In a double-blind study involving 58 patients with nail bed psoriasis, topical application of calcipotriol ointment twice daily was found to be as effective as twice daily application of betamethasone dipropionate in reducing subungual hyperkeratosis after 3 9 months 30. Topical cyclosporine preparation showed to improve pitting and onycholysis in a small, placebo-controlled study. Although phototherapy with narrow-band UVB and photochemotherapy with UVA, in addition to oral psoralen (PUVA), have been successfully used in psoriasis, there is not enough evidence to support their beneficial effects in nail psoriasis. Nail psoriasis: a retrospective study on the effectiveness of systemic treatments (classical and biological therapy) Journal of the European Academy of Dermatology and Venereology. Clinical studies have shown excellent efficacy, favorable benefit to side-effects ratio, and safe long-term usage. Effective treatment of psoriasis is needed because of the associated morbidity of psoriasis. In Europe, etanercept is indicated for the treatment of adults with chronic moderate to severe plaque psoriasis who have failed to respond to, or who have a contraindication to, or who are intolerant to other systemic therapies or photochemotherapy including cyclosporine, methotrexate or PUVA. Psoriasis is a complex, chronic, multifactorial, inflammatory disease that involves hyperproliferation of the keratinocytes in the epidermis, with an increase in the epidermal cell turnover rate (see the image below). In a retrospective study of 48 patients (mean age, 51 yr; 33 women, 15 men), psoralen-UVA (PUVA) therapy was found to be an appropriate treatment alternative for palmoplantar psoriasis, according to Carrascosa et al.
Based upon data from open-label or retrospective studies and case reports, a panel of experts suggested that patients with severe, unstable disease should be treated with cyclosporine or infliximab due to the rapid onset and high efficacy of these agents 12. Based upon data from open-label or retrospective studies and case reports, a panel of experts suggested that patients with severe, unstable disease should be treated with cyclosporine or infliximab due to the rapid onset and high efficacy of these agents 12. Although topical vitamin D analogs are effective as monotherapy for some patients, a systematic review found that combination therapy with a topical corticosteroid is more effective than either treatment alone 24. Phototherapy and photochemotherapy require the supervision of a dermatologist trained in these treatment modalities. In the retrospective study involving 195 psoriasis patients receiving either BBUVB or NBUVB, Weischer et al. A comparative study of sequential cyclosporine and NBUVB vs. 311 nm UVB phtotherapy- an effective treatment for psoriasis. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. FAE were introduced as a systemic psoriasis treatment in 1959 and empirically developed further between 1970 and 1990 in Germany, Switzerland, and the Netherlands. Using this treatment regimen, Sch fer reported good effectiveness results in treating psoriasis patients with FAE on a large scale in a specialized clinic in Leysin, Switzerland. The other studies were retrospective multicenter or single center studies.
Its effectiveness has profoundly influenced dermatologic therapy in general, providing treatment for a number of diverse disorders besides psoriasis and vitiligo. In addition, there is no adequate evidence of the effectiveness of laser therapy in combination with topical therapy. Feldman et al (2002) reported on a multi-center study of the excimer laser involving 124 patients with stable mild-to-moderate plaque-type psoriasis; 32 of whom dropped out of the study before completing the course of treatment. The authors concluded that the excimer laser appears to be safe and effective for psoriasis, and has an advantage over conventional photo-chemotherapy in that it requires fewer visits and targets only the affective areas of skin, sparing the surrounding uninvolved skin. Nonbiologic systemic therapies may be effective but can be associated with significant short-term and long-term adverse events (hepatotoxicity, nephrotoxicity, hypertension, dyslipidemia, malignancy, and teratogenicity). In patients with chronic plaque psoriasis treated with systemic biologic therapy, systemic nonbiologic therapy, or phototherapy, which patient or disease characteristics (e. Trials and observational studies that compared biologic systemic agents with either nonbiologic systemic agents or phototherapy were included. One mixed-treatment comparison that evaluated PASI 50, PASI 75, and PASI 90 suggested that the probability of achieving any of the three PASIs was highest for infliximab, followed by adalimumab, etanercept, methotrexate, cyclosporine, efalizumab, alefacept, and finally supportive care.
Treatment Of Psoriasis
Psoriasis treatments can be divided into three main types: topical treatments, light therapy and systemic medications. Currently, calcineurin inhibitors tacrolimus (Prograf) and pimecrolimus (Elidel) are approved only for the treatment of atopic dermatitis, but studies have shown them to be effective at times in the treatment of psoriasis. Photochemotherapy involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. Like other immunosuppressant drugs, cyclosporine increases your risk of infection and other health problems, including cancer. Methotrexate, cyclosporine and retinoids are the most commonly used conventional systemic drugs. Newer studies provide insight into their more effective and safer use and as combination therapy with biologics. Keywords: Psoriasis, systemic therapy, new treatments, nonbiologics.