Review Article
Advances in Psoriasis
Abstract
Psoriasis treatments range from topical treatments and phototherapy to oral systemic medications and injections. Despite good control of the disease when applying appropriate treatments (according to disease severity, insurance parameters, patient preference, and patients’ ability to adhere), continued advancements will allow even better symptomatic control, reduced adverse effects, and patient satisfaction. This review aims to assess traditional and new psoriasis treatments and how to apply them in clinical practice. A literature review on psoriasis treatments and clinical applications was performed using PubMed. Mild-to-moderate psoriasis treatments include topicals, localized phototherapy, and newer therapies combining two types of topicals, phototherapy with topicals, and easy-to-use foam and spray vehicles. Moderateto-severe psoriasis therapies include monotherapy or various combinations of generalized phototherapy, oral treatments, and biologic agents, with new oral and biologic agents on the horizon. Dermatologists and primary care providers share roles in screening for associated comorbidities (including cardiovascular disorders, chronic kidney disease, Crohn disease, dyslipidemia, diabetes mellitus/insulin resistance, depression, metabolic syndrome, obesity, and psoriatic arthritis), managing patients’ treatments, and reevaluating treatment needs as new therapies are approved. Continued advancements in psoriasis treatment and improvement in coordinated care will allow better overall care of patients with psoriasis.This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. Braun-Falco O, Burg G. Inflammatory infiltrate in psoriasis vulgaris. A cytochemical study. Arch Klin Exp Dermatol 1970;236:297-314.
2. Bos JD, Hulsebosch HJ, Krieg SR, et al. Immunocompetent cells in psoriasis. In situ immunophenotyping by monoclonal antibodies. Arch Dermatol Res 1983;275:181-189.
3. Icen M, Crowson CS, McEvoy MT, et al. Trends in incidence of adult-onset psoriasis over three decades: a population-based study. J Am Acad Dermatol 2009;60:394-401.
4. Armstrong AW, Schupp C, Wu J, et al. Quality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003-2011. PLoS One 2012;7:e52935.
5. Menter A, Griffiths CE. Current and future management of psoriasis. Lancet 2007;370:272-284.
6. Feldman SR, Horn EJ, Balkrishnan R, et al. Psoriasis: improving adherence to topical therapy. J Am Acad Dermatol 2008;59:1009-1016.
7. Stern RS. PUVA Follow-Up Study. The risk of squamous cell and basal cell cancer associated with psoralen and ultraviolet A therapy: a 30-year prospective study. J Am Acad Dermatol 2012;66:553-562.
8. Ozdemir M, Engin B, Baysal I, et al. A randomized comparison of acitretin-narrow-band TL-01 phototherapy and acitretin-psoralen plus ultraviolet A for psoriasis. Acta Derm Venereol 2008;88:589-593.
9. Saurat JH, Geiger JM, Amblard P, et al. Randomized double-blind multicenter study comparing acitretin-PUVA, etretinate-PUVA and placebo-PUVA in the treatment of severe psoriasis. Dermatologica 1988;177:218-224.
10. Lauharanta J, Juvakoski T, Lassus A. A clinical evaluation of the effects of an aromatic retinoid (Tigason), combination of retinoid and PUVA, and PUVA alone in severe psoriasis. Br J Dermatol 1981;104:325-332.
11. Paul CF, Ho VC, McGeown C, et al. Risk of malignancies in psoriasis patients treated with cyclosporine: a 5 y cohort study. J Invest Dermatol 2003;120:211-216.
12. Armstrong AW, Robertson AD, Wu J, et al. Undertreatment, treatment trends, and treatment dissatisfaction among patients with psoriasis and psoriatic arthritis in the United States: findings from the National Psoriasis Foundation surveys, 2003-2011. JAMA Dermatol 2013;149:1180-1185.
13. Lebwohl M. Combining the new biologic agents with our current psoriasis armamentarium. J Am Acad Dermatol 2003;49(2 Suppl):S118-S124.
14. Feely MA, Smith BL, Weinberg JM. Novel psoriasis therapies and patient outcomes, part 1: topical medications. Cutis 2015;95:164-188.
15. Brown KK, Rehmus WE, Kimball AB. Determining the relative importance of patient motivations for nonadherence to topical corticosteroid therapy in psoriasis. J Am Acad Dermatol 2006;55:607-613.
16. Aslam I, Feldman SR. Practical strategies to improve patient adherence to treatment regimens. South Med J 2015;108:325-331.
17. Lebwohl M, Ali S. Treatment of psoriasis. Part 1. Topical therapy and phototherapy. J Am Acad Dermatol 2001;45:487-502.
18. Mason A, Mason J, Cork M, et al. Topical treatments for chronic plaque psoriasis: an abridged Cochrane systematic review. J Am Acad Dermatol 2013;69:799-807.
19. Kragballe K, Austad J, Barnes L, et al. Efficacy results of a 52-week, randomised, double-blind, safety study of a calcipotriol/betamethasone dipropionate two-compound product (Daivobet/Dovobet/Taclonex) in the treatment of psoriasis vulgaris. Dermatology 2006;213:319-326.
20. Mudigonda T, Dabade TS, Feldman SR. A review of targeted ultraviolet B phototherapy for psoriasis. J Am Acad Dermatol 2012;66:664-672.
21. Lapolla W, Yentzer BA, Bagel J, et al. A review of phototherapy protocols for psoriasis treatment. J Am Acad Dermatol 2011;64:936-949.
22. Gordon PM, Diffey BL, Matthews JN, et al. A randomized comparison of narrow-band TL-01 phototherapy and PUVA photochemotherapy for psoriasis. J Am Acad Dermatol 1999;41( 5 Pt 1 ):728-732.
23. Kalb RE, Strober B, Weinstein G, et al. Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference. J Am Acad Dermatol 2009;60:824-837.
24. Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol 2009;61:451-485.
25. Ozawa A, Ohkido M, Haruki Y, et al. Treatments of generalized pustular psoriasis: a multicenter study in Japan. J Dermatol 1999;26:141-149.
26. Buccheri L, Katchen BR, Karter AJ, et al. Acitretin therapy is effective for psoriasis associated with human immunodeficiency virus infection. Arch Dermatol 1997;133:711-715.
27. Moustafa F, Feldman SR. A review of phosphodiesterase-inhibition and the potential role for phosphodiesterase 4-inhibitors in clinical dermatology. Dermatol Online J 2014;20:22608.
28. Papp K, Reich K, Leonardi CL, et al. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis <ESTEEM] 1). J Am Acad Dermatol 2015;73:37-49.
29. Palfreeman AC, McNamee KE, McCann FE. New developments in the management of psoriasis and psoriatic arthritis: a focus on apremilast. Drug Des Devel Ther 2013;7:201-210.
30. Zerilli T, Ocheretyaner E. Apremilast (Otezla): a new oral treatment for adults with psoriasis and psoriatic arthritis. P T 2015;40:495-500.
31. Lowes MA, Kikuchi T, Fuentes-Duculan J, et al. Psoriasis vulgaris lesions contain discrete populations of Th1 and Th17 T cells. J Invest Dermatol 2008;128:1207-1211.
32. Lowes MA, Suarez-Farinas M, Krueger JG. Immunology of psoriasis. Annu Rev Immunol 2014;32:227-255.
33. Di Cesare A, Di Meglio P, Nestle FO. The IL-23/Th17 axis in the immunopathogenesis of psoriasis. J Invest Dermatol 2009;129:1339-1350.
34. Mortezavi M, Ritchlin C. Immunologic advances reveal new targets in psoriasis and psoriatic arthritis. Discov Med 2015;20:169-175.
35. Zaba LC, Fuentes-Duculan J, Eungdamrong NJ, et al. Psoriasis is characterized by accumulation of immunostimulatory and Th1/Th17 cell-polarizing myeloid dendritic cells. J Invest Dermatol 2009;129:79-88.
36. Di Meglio P, Di Cesare A, Laggner U, et al. The IL23R R381Q gene variant protects against immune-mediated diseases by impairing IL-23-induced Th17 effector response in humans. PLoS One 2011;6:e17160.
37. Van Voorhees A, Feldman SR, Koo JYM, et al. The Psoriasis and Psoriatic Arthritis Pocket Guide. Treatment Algorithms and Management Options, 3rd ed. https://www.psoriasis.org/health-care-providers/treating-psoriasis. Accessed November 7, 2016.
38. Takahashi H, Iinuma S, Tsuji H, et al. Biologics are more potent than other treatment modalities for improvement of quality of life in psoriasis patients. J Dermatol 2014;41:686-689.
39. Sivamani RK, Goodarzi H, Garcia MS, et al. Biologic therapies in the treatment of psoriasis: a comprehensive evidence-based basic science and clinical review and a practical guide to tuberculosis monitoring. Clin Rev Allergy Immunol 2013;44:121-140.
40. Yang H, Epstein D, Bojke L, et al. Golimumab for the treatment of psoriatic arthritis. Health Technol Assess 2011;15(Suppl 1):87-95.
41. Baranauskaite A, Raffayova H, Kungurov NV, et al. Infliximab plus methotrexate is superior to methotrexate alone in the treatment of psoriatic arthritis in methotrexate-naive patients: the RESPOND study. Ann Rheum Dis 2012;71:541-548.
42. Jacobs JW, Creemers MC, van Agtmael MA, et al. TNF-blocking drugs and infection recommendations for daily practice. Ned Tijdschr Geneeskd 2007;151:588-593.
43. Ahn CS, Dothard EH, Garner ML, et al. To test or not to test? An updated evidence-based assessment of the value of screening and monitoring tests when using systemic biologic agents to treat psoriasis and psoriatic arthritis. J Am Acad Dermatol 2015;73:420-428. e1.
44. Zachariae C, Mork NJ, Reunala T, et al. The combination of etanercept and methotrexate increases the effectiveness of treatment in active psoriasis despite inadequate effect of methotrexate therapy. Acta Derm Venereol 2008;88:495-501.
45. Tyring S, Gordon KB, Poulin Y, et al. Long-term safety and efficacy of 50 mg of etanercept twice weekly in patients with psoriasis. Arch Dermatol 2007;143:719-726.
46. Papp KA, Langley RG, Lebwohl M, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). Lancet 2008;371:1675-1684.
47. Feely MA, Smith BL, Weinberg JM. Novel psoriasis therapies and patient outcomes, part 2: biologic treatments. Cutis 2015;95:282-290.
48. Menon B, Gullick NJ, Walter GJ, et al. Interleukin-17 + CD8 + T cells are enriched in the joints of patients with psoriatic arthritis and correlate with disease activity and joint damage progression. Arthritis Rheumatol 2014;66:1272-1281.
49. Roman M, Madkan VK, Chiu MW. Profile of secukinumab in the treatment of psoriasis: current perspectives. Ther Clin Risk Manag 2015;11:1767-1777.
50. Levin AA, Gottlieb AB. Specific targeting of interleukin-23p19 as effective treatment for psoriasis. J Am Acad Dermatol 2014;70:555-561.
51. Kopp T, Riedl E, Bangert C, et al. Clinical improvement in psoriasis with specific targeting of interleukin-23. Nature 2015;521:222-226.
52. Fioranelli M, Roccia MG, Lotti T. Brodalumab versus ustekinumab in psoriasis. Dermatol Ther 2016;29:298.
53. Nakagawa H, Niiro H, Ootaki K, et al. Brodalumab, a human anti-interleukin-17-receptor antibody in the treatment of Japanese patients with moderate-to-severe plaque psoriasis: efficacy and safety results from a phase II randomized controlled study. J Dermatol Sci 2016;81:44-52.
54. Papp K, Leonardi C, Menter A, et al. Safety and efficacy of brodalumab for psoriasis after 120 weeks of treatment. J Am Acad Dermatol 2014;71:1183-1190. e3.
55. Danesh MJ, Kimball AB. Brodalumab and suicidal ideation in the context of a recent economic crisis in the United States. J Am Acad Dermatol 2016;74:190-192.
56. Griffiths CE, Reich K, Lebwohl M, et al. Comparison of ixekizumab with etanercept or placebo in moderate-to-severe psoriasis (UNCOVER-2 and UNCOVER-3): results from two phase 3 randomised trials. Lancet 2015;386:541-551.
57. Marinoni B, Ceribelli A, Massarotti MS, et al. The Th17 axis in psoriatic disease: pathogenetic and therapeutic implications. Auto Immun Highlights 2014;5:9-19.
58. Tanita K, Fujimura T, Kakizaki A, et al. Psoriasiform drug eruption caused by abatacept: immunohistochemical investigation of STAT signaling. Case Rep Dermatol 2015;7:166-170.
59. Suarez-Farinas M, Arbeit R, Jiang W, et al. Suppression of molecular inflammatory pathways by Toll-like receptor 7, 8, and 9 antagonists in a model of IL-23-induced skin inflammation. PLoS One 2013;8:e84634.
60. Balak DMW, van Doorn MBA, Rissmann R, et al. Results from a randomized, double-blind, placebo-controlled, monotherapy trial of IMO-8400 demonstrate clinical proof-of-concept for Toll-like receptor 7, 8 and 9 antagonism in psoriasis (#1805). San Francisco:Paper presented at: American Academy of Dermatology annual meeting March 20-24 , 2015.
61. Wagner T, Thienel U, Vieser E, et al. AB0484 an integrated pharmacokinetic and pharmacodynamic approach to guide dose selection of namilumab, an anti-GM-CSF monoclonal antibody, for phase II rheumatoid arthritis studies. http://ard.bmj.com/content/74/Suppl_2/1059.2.abstract. Accessed October 26, 2016.
62. The psoriasis PACT: partnership to advance care and treatment. http://ra.psopact.com. Published 2014. Accessed February 5, 2016.
63. Liu JT, Yeh HM, Liu SY, et al. Psoriatic arthritis: epidemiology, diagnosis, and treatment. World J Orthop 2014;5:537-543.
