Modern Psoriasis Treatment: From Topicals to IL-23 and IL-17 Biologics

"Modern Psoriasis Treatment: From Topicals to IL-23 and IL-17 Biologics" steps back to survey how clinicians actually treat psoriasis in 2026.

Dr. Strober walks through the full psoriasis treatment landscape, calling the long list of options a genuine benefit for patients. He starts with topicals for milder disease: topical steroids and newer nonsteroidals such as tapinarof and roflumilast. For inverse psoriasis, he cites topical calcineurin inhibitors like tacrolimus and pimecrolimus.

He then turns to systemic-appropriate patients who cannot manage on topicals alone. Phototherapy is an old mainstay, but he notes only about 5 percent of patients can realistically sustain the frequent clinic visits it requires, and many lack access. Among older systemics, Dr. Strober mentions methotrexate, cyclosporine, and acitretin. He describes them as variably immunosuppressive, with different adverse-event and monitoring profiles, and argues they are largely too toxic or insufficiently effective, with low cost their main advantage.

Modern oral agents include apremilast, a lower-efficacy PDE-4 inhibitor, and deucravacitinib, a more recently approved TYK2 inhibitor. He anticipates more potent follow-on TYK2 inhibitors within a few years. On biologics, Dr. Strober reviews the older TNF-alpha inhibitors, etanercept, adalimumab, infliximab, and certolizumab, as effective but generally lower in efficacy than newer agents. He highlights ustekinumab, the sole IL-12/23 inhibitor, as groundbreaking for allowing every-12-week maintenance dosing.

The modern biologics he now favors are the IL-23 inhibitors, tildrakizumab, guselkumab, and risankizumab, and the IL-17 pathway inhibitors, including secukinumab, ixekizumab, the receptor blocker brodalumab, and the IL-17A/F inhibitor bimekizumab. He estimates roughly 14 biologics have been available over time. Dr. Strober says he has gravitated toward the IL-17 and IL-23 inhibitors for their less frequent dosing, high efficacy, and good tolerability.

In "Can Psoriasis Treatment Prevent PsA? Biologics, Phototherapy, and Other Treatments," the discussion turns to whether the choice of therapy can itself lower psoriatic arthritis risk.