ABSTRACT
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.
Subject(s)
Complementary Therapies/methods , Dermatologic Agents/administration & dosage , Dermatology/methods , Psoriasis/therapy , Academies and Institutes/standards , Administration, Cutaneous , Combined Modality Therapy/methods , Combined Modality Therapy/standards , Complementary Therapies/standards , Dermatology/standards , Evidence-Based Medicine/methods , Evidence-Based Medicine/standards , Foundations/standards , Humans , Patient Education as Topic/standards , Psoriasis/diagnosis , Severity of Illness Index , Treatment Outcome , United StatesABSTRACT
Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 2% of the world's population. In this guideline, we focus the discussion on systemic, nonbiologic medications for the treatment of this disease. We provide detailed discussion of efficacy and safety for the most commonly used medications, including methotrexate, cyclosporine, and acitretin, and provide recommendations to assist prescribers in initiating and managing patients on these treatments. Additionally, we discuss newer therapies, including tofacitinib and apremilast, and briefly touch on a number of other medications, including fumaric acid esters (used outside the United States) and therapies that are no longer widely used for the treatment of psoriasis (ie, hydroxyurea, leflunomide, mycophenolate mofetil, thioguanine, and tacrolimus).
Subject(s)
Psoriasis/drug therapy , Acitretin/therapeutic use , Cyclosporine/therapeutic use , Drug Monitoring , Humans , Methotrexate/therapeutic use , Piperidines/therapeutic use , Pyrimidines/therapeutic use , Thalidomide/analogs & derivatives , Thalidomide/therapeutic useABSTRACT
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.
Subject(s)
Cardiovascular Diseases/epidemiology , Mental Health , Metabolic Syndrome/epidemiology , Obesity/epidemiology , Physician's Role , Psoriasis/epidemiology , Psoriasis/psychology , Quality of Life , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/epidemiology , Comorbidity , Dyslipidemias/epidemiology , Evidence-Based Medicine , Humans , Hypertension/epidemiology , Inflammatory Bowel Diseases/epidemiology , Kidney Diseases/epidemiology , Life Style , Liver Diseases/epidemiology , Lung Diseases, Obstructive/epidemiology , Neoplasms/epidemiology , Patient Education as Topic , Psoriasis/therapy , Sleep Apnea Syndromes/epidemiologyABSTRACT
Psoriasis is a chronic, inflammatory multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations based on the available evidence. The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.
Subject(s)
Biological Products/therapeutic use , Dermatologic Agents/therapeutic use , Psoriasis/drug therapy , Adalimumab/therapeutic use , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Biosimilar Pharmaceuticals/therapeutic use , Certolizumab Pegol/therapeutic use , Drug Therapy, Combination , Etanercept/therapeutic use , Evidence-Based Medicine , Humans , Infliximab/therapeutic use , Piperidines/therapeutic use , Pyrimidines/therapeutic use , Pyrroles/therapeutic use , Ustekinumab/therapeutic useABSTRACT
BACKGROUND: Efalizumab was voluntarily withdrawn from the market in April 2009 after four cases of progressive multifocal leukoencephalopathy. OBJECTIVE: To review the baseline characteristics and psoriasis phenotypes of patients with prior excelled response to efalizumab, and to determine the response of these patients to prior as well as subsequent therapies. By defining this subgroup of patients, particularly relating to palmoplantar psoriasis, future therapeutic considerations could be improved. DESIGN: A retrospective review of 72 patients who were on efalizumab at the time of market withdrawal was conducted. Data was obtained through chart review of patients at a specialty psoriasis clinic in Dallas, TX. MAIN OUTCOMES AND MEASURES: Patient characteristics, details of efalizumab use, and efficacy of efalizumab compared with other psoriasis treatment modalities. RESULTS: Of the 72 patients, 24 (33%) were found to have palmoplantar disease. As a group, these patients were older, more likely to be female, and less likely to have a family history of psoriasis. 48 patients (67%) were on one or more systemic and/or biologic medication prior to starting efalizumab. Their BSA improved from 5.45 to 0.8 as a group. Six patients were identified as having failed TNF alpha antagonist treatment prior to starting efalizumab. All responded well to the medication with an average BSA of 0.54. Five of these six patients had evidence of palmoplantar disease prior to starting efalizumab and five of these six patients were female. Eleven patients (15%) experienced neurologic side effects and 13 (18%) had infections while on efalizumab treatment. LIMITATIONS: This was a retrospective review. Quality of life issues could not always be fully assessed from the data available. CONCLUSIONS AND RELEVANCE: Efalizumab was effectively utilized in our clinical practice to treat patients with palmoplantar psoriasis, including six patients who had failed prior treatment with one or more TNF alpha antagonist agents.