Combination Therapy for Psoriasis More Effective Than Single Therapies


Linda Wasmer Andrews

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PHYSICIAN CONTRIBUTOR psoriasis-on-elbow

Expert Answers to Psoriasis Treatment FAQs

Dr. David Harvey, a dermatologist and surgeon, answers some common psoriasis questions.
male holding two tablets

There are several types of psoriasis treatments available today. In many cases, you’ll wind up using a combination of treatments rather than just one, since the results are often better that way.

Why is combination therapy more effective? Researchers think it’s because different kinds of psoriasis treatments have different modes of action. Together, they’re able to fight psoriasis on multiple fronts. The total effect is enhanced, so you can often cut the dose of each therapy. This reduces the risks and side effects of both, making treatment easier to tolerate.

Types of Psoriasis Treatment

Treatments for psoriasis can be divided into four main groups.

Topical therapy. These treatments are applied directly to the skin as creams, ointments, or gels. They include:

  • Anthralin (Zithranol-RR)

  • Calcipotriene (Dovonex)

  • Calcitriol (Vectical)

  • Coal tar

  • Corticosteroids

  • Salicylic acid

  • Tazarotene (Tazorec)

Light therapy. This approach involves exposing the skin to ultraviolet (UV) light under a doctor’s guidance. You may use either artificial UV light or the natural UV rays in sunlight.

Systemic therapy.
These medications, taken by mouth or injection, work throughout the whole body. Traditional systemic drugs affect the entire immune system. They include:

  • 6-Thioguanine

  • Acitretin (Soriatane)

  • Cyclosporine

  • Hydroxyurea (Hydrea)

  • Methotrexate

Biologic therapy. These medications, taken by injection or through an IV line, are a particular type of systemic therapy. Biologic drugs target specific parts of the immune system. They include:

  • Adalimumab (Humira)

  • Etanercept (Enbrel)

  • Golimumab (Simponi)

  • Infliximab (Remicade)

  • Ustekinumab (Stelara)

  • Secukinumab (Cosentyx)

Mix-and-Match Combos

For mild psoriasis—isolated patches of thick, red, scaly skin—topical treatments may be enough to control the problem. To maximize results, two or more creams are often combined. A recent article in Archives of Dermatology analyzed results from dozens of previous studies. The authors concluded that combinations of topical treatments usually work better than a single topical treatment.

For moderate to severe psoriasis, additional treatments are usually needed. The best strategy for you depends on which type of psoriasis you have, how severe it is, and how your body reacts to the treatment. Many people get the most benefit by combining topical, light, and systemic or biologic therapies.

Newer Treatment Strategy

A newer approach is to combine two types of systemic drugs: a traditional one and a biologic. More research is still needed on this approach. But studies to date suggest that it often eases psoriasis symptoms more effectively than either treatment by itself.

Adalimumab, etanercept, and infliximab have all been shown to be safe and effective when taken with methotrexate. Other combinations are also widely used.

Biologics are powerful drugs, but they take a while to work. It can take several months to get the full effects. You may see results sooner if you combine a biologic with a faster-acting systemic drug, such as cyclosporine.

Benefits of Combination Therapy

Overall, studies on various treatment combinations have shown several advantages over solo treatments. Depending on the combination, the pluses may include:

  • Faster clearing up of symptoms

  • Better and sometimes longer-lasting results

  • Lower doses of each treatment

  • Fewer problems with side effects

Because there are so many forms of medication and light therapy for treating psoriasis, there are numerous possible combinations. That only improves the odds you’ll find a combination that works well for you.

Key Takeaways

  • There are four types of therapies to treat psoriasis: topical, light, systemic, and biologic. Often, a combination of treatments works better than just one.

  • Combination therapy has several benefits: it’s faster, may have longer-lasting results, requires lower doses, and may cause fewer side effects.

  • A newer treatment approach is to combine two types of systemic drugs: a traditional one and a biologic.
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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Aug 7, 2017

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Medical References

  1. A Clinical Trial of Combination Therapy with Etanercept and Low Dose Cyclosporine for the Treatment of Refractory Psoriasis. E.J. Lee et al. Annals of Dermatology, 2010, vol. 22, pp. 138-42.
  2. Combination Treatments for Psoriasis: A Systematic Review and Meta-analysis. E.E. Bailey et al. Archives of Dermatology.
  3. Psoriasis Causes and Known Triggers. National Psoriasis Foundation.
  4. Moderate to Severe Psoriasis: Biologic Drugs. National Psoriasis Foundation.
  5. Traditional Systemic Medications. National Psoriasis Foundation.
  6. Moderate to Severe Psoriasis: ‘Off-Label’ Systemic Medications. National Psoriasis Foundation.
  7. Systemic Medications: Soriatane (Acitretin). National Psoriasis Foundation.
  8. Mild Psoriasis: Non-steroidal Prescription Topical Treatments. National Psoriasis Foundation.
  9. Over-the-Counter (OTC) Topicals. National Psoriasis Foundation.
  10. Questions and Answers About Psoriasis. National Institute of Arthritis and Musculoskeletal and Skin Diseases.
  11. What Is Psoriasis: Fast Facts, National Institute of Arthritis and Musculoskeletal and Skin Disorders.
  12. Phototherapy. National Psoriasis Foundation.
  13. Systemic Medications for Psoriasis and Psoriatic Arthritis, Including Biologics. National Psoriasis Foundation.
  14. Psoriasis Severity. National Psoriasis Foundation.
  15. Combination Therapy of Biologics with Traditional Agents in Psoriasis. L.C. Guenther. Skin Therapy Letter, 2011, vol. 16, pp. 1-3.