Psoriasis and Advanced Therapies

Psoriasis is an immune-mediated skin disease. In some people it also affects the joints. The prevalence of psoriasis in Western populations is estimated to be around 2-3%. It affects both sexes equally and occurs at all ages.

• Psoriasis can be physically and psychosocially limiting. Depending on the severity and location of psoriasis outbreaks, individuals may also experience physical discomfort and disability. Itching and pain can interfere with self-care, walking, and sleep.
• Psoriasis skin variants include plaque, pustular, guttate, erythrodermic and flexural psoriasis. Psoriasis can also involve or be limited to the scalp or nails. Plaques on the hands and feet can limit daily activities. Erythrodermic psoriasis may be associated with swelling of the legs, fatigue and even heart failure in severe cases.
• Psoriatic arthritis is most common in the joints of the fingers and toes but may also affect the hips, knees and spine (spondylitis). About 10-20% of people who have skin psoriasis also have psoriatic arthritis.
• Topical therapies for psoriasis include moisturizers, corticosteroid creams and ointments, zinc shampoo, salicylic acid lotions and shampoos, coal tar lotions and shampoos, anthralin, a vitamin D analog called calcipotriol and tazarotene cream, a topical retinoid.
• Ultraviolet light therapy (UVB and UVA phototherapy) requires 2 to 3 sessions per week for a few months, followed by maintenance sessions 2 to 4 times per month to maintain clearance. Phototherapy can be combined with topical products (coal tar, calcipotriol, topical corticosteroids or topical retinoids) or systemic retinoids (acitretin) for faster results.
• Oral therapies for psoriasis include methotrexate (taken weekly), acitretin (taken daily), cyclosporine (taken daily and used mainly as a “bridge drug” to long-term therapies) and hydroxyurea (used when other standard oral therapies are not working or not tolerated).
• Injectable agents for psoriasis, also called biologic therapies, include Enbrel (etanercept), Raptiva (efalizumab) and Humira (adalimumab) which are given by subcutaneous injection, Remicade (infliximab, an intravenous infusion) and Amevive (alefacept, an intramuscular injection). The frequency of injection or infusion depends on the drug and the severity of the psoriasis.
• With all systemic psoriasis drugs (whether oral or injectable) tuberculosis testing (PPD and chest X-ray) must be negative before beginning therapy. Some therapies also require other blood work and monitoring prior to and during therapy.