Explore how adherence to topical psoriasis medications affects treatment success; assess available topical treatments; and review the recent literature. Clinical Focus: The Spectrum of Topical Agents for the Treatment of Psoriasis. Emily M. Dr. Emily Becker and Dr. John Koo review the recent literature on topical agents for the treatment of psoriasis. Editor’s note: Clinical Literature Reviews usually focus on clinical studies that have been published recently in journals. The wide range of treatments available for psoriasis illustrates this; no one treatment will work for everyone. There is no cure for psoriasis but several new medications have recently been introduced and ongoing research looks promising.
Psoriasis is usually treated with topical medications and/or phototherapy with variable efficacy in controlling the disease. For the past three decades, research has been focused on systemic agents for the treatment of moderate-to-severe psoriasis, particularly with the introduction of biologic agents or ‘small molecules’. These agents, having a different spectrum of action from traditional agents, are actually being tested in pre-marketing clinical trials and they may potentially represent promising treatment options that could enlarge the therapeutic armamentarium for the treatment of psoriasis. Moreover, it aims to dispel myths that might have a negative impact on the use of such drugs by clinicians. The primary focus is on immunomodulators that have been successfully used in the treatment of psoriasis. As such, several aspects of psoriasis immunopathophysiology and regulatory pathways of immune cells are explored 2. Resources Websites: Recommendations for the initial management of psoriasis. NHS Clinical Knowledge Summaries.
In this article, new systemic therapies for psoriasis are discussed, including a review of the relevant clinical trials for novel therapeutics and their respective mechanisms of action, patient outcomes, and safety profiles. This article is the final installment in a 3-part series on agents in the pipeline for the management of psoriasis and PsA including topical agents, biologic treatments, and systemic therapies in phase 2 through phase 4 clinical trials. Specialty Focus Topics. A wide spectrum of promising nonbiologic systemic medications presently are in development or were recently approved for the management of moderate to severe psoriasis and psoriatic arthritis (PsA). Injected medications biologic response modifiers (biologics) are effective treatments for psoriasis and psoriatic arthritis that appear to be well tolerated. Biologics for psoriasis include: etanercept inflixamab adalimumab ustekinumab related information references: clinical focus: the spectrum of topical agents for the treatment of psoriasi. Treatment options for moderate to severe psoriasis include topical and systemic medications, phototherapy, and excimer laser, Combination therapies are often more effective than one treatment alone. Several new agents to treat psoriasis are under study, including oral medications and injectable agents. Broad spectrum or broadband UVB is radiation in the wavelength of 290 – 350 nanometers, and is the standard UVB phototherapy treatment in the United States. Various other herbal supplements have been used for psoriasis, but to date no clinical studies have been reported on these substances. Do not use any unproven therapy without first consulting a doctor to be sure such treatment is not harmful, and does not interfere with any medications you are taking.
New Topical Treatments For Psoriasis
Clinical presentation and psoriasis severity may also contribute to variation in prevalence and incidence numbers 3. In a systematic review on treatments in childhood psoriasis, three studies on the efficacy and safety of topical corticosteroids were reported 63. Obesity as a comorbidity of psoriasis has been the focus of much investigation. Drugs & Diseases. Pityriasis lichenoides variants describe scaly dermatoses with necrotic papules that are clinically and histologically different from parapsoriasis. As the nomenclature and description of the disease spectrum under the descriptive term parapsoriasis evolved, the primary focus has been on the distinction of whether the disorder progresses to mycosis fungoides (MF) or cutaneous T-cell lymphoma (CTCL). Large plaque disease is chronic, and treatment is recommended because it may prevent progression to CTCL. For more information, see the topic Psoriasis. Patients using topical treatment need follow-up every 2-3 months. Part of my research focus is to conduct clinical trials in patients with all types of immunologic skin disease. We believe that, from these studies, it will be possible to make accurate clinical predictions regarding: risk of internal malignancy, risk of lung disease, or response to various therapeutic agents. Risk of Serious Infection With Biologic and Systemic Treatment of Psoriasis Results From the Psoriasis Longitudinal Assessment and Registry (PSOLAR) JAMA DERMATOLOGY Kalb, R. The clinical introduction of tumour necrosis factor (TNF) inhibitors has deeply changed the treatment of inflammatory bowel diseases (IBD). Dermatological adverse reactions during anti-TNF treatments: Focus on inflammatory bowel disease. The use of TNF blockers may also provoke a broad spectrum of dermatological side effects, including injection site reactions, cutaneous manifestations of infusion reactions, cutaneous infections, non-melanoma skin cancer (NMSC), and psoriasis. Toward this aim, we have developed and are progressing to human clinical trials a novel topical ROR inverse agonist that has the potential to provide to patients a topical medicine with a mechanism of action that suggests it may yield the efficacy of an IL-17 biologic. As such, further investigation focused primarily on GSK2981278. This review article focused not only on the their antimicrobial abilities but also on efficacy in the treatment of several inflammatory disorders independent of the infectious agent. The advantage of the use of macrolides for the treatment of skin diseases, both locally and topically, is that they have no effect on collagen synthesis and thus they do not cause skin atrophy in contrast to the glucocorticoids. Clinical studies have confirmed the effectiveness of oral therapy with macrolide group antibiotics of psoriasis vulgaris 35.
Novel Psoriasis Therapies And Patient Outcomes, Part 3: Systemic Cutaneous Medicine For The Practitioner
Will phototherapy still be an important treatment option when all of the new biologic agents discussed in this supplement become available? This discussion is not meant to be a complete treatise on the full range of phototherapy treatment options. Applying specific wavelengths of UV light based on the psoriasis action spectrum in treating psoriasis has been the most important aspect of phototherapy in the last decade. 3 This review is beneficial because it looks at the skin as the milieu for these UV effects on the immune system, rather than focusing on isolated photochemical reactions. There are ongoing investigations in clinical trials regarding the use of photodynamic therapy, both systemic and topical, for the treatment of resistant plaque psoriasis. This review concentrates on new biological agents, focusing on the three agents approved for psoriasis within the past 18 months (alefacept, efalizumab, and etanercept). Christophers E. Psoriasisepidemiology and clinical spectrum. Two treatment sessions involving topical application of 0.1 B2 solution to the ocular surface combined with 30 mins of UVA irradiation focused on the corneal ulcer were carried out. Localized scleroderma usually begins in childhood with a wide variation in its clinical spectrum. This article exemplifies the AAFP 2008 Annual Clinical Focus on infectious disease: prevention, diagnosis, and management. Patients with simple chronic paronychia should be treated with a broad-spectrum topical antifungal agent and should be instructed to avoid contact irritants. Psoriasis and Reiter syndrome may also involve the proximal nail fold and can mimic acute paronychia.10 Recurrent acute paronychia should raise suspicion for herpetic whitlow, which typically occurs in health care professionals as a result of topical inoculation.