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Current and emerging medications for psoriasis

Patients with psoriasis now have many therapeutic options available, from topical agents to phototherapy and systemic and biologic agents.

Psoriasis is a complex immune-mediated disease that affects approximately 120 million people globally and requires chronic management.1 The condition manifests itself in the skin, joints, or both, and exhibits associated comorbidities that increase risk for early death, including metabolic syndrome, cardiovascular disease, psoriatic arthritis, depression, anxiety, nonalcoholic fatty liver disease, Crohn’s disease, and lymphoma.2

Physicians should encourage lifestyle changes to reduce modifiable cardiovascular risk factors, such as smoking, which has been shown to independently increase risk of onset and exacerbation of psoriasis. Excessive alcohol intake has been reported in up to one-third of patients with psoriasis, likely due to psychologic distress. Excess alcohol ingestion is also a risk factor for cardiovascular disease.3 As emerging research illustrates its increasing complexity, psoriasis is now considered a systemic inflammatory disorder.2

Clinically, there are 5 types of psoriasis: plaque psoriasis, guttate or eruptive psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis. Plaque psoriasis is the most common form, with monomorphic, well-demarcated erythematous plaques under a silvery scale, typically on the scalp and extensor surfaces. Guttate psoriasis exhibits tear-drop shaped lesions with scale. Inverse psoriasis is found in the intertriginous or flexural areas. Pustular psoriasis can present as either palmoplantar pustulosis or as the serious generalized pustular psoriasis. Any form can evolve into erythrodermic psoriasis, a rare and serious complication of the disease with significant risk of mortality. Psoriasis can affect the skin, nails, scalp, and joints to different degrees in each patient.2,4

The prevalence of psoriasis within certain populations ranges from less than 1% to more than 10%, depending on ethnic and geographic factors, with a 2% prevalence rate in Europe and North America.5 Family studies have shown a genetic predisposition for the disease, with the literature illustrating certain susceptibility alleles in immune-related genes.6,7 Dysregulation between the innate and adaptive immune systems, tumor necrosis factor (TNF)-α, and the interleukin (IL)-23-T helper cell 17 (Th17) axis, among other immune reactions in the cells of the skin, have all been shown to be involved in the pathogenesis of psoriasis.2,8

Read Full Article: Current and emerging medications for psoriasis – The Clinical Advisor


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