Psoriasis, When the “Usual Suspect” Therapies Work
Ms. S is a 37 year-old Caucasian female with an 18-year history of large plaque psoriasis and psoriatic arthritis. This patient had been treated in the past with the biologic, Humira, with very good results, but had to discontinue the therapy due to injection site pain. She is not a candidate for methotrexate because of her alcohol use history. She presented to the clinic looking for a new therapy that would improve her plaque symptoms and arthritis. She was given a regimen of NB-UVB twice weekly and a class I steroid to be applied twice daily to address the plaques, while she was being evaluated for Stelara (because of its less frequent injection schedule) and was awaiting insurance approval to address her psoriatic arthritis, as well as the plaque psoriasis. At her three-week follow up, her plaque psoriasis had improved by greater than 75% with only the class I steroid and NB-UVB as therapy.
Psoriasis is a chronic auto-immune, auto-inflammatory disease that has recently been associated with many systemic co-morbidities such as diabetes, hyperlipidemia, and heart/ vascular disease. Although a patient may present with plaque symptoms only, it is important to screen them for these other disorders, as well as psoriatic arthritis.
Class I steroids, or high potency steroids, address the skin manifestations of the disease because of their anti-inflammatory effect and local immunomodulation. Ultra-violet therapy, or in this case, NB-UVB has a greater anti-inflammatory effect in the superficial skin. These therapies can help to curtail the visible symptoms of the disease, while the patient awaits approval for a biologic that can address the psoriatic arthritis.
In the changing atmosphere for psoriasis treatments, we mustn’t forget how we began. The simple therapies can be just as effective, and more affordable for plaque psoriasis as the newer more expensive options.
Byline: B. Jang Mi Johnson, PA-C, SDPA Director-at-Large
Photo credit: Author