Numerous topical and systemic therapies are available for the treatment of the cutaneous manifestations of psoriasis. Established therapies such as methotrexate and phototherapy continue to play a role in the management of moderate to severe plaque psoriasis. The concept that many patients with psoriasis in the United States do not receive sufficient treatment to control the disease is suggested by an analysis of surveys performed by the National Psoriasis Foundation between 2003 and 2011 2. Environmental factors: a number of factors may trigger or exacerbate plaque psoriasis, including:Sunlight: there is usually a decrease in severity during periods of increased sun exposure (ie it often improves in the summer and is worse in the winter) but a small minority has an aggravation of symptoms during strong sunlight and sunburn can also lead to an exacerbation of plaque psoriasis. Chronic plaque psoriasis is typified by itchy, well-demarcated circular-to-oval bright red/pink elevated lesions (plaques) with overlying white or silvery scale, distributed symmetrically over extensor body surfaces and the scalp. Smaller plaques may coalesce into larger lesions, especially on the legs and sacral regions. The study sample consisted of nearly equal numbers of men and women;
Range in number from a few to many at any given time. May, in the case of smaller plaques, coalesce into larger lesions, especially on the legs and sacral regions. Systemic treatment is initiated only after topical treatments and phototherapy have proved unsuccessful. Systemic therapy should also be considered for patients with very active psoriatic arthritis, as well as for patients whose disease is physically, psychologically, socially, or economically disabling. Systemic therapies such as methotrexate, retinoids, and ciclosporin are effective for patients with refractory or extensive cutaneous disease. Climatotherapy, the oldest form of phototherapy involving exposure to sunlight, is well established at a number of clinics around the world. Elevation of liver function tests occurs in a small proportion of patients and must be monitored. It is well established in the management of various skin diseases, especially psoriasis and eczema.
Biologic therapy is a well-established strategy for managing moderate and severe psoriasis. Definitive conclusions, however, are difficult to draw due to the small number of patients included in the registry, particularly in the control cohort, and the short follow-up period. The chronic systemic inflammation present in psoriasis could explain why moderate to severe psoriasis is an independent risk factor for cardiovascular disease. The introduction of biologic therapies has greatly improved the expectations of treatment as well as the long-term control of psoriasis, and there is epidemiological evidence that these therapies may lower cardiovascular risk in psoriasis as they do in rheumatoid arthritis. Systemic therapies are required by patients with moderate-to-severe disease; The aetiology and pathology of psoriasis are not well understood, but it has been established that T-cells are centrally involved in its development 3. As an exploratory study, there are a number of inherent limitations that should be accounted for when interpreting the results, including the small number of patients included in each of the treatment groups. Biologic therapies for psoriasis use genetically engineered drugs that target specific steps involving T cells and cytokines (e. 14 This cost is in comparison to methotrexate, the most commonly prescribed nonbiologic systemic treatment for psoriasis worldwide, which costs approximately 1,200 per year. Based on the results of their meta-analysis, the authors concluded that the efficacy of systemic agents approved for moderate-to-severe psoriasis likely differs considerably between biologic and nonbiologic agents, as well as within the two classes. Since an earlier literature search yielded a small number of randomized controlled trials and observational studies as previously allowed, a broadening of the inclusion criteria may potentially capture more literature regarding the key questions of interest.
Plaque Psoriasis: Practice Essentials, Overview, Pathophysiology
Systemic therapy is most useful for extensive psoriasis, difficult to treat psoriasis meaning not very responsive to either topical treatments or phototherapy. Generally, neo-tegison works well but only at higher doses where it is not easily tolerated: dry skin, dry and cracked lips, hair loss, and aching joints. Kim Papp, established a clinical research centre located in Kitchener-Waterloo, Ontario.