Psoriasis — and the dry, itchy, scaly patches of skin that it causes — doesn’t usually go down without a fight. And if your symptoms haven’t responded to topical treatments or you have certain types of psoriasis that can be challenging to treat, your doctor might recommend trying biologics as a treatment for your psoriasis. To which you might say, understandably, “What the heck is a biologic?”
They definitely sound a little sci-fi, but these types of treatments are very real and may be helpful if other treatments haven’t worked for you.
Wait, what are biologics?
Biologic treatments are a type of drug given by IV or injection every few weeks or months, Kyle Cheng, M.D., health sciences assistant clinical professor at the David Geffen School of Medicine and director of the UCLA Psoriasis Specialty Clinic at UCLA Medical Center, tells us. Psoriasis is an autoimmune disease—meaning that it results from a situation in which the immune system attacks a part of the body as if it were a pathogen—so biologics work by dampening the immune system response.
There are, generally, three major kinds of biologics used today to treat psoriasis, Shari Lipner, M.D., Ph.D., dermatologist at Weill Cornell Medicine and NewYork-Presbyterian, tells SELF. They’re categorized by the specific component of the immune system they act on: tumour necrosis factor alpha (TNF-alpha), interleukin-17 (IL-17), and interleukin-23 (IL-23).
How do biologics work to help treat psoriasis?
As we mentioned, drugs like these work because they target a specific part of the immune system that’s involved in psoriasis, Dr. Cheng explains. But they accomplish that in slightly different ways.
Biologics that target TNF-alpha are generally older drugs (like adalimumab and infliximab), and because TNF-alpha is involved in a lot of normal bodily processes outside of psoriasis, targeting it could come with more side effects than newer options. Specifically, TNF-alpha is a type of protein called a cytokine, and it has actions all over the body related to infections and inflammation. That’s why, in addition to helping treat the symptoms of psoriasis, drugs that modulate TNF-alpha can also be helpful in treating conditions like inflammatory bowel disease and rheumatoid arthritis.
Those newer options—biologics that target IL-17 (such as brodalumab and ixekizumab) or IL-23 (like risankizumab-rzaa and guselkumab)—are working on parts of the immune system that seem to play a large role in the formation of psoriasis plaques. So targeting them is less likely to affect the rest of your body than a TNF-alpha biologic might. Interleukins, another type of cytokine, are produced by white blood cells, which play a crucial role in the body’s immune responses. But different interleukins have different jobs and pathways in the body. Although IL-17 and IL-23 do seem to have minor roles in fighting infections, Dr. Cheng says, their most major role seems to be in psoriasis. Still, no biologic treatment is going to be 100% specific, Dr. Lipner says.
Depending on your exact symptoms, your doctor may recommend combining your biologic with another treatment, like topical medications or UV therapy. But biologics aren’t usually combined with each other, Dr. Cheng says.
Depending on the exact treatment, patients may see improvements with biologics within a month, Dr. Cheng says, and they’ll see maximum results within three months. That said, if you stop using the biologic, you can expect your psoriasis to come back. So patients who find success with biologics can probably expect to be on them for a while, Dr. Lipner says.
Biologics are just one option to treat psoriasis.
The right treatment for you depends on the severity of your psoriasis symptoms, how much of your body is affected by those symptoms, and how much they’re affecting your overall quality of life. Additionally, if you have psoriasis patches in notoriously hard-to-treat areas like your hands, feet, or scalp, or if you’ve developed symptoms of psoriatic arthritis, your doctor may want to give you a more intense treatment like a biologic earlier on.
But, ultimately, there’s no one treatment plan that’s going to be a winner for everyone. And figuring out what works for you — or what combination of treatments works for you — may be a long process involving some trial and error. So it’s crucial to talk over your options with your doctor.