If you live with moderate or severe psoriasis, your doctor may recommend immune-targeting biologics to block reactions in the body related to inflammation and cell growth.
Psoriasis is an immune-mediated inflammatory skin condition characterized by thickened, scaly patches of skin. On lighter skin, these patches may be red or pink with silver scales. On darker skin, they may appear purple or brown with gray scales.
Psoriasis can appear on any part of the body. It can be particularly difficult to treat in areas such as the scalp, face, hands, feet, and genitalia.
Mild forms of psoriasis are treated with topical medications such as corticosteroids and retinols, which work by managing inflammation and promoting skin turnover directly at psoriasis sites.
If you have moderate or severe psoriasis, however, topical treatments may not be effective or practical. More advanced treatments include the use of biologics, medications created using biological materials like enzymes, antibodies, or cellular tissue.
Biologics are systemic treatments that target specific cells in the immune system to block the inflammation underlying psoriasis. Here’s what you can expect if your doctor prescribes a biologic to help treat your psoriasis.
Biologics are medications created using biological material. They include familiar products like vaccines, insulin, and erythropoietin, a hormone used in treatments for cancer and chronic kidney disease.
Biologics work by providing targeted treatments, also called precision medicine. Rather than affecting your entire body like other systemic medications, they target specific processes contributing to a particular disease.
In the case of psoriasis, biologics address specific dysfunctions in the immune system. Some work by blocking the function of immune cells called T cells, which promote inflammation and stimulate the growth of keratinocytes. This causes a buildup of skin known as a psoriasis plaque.
Other biologics target proteins in the immune system, such as tumor necrosis factor-alpha (TNF-alpha) or interleukins 17-A, 17F, 12, or 23. These pro-inflammatory molecules are involved in the same process as T cells in psoriasis, just at a different point of the immune response.
By using a biologic to treat psoriasis, you’re able to focus on the immune-mediated responses that lead to symptoms rather than only treating the visible signs on your skin.
If your current treatment plan is not relieving your psoriasis symptoms, you may want to talk with your doctor about biologics. These medications are a treatment option for moderate to severe psoriasis:
- Moderate psoriasis occurs when psoriasis covers 3–10% of your body.
- Severe psoriasis occurs when psoriasis covers more than 10% of your body.
Your doctor may prescribe a biologic if:
- first-line treatments for psoriasis aren’t producing results
- psoriasis is affecting large areas of your body
- your symptoms are affecting your quality of life
- you’re experiencing side effects from other medications used to treat psoriasis
- you also have a related condition such as psoriatic arthritis
There are several reasons doctors may not jump right to biologic use, however.
Biologics are an emerging area of medical technology. As such, they don’t have the same abundance of research behind them as more traditional approaches.
They’re typically more involved, requiring administration by intravenous (IV) infusion at a clinic or self-administration injections at home. This may be a good option if you often forget to take your oral medication or apply topical treatments.
But you should also consider if you’re comfortable self-injecting or getting an IV. If you don’t like needles, you may prefer to stick with oral or topical treatments. You should also speak with your doctor about what your biologic administration schedule might be to ensure you won’t miss a dose.
As intricately synthesized substances, biologics can be more expensive compared to other treatments, ranging between
If you’re unable to afford the biologic prescribed for you, speak with your doctor about financial assistance options that may be available to you.
Although generally considered safe, biologics for psoriasis can make you more susceptible to infections due to their effects on the immune system. Biologics may not be right for you if you have a history of tuberculosis or have a weakened immune system due to conditions such as HIV or cancer.
Before starting a biologic, your doctor will likely test for tuberculosis and perform other screening tests to ensure a biologic is safe for you.
There are currently 12 biologics approved by the Food and Drug Administration (FDA) to treat psoriasis.
These include:
- TNF-inhibitors
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
- etanercept (Enbrel)
- infliximab (Remicade)
- IL-17A inhibitors
- brodalumab (Siliq)
- ixekizumab (Taltz)
- secukinumab (Cosentyx)
- IL-17A/17F inhibitor
- bimekizumab (Bimzelx)
- IL-23 inhibitors
- guselkumab (Tremfya)
- risankizumab (Skyrizi)
- tildrakizumab (Ilumya)
- IL-12/23 inhibitor
- ustekinumab (Stelara)
The biologic your doctor suggests will depend on the severity of your psoriasis, your overall health, and other factors such as any co-existing conditions.
For people with moderate to severe psoriasis, biologics may be the most effective treatment option. But not every biologic works for every person or for every type of psoriasis.
If you’re on a biologic and symptoms haven’t improved within the initial treatment window (typically weeks or months) your doctor may suggest a different biologic.
Biologics have a good safety profile when used appropriately, but they aren’t for everyone or every case of psoriasis.
Before starting a biologic, talk with your doctor about:
- plans for pregnancy or current pregnancy
- breastfeeding
- pre-existing conditions such as diabetes
- lifestyle factors such as smoking and alcohol use
- any history of infections
- age-related risks
- overall costs
- time and schedule commitment
- what happens if you miss a dose
- side effects to watch for
- interactions with current medications or vaccines
- signs you should stop taking the biologic
Biologics for psoriasis are administered by injection, either directly into your vein through an infusion or subcutaneously into the fatty tissue under the skin.
Infusions are done in a clinical setting with your medical team and may require a few hours for administration followed by time in the clinic for observation. Depending on the biologic, you’ll need to return for additional infusions anywhere between
At-home administration typically involves the use of prefilled syringes, auto-injectors, or pen devices.
Many are used twice a week, though some are spaced out as single doses across multiple weeks. After an initial loading dose, maintenance injections are done less frequently, generally every
Throughout treatment, your doctor will regularly evaluate your progress and monitor for side effects. The frequency of follow-ups depends on factors such as your overall health, the severity of your symptoms, and the biologic you’re using.
You may visit your doctor every few weeks, monthly, or several times a year once you’ve reached a maintenance dose.
Like most medications, biologics do come with the potential for side effects. These may include:
- injection site irritation
- increased risk for infection, particularly upper respiratory and urinary infections
- flu-like symptoms
- allergic reaction
- headache
- stomach pain or nausea
- diarrhea
- itching
- muscle aches and pains
- fatigue
- dizziness
- depressed mood
Each biologic used for psoriasis comes with its own set of specific side effects. Infliximab, for example, an infusion-administered biologic
If you experience side effects, speak with your doctor. They may be able to recommend ways to prevent or manage side effects.
Biologics take time to work. Most have a loading dose period of
Based on your rate of progress, your dose is then dropped to maintenance level. This is when you’re receiving maximum benefit with the least amount of treatments.
Progress isn’t always immediate or significant, especially during the first treatments. You’ll know a biologic is working when:
- there’s a reduction in size, number, or severity of psoriasis plaques
- new psoriasis plaques appear less often
- secondary symptoms such as itching, discomfort, and sleep disturbance improve
- laboratory tests show a decrease in inflammatory markers in the bloodstream
Your doctor will monitor your progress closely, but if you’re not satisfied with the results, it’s OK to review your treatment options. You can consult with your current medical team, or you can seek a second or third opinion from a dermatological expert.
Over time, a biologic may become less effective. This may be because your body develops antibodies to the medication. if the biologic you’re currently taking is ineffective or stops working, your doctor may recommend you try another biologic or another class of medication.
Biologics for psoriasis work by targeting specific immune processes thought to underlie inflammation and excessive tissue growth. They aren’t first-line treatments for this condition but are available when traditional therapies haven’t been effective.
Not everyone is a candidate for biologic use, and not all biologics will work for every case of psoriasis.
If your psoriasis is moderate to severe, involves a large portion of your body, or occurs alongside related conditions like psoriatic arthritis, your doctor may recommend starting a biologic.