Photo Credit: by psoriasisforbundet, flickr.com
Are you tired of red, scaly patches that refuse to leave, no matter how many creams you try? In 2025, two oral psoriasis treatments are changing the game: deucravacitinib (Sotyktu) and apremilast (Otezla). With plaque psoriasis affecting an estimated 7.5 million Americans as of 2021, knowing which “step-up” therapy delivers the fastest, longest-lasting relief is more critical than ever. In this guide, you’ll learn exactly how each drug works, see real-world head-to-head results, compare U.S. costs, find out about the American Academy of Dermatology (AAD) guidelines, and grab expert summer-fall skincare tips to keep your skin calm and clear.
What Is Psoriasis and Who Gets It?
Psoriasis is a skin condition that happens when your body’s defense system (the immune system) gets a bit overzealous and speeds up the life cycle of your skin cells. Normally, skin cells take around a month to grow and shed, but with psoriasis, that process happens in just a few days. The result? Patches of thick, red skin covered in silvery scales. This often occurs on your elbows, knees, scalp, or lower back. These patches can feel itchy or sore or even crack and bleed.
While anyone can get psoriasis, it most often appears between the ages of 20 and 30 or again around 50 to 60. There’s no single cause, but it tends to run in families. Triggers include stress, infections (like strep throat), certain medications, smoking, and even changes in the weather. About 3% of U.S. adults, that’s roughly 7.5 million people, live with plaque psoriasis, the most common form. Treatments range from creams and light therapy to the newest oral pills, but understanding what psoriasis is and what sparks your own flares is the first step toward clearer, more comfortable skin.
Understanding Key Psoriasis Measures: PASI and DLQI
Before we dive into more information about psoriasis treatment, here are two measurements you need to know:
• Psoriasis Area and Severity Index (PASI): Combines a judgement about lesion redness, thickness, scaling, and body-surface area involved. PASI-75 means a 75% reduction from baseline, while PASI-90 means a 90% reduction.
• Dermatology Life Quality Index (DLQI): This is a 10-question survey on daily-life impact. A DLQI 0-1 score indicates no significant effect on your quality of life.
These scales matter because they indicate how well psoriasis treatments work.
How Sotyktu (Deucravacitinib), a TYK2 Inhibitor, Works
Let’s take a look at how the psoriasis treatment and TYK2 inhibitor, deucravacitinib (Sotyktu), works.
Think of your immune system as a series of light switches that tell your white blood cells when to turn on inflammation. One of those “switches” is a protein called tyrosine kinase 2 (TYK2). In psoriasis, TYK2 is stuck in the “on” position, helping send messages that ramp up production of key troublemakers, which, in turn, drive your skin cells to grow too fast and form those red, scaly plaques. These troublemakers include molecules like interleukin-23 (IL-23) and interleukin-17 (IL-17).
This is how deucravacitinib (Sotyktu) fixes the switch. It:
• Locks TYK2 off: Deucravacitinib slips into a special pocket on the TYK2 protein and holds it in an inactive pose — think of it as wedging a doorstop under the switch so it can’t flip on.
• Stops inflammatory messaging: With TYK2 locked down, it can’t pass along the “make more IL-23 and IL-17” orders. That means fewer of those runaway immune signals are reaching your skin.
• Slows skin-cell overdrive: Without those inflammatory “go” signals, your skin cells return to their normal 28-day growth cycle instead of turning over in just a few days. Plaques shrink, redness fades, and itching eases.
Because deucravacitinib works inside your cells at the very start of the inflammatory chain, it’s like preventing a domino effect before the first tile even tips. This helps clear plaques more deeply and steadily than drugs that target downstream messengers. And since it’s a once-daily pill, it’s a simple way to keep that TYK2 switch in the “off” position day after day.
How Otezla (Apremilast), a PDE4 Inhibitor, Works
Now let’s focus on how the PDE4 inhibitor apremilast (Otezla) works.
This time, imagine your immune system as a car: you have an accelerator pedal that ramps up inflammation when you need to fight infections (which is good), but sometimes it still floors the gas when it’s not necessary. This leads to unwanted inflammation in your skin. Inside your immune cells, an enzyme called phosphodiesterase 4 (PDE4) acts like a mechanic who keeps removing one of the natural “brakes” on that pedal, a molecule called cyclic AMP (cAMP). Less cAMP means the pedal stays floored, and inflammation stays in overdrive when it doesn’t need to.
Apremilast (Otezla) works like applying the brakes. It:
• Disables the mechanic: Apremilast blocks PDE4, so it can’t break down cAMP.
• Builds up cAMP “brakes”: With PDE4 out of action, cAMP levels rise inside the cell. Think of it as installing a stronger brake system.
• Dials down inflammatory signals: Higher cAMP shifts your immune cells away from producing pro-inflammatory molecules (like IL-23, and IL-17) and boosts anti-inflammatory ones (like IL-10).
• Slows skin-cell turnover: With the inflammatory engine revving less, your skin cells go back to their normal growth pace and there’s no more pileups of red, scaly plaques.
Because apremilast works by restoring your immune system’s natural braking mechanism, it gently turns down inflammation across multiple messengers rather than hitting just one target. Taken as a twice-daily pill, it offers a steady way to ease the inflammatory drive behind psoriasis.
Head-to-Head Efficacy and Patient Experience of Deucravacitinib (Sotyktu) and Apremilast (Otezla)
Now that we understand the basics, we can look at how apremilast and deucravacitinib stack up. While no direct comparison trial exists, pivotal phase three studies offer clear insights.
The important things shown include:
• Both medications cleared skin well.
• Both medications led to a better quality of life.
• Both medications showed that itching improvements occurred in under one month.
• Both therapies show low rates of serious side effects.
To drill down on the technical specifics, by week 16 in their pivotal trials:
• Skin‐clearance (PASI-75): Deucravacitinib led to a 53-58% Psoriasis Area and Severity Index-75 (PASI-75) response, compared with about 33-35% for apremilast.
• High‐clearance (PASI-90): Deucravacitinib delivered PASI-90 rates of 27-36%, versus roughly 11-15% with apremilast.
• Quality of life (DLQI 0–1): In the deucravacitinib extension, 29-34% of patients achieved a Dermatology Life Quality Index (DLQI) score of 0-1 by week 16 and this benefit held long term, while 35% of apremilast patients hit DLQI 0-1 by week 16 versus 19% on placebo.
• Speed of relief: Itching improvements appeared as early as week two with deucravacitinib, compared to week four with apremilast.
• Safety profiles: Both therapies show low rates of serious adverse events. Gastrointestinal side effects (e.g., nausea, diarrhea) are more common with apremilast, whereas deucravacitinib may cause mild laboratory‐value shifts (e.g., transient liver‐enzyme elevations) without clinical consequence.
(You’ll find this information here and here for deucravacitinib, and here and here for apremilast.)
Cost in the United States of Deucravacitinib (Sotyktu) and Apremilast (Otezla)
Unfortunately, these effective medications can be quite costly in the United States; however, you may be able to cut costs by buying through a Canadian pharmacy.
• Otezla (Apremilast):
o List price in the United States ≈ USD $5,096 per month (30×30mg); this works out to USD $170 per day.
o Otezla at Canadian Pharmacy King: CAD $2,142.84 per 56 days (56×30mg) ≈ USD $1,562.77; this works out to USD $27 per day.
o The equivalent generic at Canadian Pharmacy King: CAD $557.13 per 56 days (56×30mg) ≈ USD $406.26; this works out to USD $7 per day.
• Sotyktu (Deucravacitinib):
o List price in the United States ≈ USD $6,677.77 per month (30×6 mg); this works out to USD $222 per day.
o Deucravacitinib at Canadian Pharmacy King: CAD $1,799.99 per 28 days (28×6mg) ≈ USD $1,311.29; this works out to $47 per day.
Note all costs are approximate and may vary depending on suppliers and other factors.
Psoriasis Treatment According to the American Academy of Dermatology Guidelines
The most recent Psoriasis Clinical Guidelines by the AAD recommend a stepwise approach to treating the illness. This means that how you treat your psoriasis will depend on how severe your illness is and what other treatments you have tried.
Their guidelines say that for:
1. Mild disease: Topical therapies (such as corticosteroids and vitamin D analogues) should be used.
2. Moderate disease: Phototherapy and traditional systemic agents (such as methotrexate and cyclosporine) should be used.
3. Severe or refractory disease:
o First-line advanced therapy: Biologics (such as interleukin-17 inhibitors), or a PDE4 inhibitor (apremilast) for oral therapy can be used.
o Alternative oral option: TYK2 inhibitor (deucravacitinib) for patients who are needle-averse, have contraindications to biologics, or have failed prior systemics can be used.
Lifestyle, Diet, and Holistic Support
While psoriasis medication can make a huge difference to your quality of life, it tends to work best alongside healthy daily habits. You should consider things like:
• An anti-inflammatory det: This diet should include cold-water fish rich in omega-3 fatty acids, colorful fruits and vegetables for antioxidants, and whole grains, while limiting red meat and processed foods.
• Weight management: It’s important to remember that obesity exacerbates psoriasis and that even a small 5-10% weight loss can improve PASI scores.
• Stress reduction: Yoga, mindfulness meditation, and cognitive behavioral therapy can reduce flare frequency.
• Smoking cessation: Smoking heightens severe flare risk, particularly in cooler months.
• moderation: Excessive alcohol can worsen inflammation and interfere with treatments.
You can read more about the evidence behind these habits here and here.
Summer and Fall Psoriasis Control Tips
Seasonal factors can trigger flares or help clear skin, so pay attention to the calendar to make sure you keep psoriasis at bay. Consider these seasonal psoriasis control tips:
1. Get out in the sun: Time in the sun can be helpful, but don’t forget sunscreen, which needs to protect against UVA and UVB rays, be made for sensitive skin, be fragrance-free, and have a sun protection factor (SPF) of at least 30.
2. Go swimming in the ocean: Salt water can help remove dead skin and improve the look of psoriasis. However, swimming can also dry skin out, so always rinse off and moisturize afterward.
3. Stay cool: Sweat and heat can trigger psoriasis, so try to stay cool. Keep in mind, though, air conditioning can dry skin out, so make sure to moisturize frequently if you spend time in air-conditioned rooms.
4. Hydrate and repair the moisture barrier: Once seasonal activities have dried out your skin, use ceramide-rich, fragrance-free moisturizers twice daily. Also, apply them immediately after showers (which should be lukewarm).
5. Prevent infections: Infections can increase the risk of psoriasis flares and progression of the illness, so vaccines like the flu vaccine and others can be very helpful.
6. Focus on stress management: Autumn can be a particularly stressful time as kids get back to school and summer vacation ends. Ensure stress-management routines are part of the equation.
7. Use gentle skincare: Use non-soap cleansers, pat dry, and skip harsh exfoliants.
8. Wear breathable fabrics: Cotton or moisture-wicking clothes are best for the summer, while lightweight wool blends work well in the fall.
Check out more summer and fall psoriasis tips here.
Mastering Your 2025 Psoriasis Control Plan
With deucravacitinib (Sotyktu) and apremilast (Otezla) both offering powerful, convenient oral step-up options, your choice hinges on balancing speed and depth of clearance, safety, cost, and personal preference. Pair your selected therapy with proven summer-fall skin care strategies and lifestyle tweaks to keep flares at bay, and get clearer, more comfortable skin all year long.
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