Psoriasis is a skin condition involving scaly plaques that can cause itching and pain. Many treatments are available. Switching psoriasis medications should be an informed decision with overall treatment goals in mind.

Psoriasis is a chronic inflammatory disease affecting 3% of adults in the United States.

Health experts do not know the exact cause of psoriasis, but it may be the result of an overactive immune system that mistakenly attacks skin cells. In response, the body replenishes the skin cells more frequently, and this buildup of skin cells leads to symptoms such as scaly plaques.

In addition to adopting certain lifestyle habits to avoid triggering flare-ups, a person can try many types of active treatments for psoriasis, including:

  • topical medications
  • phototherapy
  • systemic medications (such as biologics)

Some people may need only one medication. But for others, certain medications might not show satisfactory results. In some cases, a particular treatment might work well for a while but become less effective over time.

Here is what is important to know about switching psoriasis medications.

The primary goal of taking medication to treat psoriasis is generally to reduce the frequency and severity of symptoms. If a person’s current medication is not achieving this goal, they might consider making a switch.

“When psoriasis medications stop working or cause side effects, it is time to consider trying something new,” said Dr. Tanya Nino, a dermatologist with Providence St. Joseph Hospital in Orange County, California.

For example, biologics can cause undesirable side effects such as upper respiratory tract infections or urinary tract infections. Switching to a different medication — even a different biologic — might eliminate these side effects.

According to Dr. Amy Huang, a board certified dermatologist with Medical Offices of Manhattan, “[You] may want to consider switching if the therapy is not alleviating the symptoms of psoriasis within a certain amount of time.”

But what should a person’s expectations be for how quickly a new medication will show results?

“[A person] may switch biologics if they still have an unacceptable number of plaques after 180 days or more,” Huang explained.

Although a person may already have a medication regimen for psoriasis, a doctor may recommend switching to a different medication for any of the following reasons:

  • The medication is not working, or the symptoms are not improving.
  • Side effects have become too bothersome.
  • The cost of the medication is out of the person’s budget.
  • The person has developed a resistance to a medication that previously worked well, so the medication has become less effective.

A doctor can make safe medication recommendations to meet a person’s treatment goals.

Reasons for changing from one biologic to another

Some biologics work by targeting specialized proteins called interleukins in an attempt to disrupt white blood cells and prevent them from overreacting to skin cells.

According to Dr. Nino, a doctor might recommend switching from one biologic to another if a person has developed resistance to one biologic and needs a different biologic (with a different target interleukin).

“We may also make a change to find a better dosing schedule for each individual patient,” said Nino.

Before starting to take a new medication, a person should talk with their doctor to help set expectations.

“I would suggest talking with your dermatologist [and] reviewing the side effects to see what is best for your individual needs,” recommended Nino.

Huang recommends taking the following steps after making the switch:

  • Take the medication as prescribed.
  • Continue close follow-up with the doctor.
  • Let the doctor know about any new side effects.
  • Note any new medical concerns.

Among the newest treatments for psoriasis are deucravacitinib (Sotyktu) and bimekizumab (Bimzelx).

The Food and Drug Administration (FDA) approved deucravacitinib in 2022 to treat moderate to severe plaque psoriasis in adults.

“It is a tyrosine kinase 2 inhibitor and is taken orally. Tyrosine kinase 2 is a member of the Janus kinase (JAK) family of molecules, which signal the inflammatory pathway that causes psoriasis,” explained Nino.

Tyrosine kinase 2 (Tyk2) is a protein that interacts with interleukins, allowing immune cells to communicate with each other.

The FDA approved bimekizumab in 2023. “[It’s] the first and only IL-17A and IL-17F inhibitor approved for moderate to severe plaque psoriasis in adults,” said Huang.

IL-17A and IL-17F are two types of interleukins.

There are many options for treating psoriasis. A doctor, or a specialist such as a dermatologist, can help a person find the treatment that best fits their treatment goals.

The right medication might change over time, and a doctor can make recommendations to meet a person’s needs.

While psoriasis might be uncomfortable, painful, or distressing, there are many available treatments that can help.

When starting a new medication, a person should note any side effects or new symptoms they experience. This can help the doctor determine whether the treatment is working or whether the person may need to switch to another medication.