Injections are a common treatment for people with moderate to severe psoriasis. Doctors often use them when other treatments haven’t worked, such as pills, topicals, or phototherapy. Topicals are creams or ointments that go directly on the skin. Phototherapy is a treatment that uses special light to help the skin.

Some members of MyPsoriasisTeam have wondered about the effectiveness of injectable medications for psoriasis. “Has anyone been on psoriasis injections?” one member asked. “Is it a lifelong treatment? Does it clear the skin for good or just manage it?”

This article explores different types of injectable medications available for psoriasis and how they work.

Understand the Differences in Injectable Medications

“Is the injection a good move or a bad one?” one MyPsoriasisTeam member asked.

The answer depends on several factors. Injectable medications are used for different types of psoriatic disease, and your doctor may need to run some tests to find the right injectable medication for you. Injectable medications for psoriasis can include corticosteroids (steroids), immunomodulators, or biologics. They vary in how they work and how they are given.

Subcutaneous Injection

Subcutaneous injections are given just under the skin and can often be administered at home. This makes them a convenient option for people who want more control over their treatment routine. These injections are usually easy to use and help people stay on schedule without needing to visit their healthcare provider often.

IV Infusion

Some medications are given through intravenous (IV) infusion, which means they’re injected directly into a vein. This treatment requires an appointment at a doctor’s office or infusion center. While it’s less convenient because of the in-person visits, IV infusions can deliver a stronger dose of medicine more quickly. For example, people with more severe or hard-to-treat psoriasis may benefit from this kind of treatment.

Intralesional Injection

Intralesional injections deliver corticosteroids directly into psoriatic plaques. This targets stubborn areas of inflammation. These local injections can offer quick relief for specific areas of skin. When choosing a treatment plan, it’s important to consider the delivery method, frequency, and how it fits into your daily life. Your healthcare provider can help you find the best option for your needs.

How Do Injectable Medications Work?

Psoriasis is caused by a problem with the immune system. In people with psoriasis, the immune system is overactive and causes inflammation. Injectable medications provide relief by tackling different factors that contribute to this inflammation. These factors are known as the medication’s mechanism of action.

Getting the Injection

Some injections need to be given by a healthcare provider, while others you can give yourself at home. Although self-administration can be nerve-racking, many members of MyPsoriasisTeam have learned to feel comfortable injecting themselves. If you’re worried that it will hurt, there are ways to make it less painful. Letting the medication reach room temperature, rotating injection sites, and practicing mindfulness techniques can help reduce discomfort.

Now, let’s explore the medications and how they work in the body:

1. Corticosteroids

Corticosteroid injections are sometimes injected directly into psoriasis lesions when topical treatments aren’t effective or if the lesion is hard to treat with topical creams (like those on the scalp). When the immune system responds, it produces cytokines. Cytokines are small proteins that cause inflammation. Corticosteroids block the production of these cytokines, reducing inflammation and providing relief from painful, swollen joints or skin plaques. However, corticosteroids are usually used for a short time to avoid side effects, and topical corticosteroid treatment is always the first choice for psoriasis. An example of an intralesional corticosteroid is triamcinolone (Kenalog).

2. Methotrexate

Methotrexate is a common disease-modifying antirheumatic drug (DMARD) used to manage both skin and joint symptoms of psoriasis and psoriatic arthritis. DMARDs are medicines that help slow down certain diseases and protect the joints and tissues from damage. Methotrexate can be taken by mouth or injected. Available under brand names like Otrexup and Rasuvo, methotrexate works by calming the immune system’s overactive response, which is what causes inflammation in psoriasis. Methotrexate targets multiple immune pathways, making it an effective treatment for many people. However, regular checkups are important because methotrexate can cause side effects, including liver toxicity, which means the medicine can harm the liver.

3. Biologics

Biologics are treatments that target specific proteins or cells in the immune system that contribute to psoriasis. Biologics are medicines made from living cells. They target specific parts of the immune system that cause inflammation in psoriasis. Biologics work on the body in different ways (mechanisms of action) and can be given in different forms.

People with psoriasis often produce too many cytokines, including tumor necrosis factor-alpha (TNF-alpha) and specific interleukins (ILs), like IL-12, IL-17, and IL-23. Inhibitors of these proteins help reduce inflammation.

TNF-Alpha Inhibitors

TNF-alpha inhibitors are a group of biologic drugs that target TNF-alpha, a key protein in the inflammatory process. These biologics have greatly improved treatment for moderate to severe psoriasis. TNF-alpha inhibitors usually need to be injected regularly, from weekly to bimonthly, depending on the specific drug. Here are some commonly prescribed TNF-alpha inhibitors approved by the U.S. Food and Drug Administration (FDA) for the treatment of psoriasis, all given subcutaneously except for infliximab, which is administered intravenously:

• Adalimumab (Humira)
• Certolizumab pegol (Cimzia)
• Etanercept (Enbrel)
• Infliximab (Remicade)

Interleukin Inhibitors

Interleukin inhibitors target specific interleukins (ILs) like IL-12, IL-17, and IL-23, which contribute to the overactive immune response seen in psoriasis. These biologics take a more targeted approach and can help people who haven’t gotten better with other treatments. These are some commonly prescribed interleukin inhibitors approved by the FDA for treating psoriasis, all administered subcutaneously:

• Bimekizumab-bkzx (Bimzelx) — IL-17A/IL-17F inhibitor
• Brodalumab (Siliq) — IL-17 inhibitor
• Guselkumab (Tremfya) — IL-23 inhibitor
• Ixekizumab (Taltz) — IL-17 inhibitor
• Risankizumab-rzaa (Skyrizi) — IL-23 inhibitor
• Secukinumab (Cosentyx) — IL-17 inhibitor
• Tildrakizumab-asmn (Ilumya) — IL-23 inhibitor
• Ustekinumab (Stelara) — IL-12/IL-23 inhibitor

4. T-Cell Inhibitors

T-cell inhibitors target T cells, which are responsible for triggering the immune response that leads to inflammation in psoriasis. By blocking T cells, these inhibitors help reduce inflammation and lessen symptoms. One FDA-approved T-cell inhibitor is abatacept (Orencia), which can be given either subcutaneously or intravenously, based on a person’s needs.

5. Biosimilars

Biosimilars are highly similar to previously approved biologic medications (known as reference products) but are often more affordable. They treat psoriasis in the same way as their reference biologics but at a lower cost. There are several biosimilars available. If you’re interested in learning more about them, talk to your dermatologist.

Know the Side Effects and Risks of Injectables

Because injected medications for psoriasis suppress parts of the immune system, they come with risks and potential serious side effects. Your dermatologist can provide medical advice to help you choose the right injectable for you. They can also tell you about common side effects to expect and which side effects are serious.

It’s important to discuss any other over-the-counter or prescription drugs you take with your doctor. This can help them advise you about any potential interactions. Also, talk to your doctor about family planning. Some medications may not be safe if you’re pregnant, breastfeeding, or planning to become pregnant.

Talk With Others Who Understand

On MyPsoriasisTeam, the social network for people with psoriasis and psoriatic arthritis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and psoriatic arthritis.

Are you using prescribed injectable medications for psoriasis? Share your experience in the comments below, or start a conversation by posting on your Activities page.