Psoriasis and Treatment: Past, Present and Future Aspects.

The management of psoriasis has evolved considerably over the past 100 years. This has occurred in parallel with our understanding of the pathogenesis of this common, complex and enigmatic disease. It should be celebrated as an outstanding example of successful translational research. With precise targeting of immune pathways for the treatment of psoriasis with new biologics and small molecules has come the realisation that the most effective approach to patient management is a holistic one which encompasses the biopsychosocial nature of the disease. This involves a stratified medicine approach to identifying the best drug for an individual allied to patient education, screening for comorbidity, and regular review as both the clinical presentation and the patient's needs will change over time. Al-though there is not yet a cure for psoriasis - the whole person, systems approach to patient management, that is in part dependent on early intervention, should help to ensure an optimal outcome.

A Brief History of Psoriasis Management in Canada.

Psoriasis is a chronic, inflammatory disease with a varying degree of clinical presentations. Managing psoriasis has always been arduous due to its chronicity and its propensity to relapse. Prior to the development of targeted biologic therapies, there were few effective treatments for psoriasis. Ancient psoriasis therapies included pinetar, plant extracts, psychotherapy, arsenic, and ammoniated mercury. In the 19th century, chrysarobin was developed. Then, in the early half of the 20th century, anthralin and coal tar were in widespread use. In the latter half of the 20th century, treatments were limited to topical first-line therapies, systemic drugs, and phototherapy. However, as the treatment of psoriasis has undergone a revolutionary change with the development of novel biologic therapies, patients with moderate to severe psoriasis have been able to avail therapies with high efficacy and durability along with an acceptable safety profile. This article is a brief historical review of the management of psoriasis prior to the inception of biologics and with the development of novel biologic therapies.

Use of mineral waters in the treatment of psoriasis: Perspectives of Persian and conventional medicine.

Psoriasis is a chronic inflammatory disease, which is accompanied by social and emotional complications leading to considerable disability. There is no definitive cure and treatment options carry complications. Balneotherapy has been used for years in psoriasis. Antibiotic, keratolytic, and anti-inflammatory effects of these waters have been proved. Persian medicine (PM) is a source of natural remedies for skin disease. The aim of study is to explain scientific evidences of Persian mineral waters as a treatment option for psoriasis. This is a narrative review, which investigates medical manuscripts of medieval Persia from 10th to 19th centuries AD noted as credible textbooks about mineral waters. Furthermore, balneotherapy evidences searched in databases including Pubmed, Scopus, and Cochrane until December 2017 to obtain clinical evidences related to psoriasis. In PM, mineral waters have keratolytic activity and can regulate superficial skin layers hyperproliferation, which is recommended for psoriasis treatment. In various studies, antiproliferative, keratolytic, antibiotic, anti-inflammatory, and antioxidant effects of these waters have been proved completely. There are scientific evidences, which demonstrate that mineral waters in Persia, can reduce clinical symptoms of psoriasis and improve quality of life in patients. Therefore, this method might be considered as treatment options for psoriasis.

Interleukin 17A: toward a new understanding of psoriasis pathogenesis.

Molecular and cellular understanding of psoriasis pathogenesis has evolved considerably over the last 30 years beginning in the early 1980s when psoriasis was thought to be a skin disease driven by keratinocyte hyperproliferation. During the next 20 years, the role of the immune system and T-helper (Th) cells in psoriasis pathogenesis was recognized. The presence of the interleukin (IL)-12 cytokine in psoriatic lesions led to the postulate that psoriasis is mediated by Th1 cells. Recent evidence has revealed a role for Th17 cells, and other immune cells, as proximal regulators of psoriatic skin inflammation. IL-17A, the principal effector cytokine of Th17 cells, stimulates keratinocytes to produce chemokines, cytokines, and other proinflammatory mediators thereby enabling IL-17A to bridge the innate and adaptive immune systems to sustain chronic inflammation. This model underlies the rationale for inhibiting IL-17A signaling as a potential therapeutic approach to disrupt the psoriatic inflammatory loop. Several monoclonal antibodies that inhibit the IL-17 pathway are in clinical development. These agents exhibit promising clinical efficacy and tolerability profiles including immunohistochemical improvement in psoriatic plaques. Results from clinical trials with IL-17 pathway inhibitors are refining our understanding of psoriasis pathogenesis and may provide a new therapeutic approach for patients with moderate to severe psoriasis.

Psoriasis and psoriatic arthropathy, historical aspects: part I.

Psoriasis was probably described no later than the first century AD, and the term was coined in the second century. However, a clear association between descriptions recognizable as psoriasis and articular symptoms began in the 19th century. This review was from the English-language, German, and French literature. The development of the differentiation of psoriatic arthritis from clinically similar symptoms, including relevant serologic and radiologic findings and therapeutics with a focus up to the 1960s and the recognition of the efficacy of methotrexate, is reported.

Elephantiasis, elastin, and chronic wound healing: 19th century and contemporary viewpoints relevant to hypotheses concerning lymphedema, leprosy, erysipelas, and psoriasis--review and reflections.

Both wound healing and lymphedema have fibrosis of the skin in common. They also share destruction of elastin by elastases from neutrophils as a significant feature. These are not new observations, and the writings of Unna and Kaposi are recalled. The contemporary observations on elastin by Gerli and his team are discussed in the light of these much earlier opinions.

George Higoumenakis (1895-1983): Greek dermatologist.

This paper describes the Higoumenakis sign, enlargement of the sternal end of the clavicle in patients with late congenital syphilis and the dermatologist after whom it is named. Several professors and doctors from the Medical School of the University of Athens opposed his actions especially at the University in Greece. His persistence led him to productive scientific activity in syphilis, leishmaniasis and psoriasis. He became a member of the Greek Parliament from 1964 to 1967 and eventually Minister of Hygiene - even though this may have been an imprudent political choice, due to the unstable socio-political status of that period. He died on 27 December 1983 at the age of 88.

Exploratory psychotherapy in the treatment of psoriasis. Twelve hundred years ago.

Twelve hundred years ago, Jasaliq, a Persian physician, treated a patient who was suffering from psoriasis. Although psoriasis was not clearly differentiated from leprosy in the West until the 1840s, it was clinically described and differentiated as a separate entity in Persia in the eighth century AD. In this case history reported in one of the oldest Persian texts, Chahar Maqala, written in 1155 AD, the physician formulated a dynamic relationship between the outbreak of psoriasis in his patient and the existence of severe interpersonal conflicts. In treating his patient, he skillfully used therapeutic modalities that are now prevalent in exploratory and psychodynamic psychotherapy. The techniques of developing a therapeutic alliance, therapeutic confrontation, clarification, dynamic interpretation, and exploration of intrapsychic and interpersonal conflicts are in accord with our present concepts of exploratory and dynamic psychotherapy.

Oral methoxsalen photochemotherapy for the treatment of psoriasis: a cooperative clinical trial. 1977.

Extensive psoriasis in 1,308 patients has been treated two or three times a week with oral 8-methoxypsoralen followed by high intensity, long-wave ultraviolet light (PUVA). Excluding 169 patients still under early treatment, psoriasis cleared in 88% and failed to clear in 3%. One percent dropped out due to complications of treatment, and 8% for other reasons. The twice-a-week schedule was superior for patients with lighter skin types. Once a remission was induced, there was no difference in its maintenance when patients were treated once a week, once every other week, or once every third week. Each of these schedules was superior to no maintenance treatment. Immediate side effects of the 45,000 treatments administered in the first 18 months of this study were uncommon, temporary, and generally mild. No clinically significant changes in laboratory screening or eye examinations attributable to PUVA have been uncovered.

The Goeckerman treatment in psoriasis: six decades of experience at the Mayo Clinic.

The Goeckerman treatment for severe psoriasis has been used at the Mayo Clinic for six decades in a closely supervised hospital setting. It is an effective and safe method of treatment and is still the standard with which new forms of treatment must be compared.

Historical development of local therapy of psoriasis vulgaris.

Throughout the history people have used various remedies for the treatment of psoriasis. Some of them were bizarre, some ineffective and harmful, and some have survived until today and are still in use. Salicylic acid, anthralin, coal tar, corticosteroids, vitamin D3 analogues, retinoids must be mentioned as remarkably effective ones. Phototherapy and laser therapy are both promising techniques, as well as immunomodulators. Underlying mechanisms of psoriasis and mode of action of therapeutics that have been elucidated over the time allowed for the development of more potent and promising therapy of psoriasis.

Psoriasis treatment--yesterday, today, and tomorrow.

In this historical review the authors investigated the treatment of psoriasis through the centuries. There are numerous obstacles in search for the description of psoriasis vulgaris in the works of the great physicians in the antiquity. Most remedies have been developed empirically. During the last two centuries, innumerable drugs have been employed in the treatment of psoriasis. Today dermatologists use the rotational treatment to diminish adverse drug events. In the future psoriasis will probably be cured with the new biological agents.