Topical Treatments:

• Emollients
• Corticosteroids
• Vitamin D analogs
• Calcineurin Inhibitors
• Other Topical Agents

Systemic Treatments:

• Methotrexate
• Oral Retinoids
• Cyclosporine A

Biological Treatments:

• Enbrel (Etanercept)
• Humira (Adalimumab)
• Remicade (Infliximab)
• Stelara (Ustekinumab)

Phototherapy

• PUVA
• UVB
• Excimer Laser & Light

Etanercept

Etanercept (trade name Enbrel) is a fusion protein produced by recombinant DNA that treats autoimmune diseases by interfering with tumor necrosis factor (TNF) by acting as a TNF inhibitor. It binds to TNFα and decreases its role in disorders involving excess inflammation in humans and other animals, including autoimmune diseases such as ankylosing spondylitis, juvenile rheumatoid arthritis, psoriasis, psoriatic arthritis, rheumatoid arthritis, and, potentially, in a variety of other disorders mediated by excess TNFα.

Etanercept has been found to improve both cutaneous psoriasis and psoriatic arthritis. Patients over 8 years old should receive once-weekly sub­cutaneous etanercept 0.8 mg/kg (<50 mg) for up to 24 weeks. Treatment should be discontinued in patients who show no response after 12 weeks. Currently, etanercept is the biological agent most carefully studied to be used in children with psoriasis. Etanercept provides a good balance of safety and efficacy in children and adults with moderate to severe plaque psoriasis.

The theoretically increased risk of tuberculosis and other severe infections occurring during etanercept treatment needs to be ruled out before initiating therapy though tuberculosis is very low both in clinical studies but it is still present.  It is prudent to update all immunizations and perform PPD prior to starting treatment.