Advances in Psoriasis

Jaclyn Smith, BS; Abigail Cline, PhD; Steven R. Feldman, MD, PhD

Disclosures

South Med J. 2017;110(1):65-75. 

In This Article

Abstract and Introduction

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. Moderate-to-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.

Introduction

Psoriasis is a chronic inflammatory disorder most often characterized by well-demarcated erythematous plaques with silver scales, although other presentations, including guttate, pustular, erythrodermic, palmoplantar, and nail psoriasis can occur. Historically, psoriasis was regarded as a cutaneous disease of hyperproliferation; however, it is a complex immune-mediated disease driven by T lymphocytes and dendritic cells.[1,2] The prevalence of psoriasis in adults ranges from 0% to 12%, and data indicate that its incidence may be increasing.[3] Psoriasis has rheumatologic, cardiometabolic, and psychiatric comorbidities that reduce patients' quality of life.[4] As such, psoriasis treatments address disease severity, relevant comorbidities, patient preference, and evaluation of individual patient response.[5]

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