Psoriasis represents a potentially life-altering disease that can profoundly impact physical, emotional and social functioning, and overall quality of life. Part I of this 2-part series will focus on topical agents, their varying degrees of effectiveness, potential side-effects and applications in clinical practice.
Excimer Laser Therapy for Hairline Psoriasis: A Useful Addition to the Scalp Psoriasis Treatment Algorithm
Scalp psoriasis, especially around the hairline, can cause significant impairment in quality of life due to its visibility. This articles makes a case for a combination of 308 nm excimer laser with clobetasol spray for the treatment of scalp psoriasis.
Methotrexate has been used for over half a century to treat a wide spectrum of skin conditions. This article delves into research on the pharmacogenetic properties of the drug as well as the variety of skin conditions that Methotrexate is used to treat.
A Review of Ixekizumab, an Anti-Interleukin-17A Monoclonal Antibody, for Moderate-to-Severe Plaque Psoriasis
Recent advances in our understanding of the innate and adaptive immune systems have led to the identification of interleukin (IL)-17 as a key pro-inflammatory mediator in psoriasis. We review phase 1-3 clinical trials of ixekizumab, for treatment of moderate-to-severe plaque psoriasis.
The choice of treatment for psoriasis in children, as in adults, is determined by disease acuity, morphology, distribution, and severity. Part II of this 2-part series features an overview of systemic and light therapies including their varying degrees of effectiveness, potential side-effects and applications in clinical practice.
Tildrakizumab is a promising therapeutic option for patients with moderate-to-severe chronic plaque psoriasis. The specificity of the drug in targeting the p19 subunit of IL-23 allows for the high efficacy and safety of long-term treatment as demonstrated in clinical trials.
Psoriasis types and subtypes can influence preferred treatment modality. This article discusses the symptoms specific to the psoriasis subtype, and considerations for selecting treatment.
Interleukin-17 (IL-17) is believed to be a potent driver of plaque psoriasis. This article reviews efficacy and safety results from Phase 2 and 3 trials with monoclonal antibodies targeting IL-17RA (brodalumab), and IL-17A (ixekizumab and secukinumab) for the treatment of plaque psoriasis.
This article focuses on topical D3 vitamin analogues for the treatment of psoriasis. Therapeutic efficacy, toxicity, patient adherence, combination therapy, and the family physician's role in psoriasis treatment are covered.
For many years, clinicians have expressed ongoing concerns about treatment adherence by patients, especially pertaining to those with chronic skin disorders. Although crucial to effective therapeutic outcomes, the issue of patient adherence has been largely ignored in dermatologic disease management until recently.
Approximately 50% of patients with psoriasis have nail psoriasis but the life time chance of nail changes must be much higher. Nail changes in psoriasis include pitting, thickening, onycholysis, discoloration, oily spots, splinter hemorrhages and paronychia. Treatment of choice depends on the form the psoriasis takes.
Treatments for Scalp Psoriasis with Emphasis on Calcipotriol Plus Betamethasone Dipropionate Gel (Xamiol®)
Scalp psoriasis occurs in 50%-75% of patients with plaque psoriasis. It may be the only area of the body affected, or it may be associated with disease elsewhere, including psoriatic arthritis. Most cases are treated topically, usually with steroids and/or calcipotriol.
Adherence to topical treatment for psoriasis remains a challenge as the daily application creates a significant treatment burden. New topical therapeutic options need to offer a combination of higher efficacy and better patient acceptability, including...
IL-12/IL-23 Inhibitors: The Advantages and Disadvantages of this Novel Approach for the Treatment of Psoriasis
Psoriasis is a common chronic inflammatory skin disease that is mediated, in part by the body’s T-cell inflammatory response mechanisms. Current data regarding the efficacy of these agents show they may have the potential to become the new clinical gold standard for biologic therapy to treat psoriasis.
Although PDT remains an investigational treatment modality in dermatology, several important areas of development may ultimately lead to official and practical acceptance of PDT for the skin. Various uses of PDT are evaluated.
Methotrexate has been an important agent in the management of dermatologic conditions for decades. Although first indicated for the treatment of psoriasis, MTX has been shown to be a successful treatment option for a wide array of skin diseases.
Hand and foot psoriasis is a chronic and debilitating disease that manifests as plaque-type or pustular-type lesions. Although the palms and soles represent only 2% of the total body surface area, psoriasis of these regions may lead to physical dysfunctions that can greatly impair dexterity, mobility, and the quality of life.
Sirolimus, also known as rapamycin (SRL, Rapamune®), was approved in 1999 by the US Food and Drug Administration to prevent graft rejection in renal transplantation. This articles reviews Sirolimus, its pharmacokinetics, mechanism of action, and indication.
Chronic palmoplantar pustular psoriasis is a disabling condition characterized by recurrent crops of sterile pustules on a background of erythema, fissuring and scaling. Genetic and environmental factors have been implicated in its etiology.
The exact role of biologics in the treatment of pediatric psoriasis remains undefined but evolving. This article will provide a summary of the cumulative pediatric safety and efficacy data for the anti-tumor necrosis factor-alpha (TNF-α) agents and interleukin (IL)-12 and IL-23 (IL12/23) pathway inhibitor.
Scalp conditions such as itchy scalp, dandruff, seborrheic dermatitis, and scalp psoriasis are common. The emotional effect these complaints cause are often ignored or trivialized, but as dermatologists we should appreciate the relief that appropriate advice and treatment will bring to our patients.
Acitretin (SORIATANE®, Roche Pharmaceuticals) is an aromatic retinoid, effective in the treatment of severe psoriasis. This study highlights data from two existing clinical trials to capture PASI 50 and PASI 75 responder rates which represent a common metric used in current psoriasis clinical trials.
In the past three decades, major advances have been made in understanding the pathogenesis of psoriasis. This review focuses on the role of IL-23 in psoriasis pathogenesis and the current therapies targeting IL-23 that are being studied in clinical trials.
Etanercept is a tumor necrosis factor antagonist with anti-inflammatory effects. It is currently approved in the US for psoriasis, psoriatic arthritis, ankylosing spondylitis, rheumatoid arthritis and juvenile rheumatoid arthritis. Clinical trials have shown this agent to have an excellent safety profile and to be well tolerated by both adult and pediatric patients.
If methotrexate were introduced as a new drug today, it would be hailed as a major advance in the management of psoriasis, as well as for a number of other conditions. When patients are properly screened and educated about the correct use of this drug, and appropriately monitored during treatment, MTX is often very safe, simple to use, inexpensive, and well-tolerated.
This review concentrates on those drugs which have been clearly shown, or are widely reputed, to make psoriasis worse. There is insufficient clinical evidence to justify the inclusion of many drugs which have been included in published lists of drugs said to exacerbate psoriasis.
Calcipotriol and Betamethasone Dipropionate (Dovobet®, Daivobet®): A New Formulation for the Treatment of Psoriasis
A new compound product containing calcipotriol 50μg/gm and betamethasone dipropionate 0.5mg/gm (Dovobet*, LEO Pharma) in an ointment base was recently introduced in Canada for the treatment of psoriasis.
A Closer Look at the Data Regarding Suicidal Ideation and Behavior in Psoriasis Patients: The Case of Brodalumab
There is no clear evidence that monoclonal antibodies influence neurological function and modulate behavior in humans. More research in this area is necessary in order to begin to understand the potential effects of..
Psoriasis, acne vulgaris and photoaging are common conditions. Tazarotene is a pro-drug of tazarotenic acid, a receptor-selective retinoid, which has shown efficacy in the treatment of these disorders. In the treatment of acne vulgaris, it has greater comedolytic activity than the currently available topical retinoids.
This article discusses the role that dermatologists can play in recognizing the cutaneous manifestations linked with some systemic conditions. Identifying the underlying disorder will contribute to appropriate diagnosis and improved management.
Once Daily Application of a Combination of Calcipotriol and Betamethasone Dipropionate (Dovobet®, Daivobet®) for the Treatment of Psoriasis
This new compound product containing 50µg/gm calcipotriol and 0.5mg/gm betamethasone dipropionate was recently introduced in Canada for the treatment of psoriasis. Clinical trials demonstrated that this compound was more active than either agent used alone.
In this review, we summarize the most common immunosuppressant medications currently used in dermatology, and provide recommendations for infection screening prior to initiating treatment.
Biologic agents were introduced during the past decade as a new class of treatments for chronic psoriasis. This review will discuss data from clinical trials that have provided new insights into the efficacy, safety, and cost effectiveness of alefacept as a treatment for psoriasis.
Alcohol is a serious cause of morbidity and mortality in our society and is implicated in multiple health conditions, including hepatic failure, neurological damage, and hematological disorders. Herein, we review the evidence concerning the influences of alcohol in skin conditions.