Psoriasis is a chronic autoimmune condition that primarily affects the skin. It manifests as red, scaly patches and can significantly impact a person’s quality of life.

While there are various treatments available for psoriasis, such as light therapy for psoriasis, injections have gained prominence for their effectiveness in managing moderate to severe cases. These treatments work by targeting the overactive immune response that causes the condition, providing relief from symptoms and often improving overall skin appearance.

Below, we explore the different types of injections used to treat psoriasis, their benefits and side effects, as well as considerations for those seeking this treatment.

Types of Injected Treatments for Psoriasis

There are two main categories of injected treatments for psoriasis: biologic therapies and systemic medications like methotrexate. These options are generally considered after topical treatments or phototherapy prove insufficient. Here is an overview of these injectable therapies:

1. Biologic Therapies

Biologics are advanced medications derived from living organisms. They target specific parts of the immune system to interrupt the processes driving psoriasis. Biologics are administered via subcutaneous (under the skin) injections or intravenous infusions. They include:

• Tumor Necrosis Factor (TNF) Blockers: Medications like adalimumab (Humira) and etanercept (Enbrel) inhibit TNF-alpha, a protein that causes inflammation. These are commonly used for moderate to severe plaque psoriasis and psoriatic arthritis.
• Interleukin (IL) Inhibitors: Drugs like secukinumab (Cosentyx), ustekinumab (Stelara), and ixekizumab (Taltz) target specific interleukins (e.g., IL-17, IL-23) that play a key role in inflammation and skin cell overproduction.
• T-Cell Targeted Agents: Alefacept (Amevive) was one of the earlier biologics designed to reduce the activity of T-cells (a type of immune cell), though it has been largely replaced by newer options.

2. Methotrexate (Injectable Form)

Methotrexate is a well-known systemic medication that can be administered as an injection. It suppresses the overall immune response, thereby reducing inflammation and slowing the rapid turnover of skin cells. Methotrexate injections are particularly beneficial for patients who do not respond to topical treatments or have psoriatic arthritis.

3. Other Options

For certain individuals, corticosteroid injections may be used to manage isolated, stubborn psoriasis plaques. However, long-term use of steroids is typically avoided due to potential side effects.

How Biologics Work

Biologics are designed to work with precision, targeting specific components of the immune system rather than suppressing immunity overall. For example, IL-17 inhibitors like secukinumab block a protein that plays a significant role in skin inflammation. By zeroing in on these specific mechanisms, biologics often result in faster and more sustained improvement compared to traditional systemic drugs. Patients typically see significant skin clearance after several weeks or months of consistent injections.

Benefits of Injectable Treatments

There are several advantages to using injections for treating moderate to severe psoriasis:

• High Efficacy: Injectable medications, particularly biologics, have been shown to provide substantial skin clearance for many patients, improving their confidence and quality of life.
• Convenience: Most injections are administered at home following proper training, reducing the need for frequent clinic visits.
• Longer Remission Periods: Unlike topical treatments, injections often result in prolonged periods of symptom control, which can enhance patient adherence.
• Reduced Systemic Side Effects: Biologics are more targeted in their approach compared to traditional drugs like methotrexate, which may cause widespread immunosuppressive effects.

Potential Side Effects and Risks

While injectable medications are generally well-tolerated, there are some potential side effects and risks to consider:

1. Injection Site Reactions: Common side effects include redness, swelling, and discomfort at the injection site. These are typically mild and resolve on their own.
2. Immune Suppression: Because biologics suppress certain components of the immune system, patients may be more susceptible to infections, such as upper respiratory tract infections or reactivation of latent tuberculosis.
3. Allergic Reactions: Although rare, some individuals may experience serious allergic reactions to injected medications, requiring immediate medical attention.
4. Liver and Kidney Effects: Systemic drugs like methotrexate can impact liver and kidney function, so regular blood tests are needed during treatment.
5. Development of Antibodies: Over time, some patients may develop antibodies against biologic drugs, reducing their effectiveness.

Who is Eligible for Injectable Treatments?

Injectable treatments are typically reserved for individuals with moderate to severe psoriasis who have not responded adequately to other treatments, such as topical creams, phototherapy, or oral medications. Eligibility also depends on the patient’s overall health, as certain biologics or systemic drugs may not be suitable for individuals with specific health conditions, such as a history of infections or liver diseases. A dermatologist will evaluate each patient’s unique case to determine the most appropriate therapy.

Administration and Frequency of Treatments

Most injectable therapies are designed to be easy to administer with minimal disruption to daily life. Depending on the medication, injections may be required as frequently as once a week or as infrequently as once every three months. Many patients receive the first few doses under their healthcare provider’s supervision to ensure proper technique before transitioning to self-administration. Regular follow-ups are essential to monitor treatment progress and address potential side effects.

Lifestyle and Monitoring Considerations

Before and during treatment with injections, patients may need to make certain lifestyle adjustments or adhere to specific monitoring requirements:

• Blood Tests: Regular bloodwork is necessary to assess the impact of treatment on liver, kidney, and immune function.
• Vaccinations: Patients should receive necessary vaccinations (e.g., flu and pneumonia vaccines) before starting biologics, as live vaccines are not recommended during treatment.
• Nutrition and Skincare: Maintaining a healthy diet and following a dermatologist-approved skincare routine can further complement the effects of injectable treatments.

Cost and Insurance

Injectable psoriasis treatments, especially biologics, can be expensive. However, many manufacturers offer patient assistance programs or co-pay savings cards to help offset costs. Additionally, most health insurance plans cover biologics for psoriasis when prescribed by a dermatologist, but prior authorization may be required. Patients should work closely with their healthcare provider and insurance company to ensure coverage and minimize out-of-pocket expenses.

A Promising Future for Psoriasis Treatment

The advent of injectable treatments, particularly biologics, marks a significant advancement in the management of psoriasis. These medications provide hope for those who have struggled with the physical and psychological toll of the condition, offering improved skin clearance and enhanced quality of life. Research continues to develop more targeted therapies with fewer side effects, making the future of psoriasis treatment more promising than ever.

Final Thoughts

Injectable treatments for psoriasis present a powerful option for managing this challenging condition. While these therapies may not be suitable for everyone, they have transformed the outlook for many patients with moderate to severe cases.