Psoriasis

Psoriasis represents a potentially life-altering disease that can profoundly impact physical, emotional and social functioning, and overall quality of life. Part I of this 2-part series will focus on topical agents, their varying degrees of effectiveness, potential side-effects and applications in clinical practice.

Psoriasis is a chronic, recurrent, immune-mediated, papulosquamous skin condition characterized by rapid proliferation of keratinocytes. This article focuses on the role of vitamin D analogues in the treatment of psoriasis.

A review of corticosteroids, including use, adverse effects, vehicle, generic vs brand name drugs. Physicians and pharmacists alike should be aware of the importance and the difference of various vehicles when prescribing topical corticosteroids.

In this review, we summarize the most common immunosuppressant medications currently used in dermatology, and provide recommendations for infection screening prior to initiating treatment.

Topical agents for the treatment of psoriasis are indicated for patients whose affected area is < 10% of their skin. However, for long-term use, their effectiveness can be limited. Topical sequential therapy involves the application of a class I corticosteroid and calcipotriene in three different phases.

Combination therapy is both commonly used and effective in treating psoriasis. Common combinations like acitretin+light therapy, methotrexate+UVB, and tar+anthralin are discussed.

Although PDT remains an investigational treatment modality in dermatology, several important areas of development may ultimately lead to official and practical acceptance of PDT for the skin. Various uses of PDT are evaluated.

Dovobet®/ Daivobet®/ Taclonex® is a product combining two molecules, calcipotriol and betamethasone dipropionate, that may offer psoriatic patients with an option for maintenance therapy. The efficacy and safety of this combined formulation when used over a 4-week period is well documented.

A new compound product containing calcipotriol 50μg/gm and betamethasone dipropionate 0.5mg/gm (Dovobet*, LEO Pharma) in an ointment base was recently introduced in Canada for the treatment of psoriasis.

With the availability of tildrakizumab (Ilumya), an interleukin-23 (IL-23) inhibitor, dermatologists are very optimistic about the continued success of this biologic drug used to treat psoriasis patients.

This article focuses on topical D3 vitamin analogues for the treatment of psoriasis. Therapeutic efficacy, toxicity, patient adherence, combination therapy, and the family physician's role in psoriasis treatment are covered.

Topical treatments are usually the first line therapies for psoriasis. Corticosteroids, calcipotriol/calcupotriene, tazarotene, tars, and anthralin are discussed.

Biologics represent a new type of treatment that shows promise. This article provides a quick overview of how they work, and what makes these classes of drugs promising.

Psoriasis is a common dermatosis, affecting children in North America. Many papers have stressed the treatments available for adult psoriasis, but few have dealt with this disorder in children. Topical treatment modalities continue to be the first line therapy for childhood psoriasis.

Topical therapy forms the cornerstone of treatment in the management of psoriasis. Topical options, vehicle advances, and treatment efficacy of several topicals are discussed for managing psoriasis.

Research has shown high levels of effectiveness are maintained for 5 years and beyond with tildrakizumab (Ilumya), an interleukin-23 (IL-23) inhibitor.

The benefits of transitioning from Cal/BD ointment or gel to aerosol foam formulation in this Canadian patient population were similar to those reported in clinical studies and were seen consistently among patients with a range of treatment priorities and with differing history of psoriasis severity and treatment history.

Tildrakizumab is a promising therapeutic option for patients with moderate-to-severe chronic plaque psoriasis. The specificity of the drug in targeting the p19 subunit of IL-23 allows for the high efficacy and safety of long-term treatment as demonstrated in clinical trials.

Although biologics are well-studied, expertise regarding their use is often lacking. Many biologics have been added to the market in recent years with distinctive characteristics. This study was designed to create a tool to assist physicians involved in the care of patients with psoriasis undergoing biologic treatment.

Scalp conditions such as itchy scalp, dandruff, seborrheic dermatitis, and scalp psoriasis are common. The emotional effect these complaints cause are often ignored or trivialized, but as dermatologists we should appreciate the relief that appropriate advice and treatment will bring to our patients.

Approximately 50% of patients with psoriasis have nail psoriasis but the life time chance of nail changes must be much higher. Nail changes in psoriasis include pitting, thickening, onycholysis, discoloration, oily spots, splinter hemorrhages and paronychia. Treatment of choice depends on the form the psoriasis takes.

Acitretin (SORIATANE®, Roche Pharmaceuticals) is an aromatic retinoid, effective in the treatment of severe psoriasis. This study highlights data from two existing clinical trials to capture PASI 50 and PASI 75 responder rates which represent a common metric used in current psoriasis clinical trials.

For many years, clinicians have expressed ongoing concerns about treatment adherence by patients, especially pertaining to those with chronic skin disorders. Although crucial to effective therapeutic outcomes, the issue of patient adherence has been largely ignored in dermatologic disease management until recently.

Biologic compounds are being used more frequently to treat a multitude of systemic inflammatory conditions. This article discusses the increased risk of opportunistic infections of tuberculosis, herpes zoster, Legionella pneumophila, and Listeria monocytogenes.

Psoriasis and eczema can at times be recalcitrant to conservative topical treatment. This article focuses on corticosteroid strength and their appropriate uses for various presentations.

If methotrexate were introduced as a new drug today, it would be hailed as a major advance in the management of psoriasis, as well as for a number of other conditions. When patients are properly screened and educated about the correct use of this drug, and appropriately monitored during treatment, MTX is often very safe, simple to use, inexpensive, and well-tolerated.

Interleukin-17 (IL-17) is believed to be a potent driver of plaque psoriasis. This article reviews efficacy and safety results from Phase 2 and 3 trials with monoclonal antibodies targeting IL-17RA (brodalumab), and IL-17A (ixekizumab and secukinumab) for the treatment of plaque psoriasis.

Interleukin (IL)-17 is important in the pathophysiology of psoriasis and has proven to be an effective therapeutic target. As brodalumab enters the marketplace, a review of this important biologic, its safety profile, and discussion of possible adverse effects is in order.

This review concentrates on those drugs which have been clearly shown, or are widely reputed, to make psoriasis worse. There is insufficient clinical evidence to justify the inclusion of many drugs which have been included in published lists of drugs said to exacerbate psoriasis.

Psoriasis is a chronic condition that affects the well-being and quality of life of patients. The disease is associated with an increased risk of depression and suicidality, which may not be fully understood by the general population.

While biologics changed the way psoriasis is treated by providing effective targeted therapy, they are not without limitations. Small molecules are emerging therapeutic options for the treatment of psoriasis.

When prescribing brodalumab, or any other biologic agent, physicians should screen patients for psychiatric comorbidities. Assessment of risk versus benefit, and having an honest conversation with patients regarding the label, will help provide better patient care for both physical and mental health.

The addition of biologics that target IL-23p19 (Risankizumab) to our therapeutic armamentarium has succeeded in improving outcomes in patients with moderate-to-severe plaque psoriasis.

Psoriasis remains a therapeutic challenge. Involvement of the scalp can be minimal (“dandruff”) or more significant and difficult to manage. Gentle treatment, reducing trauma, and treating the inflammation and pruritus will improve therapeutic results.

Etanercept (Enbrel®, Amgen and Wyeth), a tumor necrosis factor (TNF) antagonist, was approved in January 2002, for the treatment of psoriatic arthritis (PsA). Etanercept was evaluated for the treatment of PsA and psoriasis in a preliminary study of 60 patients and in a confirmatory phase III study of 205 patients.

Many aspects of psoriasis remain a mystery - but one that is slowly becoming revealed. Various immunobiological treatments for psoriasis are covered in this article.

Topical ruxolitinib shows promise in various dermatological conditions, including atopic dermatitis, vitiligo, psoriasis, and lichen planus, with a favorable safety profile compared to oral JAK inhibitors. However, its effectiveness in alopecia areata remains inconclusive.

Recent advances in our understanding of the innate and adaptive immune systems have led to the identification of interleukin (IL)-17 as a key pro-inflammatory mediator in psoriasis. We review phase 1-3 clinical trials of ixekizumab, for treatment of moderate-to-severe plaque psoriasis.

Most people with mild-to-moderate psoriasis manage their disease with topical therapies. However, adherence to topical treatment remains a challenge.. Read about new topical therapeutic options.

Psoriasis has a greater mental and physical impact than myocardial infarction, hypertension, diabetes mellitus, arthritis, and cancer; only depression had a greater mental impact, and congestive heart failure a greater physical impact.