A brief outline on the management of Psoriasis

Psoriasis is a chronic inflammatory skin condition characterized by well-defined, erythematous scaly plaques. Psoriasis can occur at any age, and is usually a lifelong disease with fluctuations in severity and extent. There are many subtypes of Psoriasis including Small Plaque Psoriasis, characterized by plaques less than 3 cm in size, Chronic Plaque Psoriasis, in which the plaques are larger than 3 cm in size, Palmoplantar Psoriasis which mainly affects the palms and soles, and many other types that vary in distribution and severity.

There are many modalities in the management of Psoriasis which usually depend on the severity of the disease at time of treatment initiation. These include simple lifestyle modifications such as smoking cessation and maintaining a healthy weight. Mild Psoriasis may be managed by topical drugs, such as Salicylic acid, Topical corticosteroids, Calcineurin inhibitors (tacrolimus,pimecrolimus). Management of more severe disease may include systemic agents such Methotrexate, Cyclosporin and Azathioprine. Systemic corticosteroids should be avoided as they can precipitate a flare of Psoriasis. Recently, there has been great interest in the use of biologic agents, some of these include Tumor Necrosis Factor inhibitors such as Infliximab and Etanarcept, The IL-12,23 antagonist Ustekinumab, and Guselkumab, a systemic anti-IL-23p19 agent. These biological agents are usually reserved for refractory disease which doesn’t respond to the conventional drugs.

Very recently (November 2019), new evidence emerged on the use Guselkumab for treatment-resistant Palmoplantar Psoriasis, the clinical trial found that guselkumab improved disease severity scores for PPP refractory to conventional treatment, it also supported that Guselkumab was well-tolerated with infrequent adverse effects.

In conclusion, Psoriasis is a life-long disease which may be debilitating without treatment. The discovery of new biological agents shows promise in controlling even the most severe forms of the disease with great success.

Written by: Turki Alsehli

Sources:

UpToDate.com, Dermnetnz.org, PubMed

Efficacy and Safety of Guselkumab in Japanese Patients With Palmoplantar Pustulosis: A Phase 3 Randomized Clinical Trial. Terui T, Kobayashi S, Okubo Y, Murakami M, Zheng R, Morishima H, Goto R, Kimura T

JAMA Dermatol. 2019