If you’ve been living with psoriasis for years, you may have tried all sorts of creams, tablets and lifestyle changes to keep it under control. You may even feel like you’ve exhausted your options, especially if your flare-ups keep returning or your symptoms impact your confidence and day-to-day comfort. This is where biologic medicines come in. They’ve completely transformed the way we treat moderate to severe psoriasis, offering targeted relief when traditional treatments simply aren’t enough.
In this guide, I’ll walk you through everything you need to know about biologics how they work, who they’re designed for and what results you can realistically expect. I want to give you a clear, honest picture so you feel more confident about your next steps, whether you’re considering a biologic for the first time or trying to understand whether you qualify.
What Are Biologic Treatments for Psoriasis?
Biologics are advanced medicines made from living cells, designed to target specific parts of your immune system that drive psoriasis. Unlike creams or tablets that work more broadly, biologics switch off the exact overactive pathways that trigger inflammation and skin overgrowth.
Psoriasis is an immune-mediated condition, which means your immune system mistakenly accelerates your skin cell turnover. Certain immune proteins like TNF-alpha, IL-17 and IL-23 play an important role in this process. Biologics block these proteins, calming the inflammatory cycle and slowing skin production to a normal rate. Because biologics target the root cause rather than simply soothing the symptoms, many patients experience clearer skin and fewer flare-ups for the first time in years.
How Biologics Differ From Traditional Psoriasis Treatments
If you’ve used topical creams or oral tablets before, you’ll know that results can be inconsistent or short-lived. Biologics work differently.
Creams and ointments – These mostly treat the surface symptoms, not the underlying immune activity. They help with redness, scaling and itch but they can’t stop psoriasis from forming.
Phototherapy – This can calm inflammation, but it requires frequent clinic visits and results may fade if sessions stop.
Oral tablets (e.g., methotrexate, ciclosporin) – These suppress the immune system more generally. They can work well but may cause side effects and can’t always be used long term.
Biologics – They act directly on the immune pathways that cause psoriasis. This makes them more effective for people with moderate to severe disease, especially if other treatments haven’t worked.
If your psoriasis has been resistant to traditional therapies, biologics may offer a level of control you haven’t experienced before.
Who Qualifies for Biologic Psoriasis Treatment?
Not everyone with psoriasis requires biologic treatment. These medications are generally recommended for people with moderate to severe psoriasis, particularly when large areas of the body are affected, daily life or confidence is impacted, or previous treatments like topical creams, phototherapy, or systemic tablets have not worked or caused severe side effects. Biologics may also be considered if certain tablets cannot be taken due to health reasons.
Dermatologists will also evaluate whether psoriasis is causing complications such as psoriatic arthritis, frequent flare-ups, or involvement of the scalp, nails, or palms and soles. Sleep problems, emotional distress, or negative effects on mental health, social life, and work can also be important factors in determining eligibility for biologic therapy.
Types of Biologic Medicines for Psoriasis
There are several classes of biologics, each targeting a different immune pathway. Understanding the differences can help you make sense of treatment recommendations.
TNF-alpha inhibitors: TNF-alpha inhibitors were the first biologic treatments developed for psoriasis. They target and block TNF-alpha, a protein that plays a central role in inflammation. Common examples of TNF-alpha inhibitors include etanercept, infliximab, and adalimumab. While effective, these medications are now typically used when newer biologic options are not suitable.
IL-12/23 inhibitors: IL-12/23 inhibitors are biologic medicines that target two key pathways involved in inflammation. Ustekinumab is an example of this class. These treatments provide effective long-term control of psoriasis and are convenient due to their infrequent dosing schedule.
IL-17 inhibitors: IL-17 inhibitors are biologic treatments that block IL-17, a protein that plays a major role in the development of psoriasis plaques. Examples include secukinumab, ixekizumab, and brodalumab. They often act quickly, making them a popular choice for people with severe psoriasis.
IL-23 inhibitors: IL-23 inhibitors are highly effective biologic treatments that target a key inflammatory pathway in psoriasis. Examples include guselkumab, tildrakizumab, and risankizumab. They are known for providing long-lasting remission and require fewer injections, making them convenient for long-term management.
How Biologics Are Given
Biologics are typically given through injections, either under the skin (subcutaneous) or through an intravenous infusion (IV). Many patients learn to administer subcutaneous injections at home, which makes treatment much more convenient and reduces the need for frequent clinic visits. Infusions are usually given in a clinic or hospital setting under medical supervision.
Injection frequency varies depending on the specific biologic and your treatment plan, but common schedules include:
- Every 1–2 weeks: Some biologics require more frequent dosing initially to control symptoms effectively. This schedule may be temporary until your psoriasis comes under control.
- Every 4 weeks: Many biologics use a monthly dosing schedule, which balances efficacy with convenience. Patients often find this easier to remember and incorporate into their routine.
- Every 8–12 weeks: Certain biologics are designed for less frequent dosing, which can improve adherence and reduce disruptions to daily life.
Your dermatologist will recommend a schedule that suits your lifestyle, treatment goals, and the type of psoriasis you have. They will also provide guidance on proper injection technique, storage, and how to manage any potential side effects.
How Quickly Do Biologics Work?
Patients often want to know how quickly biologic treatments start working. The timeline can vary depending on the specific biologic, but general improvements are usually seen as follows: within 2–4 weeks, itching and redness may decrease; by 4–8 weeks, plaques often begin to thin; and between 8–12 weeks, many patients notice significant clearance.
For some biologics particularly IL-17 and IL-23 inhibitors results can be remarkably fast. Many people who have struggled with severe plaques for years experience major improvements sooner than they anticipate, with up to 90–100% clearance achievable in 12–24 weeks for many patients.
What Level of Improvement Can You Realistically Expect?
While no treatment can guarantee complete clearance for everyone, biologics offer some of the highest success rates in dermatology and can lead to a dramatic improvement in quality of life. Most patients notice a major reduction in plaques, smoother and more even skin, significantly less itching, fewer flare-ups, improved sleep, greater comfort, and enhanced confidence and mental wellbeing. These changes can make daily life much easier and reduce the emotional burden of living with psoriasis.
Clinical studies show that 70–90% of patients achieve PASI 75 (a 75% improvement in symptoms), 60–80% reach PASI 90 (near-clear skin), and many even attain PASI 100 (completely clear skin). For numerous patients, biologics provide the most significant and lasting improvement they have ever experienced, often surpassing all previous treatments and allowing them to regain normalcy in both appearance and daily activities.
Psoriatic Arthritis and Biologics
If you have joint pain, stiffness or swelling, your psoriasis may be linked to psoriatic arthritis. Biologics can treat both skin and joint symptoms at the same time. This is important because untreated psoriatic arthritis can cause long-term joint changes. Early treatment reduces inflammation and can prevent permanent damage.
Safety and Side Effects of Biologic Treatment
Biologics are generally considered safe and well-tolerated, but like any medication, they carry potential risks. Your dermatologist will discuss these with you and tailor monitoring to your individual needs.
Common, mild side effects
These are usually temporary and manageable:
- Redness or swelling at the injection site: Mild irritation is common and typically resolves within a day or two. Applying a cool compress can help.
- Mild headaches: Some patients experience short-lived headaches shortly after injection. Staying hydrated and resting often helps.
- Temporary fatigue: Feeling slightly tired is normal, especially during the first few doses, and usually improves over time.
- Slight increase in colds or infections: Because biologics affect the immune system, you may notice more frequent mild infections, but these are generally not severe.
Less common effects
These require closer monitoring:
- Increased risk of certain infections: Biologics can suppress parts of the immune system, making it easier to catch bacterial or viral infections. Promptly reporting unusual symptoms to your doctor is important.
- Reactivation of tuberculosis (TB): Some biologics can trigger latent TB. Screening before starting treatment is essential to prevent this.
- Rare allergic reactions: Although uncommon, severe reactions can occur. Clinics are prepared to manage them safely.
Long-term safety
Biologics do not cause organ toxicity, unlike some oral systemic medications used for psoriasis. Many people safely use them for years with regular monitoring, including blood tests and periodic health checks. This long-term safety profile, combined with their effectiveness, makes biologics a valuable option for moderate to severe psoriasis.
What Happens If a Biologic Stops Working?
In some cases, a biologic may provide excellent results initially but gradually lose effectiveness over time. If this happens, it doesn’t mean your treatment options are over. Your dermatologist can take several approaches to help restore control, such as adjusting the dosing schedule, switching you to a different class of biologic, adding a short-term topical treatment, or investigating underlying triggers like infections, stress, or other health changes that might be reducing the drug’s effectiveness.
With the wide range of biologic therapies now available, losing response to one medication is not uncommon and can usually be managed successfully. Many patients go on to achieve excellent results by switching biologics or combining treatments, allowing them to maintain clear or near-clear skin, reduce flare-ups, and improve overall comfort, confidence, and quality of life.
Lifestyle Considerations While on Biologics
While biologics can provide dramatic improvements in psoriasis, your lifestyle choices still play a crucial role in keeping flare-ups under control and supporting long-term results. Maintaining a healthy weight, reducing alcohol consumption, quitting smoking, managing stress effectively, protecting your skin from irritation, and adhering strictly to your injection schedule can all significantly enhance the effectiveness of your treatment. Even small daily habits, such as using gentle skincare products and avoiding harsh scrubbing, can make a noticeable difference over time.
When biologic therapy is combined with a proactive lifestyle and consistent skincare routine, patients have the best chance of maintaining clear, comfortable skin over the long term. This approach not only helps reduce the frequency and severity of flare-ups but also supports overall physical and emotional wellbeing, allowing you to feel more confident, sleep better, and enjoy daily activities without the constant burden of psoriasis symptoms.
Who Should Avoid Biologic Treatments?
Biologics are not suitable for everyone, and your dermatologist will carefully assess whether they are appropriate for you. They may not be recommended if you:
- Have an active infection: Biologics suppress parts of the immune system, which can make existing infections worse or harder to control. Treating the infection first is essential before starting therapy.
- Are pregnant or breastfeeding: Some biologics are not recommended during pregnancy or while breastfeeding due to potential risks to the baby. Your dermatologist can advise on safer alternatives or timing options.
- Have certain immune-related conditions: People with conditions that already affect immune function, such as multiple sclerosis or lupus, may be at higher risk of complications with biologic therapy.
- Have untreated tuberculosis: Biologics can reactivate latent TB, so untreated tuberculosis is a strict contraindication. Screening and treatment of TB are required before starting therapy.
- Are unable to attend regular monitoring appointments: Biologics require ongoing follow-up, including blood tests and health checks, to ensure safety and detect any early side effects.
Your dermatologist will help you weigh the benefits against the potential risks, taking your medical history, lifestyle, and psoriasis severity into account. This ensures that biologic treatment is both safe and effective for you.
FAQs:
1. How do biologic treatments work for psoriasis?
Biologics target specific components of the immune system that drive psoriasis, rather than broadly suppressing immune function like some traditional medications. They focus on proteins such as TNF-alpha, IL-17, or IL-23, which play a key role in triggering inflammation and excessive skin cell growth. By inhibiting these proteins, biologics slow down the rapid turnover of skin cells, reduce redness and scaling, and help prevent new plaques from forming. This targeted approach allows patients to experience more consistent and longer-lasting improvements in their skin compared with topical treatments or oral tablets.
2. Who is eligible for biologic treatment?
Biologics are generally recommended for people with moderate to severe psoriasis, particularly when large areas of the skin are affected or when the condition significantly impacts daily life and mental wellbeing. Eligibility is usually considered after other treatments such as topical creams, phototherapy, or systemic tablets have failed, caused side effects, or cannot be safely used. Dermatologists also take into account complications like psoriatic arthritis, scalp or nail involvement, frequent flare-ups, and the emotional or social effects of psoriasis, which can influence the decision to start biologic therapy.
3. How are biologics administered?
Biologic medications are typically delivered via injections under the skin (subcutaneous) or, in some cases, through intravenous infusions in a clinical setting. Many patients are taught to administer subcutaneous injections at home, which adds convenience and reduces the need for frequent clinic visits. The dosing schedule varies depending on the specific biologic and individual treatment plan, ranging from weekly or biweekly injections to monthly or even less frequent dosing. Your dermatologist will provide personalised guidance on how to administer the medication safely, store it correctly, and manage potential side effects.
4. How quickly can patients expect to see results?
The speed of improvement depends on the specific biologic used and individual response, but most patients notice a reduction in redness and itching within two to four weeks. Plaques often start to thin between four and eight weeks, and significant clearance may be observed within eight to twelve weeks. Certain biologics, particularly IL-17 and IL-23 inhibitors, can produce dramatic improvements even faster, with some patients achieving near-complete clearance within three to six months. Overall, early response is usually a good indicator of how the treatment will perform in the longer term.
5. What level of improvement is realistic with biologics?
While complete clearance cannot be guaranteed for every patient, biologics often lead to the most substantial improvements seen in psoriasis care. Many individuals experience major reductions in plaques, smoother skin, and less itching, which translates into better sleep, comfort, and confidence. Clinical studies show that a significant proportion of patients achieve PASI 75, meaning a 75% improvement in symptoms, and a notable number reach PASI 90 or even PASI 100. This can result in dramatic enhancement of quality of life, with many patients feeling freer from the physical and emotional burdens of psoriasis than they have in years.
6. Can biologics treat psoriatic arthritis as well?
Yes, certain biologic therapies are effective for both the skin and joint symptoms associated with psoriatic arthritis. Inflammation in the joints can lead to pain, stiffness, and long-term damage if left untreated. By targeting the same immune pathways responsible for psoriasis, biologics can reduce joint inflammation, improve mobility, and prevent permanent changes to the joints. Early intervention is especially important, as managing both skin and joint symptoms simultaneously can prevent worsening disability and improve overall outcomes.
7. Are biologics safe for long-term use?
Biologics have a strong safety profile when used under regular supervision. Most patients tolerate these medications well, and long-term studies have shown no significant organ toxicity, unlike some oral systemic treatments. Regular monitoring, including blood tests and periodic health checks, helps detect any side effects early and ensures continued safety. While biologics can slightly increase the risk of mild infections, serious adverse effects are uncommon when patients follow the recommended precautions and attend scheduled follow-ups.
8. What should patients do if a biologic stops working?
It is not unusual for a biologic to lose effectiveness over time. If this occurs, your dermatologist can explore several strategies to regain control of your psoriasis. Adjustments may include changing the dosing schedule, switching to a different biologic in another class, or using short-term topical treatments to address flare-ups. Identifying triggers such as infections, stress, or other health changes can also improve outcomes. With multiple biologic options now available, most patients can achieve clear or near-clear skin even if one therapy loses effectiveness.
9. Are there lifestyle considerations while on biologics?
Lifestyle plays a crucial role in supporting the effectiveness of biologic therapy. Maintaining a healthy weight, reducing alcohol consumption, quitting smoking, managing stress, and protecting the skin from irritation can enhance treatment outcomes. Adhering strictly to injection schedules and following a gentle skincare routine further helps maintain clear skin. By combining biologic therapy with positive lifestyle choices, patients increase the likelihood of sustaining long-term improvements and reducing the frequency and severity of flare-ups.
10. Who should avoid biologic treatment?
Biologics are not suitable for everyone. Patients with active infections, untreated tuberculosis, or certain immune-related conditions may be advised against starting biologic therapy. Pregnant or breastfeeding individuals may need alternative treatments due to potential risks. Biologics also require ongoing monitoring and follow-up, so patients who are unable to attend regular appointments may not be ideal candidates. Dermatologists carefully weigh the benefits against potential risks, considering the patient’s medical history, lifestyle, and psoriasis severity to ensure safe and effective treatment.
Final Thoughts: Considering Biologic Treatments for Psoriasis
Biologic treatments have transformed the management of moderate to severe psoriasis, offering targeted relief where traditional therapies may fall short. They can help reduce plaques, itching, and flare-ups, improving both physical comfort and emotional wellbeing. While biologics are highly effective, their success depends on careful selection, regular monitoring, and a proactive approach to lifestyle and skincare.
If you’re considering psoriasis treatment in London, contact us at London Dermatology Centre to book a consultation with one of our specialists. We’re here to help guide you toward the most suitable and effective treatment for your needs.
References:
1. Bauer, J. W. et al., 2021. Efficacy and Safety of Biologics for Psoriasis and Psoriatic Arthritis and Their Impact on Comorbidities. International Journal of Molecular Sciences, 21(5), 1690. https://www.mdpi.com/1422-0067/21/5/1690
2. Cui, L., Chen, R., Subedi, S., Yu, Q., Gong, Y., Chen, Z. & Shi, Y., 2018. Efficacy and Safety of Biologics Targeting IL‑17 and IL‑23 in the Treatment of Moderate‑to‑Severe Plaque Psoriasis: A Systematic Review and Meta‑Analysis of Randomized Controlled Trials. International Immunopharmacology, 62, pp.46–58. https://pubmed.ncbi.nlm.nih.gov/29990694/
3. Frambach, Y., Langley, R.G., Puig, L. & van den Reek, J., 2016. Biologic Therapy in Psoriasis (Part II): Efficacy and Safety of New Treatment Targeting IL‑23/IL‑17 Pathways. Expert Review of Clinical Immunology, 12(7), pp.753–770. https://pubmed.ncbi.nlm.nih.gov/29299984/
4. Petrou, I. et al., 2022. Effectiveness and Safety of Biological Therapies in Very Severe Plaque Psoriasis: A Real‑Life Retrospective Study. Journal of Personalized Medicine, 14(2), 186. https://www.mdpi.com/2075-4426/14/2/186
5. de Jong, E. et al., 2024. Drug Survival of IL‑17 and IL‑23 Inhibitors for Psoriasis: A Systematic Review and Meta‑Analysis. Drugs, online first. https://pubmed.ncbi.nlm.nih.gov/38630365/