Psoriasis and Psoriatic Arthritis

Pathophysiology, Therapeutic Intervention, and Complementary Medicine

Siba P. Raychaudhuri, Smriti Raychaudhuri, Debasis Bagchi, Siba P. Raychaudhuri, Smriti Raychaudhuri, Debasis Bagchi

• Publisher: CRC Press
• Year: 2017
• Print ISBN: 9781498756068
• eBook ISBN: 9781351648950
• Edition: 1
• Topic: Medicina
• Subtopic: Dermatologia

Psoriasis is a life-long chronic autoimmune disease characterized by thick scaly skin lesions and often associated with severe arthritis. In psoriasis, lesions skin cells, keratinocytes, grow too quickly, resulting in thick, white, silvery or red patches on skin. Normal skin cells grow gradually and flake off about every four weeks, but psoriasis causes new skin cells to move rapidly to the surface of the skin in days rather than weeks. Psoriasis symptoms often appear on the elbows, scalp, feet, knees, hands, or lower back, or as flaking or patches on the skin. It is most common in adults, but teenagers and children can also suffer from psoriasis.

Psoriasis is not only a skin condition; it is a chronic disease of the immune system. Chronic psoriasis is associated with other health conditions such as psoriatic arthritis, several inflammatory disorders, type 2 diabetes, and cardiovascular disease. This book provides extensive coverage of psoriasis and psoriatic arthritis. It features information on epidemiology and etiology of psoriasis, pathogenesis, genetics of psoriasis, clinical manifestations, and treatment options using cutting-edge drugs including adalimumab and tofacitinib.

Natural phytochemicals and nutraceuticals have demonstrated efficacy in ameliorating psoriasis. The book dedicates comprehensive coverage of nutraceutical therapeutic options including antioxidants, bioactive peptides, carotenoids, alpha lipoic acid, curcumin, and whey protein. These inexpensive natural therapeutics are not associated with any known adverse side effects.

Section IV-ATreatment RegimenPharmaceuticals and Treatment

11Current Recommendations for the Treatment of Psoriasis

Chelsea Ma and Emanual Maverakis

11.1Introduction

11.2Topical Therapies

11.2.1In the Pipeline

11.3Phototherapy

11.4Nonbiologic Systemic Therapy

11.4.1In the Pipeline

11.5Biological Therapies

11.5.1TNF-Targeting Therapeutics

11.5.2Important Considerations

11.6Inhibition of IL-12 and IL-23

11.7Inhibition of IL-17A

11.8In the Pipeline

11.9Conclusion

References

11.1Introduction

The history of psoriasis treatment spans over a century, with the first modern treatment consisting of anthralin in the late 1800s. In 1925, dermatologist William H. Goeckerman discovered an adjunctive effect of coal tar and ultraviolet radiation on psoriasis plaques.1 In terms of effectiveness, Goeckerman therapy was the gold standard treatment regimen for several decades, although therapy sessions are time-consuming and require patients to attend day centers. In 1952, 2 years after the Nobel Prize was awarded for the development of cortisone, topical hydrocortisone was found to successfully treat inflammatory skin conditions. This revolutionized the treatment of psoriasis and remains the mainstay of topical treatments today. Other topical therapies, including retinoids and vitamin D, were later developed in the 1980s.

The Food and Drug Administration (FDA) approved methotrexate as the first systemic treatment for psoriasis in 1972, followed by cyclosporine in 1997. However, these immunosuppressive agents are sometimes poorly tolerated and/or are associated with significant adverse events, such as organ toxicities. The 1990s also saw the innovation of biologic agents, which are injectables with specificities for unique aspects of the immune system, mainly soluble mediators of inflammation. However, the first biologic developed for psoriasis, alefacept, blocked CD2 on T cells from interacting with the lymphocyte function–associated antigen (LFA) 3 on antigen-presenting cells. This agent was approved by the FDA for psoriasis in 2003.2 The next wave of biologic agents targeted tumor necrosis factor (TNF). Most recently, interleukin (IL)-targeting biologics have become more widely used, but all of these agents have made a substantial impact on psoriasis treatment given their favorable tolerability and short- and long-term efficacies. Even in the setting of this treatment revolution, therapeutic discovery in psoriasis remains an active and dynamic area, with newer agents striving to achieve enhanced safety, efficacy, convenience, and immunological selectivity. Ironically, Goeckerman therapy remains a gold standard for therapeutic efficacy, but today only a few treatment centers remain.

This chapter reviews the multiple psoriasis treatment options that are currently available, including traditional topical therapies, phototherapy, systemic therapies, and the latest addition of biological therapies. These various modalities are designed to target the different components of the diverse pathways involved in the pathophysiology of psoriasis. Treatment is guided by severity of disease, type of psoriasis, treatment response, patient comorbidities, and patien...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Contents
• Preface
• Editors
• Author
• Section IDisease Epidemiology and Genetics
• Section IIPathogenesis
• Section IIIPsoriatic Disease: Clinical Profiles
• Section IV-ATreatment RegimenPharmaceuticals and Treatment
• Section IV-BTreatment RegimenNutraceuticals in Psoriasis
• Index