Publications were identified by searching Medline, Ovid, and the Cochrane Library databases with the terms “psoriasis”, “therapy”, “corticosteroids”, “vitamin D3”, “calcitriol”, “tacalcitol”, “calcipotriol”, “calcineurin inhibitors”, “tacrolimus”, “pimecrolimus”, “tazarotene”, “dithranol”, “coal tar”, “ultraviolet”, “phototherapy”, “nb-uvb”, “bb-uvb”, “uva”, “puva”, “psoralen”, “methotrexate”, “retinoid”, “acitretin”, “etretinate”, “ciclosporine”, “fumarates”, “hydroxycarbamide”, “hydroxyurea”,
SeriesCurrent and future management of psoriasis
Section snippets
General principles
As with any chronic disease, education and a sympathetic approach are important in the initial encounter between patient and doctor. Patients must understand the genetic, environmental, and real-life implications of psoriasis. Exacerbating factors such as stress, excessive alcohol and tobacco consumption, and use of some drugs (including β-blocking agents, lithium carbonate, antimalarials, and interferons) should be avoided, and patients should be assessed for acute infections, particularly
Topical therapy
Topical monotherapy remains the mainstay of treatment for most patients with psoriasis, especially those with limited disease (figure 1). Although effective for individual plaques, it is time consuming, and compliance is a substantial issue. Thus, it is important to individualise and simplify topical therapy and understand the uses of different bases: creams, lotions, foams, sprays, ointments, and gels.
Broadband and narrowband UVB
Natural sunlight has been used for centuries in the treatment of psoriasis. The Dead Sea, because of its unique location below sea level and spectrum of UVR, is an attractive destination for patients, but unfortunately does not result in long remissions of psoriasis. Although the most effective wavelength of UVR for psoriasis was first determined to be in the 311–313 nm (narrowband UVB) range more than 30 years ago,57 only recently have phototherapy units containing these specially designed
Systemic treatments
Traditional systemic agents have been available for psoriasis since methotrexate was first approved by the US Food and Drug Administration in 1971 and remain the mainstay of treatment for patients with moderate to severe disease (figure 3) and those unresponsive to topical agents or phototherapy. Additionally, patients may be suited to systemic treatment if they have physical restrictions (eg, hand or foot psoriasis, associated psoriatic arthritis) or significant quality of life issues. All
Biological agents
An appreciation of the immune pathways critical to the pathogenesis of psoriasis has led to the development of new agents that target these specific steps. Biological agents are recombinant molecules that are designed on the basis of genetic sequences from various organisms and that are often similar or identical to proteins produced by human beings. They include fusion proteins, recombinant proteins (eg, cytokines, selective receptors), and monoclonal antibodies, and are common treatments for
Future treatments
Although biological treatments have been a great advance in the management of psoriasis, their exact place in the hierarchy of systemic therapies will not be known until controlled trials have compared them against each other and with traditional approaches.
Research over the next decade will reveal new, specifically targeted biological therapies for the management of inflammatory immune-mediated diseases, including psoriasis. Anti-interleukin 12/23 agents have shown great promise in phase II
Search strategy and selection criteria
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2023, Journal of Drug Delivery Science and TechnologyThe extracellular matrix of the skin: systemic diseases with local manifestations
2023, Biochemistry of Collagens, Laminins and Elastin: Structure, Function and Biomarkers, Third EditionPsoriasis: Interplay between dysbiosis and host immune system
2022, Autoimmunity ReviewsCitation Excerpt :In case of severe psoriasis or patients nonresponsive to topical treatment, conventional systemic medications including methotrexate, cyclosporine, acitretin, and sulfasalazine are initiated. In the last couple of decades, several biologicals have been approved for the treatment of moderate to severe psoriasis [198,199]. Advances in computing and high-throughput sequencing technology have enabled in-depth analysis of composition and functionality of human skin and gut microbiota.
Liposome mediated topical delivery of Ibrutinib and Curcumin as a synergistic approach to combat imiquimod induced psoriasis
2022, Journal of Drug Delivery Science and TechnologyDexamethasone and Fumaric Acid Ester Conjugate Synergistically Inhibits Inflammation and NF-κB in Macrophages
2021, Bioconjugate ChemistryMulti-component clobetasol-loaded monolithic lipid-polymer hybrid nanoparticles ameliorate imiquimod-induced psoriasis-like skin inflammation in Swiss albino mice
2020, Acta BiomaterialiaCitation Excerpt :Increased cytokine and other inflammatory mediators also led to angiogenesis by increasing the production of vascular endothelial growth factor (VEGF), leading to the progression of the psoriatic condition [5–8]. Currently, topical corticosteroids are the treatment of choice for symptomatic relief from psoriasis [9–11]. These corticosteroids cause induction of phospholipase A2 inhibitory proteins, collectively called as lipocortins.