Treatment Approaches to Moderate to Severe Psoriasis

Abstract

Psoriasis is a common disease, which has a considerable impact on patients and the health care system. Treatment approaches to the disease may be various because some issues are not definitely addressed. Moreover, the therapeutic paradigms are continuously changing because of the recent approval of new treatments for psoriasis such as interleukin (IL)-17 inhibitors and apremilast. In this review, the factors influencing psoriasis severity, the indications for systemic treatments, the overall parameters to be considered in the treatment choice, life style interventions, and the recommendations for the use, screening, and monitoring of systemic therapies available including acitretin, cyclosporine, methotrexate, apremilast, adalimumab, etanercept, infliximab, secukinumab, ixekizumab, and ustekinumab are discussed. Finally, treatment approaches in special patient populations including children, the elderly, pregnant women, patients with a history of neoplasm, and candidates for surgical procedures are reported.

Keywords: biologics; psoriasis; therapy.

Figure 1

An 18-year-old man with severe chronic plaque psoriasis. Otherwise healthy, no comorbidities and concomitant medications. Treated in the past with topicals, as well as phototherapy (nb-UVB), methotrexate, acitretin, and cyclosporine with no or very limited efficacy. He had manifested good but unsatisfactory response to adalimumab (PASI50). Treatment with secukinumab led to a dramatic response within two months (PASI90).