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Malagoli P, Dapavo P, Amerio P, Atzori L, Balato A, Bardazzi F, Bianchi L, Cattaneo A, Chiricozzi A, Congedo M, Fargnoli MC, Giofrè C, Gisondi P, Guarneri C, Lembo S, Loconsole F, Mazzocchetti G, Mercuri SR, Morrone P, Offidani AM, Palazzo G, Parodi A, Pellacani G, Piaserico S, Potenza C, Prignano F, Romanelli M, Savoia P, Stingeni L, Travaglini M, Trovato E, Venturini M, Zichichi L, Costanzo A. Secukinumab in the Treatment of Psoriasis: A Narrative Review on Early Treatment and Real-World Evidence. Dermatol Ther (Heidelb) 2024; 14:2739-2757. [PMID: 39316358 DOI: 10.1007/s13555-024-01255-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/12/2024] [Indexed: 09/25/2024] Open
Abstract
Psoriasis is a chronic, immune-mediated, inflammatory skin disease, associated with multiple comorbidities and psychological and psychiatric disorders. The quality of life of patients with this disease is severely compromised, especially in moderate-to-severe plaque psoriasis. Secukinumab, a fully humanized monoclonal antibody, was the first anti-interleukin (IL)-17 biologic approved for treating psoriasis. Secukinumab demonstrated long-lasting efficacy and a good safety profile in individuals with plaque psoriasis, and it is associated with an improvement in health-related quality of life. While there is evidence that early treatment with systemic therapy can affect disease progression and improve long-term outcomes in other autoimmune diseases, evidence is limited in psoriasis, especially in real-world settings. This review provides an overview of studies describing the effectiveness of secukinumab in the treatment of psoriasis summarizing the literature and focusing on real-world evidence and early intervention.
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Affiliation(s)
- Piergiorgio Malagoli
- Psocare Unit, IRCCS Policlinico San Donato, 20097, San Donato Milanese (Milan), Italy
| | - Paolo Dapavo
- Clinica Dermatologica Universitaria di Torino, ASO Città della Salute e della Scienza, 10126, Turin, Italy
| | - Paolo Amerio
- Dermatology Unit, UOC Dermatologia, Università G.d'Annunzio, 66100, Chieti-Pescara, Italy
| | - Laura Atzori
- Dermatology Unit, Department Medical Sciences and Public Health, University of Cagliari, 09124, Cagliari, Italy
| | - Anna Balato
- Dermatology Unit, University of Campania Luigi Vanvitelli, 81055, Naples, Italy
| | - Federico Bardazzi
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Luca Bianchi
- Dermatology Unit, Fondazione Policlinico Tor Vergata, 00133, Rome, Italy
| | - Angelo Cattaneo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Andrea Chiricozzi
- Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | | | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Claudia Giofrè
- U.O.C.di Dermatologia, Dermatology Unit, Azienda Ospedaliera Papardo, 98158, Messina, Italy
| | - Paolo Gisondi
- Sezione di Dermatologia e Venereologia, Dermatology Unit, Medicine Department, Università di Verona, 37129, Verona, Italy
| | - Claudio Guarneri
- Department of Biomedical, Dental Sciences and Morphofunctional Imaging, Section of Dermatology, University of Messina, 98122, Messina, Italy
| | - Serena Lembo
- Department of Medicine, Surgery and Dental Sciences "Scuola Medica Salernitana", Università di Salerno, 84081, Fisciano, Italy
| | | | | | - Santo Raffaele Mercuri
- Unit of Dermatology and Cosmetology, I.R.C.C.S. San Raffaele Hospital, 20132, Milan, Italy
| | - Pietro Morrone
- UOC Dermatologia, Dermatology Unit, Dipartimento Chirurgico Polispecialistico, Azienda Ospedaliera di Cosenza, 87100, Cosenza, Italy
| | - Anna Maria Offidani
- Department of Clinical and Molecular Sciences, Università Politecnica della Marche, 60121, Ancona, Italy
| | - Giovanni Palazzo
- Ospedale Distrettuale di Tinchi, Azienda Sanitaria di Matera, 75015, Pisticci, Italy
| | - Aurora Parodi
- DiSSal Clinica Dermatologica, Università di Genova, Ospedale-policlinico San Martino IRCCS, 16132, Genoa, Italy
| | - Giovanni Pellacani
- Dermatology, Department of Clinical Internistic Anaesthesiological and Cardiovascular Science, La Sapienza University of Rome, 00185, Rome, Italy
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Concetta Potenza
- Dipartimento di Scienze e Biotecnologie Medico-Chirurgiche, Facoltà di Farmacia e Medicina, Sapienza Università di Roma - Polo Pontino, 00185, Latina, Italy
- UOC Dermatologia, Dermatology Unit, "Daniele Innocenzi," ASL Latina, 04100, Latina, Italy
| | - Francesca Prignano
- Department of Health Science Section of Dermatology, University of Florence, 50121, Florence, Italy
| | - Marco Romanelli
- Dermatology Unit, Azienda Ospedaliero Universitaria Pisana, Ospedale Santa Chiara, 56126, Pisa, Italy
| | - Paola Savoia
- Department of Health Science, University of Eastern Piedmont, 28100, Novara, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, 06123, Perugia, Italy
| | - Massimo Travaglini
- U.O.S.D. Dermatologica - Centro per la cura della psoriasi, Ospedale A. Perrino, Brindisi, Italy
| | - Emanuele Trovato
- Unit of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100, Siena, Italy
| | - Marina Venturini
- Dermatology Department, University of Brescia and ASST Spedali Civili Hospital, 25123, Brescia, Italy
| | - Leonardo Zichichi
- Dermatology Unit, UOC Dermatologia, Ospedale S A Antonio Abate, ASP Trapani, 91016, Erice, Italy
| | - Antonio Costanzo
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy.
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milano, Italy.
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Microneedles as a momentous platform for psoriasis therapy and diagnosis: A state-of-the-art review. Int J Pharm 2023; 632:122591. [PMID: 36626973 DOI: 10.1016/j.ijpharm.2023.122591] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
Psoriasis is a chronic, autoimmune, and non-communicable skin disease with a worldwide prevalence rate of 2-3%, creating an economic burden on global health. Some significant risk factors associated with psoriasis include genetic predisposition, pathogens, stress, medications, etc. In addition, most patients with psoriasis should also deal with comorbidities such as psoriatic arthritis, inflammatory bowel diseases, cardiovascular diseases, and psychological conditions, including suicidal thoughts. Based on its severity, the treatment approach for psoriasis is categorised into three types, i.e., topical therapy, systemic therapy, and phototherapy. Topical therapy for mild-to-moderate psoriasis faces several issues, such as poor skin permeability, low skin retention of drug formulation, greasy texture of topical vehicle, lack of controlled release, and so on. On the other arrow, systemic therapy via an oral or parenteral route of drug administration involves numerous drawbacks, including first-pass hepatic metabolism, hepatotoxicity, gastrointestinal disturbances, needle pain and phobia, and requirement of healthcare professional to administer the drug. To overcome these limitations, researchers devised a microneedle-based drug delivery system for treating mild-to-moderate and moderate-to-severe psoriasis. A single microneedle system can deliver the anti-psoriatic drugs either locally (topical) or systemically (transdermal) by adjusting the needle height without involving any pain. In this contemplate, the current review provides concise information on the pathophysiology, risk factors, and comorbidities of psoriasis, followed by their current treatment approaches and limitations. Further, it meticulously discusses the potential of microneedles in psoriasis therapy and diagnosis, along with descriptions of their patents and clinical trials.
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Nanotechnology-based alternatives for the topical delivery of immunosuppressive agents in psoriasis. Int J Pharm 2023; 631:122535. [PMID: 36566826 PMCID: PMC9876733 DOI: 10.1016/j.ijpharm.2022.122535] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Psoriasis is a recurring, immune-mediated dermatological disorder. Many therapeutic agents are available for the treatment of psoriasis, including immunosuppressants and biologic treatments with immunosuppressant action. The employment of nanotechnology allows drug tailoring to achieve dermal targeting, improve efficacy and minimize undesirable effects. Here we discuss the use of the topical route in combination with nano-based drug delivery systems containing immunosuppressants for the management of psoriasis. This review is based on articles selected from 2011 to 2022, using the keywords "Psoriasis" AND "Immunosuppressants" AND "Nano*" in the main databases. Fifty-seven articles were retrieved, although only forty-two matched the inclusion criteria. Nanocarriers such as liposomes, ethosomes, niosomes, solid lipid nanoparticle, nanostructured lipid carriers and microspheres containing immunosuppressive drugs (methotrexate, cyclosporine, tacrolimus, and etanercept) were identified. The main findings of these studies are related to the improved in vitro/ex vivo permeation/penetration and therapeutic efficacy of nanoparticles in vitro and in vivo, compared to the drug in solution. Based on the studies discussed in this review, encapsulation in several types of nanocarriers decreases toxicity, dose, and dose frequency. Furthermore, it enables specific targeting of the active drug, pointing to the possibility of improving topical therapy for psoriasis. In conclusion, nanoformulations represent a novel and promising tool for psoriasis treatment.
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Gianfredi V, Casu G, Bricchi L, Kacerik E, Rongioletti F, Signorelli C. Epidemiology of psoriasis in Italy: burden, cost, comorbidities and patients' satisfaction. A systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022332. [PMID: 36533772 PMCID: PMC9828893 DOI: 10.23750/abm.v93i6.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM The Italian data on psoriasis are partial and, in most cases, come from monocentric studies, not representative of the population. Our aim was to conduct a systematic review of the available evidence in order to get the overall picture of the Italian epidemiology (prevalence and incidence); burden of disease (direct and indirect costs, the impact on quality of life); comorbidities; and finally, the patients' satisfaction and acknowledgement of both the disease and the care services available. METHODS This systematic review followed the guidelines of the Cochrane Collaboration and the Prepared Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020. The literature search was conducted on PubMed/Medline and Scopus. RESULTS Out of 387 retrieved articles, 41 were included in the analysis. Psoriasis is a frequent condition in Italy: the prevalence is between 1,8% and 4,8% and the incidence is between 107,742 and 230,62 per 100.000 person-years. The most frequent comorbidities associated to psoriasis are: diabetes, hypertension, obesity, depression, cardiovascular diseases, hypertriglyceridemia, and hypercholesterolemia. The quality of life and severity of the disease are mostly affected by other concurrent diseases, early onset of the disease, low income, and low level of education. The costs of psoriasis were estimated between 500 euro and 15.000 euro depending on the disease's severity, the treatments used and hospitalization. CONCLUSIONS In conclusion, psoriasis is a high-impact chronic disease. It is therefore fundamental to advocate a multidisciplinary approach to obtain a better health outcome, the patients' management and the cost savings could benefit from it.
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Affiliation(s)
- Vincenza Gianfredi
- Department of Biomedical Sciences for Health, University of Milan, via Pascal, 36, 20132, Milan, Italy, CAPHRI Care and Public Health Research Institute, Maastricht University, 6211 Maastricht, The Netherlands
| | - Giulia Casu
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Lucia Bricchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Erika Kacerik
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy, IRCCS San Raffaele Hospital, Milan, Italy
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Fahrbach K, Sarri G, Phillippo DM, Neupane B, Martel SE, Kiri S, Reich K. Short-Term Efficacy of Biologic Therapies in Moderate-to-Severe Plaque Psoriasis: A Systematic Literature Review and an Enhanced Multinomial Network Meta-Analysis. Dermatol Ther (Heidelb) 2021; 11:1965-1998. [PMID: 34549383 PMCID: PMC8611163 DOI: 10.1007/s13555-021-00602-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/19/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Many targeted, systemic therapies have been developed for treatment of moderate-to-severe psoriasis (PsO). A network meta-analysis (NMA) allows for comparison between treatments not directly compared in randomized controlled trials (RCT). This study's objective was to compare the short-term (10-16 weeks) clinical efficacy according to the Psoriasis Area and Severity Index (PASI) among approved biologic treatments for moderate-to-severe PsO using a novel (enhanced) NMA model. METHODS A systematic literature review (SLR) of RCTs for patients with moderate-to-severe PsO was conducted. English publications in MEDLINE, Embase, and The Cochrane Library up to March 2019 were searched. An enhanced multinomial Bayesian NMA was performed to simultaneously adjust for baseline risk and utilize the conditional nature of the PASI (50, 75, 90, and 100) levels. The model relaxes typical constraints that all treatments must have the same ranks across PASI levels. RESULTS The SLR resulted in 319 relevant publications, of which 72 publications from 73 RCTs reporting 10- to 16-week data for at least one PASI response level (30,314 total patients) were included. Interleukin (IL) inhibitors (risankizumab, ixekizumab, brodalumab, secukinumab, and guselkumab) were the best performing treatments for achieving all PASI levels. Etanercept was outperformed by the other subcutaneous tumor necrosis factor α inhibitors. Application of an enhanced NMA model that allowed treatment rankings to differ by PASI level tested the robustness of results of previous NMAs in PsO. CONCLUSION The results of this model confirmed that IL inhibitors are likely the best short-term treatment choices for improving all PASI levels.
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Affiliation(s)
- Kyle Fahrbach
- Evidera (Evidence Synthesis), 500 Totten Pond Road, Fifth Floor, Waltham, MA, 02451, USA.
| | - Grammati Sarri
- Evidera (Evidence Synthesis) The Ark, 201 Talgarth Rd., Hammersmith, London, W6 8BJ, UK
| | - David M Phillippo
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
| | - Binod Neupane
- Evidera (Evidence Synthesis), 500 Totten Pond Road, Fifth Floor, Waltham, MA, 02451, USA
| | - Samantha E Martel
- Evidera (Evidence Synthesis), 500 Totten Pond Road, Fifth Floor, Waltham, MA, 02451, USA
| | | | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf and Skinflammation® Center, Hamburg, Germany
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Abdulridha SH, Kadhim DJ, Razzak SAA. Beliefs about Medicines among a Sample of Iraqi patients with Psoriasis. Innov Pharm 2021; 12:10.24926/iip.v12i1.3584. [PMID: 34007676 PMCID: PMC8102969 DOI: 10.24926/iip.v12i1.3584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate beliefs about use of medications for a sample of Iraqi psoriasis patients, and to examine the association between these beliefs and selected patient's related factors. METHODS This cross-sectional study included 300 patients with diagnosed psoriasis. Participants were recruited at the center of Dermatology and Venereology, Medical City in Baghdad, the capital city of Iraq. Patients' mean age was 35.15years (±10.54). Beliefs about medicines were measured by the Arabic version of Beliefs about Medicines Questionnaire. RESULTS Most the patients (76.7%) had strong beliefs in the need (acceptance beliefs) for their psoriasis medicines (specific-necessity score higher than specific-concern), whereas 15.0% of patients had specific-concern score higher than specific-necessity and 8.3% of patients had specific-necessity score equal to specific-concern. At the same time, 74.4% of the patients believed that the medicines disrupt their lives and (35.6%) of them had concerns about the possibility of becoming addicted on these medicines. Many other patients were worried about the long-term consequences of the medicines (58.7%). In addition, 31.0% of the participants believe that all medicines are poisoning, and that they do more harm than good. Finally, many of the participants believed that physicians prescribe too many medicines (46.7%), and they can minimize the number of prescribed medicines by spending more time with their patients (32.6%). CONCLUSIONS Female gender and longer disease duration have direct association with specific necessity, while psoriasis severity has a direct association with specific concern. In conclusion, Beliefs about medications and habit strength are important modifiable drivers to enhance adherence and clinical outcomes in the control of psoriasis.
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Affiliation(s)
| | - Dheyaa J. Kadhim
- Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Baghdad, Iraq
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Domala A, Bale S, Godugu C. Protective effects of nanoceria in imiquimod induced psoriasis by inhibiting the inflammatory responses. Nanomedicine (Lond) 2020; 15:5-22. [PMID: 31868114 DOI: 10.2217/nnm-2018-0515] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim: To investigate the effect of cerium oxide nanoparticles (nanoceria) on psoriasis. Materials & methods: Fourier transform infrared, powder x-ray diffraction and scanning electron microscopy were used to characterize nanoceria. Imiquimod (62.5 mg/mice) was used for the induction of psoriasis while nanoceria was administered/applied via multiple routes (topical gel, intraperitoneal and subcutaneous) as a therapeutic intervention once daily. Results: Nanoceria significantly attenuated splenic hypertrophy, psoriasis area severity index scoring, and lipid peroxidation. It also reduced the expression of various inflammatory and proliferation markers such as IL-17, IL-22, IL-23, Ki-67, NF-κB, COX-2 and GSK3. Conclusion: Nanoceria exerts an antipsoriatic effect by inhibiting major pathogenic immune axes namely the Th-cell mediated IL-17/IL-23 axis and by downregulating other crucial inflammatory proteins like NF-κB, COX-2 and GSK3.
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Affiliation(s)
- Akshara Domala
- Department of Regulatory Toxicology, National Institute of Pharmaceutical Education & Research (NIPER), Balanagar, Hyderabad, Telangana, 500037, India
| | - Swarna Bale
- Department of Regulatory Toxicology, National Institute of Pharmaceutical Education & Research (NIPER), Balanagar, Hyderabad, Telangana, 500037, India
| | - Chandraiah Godugu
- Department of Regulatory Toxicology, National Institute of Pharmaceutical Education & Research (NIPER), Balanagar, Hyderabad, Telangana, 500037, India
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Sârbu MI, Georgescu SR, Tampa M, Sârbu AE, Simionescu O. Biological therapies in psoriasis - revisited. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2018; 56:75-84. [PMID: 29168976 DOI: 10.1515/rjim-2017-0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Indexed: 06/07/2023]
Abstract
Psoriasis is a chronic, immune mediated disorder affecting approximately 2% of the population. Even in our days, patients with psoriasis are confronted with stigmatization and social rejection. As a result, their quality of life is significantly impaired. Biological therapies have revolutionized the treatment of moderate to severe psoriasis. The aim of this paper is to look over the most important biological therapies available for the management of plaque-type psoriasis.
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Affiliation(s)
| | - Simona-Roxana Georgescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Victor Babeş" Hospital of Infectious and Tropical Diseases, Dermatology Department, Bucharest, Romania
| | - Mircea Tampa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Victor Babeş" Hospital of Infectious and Tropical Diseases, Dermatology Department, Bucharest, Romania
| | | | - Olga Simionescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Colentina" Clinical Hospital, Dermatology Department I, Bucharest, Romania
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Lohman ME, Lio PA. Comparison of psoriasis and atopic dermatitis guidelines-an argument for aggressive atopic dermatitis management. Pediatr Dermatol 2017; 34:739-742. [PMID: 28944965 DOI: 10.1111/pde.13282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The development of effective systemic treatments has revolutionized the treatment of inflammatory skin diseases. The availability of safe new treatments and the understanding of psoriasis as a systemic disease with comorbidities and effects on quality of life have driven the current aggressive treatment paradigm of psoriasis. Historically the morbidity of atopic dermatitis (AD) has been dismissed, given the perception of AD as "just" a rash. Differences in the guidelines for psoriasis and AD management may suggest variations in the current conceptualization of disease severity and effects on quality of life. Published guidelines from the American Academy of Dermatology for the management of psoriasis and AD were reviewed. We recorded the similarities and differences in disease assessment and therapy. The threshold to use biologic agents for moderate to severe psoriasis highlights the aggressive nature of modern psoriasis treatment. AD guidelines include an assessment of quality of life but do not designate a disease severity threshold for systemic treatment. AD and psoriasis have a tremendous effect on quality of life. The AD guidelines have a less aggressive approach to disease management than the psoriasis guidelines. We should think critically about rapid advancement to systemic agents in AD management, especially now that more and better agents are being developed.
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Affiliation(s)
- Mary E Lohman
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Peter A Lio
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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