RESUMEN
BACKGROUND: Precision medicine utilizes an individual’s genomics to improve diagnosis, prognosis, and therapy. The joint American Academy of Dermatology and National Psoriasis Foundation 2019 guidelines recognized the need to identify biomarkers that can predict the optimal biologic agent for an individual patient. This paper examines the current state of precision medicine in dermatology and how its use can improve outcomes in psoriasis. METHODS: A search of PubMed/MEDLINE using the terms precision medicine, personalized medicine, biomarkers, genomics, and dermatology was performed to identify relevant publications. An expert consensus panel was then convened to assign levels of evidence to each article using strength of recommendation taxonomy and create consensus statements requiring a two-thirds supermajority for agreement utilizing a modified Delphi approach. RESULTS: Thirteen articles met inclusion and exclusion criteria and were assigned levels of evidence. The panel created 10 consensus statements on how precision medicine can improve patient outcomes, all of which received a unanimous (6/6) vote. CONCLUSION: Choosing a biologic medication for psoriasis often relies on patient preference, provider preference, and a trial-and-error approach. Utilizing precision medicine tests such as Mind.Px can help providers identify biomarkers unique to a patient’s pathophysiology and choose the optimal medication through a targeted and evidence-based approach. Zakria D, Brownstone N, Armstrong AW, et al. Integrating precision medicine into medical dermatology clinical practice: an expert consensus panel. J Drugs Dermatol. 2023;22(6):588-593. doi:10.36849/JDD.7432.
Asunto(s)
Dermatología , Psoriasis , Humanos , Medicina de Precisión , Psoriasis/diagnóstico , Psoriasis/tratamiento farmacológico , ConsensoRESUMEN
BACKGROUND: An urgent need exists in the United States to establish treatment goals in psoriasis. OBJECTIVE: We aim to establish defined treatment targets toward which clinicians and patients with psoriasis can strive to inform treatment decisions, reduce disease burden, and improve outcomes in practice. METHODS: The National Psoriasis Foundation conducted a consensus-building study among psoriasis experts using the Delphi method. The process consisted of: (1) literature review, (2) pre-Delphi question selection and input from general dermatologists and patients, and (3) 4 Delphi rounds. RESULTS: A total of 25 psoriasis experts participated in the Delphi process. The most preferred instrument was body surface area (BSA). The most preferred time for evaluating patient response after starting new therapies was at 3 months. The acceptable response at 3 months postinitiation was either BSA 3% or less or BSA improvement 75% or more from baseline. The target response at 3 months postinitiation was BSA 1% or less. During the maintenance period, evaluation every 6 months was most preferred. The target response at every 6 months maintenance evaluation is BSA 1% or less. LIMITATIONS: Although BSA is feasible in practice, it does not encompass health-related quality of life, costs, and risks of side effects. CONCLUSION: With defined treatment targets, clinicians and patients can regularly evaluate treatment responses and perform benefit-risk assessments of therapeutic options individualized to the patient.
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Psoriasis/terapia , Superficie Corporal , Fundaciones , Humanos , Planificación de Atención al Paciente , Guías de Práctica Clínica como Asunto , Consejos de Especialidades , Estados UnidosRESUMEN
Psychodermatology is an underappreciated field that studies psychocutaneous disorders, which are conditions that have both dermatologic and psychiatric characteristics. Underlying psychiatric comorbidity is estimated to occur in up to one-third of dermatologic patients, and psychiatric illness may either be the cause or the consequence of dermatologic disease. Psychodermatologic patients lack insight and often do not recognize a psychiatric etiology for their symptoms and therefore comprise some of the most challenging cases to treat. Herein, we discuss the background and clinical presentation of the most commonly encountered psychodermatologic conditions, including delusional infestation, neurotic excoriations, factitial dermatitis, trichotillomania and body dysmorphic disorder, followed by practical diagnostic and therapeutic recommendations.
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Trastorno Dismórfico Corporal/etiología , Trastornos Mentales/etiología , Conducta Autodestructiva/etiología , Enfermedades de la Piel/etiología , Tricotilomanía/etiología , Trastorno Dismórfico Corporal/complicaciones , Trastorno Dismórfico Corporal/terapia , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/terapia , Conducta Autodestructiva/complicaciones , Conducta Autodestructiva/terapia , Enfermedades de la Piel/complicaciones , Enfermedades de la Piel/terapia , Tricotilomanía/complicaciones , Tricotilomanía/terapiaRESUMEN
BACKGROUND: Difficulty in patient access to care and affordability are major problems faced by our dermatology specialty in the United States. However, Taiwan provides adequate and affordable dermatologic care for all of its citizens. Herein we describe our first-hand observations and findings of the outpatient dermatology experience in Taipei, and contrast it to the experience in the United States. OBSERVATION: In Taipei, Taiwan, we observed patient management, electronic documentation, and billing during outpatient dermatology visits in five settings: one academic hospital outpatient dermatology department, one academic hospital Information Technology department, and three private dermatologists' offices. Through our observations, we found that the dermatology specialty in Taiwan is able to overcome challenges with access to care and affordability through three key system features: (1) short yet frequent patient visits (2) close proximity of ancillary staff, and (3) an integrated and paperless electronic medical record and billing system. CONCLUSIONS: The Taiwan system is attained with some sacrifice, such as shorter time spent with patients and less personalized care. However, because this system can meet the basic dermatological needs of the entire population, possibly better than our current system, it behooves us to study the Taiwan system with respect and care.
Asunto(s)
Dermatología/organización & administración , Registros Electrónicos de Salud/organización & administración , Relaciones Interinstitucionales , Programas Nacionales de Salud/tendencias , Médicos/normas , Humanos , Taiwán , Estados UnidosRESUMEN
Over the past 2 decades, considerable progress has been made to further elucidate the complex pathogenesis of psoriasis, facilitating the development of a new armamentarium of more effective, targeted therapies. Despite these important advances, substantial deficits remain in our understanding of psoriasis and its treatment, necessitating further research in many areas. In the sixth section of the American Academy of Dermatology Psoriasis Guidelines of Care, gaps in research and care were identified. We discuss the most important gaps in research that currently exist and make suggestions for studies that should be performed to address these deficits. These encompass both basic science and clinical research studies, including large, prospective epidemiologic studies to determine the true prevalence and natural history of psoriasis; further molecular studies in patients with psoriatic and psoriatic arthritis to understand the function of psoriasis susceptibility genes and to identify novel therapeutic targets; studies to examine the role of environmental factors in the development of psoriasis; further investigation of the relationship between psoriasis and cardiometabolic disease; studies that examine the role of adjunctive therapies such as psychological interventions in appropriate patient groups; and finally, studies to identify biomarkers of disease severity and treatment response to optimize patient therapy.
Asunto(s)
Investigación Biomédica , Psoriasis/etiología , Psoriasis/terapia , Ansiedad/epidemiología , Biomarcadores , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Depresión/epidemiología , Diabetes Mellitus/epidemiología , Ambiente , Estudios Epidemiológicos , Predisposición Genética a la Enfermedad , Humanos , Síndrome Metabólico/epidemiología , Obesidad/epidemiología , Guías de Práctica Clínica como Asunto , Psoriasis/epidemiología , Psoriasis/psicología , Índice de Severidad de la Enfermedad , Fumar/epidemiologíaRESUMEN
Progressive multifocal leukoencephalopathy (PML) is a frequently fatal demyelinating disease of the brain caused by activation of the John Cunningham virus. It typically occurs in immunocompromised patients, including transplant recipients on immunosuppressant medications, patients receiving chemotherapy for hematologic malignancies, and patients with human immunodeficiency virus. Unfortunately, there is no effective treatment for PML. By contrast, reversible progressive leukoencephalopathy syndrome (RPLS) is a generally treatable disorder that is diagnosed based on clinical symptoms (eg, altered mental status, visual abnormalities, headache, and seizures) and neuroradiographic changes (eg, cerebral edema). It is classically associated with malignant hypertension and immunosuppressive medications. Symptoms usually resolve over time, or with treatment of the underlying cause. Amid the relatively recent withdrawal of efalizumab from the US market because of its association with PML, and the added warning found on ustekinumab describing RPLS as a possible adverse effect, there has been an increasing level of concern in dermatology that biologics and other systemic medications used in the treatment of psoriasis may be related to an increased risk of specific leukoencephalopathies. In this review, we evaluate the association of prebiologics (eg, cyclosporine, methotrexate, acitretin) and biologics (eg, adalimumab, alefacept, efalizumab, etanercept, infliximab, rituximab, and ustekinumab) with the potential risk of developing PML and RPLS.
Asunto(s)
Fármacos Dermatológicos/efectos adversos , Inmunosupresores/efectos adversos , Leucoencefalopatía Multifocal Progresiva/inducido químicamente , Anticuerpos Monoclonales/efectos adversos , Terapia Biológica , Humanos , Leucoencefalopatía Multifocal Progresiva/epidemiología , Psoriasis/complicaciones , Psoriasis/tratamiento farmacológico , RiesgoRESUMEN
Psychodermatology is an interface between dermatology and psychiatry. The different disorders within psychodermatology can be categorized in 2 ways: by the type of psychodermatologic disorder or by the underlying psychiatric disorder. The types of psychodermatologic disorders include psychophysiological, primary psychiatric, secondary psychiatric, and cutaneous sensory disorder. The psychiatric disorders include anxiety, depression, obsessive-compulsive disorder, and psychosis. This manuscript gives an overview of the different psychodermatologic disorders, underlying psychiatric disorders, and how to manage psychodermatology cases.
Asunto(s)
Dermatología/métodos , Trastornos Mentales , Psiquiatría/métodos , Enfermedades de la Piel , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Enfermedades de la Piel/complicaciones , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/terapiaRESUMEN
Dermatologic disorders comprise 15% to 20% of complaints seen in general practice. Skin disorders result in a negative impact to the patient not only physically but also psychologically, socially, and occupationally. The most common trigger for several inflammatory skin disorders, including psoriasis, is emotional stress. Understanding the significance of emotional triggers to common inflammatory dermatologic disorders is critical to the optimal management of these conditions. This article will provide an overview of the effects of emotional stress on skin disorders and psychotherapeutic options.
Asunto(s)
Dermatitis , Psicoterapia/métodos , Estrés Psicológico , Dermatitis/etiología , Dermatitis/psicología , Dermatitis/terapia , Humanos , Factores Desencadenantes , Estrés Psicológico/complicaciones , Estrés Psicológico/psicología , Estrés Psicológico/terapiaRESUMEN
When patients with psychodermatologic disorders present in clinic, the dermatologist can refer them to psychiatrists or other mental health care professionals. However, it is often the case that these patients will refuse a psychiatric referral because they either do not believe they have a disorder of psychiatric nature or they feel there is societal stigma associated with psychiatric illness. Therefore, it is essential for dermatologists to understand the common classifications for psychodermatological cases and to know how to optimally treat these patients with pharmacotherapy. The intent of this article is to help guide physicians in understanding the classifications of psychodermatological cases and in managing these conditions with pharmacotherapies. In this article, two classifications for psychodermatological cases are presented, followed by a discussion of medical therapies used to treat the main categories of psychopathologies that are more frequently encountered in dermatology. These include depression, anxiety, delusions, and obsessive-compulsive disorder.
Asunto(s)
Trastornos Mentales/complicaciones , Trastornos Psicofisiológicos/tratamiento farmacológico , Psicotrópicos/uso terapéutico , Enfermedades de la Piel/psicología , Trastornos Somatosensoriales/tratamiento farmacológico , Ansiolíticos/uso terapéutico , Antidepresivos/uso terapéutico , Antipruriginosos/uso terapéutico , Antipsicóticos/uso terapéutico , Ansiedad/tratamiento farmacológico , Ansiedad/etiología , Ansiedad/psicología , Imagen Corporal/psicología , Delirio de Parasitosis/tratamiento farmacológico , Delirio de Parasitosis/psicología , Depresión/tratamiento farmacológico , Depresión/etiología , Depresión/psicología , Trastornos Fingidos/tratamiento farmacológico , Trastornos Fingidos/psicología , Humanos , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/psicología , Trastorno Obsesivo Compulsivo/complicaciones , Trastorno Obsesivo Compulsivo/tratamiento farmacológico , Trastorno Obsesivo Compulsivo/psicología , Trastornos Psicofisiológicos/psicología , Conducta Autodestructiva/tratamiento farmacológico , Enfermedades de la Piel/etiología , Trastornos Somatosensoriales/psicología , Tricotilomanía/tratamiento farmacológico , Tricotilomanía/etiología , Tricotilomanía/psicologíaRESUMEN
The treatment options for psoriasis in HIV-infected individuals are limited due to the immunosuppressive nature of the therapeutic modalities and the patient's immunocompromised state. Etanercept has been shown to be safe and effective in the non-HIV psoriasis population with nearly 20 years of experience. However, there is limited data on the safety of etanercept use in the HIV patient population. The authors report a case of an HIV-infected patient with psoriasis who has remained mostly clear on continuous, uninterrupted etanercept use for over six years.
Asunto(s)
Infecciones por VIH/complicaciones , Inmunoglobulina G/uso terapéutico , Factores Inmunológicos/uso terapéutico , Psoriasis/tratamiento farmacológico , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Adulto , Etanercept , Humanos , Inmunoglobulina G/administración & dosificación , Inmunoglobulina G/efectos adversos , Factores Inmunológicos/administración & dosificación , Factores Inmunológicos/efectos adversos , Masculino , Psoriasis/patología , Receptores del Factor de Necrosis Tumoral/administración & dosificación , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
BACKGROUND: Psoriasis is among the top dermatologic diagnoses for older adult patients, and the number of older adult psoriasis patients is expected to rise. PURPOSE: To characterize trends in older adult psoriasis health care practices of US ambulatory physician offices from 1993 to 2009. METHODS: We used data from the National Ambulatory Medical Care Survey to assess demographics, specialties seen, and treatment in visits by older adult patients, 55 years of age and older. RESULTS: There were approximately 14.1 million outpatient visits for psoriasis among the older adult population during the study period. Older adult psoriasis patients were 52.4% female and 47.6% male. The most frequent older adult age group seen for psoriasis was the 55 to 64 year age group. Dermatologists saw 69.3% of patients, internists saw 14.5%, and general and family practitioners saw 11.6%. Topical corticosteroids were the most frequently prescribed medications. Dermatologists preferred clobetasol whereas non-dermatologists more commonly prescribed betamethasone. For both the 18 to 54 year age group and the 55 and older group, the leading 7 out of 10 medications prescribed were topical corticosteroids and calcipotriene. However, etanercept, coal tar, and fluocinolone were among the leading medications in the younger group but not in the 55 and older group. CONCLUSIONS: Treatment approach for older adult psoriasis patients showed some differences among medical specialties and among the younger and older age groups. Further research specific to older adult psoriasis patients is needed to determine optimal treatment strategies for this patient population.
Asunto(s)
Atención Ambulatoria/tendencias , Glucocorticoides/uso terapéutico , Pautas de la Práctica en Medicina/tendencias , Psoriasis/tratamiento farmacológico , Administración Cutánea , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Betametasona/uso terapéutico , Calcitriol/análogos & derivados , Calcitriol/uso terapéutico , Clobetasol/uso terapéutico , Alquitrán/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Dermatología/estadística & datos numéricos , Etanercept , Medicina Familiar y Comunitaria/estadística & datos numéricos , Femenino , Fluocinolona Acetonida/análogos & derivados , Fluocinolona Acetonida/uso terapéutico , Glucocorticoides/administración & dosificación , Encuestas de Atención de la Salud , Humanos , Inmunoglobulina G/uso terapéutico , Factores Inmunológicos/uso terapéutico , Medicina Interna/estadística & datos numéricos , Queratolíticos/uso terapéutico , Masculino , Persona de Mediana Edad , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Estados Unidos , Adulto JovenRESUMEN
Psoriasis is a chronic inflammatory skin disease that is characterized by thickened red plaques covered with silvery scales. Excimer laser therapy is a cutting-edge advancement in UVB phototherapy. In contrast to traditional phototherapy, the 308 nm excimer laser only targets psoriasis plaques, while it spares uninvolved skin. It allows for treatment with a supra-erythmogenic dose of UVB irradiation. Targeted UVB therapy is a possible treatment especially for many who have failed topical treatments, systemic therapy, and traditional phototherapy. For safe and effective psoriasis treatment, a combination of therapies may be used, including a combination of laser treatment with topical medications. We present two cases demonstrating effective treatment with excimer laser in conjunction with clobetasol spray and calcitriol ointment for 12 weeks. Long-term near-clearance of psoriasis was sustained after 6 months and one-year follow up periods without further therapy.
Asunto(s)
Calcitriol/uso terapéutico , Clobetasol/uso terapéutico , Glucocorticoides/uso terapéutico , Psoriasis/terapia , Terapia Ultravioleta , Vitaminas/uso terapéutico , Adulto , Calcitriol/administración & dosificación , Clobetasol/administración & dosificación , Terapia Combinada , Glucocorticoides/administración & dosificación , Humanos , Terapia por Láser , Quimioterapia de Mantención , Masculino , Índice de Severidad de la Enfermedad , Vitaminas/administración & dosificaciónRESUMEN
Psoriasis is a chronic, inflammatory skin condition with negative impacts both physical and psychological. Scalp psoriasis, especially around the hairline, can cause significant impairment in quality of life due to its visibility. Options for treatment of facial psoriasis, including hairline involvement, are the use of low potency topical steroids, calcineurin inhibitors, and vitamin D analogues. Though the use of excimer laser for scalp psoriasis has been reported, there are no cases or studies specifically examining excimer laser phototherapy for the treatment of hairline psoriasis. We present a case of rapid improvement of hairline psoriasis using a regimen of 308 nm excimer laser with clobetasol spray and recommend an algorithm for the optimal treatment of scalp psoriasis utilizing currently available antipsoriatic therapies.
Asunto(s)
Clobetasol/uso terapéutico , Glucocorticoides/uso terapéutico , Láseres de Excímeros/uso terapéutico , Psoriasis/terapia , Anciano , Algoritmos , Clobetasol/administración & dosificación , Terapia Combinada , Femenino , Estudios de Seguimiento , Glucocorticoides/administración & dosificación , Humanos , Psoriasis/patología , Calidad de Vida , Cuero Cabelludo/patología , Resultado del TratamientoRESUMEN
The increased risk to patients on anti-tumor necrosis factor-alfa therapy of developing active tuberculosis supports screening of these patients for latent tuberculosis infection. The current practice of determining the presence of latent tuberculosis infection primarily, and often entirely, depends on the use of tuberculin skin testing (TST). We report a patient with psoriasis on long-term etanercept therapy who had a negative TST result and a positive interferon-gamma release assay result. Similar cases have also been found through a review of the literature. These findings suggest that TST might be unreliable during long-term anti-tumor necrosis factor-alfa therapy. QuantiFeron-TB Gold testing may be a more appropriate primary test in patients with risk factors for false-negative TST results.
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Inmunoglobulina G/uso terapéutico , Inmunosupresores/uso terapéutico , Tuberculosis Latente/diagnóstico , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Prueba de Tuberculina/métodos , Adulto , Artritis Psoriásica/diagnóstico , Artritis Psoriásica/tratamiento farmacológico , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Etanercept , Reacciones Falso Negativas , Humanos , Masculino , Psoriasis/diagnóstico , Psoriasis/tratamiento farmacológico , Medición de Riesgo , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
Narrowband ultraviolet B phototherapy is an important treatment option for psoriasis and other skin diseases. When narrowband ultraviolet B phototherapy is initiated, one method involves determining the minimal erythema dose for each patient with the starting dose at 50% to 70% of the minimal erythema dose. An alternative method involves using the recommended narrowband ultraviolet B exposure dose based on a patient's Fitzpatrick skin type. When the recommended narrowband ultraviolet B exposure doses of separate publications are compared, alarming differences are found. These discrepancies not only create confusion but also suggest the risk of phototoxicity, or its opposite, namely the risk of suboptimal dosimetry. For these reasons, this article discusses possible explanations for the wide variation in dosimetry recommendations. To remedy the current situation, the authors advocate a national standard for the practice of phototherapy treatment with the guidelines of the United Kingdom as a possible model for emulation.
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Fototerapia/normas , Guías de Práctica Clínica como Asunto/normas , Radiometría/normas , Terapia Ultravioleta/normas , Relación Dosis-Respuesta en la Radiación , Humanos , Evaluación de Necesidades , Dosificación Radioterapéutica , Enfermedades de la Piel/radioterapia , Reino UnidoRESUMEN
Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In the first 5 parts of the American Academy of Dermatology Psoriasis Guidelines of Care, we have presented evidence supporting the use of topical treatments, phototherapy, traditional systemic agents, and biological therapies for patients with psoriasis and psoriatic arthritis. In this sixth and final section of the Psoriasis Guidelines of Care, we will present cases to illustrate how to practically use these guidelines in specific clinical scenarios. We will describe the approach to treating patients with psoriasis across the entire spectrum of this fascinating disease from mild to moderate to severe, with and without psoriatic arthritis, based on the 5 prior published guidelines. Although specific therapeutic recommendations are given for each of the cases presented, it is important that treatment be tailored to meet individual patients' needs. In addition, we will update the prior 5 guidelines and address gaps in research and care that currently exist, while making suggestions for further studies that could be performed to help address these limitations in our knowledge base.
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Artritis Psoriásica/terapia , Fármacos Dermatológicos/uso terapéutico , Guías de Práctica Clínica como Asunto , Psoriasis/terapia , Artritis Psoriásica/diagnóstico , Manejo de Caso , Terapia Combinada , Medicina Basada en la Evidencia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Fototerapia/métodos , Psoriasis/diagnóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this fifth of 6 sections of the guidelines of care for psoriasis, we discuss the use of ultraviolet (UV) light therapy for the treatment of patients with psoriasis. Treatment should be tailored to meet individual patients' needs. We will discuss in detail the efficacy and safety as well as offer recommendations for the use of phototherapy, including narrowband and broadband UVB and photochemotherapy using psoralen plus UVA, alone and in combination with topical and systemic agents. We will also discuss the available data for the use of the excimer laser in the targeted treatment of psoriasis. Finally, where available, we will summarize the available data that compare the safety and efficacy of the different forms of UV light therapy.
Asunto(s)
Artritis Psoriásica/terapia , Fototerapia , Psoriasis/terapia , Adulto , Niño , Femenino , Humanos , Queratinocitos/patología , Terapia PUVA , Fotoquimioterapia , Fototerapia/efectos adversos , Fototerapia/métodos , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones del Embarazo/terapia , Psoriasis/tratamiento farmacológicoRESUMEN
Cyclosporine has been shown to increase the risk of lymphoma when used in organ transplant patients; however, studies have failed to demonstrate an increased risk of lymphoma when used at lower dermatologic doses for psoriasis. The authors present a case of solid B-cell lymphoma occurring in a psoriasis patient with a history of intermittent exposure to high-dose methotrexate, followed by low-dose cyclosporine for two years and subsequently transitioned to treatment with adalimumab. Methotrexate, cyclosporine and adalimumab are each effective treatments for psoriasis. However, when faced with an interplay of several factors, closer surveillance for malignancy is warranted than that which is currently considered for monotherapy.
Asunto(s)
Ciclosporina/efectos adversos , Inmunosupresores/efectos adversos , Linfoma de Células B/inducido químicamente , Psoriasis/tratamiento farmacológico , Adalimumab , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales Humanizados , Femenino , Humanos , Metotrexato/efectos adversos , Persona de Mediana EdadRESUMEN
Delusions of parasitosis (DOP) is a psychiatric disorder characterized by the fixed false belief that one is infested with parasites or other organisms. Historically, pimozide, a first-generation antipsychotic, has been the treatment of choice for DOP, although there is risk for serious adverse effects including extrapyramidal symptoms, QTc prolongation and tardive dyskinesia. Recently, there have been several reports describing the effectiveness of second-generation antipsychotics (SGAs), but these agents have their own unique adverse effects, specifically metabolic changes with olanzapine, sedation with quetiapine and hyperprolactinemia with risperidone. Aripiprazole is a novel, third-generation antipsychotic with comparable efficacy to SGAs, but a more favorable side effect profile. Successful treatment of DOP with aripiprazole has recently been described in the psychiatric and dermatologic literature. The authors present another report to support the use of aripiprazole as an efficacious and safe alternative for treating DOP.
Asunto(s)
Antipsicóticos/uso terapéutico , Deluciones/tratamiento farmacológico , Trastornos Mentales/tratamiento farmacológico , Pimozida/uso terapéutico , Piperazinas/uso terapéutico , Quinolonas/uso terapéutico , Anciano de 80 o más Años , Antipsicóticos/efectos adversos , Aripiprazol , Deluciones/diagnóstico , Femenino , Humanos , Trastornos del Movimiento/complicaciones , Enfermedades Parasitarias/psicología , Pimozida/efectos adversos , Piperazinas/efectos adversos , Quinolonas/efectos adversos , Risperidona/uso terapéuticoRESUMEN
Psoriasis is a common, chronic, inflammatory, multi-system disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this third of 6 sections of the guidelines of care for psoriasis, we discuss the use of topical medications for the treatment of psoriasis. The majority of patients with psoriasis have limited disease (<5% body surface area involvement) and can be treated with topical agents, which generally provide a high efficacy-to-safety ratio. Topical agents may also be used adjunctively for patients with more extensive psoriasis undergoing therapy with either ultraviolet light, systemic or biologic medications. However, the use of topical agents as monotherapy in the setting of extensive disease or in the setting of limited, but recalcitrant, disease is not routinely recommended. Treatment should be tailored to meet individual patients' needs. We will discuss the efficacy and safety of as well as offer recommendations for the use of topical corticosteroids, vitamin D analogues, tazarotene, tacrolimus, pimecrolimus, emollients, salicylic acid, anthralin, coal tar, as well as combination therapy.