Psoriasis is a long-lasting autoimmune disease characterized by patches of abnormal skin. There are five main types of psoriasis: plaque, guttate, inverse, pustular, and erythrodermic. These treatments may include steroid creams, vitamin D3 cream, ultraviolet light, and immune system suppressing medications such as methotrexate. Psoriatic arthritis affects up to 30 of individuals with psoriasis. Moderate-to-severe psoriasis is typically defined as involvement of more than 5 to 10 percent of the body surface area (the entire palmar surface, including fingers, of one hand is approximately 1 percent of the body surface area 7 ) or involvement of the face, palm or sole, or disease that is otherwise disabling. There is ample evidence of efficacy of the newer systemic therapies ( biologics ); however, cost is a major consideration with these agents. Biologic agents used in the treatment of psoriasis include the anti-TNF agents adalimumab, etanercept, and infliximab, the anti-interleukin (IL)-12/23 antibody ustekinumab, and the anti-IL-17 antibody secukinumab. Side effects of topical corticosteroids, including the potential for suppression of the hypothalamic axis, are discussed separately. 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. Narrow-band ultraviolet B (UVB) therapy offers superior efficacy with less risk of burning:NICE recommends that narrow-band UVB phototherapy should be offered to people with plaque psoriasis that cannot be controlled with topical treatments alone. Adverse effects of PUVA therapy include nausea, pruritus and a burning sensation.
According to the current knowledge of the molecular and cellular basis of psoriasis, it is defined as an immune-mediated chronic inflammatory and hyperproliferative skin disease. While these biological agents may possess greater efficacy in treating moderate-to-severe psoriasis, there is a higher cost associated with their administration compared to phototherapy and traditional systemic treatments (Hankin et al 2005), with important cost differences for different biological drugs (Nelson et al 2008). Other side effects included pain, sunburn sensation, scaling, itching, tenderness, flaking, peeling, vesicles, disease flare, scab, and weeping lesions. The excimer laser may also stand superior to NB-UVB in its efficacy of mechanism. Definitions. Well defined, with sharply demarcated boundaries. Other manifestations of plaque psoriasis include the following:. The disease more commonly affects the face in children than it does in adults. The 2 main forms of phototherapy are as follows:. Systemic treatment is initiated only after topical treatments and phototherapy have proved unsuccessful.
Biologic therapies for psoriasis use genetically engineered drugs that target specific steps involving T cells and cytokines (e. Other biologic agents with similar mechanisms of action have FDA marketing approval, albeit not for the treatment of chronic plaque psoriasis (e. While biologic treatments may represent a treatment option with fewer adverse effects, there are concerns about their higher costs versus nonbiologic systemic therapies. The acronyms used the questions below are defined within the text and the list under Definitions of Terms. Psoriasis is a chronic inflammatory cutaneous disorder that can significantly affect patient quality of life (QoL). However, because systemic treatment carries a higher risk for adverse effects, moderate to severe cases are best co-managed with dermatologists, who are more familiar with the use of these agents. Biologics represent the newest class of antipsoriatic agents, although their advent has revolutionized the treatment of moderate to severe psoriasis, long-term safety remains to be established and their high cost can be prohibitive. Lifetime risks of serious adverse events from biologic treatment are less than risks patients face on a daily basis. Current data suggests biologics are not predictors of serious adverse events. The minimal risk and potentially protective effects of biologics may outweigh the consequences of undertreated or non-treated moderate-to-severe psoriasis. Treatments for moderate-to-severe psoriasis often do not meet patient and physician expectations due to adverse effects, lack of long-term efficacy, and inconvenient administration schedules. Biologic Agent Mechanism and Efficacy.
Biological Drugs Targeting The Immune Response In The Therapy Of Psoriasis
A critical review of some deceptive psoriasis treatments promoted on the net. They rarely mention risks, side effects, or offer an accurate list of ingredients so that consumers can make their own informed choice. Food and Drug Administration have strict definitions of what constitutes a drug. A disturbing trend in the last few years is for unscrupulous marketeers to include potent steroids in their otherwise nondescript skin products, without any indication or warning on the label. Treatment of psoriasis includes topical therapy, systemic therapy and phototherapy. Nanoemulsion is defined as an emulsion system consisting of oil, surfactant, and water with an isotropic, transparent (or translucent) appearance. There has been a growing interest in using nanoemulsions in topical applications, due to their high stability and their optical transparency or translucency, which make them good and very dermatologically attractive. This review highlights the potential of drug-loaded nanoemulsions for the treatment of psoriasis towards achieving better efficacy and eliminating side effects. Marketed names, Drug, Form, Ref. During the previous year, 25 potential psoriasis drugs have been in phase 1, 2, or 3 of clinical study and 4 new drugs were approved for treatment (2 for psoriasis and 2 for psoriatic arthritis). Here we focus on the novel therapeutic choices for the control of psoriasis and discuss their efficacy and side effects. Conditions that may mimic psoriasis include tinea infections, folliculitis, eczema, seborrheic dermatitis, cutaneous T-cell lymphomas, and discoid lupus erythematosus. These can include infections and kidney disease, in which there is a deficiency of erythropoietin, a material produced in the kidneys which is essential for the production of red blood cells. Drug therapy is available for many types of anemia; however, the selection of the drug depends on proper diagnosis of the cause of the anemia. People who have trouble with the side effects of ferrous sulfate may benefit from some of the specialty preparations available, but ferrous sulfate normally offers the greatest amount of iron of all commercial products. (originally an anti-cancer drug, which is also used for arthritis and psoriasis) act by reducing the metabolism of folic acid. Approaches to the management and treatment of pruritus are discussed. ContactDictionarySearch. When a primary dermatitis is present, the differential may be narrowed by the history and physical findings, such as with stigmata of atopic dermatitis, psoriasis, scabies, allergic contact dermatitis, or primary cutaneous lymphoma. Factors that are believed to enhance the sensation of itch include dryness of the epidermis and dermis, anoxia of tissues, dilation of the capillaries, irritating stimuli, and psychological responses. Product selection and recommendations must be made in consideration of each patient’s unique needs and should incorporate variables such as the individual’s skin, the desired effect, the consistency and texture of the preparation, and its cost and acceptability to the patient. Psoriasis appears to be a multifactorial disease whose exact underlying mechanism is still unclear, but environmental factors, genetic susceptibility, abnormal function of keratinocytes, and immunological disturbances of the innate and acquired immune system are all postulated 16, 17. In spite of the long history of corticosteroids in the treatment of nail psoriasis, only a few formal trials of their efficacy have been conducted.
Biologic And Nonbiologic Systemic Agents And Phototherapy For Treatment Of Chronic Plaque Psoriasis
The treatment of psoriasis has changed considerably in the last 10 years with the advent of biologic therapy a development that has increased the arsenal of drugs available for the systemic treatment of this condition. Acitretin fulfills a unique role in the strategies used to treat psoriasis because its mechanism of action is different from that of other systemic drugs. IndicationsThe summary of product characteristics (SPC) for Neotigason specifies the following indications: severe extensive psoriasis that is resistant to other forms of therapy, palmoplantar pustular psoriasis, severe congenital ichthyosis, and severe Darier disease. The efficacy of acitretin, and most of its adverse effects, are dose-dependent and vary considerably from patient to patient. Cost analysis of intervention/program, side effects, and illness. Economic evaluation for comparing two or more interventions/programs in terms of costs or benefits; evaluations include cost-effectiveness, cost-benefit, and cost-utility analyses. HIV diagnosis and treatment, and state public health resource-allocation options. The tools were created by CDC and its partners.