Undertreated Psoriasis Patients Need Answers

By Kathleen Hoffman, PhD, MSPH

A 2021 study concluded that psoriasis continues to be a common inflammatory disease, affecting more than 7.5 million adults in the US alone —  3.0% of the US adult population.1  By far the most common form (80% of cases)2 is plaque psoriasis, which intermittently creates patches of scaly and itchy skin, often on the scalp, knees, or elbows, but there are multiple distinct types with different presentations. The inflammation that creates psoriasis is also linked with an increased risk for other conditions, by a process that is not yet understood.3

One Inspire member described her experience with a wide variety of psoriasis types:

I have had Psoriasis since I was 15 and now I am 38. It started as Plaque Psoriasis on the scalp, then moved on to cover my entire body. I’ve had Inverse and Guttate Psoriasis at the same time approximately 8.5 years ago. The only parts of my body I’ve never had Psoriasis are my nose and lips. About 7 years ago, it progressed into Psoriatic Arthritis and couple years back I started seeing Pustular Psoriasis on my palms and now on the feet too. I have tried everything (holistic treatments, diets of all kinds, ointments, steroids’, methotrexate ) they all give relief for sometime and then it’s like Psoriasis wins the battle and flares up and a new form shows up.

Many people have milder symptoms and fewer events, but patients and doctors alike are puzzled by what stimulates flare-ups. Advice on preventing them includes trying to avoid some very common and random life events, including stress, certain foods, cold weather, injuries to the skin, or foods and medications that might be triggers but that vary by individual.4

….at times [my plaque psoriasis has] cleared up but it’s very rare then it roars back with a vengeance. I’ve always tried to work out what I was doing differently with my lifestyle or diet at the times it’s looked best however never have worked it out.

One member with facial psoriasis was even concerned about shaving:

I was wondering if I could use a razor to shave but I don’t know if thats a good idea because of my dry skin and I don’t want psoriasis flaring up there if I cut an area on my face.

While those who suffer from mild psoriasis might be able to cope by using topical creams or a course of steroids, sufferers of more severe flares are still considered undertreated.3

Phase III clinical trial drugs investigating new solutions

Fortunately there are several drugs in Phase III clinical trials or submitted for approval as a new drug application (NDA) that are intended to interrupt or otherwise mitigate the biochemical chain reaction that creates the varying types of psoriatic skin inflammation including new biologics, oral drugs, and topical treatments, including:

 Investigative drug  Mode of Action
 deucravacitinib (oral)  selective tyrosine kinase 2 (TYK2) inhibitor
 bimekizumab (subcutaneous injection)*  bispecific antibody capable of targeting 2 isoforms of IL-17 (IL-17A, IL-17F)
 roflumilast (cream)  phosphodiesterase type 4 inhibitor (PDE4)
 tapinarof (cream)**  aryl hydrocarbon receptor (AhR) modulating agent

*Approved in the EU
**Submitted to the FDA for NDA5

The size of the membership on Inspire interested in finding solutions and information about psoriasis is very large, currently estimated to be almost 316,500 members, who have posted their questions, comments, and concerns over 1,035,000 times.  Symptom management is a major topic in the community.

What does everyone use to relieve the intense itching? My husband has had psoriasis for 30yrs and was put on [treatment] which cleared his whole body including his nails but has recently had to stop taking it as it affected his lungs so bad that a doctor thought he had copd so now he is covered even worse than before and the itch is so bad that he’s bleeding all over!

Perhaps these new medications will provide some relief to the many undertreated sufferers of moderate to severe psoriasis. It can’t come soon enough.

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4 https://www.niams.nih.gov/health-topics/psoriasis#tab-overview