the popular FDA (Food and Drug Administration) approved biologics on the market today.
| Drug name | Administration route | Standard dosage | Common side effects | Get coupon |
| Cosentyx (secukinumab) | Injection | 300 milligrams once a week for 4 weeks, then 1 injection every month. 150 milligrams may work for some patients. | Cold symptoms, diarrhea, and upper respiratory infections | Get coupon |
| Skyrizi (risankizumab-rzaa) | Injection | 75 milligrams. Initially 2 doses over 4 weeks, then 1 dose every 12 weeks. | Upper respiratory infections, headache, fatigue, injection site reactions, and tinea infection | Get coupon |
| Ilumya (tildrakizumab-asmn) | Injection | 100 milligrams. Initially 2 doses over 4 weeks, then 1 dose every 12 weeks. | Upper respiratory infections, injection site reactions, and diarrhea | Learn more |
| Orencia (abatacept) | Injection (both prefilled syringe and autoinjector) and IV | IV Infusion: Weight based dose given every 2 weeks for 3 doses, then every 4 weeks thereafter (Adults weighing less than 60 kg: 500mg, 60 kg – 100 kg: 750 mg, greater than 100 mg: 1000mg)
Subcutaneous: 125 mg weekly, with or without IV loading dose. |
Headache, upper respiratory tract infection, sore throat, and nausea | Learn more |
How fast do biologics work?
Patients can expect to notice improvements within 12 weeks with results lasting several months, says Dr. Chimento. “While it varies from person to person, someone with a mild case of psoriasis may see symptoms reduced in as fast as one week.”
And the long-term results are impressive. “For many patients, taking a biologic has been life changing because it helped when other forms of therapy did not,” states Dr. Camp. “Some treatments can provide remission from psoriasis, in which the skin is clear or almost clear.”
RELATED: What it’s really like living with psoriasis
How much do biologics for psoriasis cost?
This class of immunosuppressive drugs are among the most expensive medications. “Without insurance, biologics can cost anywhere from $10,000 to $30,000 annually, depending on the drug and the dose,” says Dr. Chimento. “Unless your condition is severe, your insurance might not cover biologics until you’ve tried one or more systemic treatments, like methotrexate or retinoids.”
Even if you have health insurance, Dr. Camp adds that numerous pharmaceutical companies offer financial assistance via co-pay assistance programs. SingleCare works with more than 35,000 pharmacies nationwide (including CVS, Target, Walgreens and Walmart) and offers free coupons for additional savings.