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What Can You Use for Psoriasis If You Can’t Afford Otezla?

One reader reports that apremilast (Otezla) works very well to control psoriasis. There are other options for people who can't afford Otezla.

Although no one knows precisely what causes psoriasis, most experts believe this skin condition gets worse when the immune system is especially stressed. Skin cell growth goes into overdrive, and cells turn over in just a few days, rather than the normal month. Some plaques of skin become red and covered with silvery scales (the sloughing skin cells). Often, these areas itch as well as appearing unpleasant. Some prescription drugs to treat psoriasis work by calming the immune system. Others, such as apremilast (Otezla) or tofacitinib (Xeljanz), reduce inflammation. But can you afford Otezla or Xeljanz? Doctors now have many medications they could prescribe to treat psoriasis, but it seems each may be pricier than the last.

Could You Afford Otezla for Psoriasis?

Q. I have suffered with psoriasis for more than 45 years and have taken almost every treatment dermatologists offer. All are temporary and dependent on constant treatment.

I am currently on Otezla, which is extremely effective. However, I find sun, salt water and glycerin-based creams are the only ways to gain relief without prescriptions. Another calming topical is emu oil.

A. Otezla is a pricey prescription pill used to treat psoriatic arthritis, psoriasis and a rare inflammatory condition called Behcet’s disease. If your insurance company doesn’t cover it, the cost could be daunting. You may have to order it through a specialty pharmacy rather than through your neighborhood drugstore. When we inquired, we were told the price without insurance could be over $4,000 for a month’s supply.

Side effects of Otezla may include headache and digestive upset (diarrhea, indigestion, nausea and vomiting). Clinical trials show it works better than placebo and has a reasonable safety profile (American Journal of Clinical Dermatology, Feb. 2018). On the other hand, it doesn’t work for everyone. There are, however, numerous other medications.

Is Sotyktu a Good Alternative?

Q. I have had severe scalp psoriasis for many years. Home remedies, injections, UV light therapy, medications and shampoos have not helped.

My dermatologist recently prescribed Sotyktu. Do you think this is safe for me to use?

When I read the info included with the medication, I saw a couple of red flags. I am over 50 and I have had high blood pressure that I keep under control with medication.

A. Sotyktu (deucravacitinib) is a relatively new psoriasis medicine. It is in a somewhat similar category as some other biologic medications such as upadacitinib (Rinvoq) or tofacitinib (Xeljanz).

In a four-month trial of this drug to treat psoriatic arthritis, the most common side effects were sore throat, respiratory infection, sinusitis, bronchitis, rash, headache and diarrhea (Annals of the Rheumatic Diseases, June 2022). Sotyktu lowers the ability of the immune system to fight infections and must not be used in combination with other drugs that affect immune response. Some people react to this drug by developing angioedema (which can be life threatening). There are also concerns about serious infections such as tuberculosis as well as the blood cancer lymphoma.

The price might also be a worry unless your insurance plan will cover Sotyktu. GoodRx.com reports the monthly price without coverage or coupons at more than $11,000. So if you can’t afford Otezla, Sotyktu might also be out of reach.

Other Approaches to Managing Psoriasis:

We appreciate hearing about readers’ non-drug approaches. Others agree that these inexpensive options can sometimes be helpful.

Sun and Salt Water Against Psoriasis:

Doctors have equipment that can generate ultraviolet B (UVB) light waves exclusively. They use UVB to treat psoriasis, while scholars trace the origins of this treatment back to 1500 BC when healers used sunshine after they administered photosensitizing plant concoctions (Expert Review of Clinical Immunology, Nov. 2019). Presumably, UVB works because it suppresses the immune system. Sunlight contains UVB as well as UVA and is completely free during the part of the year when you can let the sun strike your skin. People using sun to calm their psoriasis must take care to avoid sunburn.

Sometimes people take a salt water bath prior to UVB exposure (Cochrane Database of Systematic Reviews, May 5, 2020). However, scientists have conducted only a few clinical trials of this approach, and these were done using indoor treatments. While the combination of salt water and ultraviolet light may work, the reviewers recommended further research to confirm this. You have been doing your own research over the years, so you know how it works for you.

Glycerin Creams and Emu Oil If You Can’t Afford Otezla:

Other readers have reported success treating their psoriasis with glycerin creams. Skin contains proteins called aquaporins that help move water through its layers (American Journal of Physiology. Renal Physiology, Jan. 2000). One of these, aquaporin-3, also moves glycerin and helps control skin cell turnover (American Journal of Physiology. Cell Physiology, June 1, 2020). A form of glycerin blocks skin cell inflammation (Molecular Pharmacology, May 2020). Although we have yet to see clinical trials of glycerin creams, we suspect that they are working through these mechanisms.

Scientists do not appear to have studied emu oil, however, except as a way of applying an herbal extract (Natural Product Research, June 2016). If you can’t afford Otezla or other expensive prescriptions, you could talk with your doctor about methotrexate or some alternative treatments.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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