Combination therapy means using more than one treatment at the same time or in sequence, so you can take advantage of as many of the benefits available to you as possible during treatment of your skin condition. Combination therapy is considered the standard of care in the treatment of psoriasis, vitiligo and many other skin conditions. No single therapy achieves 100% clearance in all people. Therefore, combination therapies, especially a combination of phototherapy with topical, oral and injectable drug therapies, is often used to achieve the best and most lasting results.
To help you understand how combination therapy typically works, we’ve put together this very brief guide explaining common treatment combinations, along with a few combinations that don’t work well together and why.
Topical corticosteroids such as clobetasol, triamcinolone and betamethasone are often used with another topical that is a non-steroid. Calcineurin inhibitors such as Elidel® or Protopic® and vitamin D analogues such as Dovonex® are topicals that can reduce inflammation without the undesirable side effects of topical corticosteroids. Two-in-one formulations such as Enstilar® and Taclonex® are highly convenient and cosmetically elegant in feel.
These medications are often used in combination with phototherapy as their side effects do not interact, but topicals must be used after phototherapy, or else they’ll physically block the penetration of the skin by the UV rays used in light treatments.
Phototherapy may also be used in combination with biologics such as TNF-α inhibitor Humira®, IL-12/23 inhibitor Stelara®, IL-17A inhibitor Cosentyx®, and many others to potentially provide additional improvement. Phosphodiesterase inhibitors such as Otezla® show promise for combination with phototherapy as they usually do not increase photosensitivity or share the same side effects. JAK inhibitors Xeljanz®, Jakafi® and melanocyte stimulating hormone Scenesse® also work well with phototherapy for vitiligo treatment.
When oral retinoids like acitretin are combined with phototherapy, they can make phototherapy more efficient and limit the frequency and duration required. This combination results in a treatment regimen that is more effective, more convenient, easier to incorporate into the day, less costly, and potentially safer during long-term treatment than phototherapy alone.
There are also some combinations that just don’t work well together. For example, combining some traditional immunosuppressive agents such as methotrexate with light therapy leads to increased photosensitivity; and combining cyclosporin and phototherapy can increase the risk of skin cancer.
It’s also important to point out that some of the combination therapies listed above that work well for many may have undesirable side effects for you personally. Be sure to talk to your doctor if you start to see them at any point during your treatment—there may be something you can change about your particular combination of treatments to find just the right one for you.