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Psoraisis Learning Zone

Treatment

Read time: 180 mins
This section of the Psoriasis Learning Zone reviews the established topical, systemic and biologic treatments available for psoriasis, considering their mode of action, available clinical data and place in the therapeutic pathway. These include the tumour necrosis factor-α (TNFα) and interleukin (IL) antagonists currently available and under development. Updated December 2020.

Treatment overview

Until recently, psoriasis treatment was focused primarily on managing acute dermatological symptoms. However, psoriasis is now regarded as a chronic systemic inflammatory condition and long-term systemic maintenance therapy is recognised as the preferred method of clinical management. Greater understanding of immunological pathways involved in psoriasis has led to the development of targeted psoriasis treatments (Nograles et al., 2010; Nast et al., 2012; Boehncke & Boencke, 2014).

 

Find out more about targeted treatments and the differences between onset of action and maintenance of response from Professor Andrew Blauvelt.

 

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Psoriasis management

Due to the range of clinical manifestations and comorbidities associated with psoriasis, a multidisciplinary and comprehensive management approach is required and has been recommended by the European League Against Rheumatism (EULAR) since 2012 (Cohen et al., 2012; Boehncke et al., 2010; Gossec et al., 2012; Mease et al., 2014).

 

Patient-oriented care requires that therapy is aligned with the patients’ needs/treatment goals. The German Psoriasis registry (PsoBest) has demonstrated that the majority of patients with moderate-to-severe psoriasis aspire to a normal everyday life with a low treatment burden (Blome et al., 2016).

 

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Topical treatments

Topical treatments are used as first-line therapy in mild psoriasis (<3% of body surface area [BSA] affected), and in some cases may be used in moderate disease (3–10% BSA affected) (Nast et al., 2012; Boehncke & Boehncke, 2014), or as an adjunct to systemic therapy for recalcitrant lesions.

 

Professor Andrew Blauvelt describes the use of topical treatments and how the boundaries between mild and moderate disease are increasingly considering patient quality of life. 

 

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Systemic treatments

Systemic treatments for psoriasis are usually reserved for moderate to severe disease (3 to >10% body surface area [BSA] affected) (Nast et al, 2012; Boehncke & Boehncke, 2014; Nast et al., 2015). Systemic treatments include oral drugs, subcutaneous injections and intravenous infusions (Nast et al., 2012; Nast et al., 2015).

 

Is there still a place for non-biologic treatments? Find out from Professor Ulrich Mrowietz.

 

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Approved biologic treatments

The efficacy and relative safety of biologic agents greatly improved the treatment of psoriasis and allowed long-term maintenance therapy, with the ultimate goal of achieving clearance of skin symptoms in moderate-to-severe psoriasis patients (Boehncke & Boehncke, 2014; Boehncke & Schön, 2015; Dommasch et al., 2019).

 

Find out how patients’ attitudes to biologic treatment have changed from Professor Ulrich Mrowietz.

 

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Biologic treatments in clinical development

Developments in understanding the immunological pathways involved in psoriasis pathogenesis have provided insights into potential new targets and have led to the development of novel biological treatments.

 

Find out from Professor Andrew Blauvelt about the treatments currently in development that dermatologists are excited about.

 

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Managing paediatric psoriasis

It is thought that around one third of patients with psoriasis begin to experience symptoms during childhood (Napolitano et al., 2016). 

For many of these paediatric patients, topical treatments including corticosteroids, vitamin D analogues and calcineurin inhibitors provide adequate control over their disease. 

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Also available in German

The Psoriasis Learning Zone is also translated and available in German.

Welcome:

Treatment references

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