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==Medical Therapy==
==Medical Therapy==
Therapies are administered according to disease severity and assessed by the Psoriasis Area and Severity Index (PASI, ranging from 0 to 72), which takes into account appearance and extension of the lesions. Interventions in medical therapy for psoriasis comprise of:
* Topical therapy
* Phototherapy
* Systemic therapy (Immunosuppressive agents)
* Biological therapy


[[Image:Psoriasis treatment ladder.png|thumb|300px|left|Schematic of psoriasis treatment ladder]]
=== Topical therapy<ref name="pmid16916825">{{cite journal |vauthors=Smith CH, Barker JN |title=Psoriasis and its management |journal=BMJ |volume=333 |issue=7564 |pages=380–4 |year=2006 |pmid=16916825 |pmc=1550454 |doi=10.1136/bmj.333.7564.380 |url=}}</ref> ===
There can be substantial variation between individuals in the effectiveness of specific psoriasis treatments. Because of this, [[Dermatology|dermatologists]] often use a trial-and-error approach to finding the most appropriate treatment for their patient. The decision to employ a particular treatment is based on the type of psoriasis, its location, extent and severity. The patient’s age, sex, quality of life, [[comorbidities]], and attitude toward risks associated with the treatment are also taken into consideration.  
* Medicated creams and ointments applied directly to psoriatic lesions can help decrease inflammation, remove built-up scale, reduce skin turn over, and clear affected skin of plaques.
* Approved drugs that can be used as topical therapy for acute management of psoriasis include:
# Corticosteroids
# Vitamin D analogues (calcipotriol)<ref name="pmid10753146">{{cite journal |vauthors=Ashcroft DM, Po AL, Williams HC, Griffiths CE |title=Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis |journal=BMJ |volume=320 |issue=7240 |pages=963–7 |year=2000 |pmid=10753146 |pmc=27334 |doi= |url=}}</ref>
# Tar
# Dithranol (anthralin)
# Tazarotene (a retinoid)
# Calcineurin inhibitors (Tacrolimus and primecrolimus- used specially foe flexural or facial psoriasis)
# Aloe vera extract 0.5 % hydrophilic cream<ref name="pmid8765459">{{cite journal |vauthors=Syed TA, Ahmad SA, Holt AH, Ahmad SA, Ahmad SH, Afzal M |title=Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study |journal=Trop. Med. Int. Health |volume=1 |issue=4 |pages=505–9 |year=1996 |pmid=8765459 |doi= |url=}}</ref>
# Anti-IL-8 monoclonal antibody cream
# Betamethasone 17-valerate 21-acetate plus tretinoin plus salicylic acid<ref name="pmid19445765">{{cite journal |vauthors=Naldi L, Rzany B |title=Psoriasis (chronic plaque) |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445765 |pmc=2907770 |doi= |url=}}</ref>
# Fish oil plus occlussion<ref name="pmid1451289">{{cite journal |vauthors=Escobar SO, Achenbach R, Iannantuono R, Torem V |title=Topical fish oil in psoriasis--a controlled and blind study |journal=Clin. Exp. Dermatol. |volume=17 |issue=3 |pages=159–62 |year=1992 |pmid=1451289 |doi= |url=}}</ref>
# Combination of nicotinamide and calcipotriene<ref name="pmid20599292">{{cite journal |vauthors=Levine D, Even-Chen Z, Lipets I, Pritulo OA, Svyatenko TV, Andrashko Y, Lebwohl M, Gottlieb A |title=Pilot, multicenter, double-blind, randomized placebo-controlled bilateral comparative study of a combination of calcipotriene and nicotinamide for the treatment of psoriasis |journal=J. Am. Acad. Dermatol. |volume=63 |issue=5 |pages=775–81 |year=2010 |pmid=20599292 |doi=10.1016/j.jaad.2009.10.016 |url=}}</ref> 
* Combined treatment with vitamin D/corticosteroid on either the body or the scalp has significantly better outcomes than vitamin D alone.<ref name="urlTopical treatments for chronic plaque psoriasis - Mason - 2013 - The Cochrane Library - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005028.pub3/full |title=Topical treatments for chronic plaque psoriasis - Mason - 2013 - The Cochrane Library - Wiley Online Library |format= |work= |accessdate=}}</ref>


In 2008, the FDA approved three new treatment options<ref>[http://www.parade.com/health/healthyskin/psoriasis-medical-breakthroughs.html "Psoriasis Medical Breakthroughs" Parade.com]</ref> available to psoriasis patients:
* The disadvantages of topical agents are variably that they can often irritate normal skin, can be time consuming and awkward to apply, cannot be used for long periods, can stain clothing or have a strong odour. As a result, it is sometimes difficult for people to maintain the regular application of these medications.  
* Abrupt withdrawal of some topical agents, particularly corticosteroids, can cause an aggressive recurrence of the condition.  
* Some topical agents are used in conjunction with other therapies, especially phototherapy.


#Taclonex Scalp, a new topical ointment for treating scalp psoriasis;
===Phototherapy<ref name="pmid194457652">{{cite journal |vauthors=Naldi L, Rzany B |title=Psoriasis (chronic plaque) |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445765 |pmc=2907770 |doi= |url=}}</ref>===
#The Xtrac Velocity excimer laser system, which emits a high-intensity beam of ultraviolet light, can treat moderate to severe psoriasis
* It has long been recognized that daily, short, non-burning exposure to sunlight helped to clear or improve psoriasis.
#The biologic drug [[adalimumab]] (brand name Humira) was also approved to treat moderate to severe psoriasis. Adalimumab had already been approved to treat psoriatic arthritis.
* [[Niels Ryberg Finsen|Niels Finsen]] was the first [[physician]] to investigate the therapeutic effects of sunlight scientifically and to use sunlight in clinical practice. This became known as phototherapy.


Medications with the least potential for adverse reactions are preferentially employed. If the treatment goal is not achieved then therapies with greater potential [[toxicity]] may be used. Medications with significant toxicity are reserved for severe unresponsive psoriasis. This is called the psoriasis treatment ladder.
* Narrow band part of the UVB spectrum (311 to 312 nm)  is most helpful for psoriasis. Exposure to UVB several times per week, over several weeks can help people attain a remission from psoriasis.
<ref name=Lofholm>{{cite journal |author=Lofholm PW |title=The psoriasis treatment ladder: a clinical overview for pharmacists |journal=US Pharm |year=2000 |volume=25 |issue=5 |pages=26–47 |url=http://www.uspharmacist.com/oldformat.asp?url=newlook/files/Feat/apr00pro.cfm&pub_id=8&article_id=511}}</ref> As a first step, medicated [[ointment]]s or creams, called topical treatments, are applied to the skin. If topical treatment fails to achieve the desired goal then the next step would be to expose the skin to [[ultraviolet]] (UV) radiation. This type of treatment is called [[phototherapy]]. The third step involves the use of medications which are taken internally by pill or [[Injection (medicine)|injection]]. This approach is called systemic treatment.


Over time, psoriasis can become resistant to a specific therapy. Treatments may be periodically changed to prevent resistance developing ([[tachyphylaxis]]) and to reduce the chance of adverse reactions occurring. This is called treatment rotation.
* Ultraviolet light treatment is frequently combined with topical (coal tar, calcipotriol) or systemic treatment (retinoids) as there is a synergy in their combination.  
* The Ingram regime, involves UVB and the application of anthralin paste.  
* The Goeckerman regime combines coal tar ointment with UVB.


[[Antibiotics]] are generally not indicated in routine treatment of psoriasis. However, antibiotics may be employed when an infection, such as that caused by the bacteria [[Streptococcus]], triggers an outbreak of psoriasis, as in certain cases of guttate psoriasis.
=== Systemic therapy ===
{| class="wikitable"
! colspan="1" rowspan="1" |Type of agent
! colspan="1" rowspan="1" |Mechanism of action
! colspan="1" rowspan="1" |Name
! colspan="1" rowspan="1" |Molecular target
! colspan="1" rowspan="1" |Formulation
! colspan="1" rowspan="1" |Administration route
|-
| colspan="1" rowspan="13" |Biologic
| colspan="1" rowspan="3" |Anti-T cells
| colspan="1" rowspan="1" |Alefacept
| colspan="1" rowspan="1" |CD2
| colspan="1" rowspan="1" |Human LFA-3/IgG1 fusion protein
| colspan="1" rowspan="1" |IM or IV
|-
| colspan="1" rowspan="1" |Efalizumab
| colspan="1" rowspan="1" |CD11a
| colspan="1" rowspan="1" |Humanized IgG1 monoclonal antibody
| colspan="1" rowspan="1" |SC
|-
| colspan="1" rowspan="1" |Abatacept
| colspan="1" rowspan="1" |CTLA-4
| colspan="1" rowspan="1" |Human CTLA4–Ig-IgG1 fusion protein
| colspan="1" rowspan="1" |SC or IV
|-
| colspan="1" rowspan="10" |Anticytokine
| colspan="1" rowspan="1" |Etanercept
| colspan="1" rowspan="1" |TNF
| colspan="1" rowspan="1" |Human TNF-R (p75)-lgG1 fusion protein
| colspan="1" rowspan="1" |SC
|-
| colspan="1" rowspan="1" |Infliximab
| colspan="1" rowspan="1" |TNF
| colspan="1" rowspan="1" |Mouse-human IgG1 chimeric monoclonal antibody
| colspan="1" rowspan="1" |IV
|-
| colspan="1" rowspan="1" |Adalimumab
| colspan="1" rowspan="1" |TNF
| colspan="1" rowspan="1" |Human IgG1 monoclonal antibody
| colspan="1" rowspan="1" |SC
|-
| colspan="1" rowspan="1" |Ustekinumab
| colspan="1" rowspan="1" |IL-12p40 (IL-2, IL-23)
| colspan="1" rowspan="1" |Human IgG1 monoclonal antibody
| colspan="1" rowspan="1" |SC
|-
| colspan="1" rowspan="1" |Briakinumab (discontinued in USA in 2011)
| colspan="1" rowspan="1" |IL-12p40 (IL-12, IL-23)
| colspan="1" rowspan="1" |Human IgG1 monoclonal antibody
| colspan="1" rowspan="1" |SC
|-
| colspan="1" rowspan="1" |Guselkumab
| colspan="1" rowspan="1" |IL-23p19
| colspan="1" rowspan="1" |Human IgG1 monoclonal antibody
| colspan="1" rowspan="1" |SC
|-
| colspan="1" rowspan="1" |Brodalumab
| colspan="1" rowspan="1" |IL-17R
| colspan="1" rowspan="1" |Human IgG2 monoclonal antibody
| colspan="1" rowspan="1" |SC
|-
| colspan="1" rowspan="1" |Ixekizumab
| colspan="1" rowspan="1" |IL-17
| colspan="1" rowspan="1" |Humanized IgG4 monoclonal antibody
| colspan="1" rowspan="1" |SC
|-
| colspan="1" rowspan="1" |Secukinumab
| colspan="1" rowspan="1" |IL-17
| colspan="1" rowspan="1" |Human IgG1 monoclonal antibody
| colspan="1" rowspan="1" |SC or IV
|-
| colspan="1" rowspan="1" |Fezakinumab
| colspan="1" rowspan="1" |IL-22
| colspan="1" rowspan="1" |Human IgG1 monoclonal antibody
| colspan="1" rowspan="1" |SC or IV
|-
| colspan="1" rowspan="5" |Small molecule
| colspan="1" |PDE4 inhibitor
| colspan="1" rowspan="1" |Apremilast
| colspan="1" rowspan="1" |PDE4
| colspan="1" rowspan="1" |NA
| colspan="1" rowspan="1" |Oral
|-
| colspan="1" rowspan="2" |JAK inhibitor
| colspan="1" rowspan="1" |Tofacitinib
| colspan="1" rowspan="1" |JAK1 and JAK3
| colspan="1" rowspan="1" |NA
| colspan="1" rowspan="1" |Oral
|-
| colspan="1" rowspan="1" |Baricitinib
| colspan="1" rowspan="1" |JAK1 and JAK2
| colspan="1" rowspan="1" |NA
| colspan="1" rowspan="1" |Oral
|-
| colspan="1" rowspan="1" |PKC inhibitor
| colspan="1" rowspan="1" |AEB071
| colspan="1" rowspan="1" |PKC
| colspan="1" rowspan="1" |NA
| colspan="1" rowspan="1" |Oral
|-
| colspan="1" rowspan="1" |A3AR agonist
| colspan="1" rowspan="1" |CF101
| colspan="1" rowspan="1" |A3AR
| colspan="1" rowspan="1" |NA
| colspan="1" rowspan="1" |Oral
|}
SC: Sub-cutaneous


A psychological symptom management programme has been reported as being a helpful adjunct to traditional therapies in the management of psoriasis.<ref>{{cite web |url=http://www.refer.nhs.uk/ViewRecord.asp?ID=637&Print=1 |title=Research Findings Register: summary number 637 |accessdate=2007-07-22 |format= |work=}}</ref>
IV: Intra-venous


===Pharmacotherapy===
IM: Intra-muscular
====Acute Pharmacotherapies====
*Topical treatment


Bath solutions and [[moisturizer]]s help sooth affected skin and reduce the dryness which accompanies the build-up of skin on psoriatic plaques. Medicated creams and ointments applied directly to psoriatic plaques can help reduce inflammation, remove built-up scale, reduce skin turn over, and clear affected skin of plaques. Ointment and creams containing [[coal tar]] (no longer available on prescription in the UK), [[dithranol]] (anthralin), [[corticosteroid]]s, [[vitamin D]]<sub>3</sub> analogues (for example, [[calcipotriol]]), and [[retinoid]]s are routinely used. The [[mechanism of action]] of each is probably different but they all help to normalise skin cell production and reduce inflammation. Activated vitamin D and its analogues are highly effective inhibitors of skin cell proliferation.
NA: Not Applicable


The disadvantages of topical agents are variably that they can often irritate normal skin, can be time consuming and awkward to apply, cannot be used for long periods, can stain clothing or have a strong odour. As a result, it is sometimes difficult for people to maintain the regular application of these medications. Abrupt withdrawal of some topical agents, particularly corticosteroids, can cause an aggressive recurrence of the condition. This is known as a rebound of the condition.
PDE4: Phosphodiesterase 4


Some topical agents are used in conjunction with other therapies, especially phototherapy.
JAK: Janus Kinase


====Chronic Pharmacotherapies====
PKC: Protein Kinase C
*Systemic treatment
 
Psoriasis which is resistant to [[topical|topical treatment]] and [[light therapy|phototherapy]] is treated by [[medication]]s that are taken internally by pill or [[Injection (medicine)|injection]]. This is called systemic treatment. Patients undergoing systemic treatment are required to have regular [[Blood test|blood]] and [[liver function tests]] because of the [[toxicity]] of the [[medication]]. [[Pregnancy]] must be avoided for the majority of these treatments. Most people experience a recurrence of psoriasis after systemic treatment is discontinued.
 
The three main traditional systemic treatments are the [[immunosuppressive drug|immunosupressant]] drugs [[methotrexate]] and [[cyclosporine]], and retinoids, which are synthetic forms of [[vitamin A]]. Other additional drugs, not specifically licensed for psoriasis, have been found to be effective. These include the [[antimetabolite]] [[tioguanine]], the [[cytotoxic]] agent [[hydroxyurea]], [[sulfasalazine]], the [[immunosuppressive drug|immunosupressants]] [[mycophenolate mofetil]], [[azathioprine]] and oral [[tacrolimus]]. These have all been used effectively to treat psoriasis when other treatments have failed. Although not licensed in many other countries [[fumaric acid|fumaric acid esters]] have also been used to treat severe psoriasis in Germany for over 20 years.
 
[[Biologics]] are manufactured proteins that interrupt the immune process involved in psoriasis. Unlike generalised [[immunosuppressive drug|immunosuppressant]] therapies such as methotrexate, biologics focus on specific aspects of the immune function leading to psoriasis. These drugs (interleukin antagonists) are relatively new, and their long-term impact on immune function is unknown. They are very expensive and only suitable for very few patients with psoriasis. Ustekinumab ([[IL-12]] and IL-23 blocker) shows hopeful results for psoriasis therapy.
 
===Phototherapy===
 
It has long been recognized that daily, short, non-burning exposure to sunlight helped to clear or improve psoriasis. [[Niels Ryberg Finsen|Niels Finsen]] was the first [[physician]] to investigate the therapeutic effects of sunlight scientifically and to use sunlight in clinical practice. This became known as phototherapy.
 
Sunlight contains many different wavelengths of light. It was during the early part of the 20th century that it was recognised that for psoriasis the therapeutic property of sunlight was due to the wavelengths classified as [[ultraviolet|ultraviolet (UV)]] light.
 
Ultraviolet wavelengths are subdivided into UVA (380–315 nm) UVB (315–280 nm), and UVC (< 280 nm). Ultraviolet B (UVB) (315–280 nm) is absorbed by the [[epidermis (skin)|epidermis]] and has a beneficial effect on psoriasis. Narrowband UVB (311 to 312 nm), is that part of the UVB spectrum that is most helpful for psoriasis. Exposure to UVB several times per week, over several weeks can help people attain a remission from psoriasis.
 
Ultraviolet light treatment is frequently combined with topical (coal tar, calcipotriol) or systemic treatment (retinoids) as there is a synergy in their combination. The Ingram regime, involves UVB and the application of anthralin paste. The Goeckerman regime combines coal tar ointment with UVB.
 
===Photochemotherapy===
 
[[Psoralen]] and ultraviolet A phototherapy ([[PUVA]]) combines the oral or topical administration of psoralen with exposure to ultraviolet A (UVA) light. Precisely how PUVA works is not known. The [[mechanism of action]] probably involves activation of psoralen by UVA light which inhibits the abnormally rapid production of the cells in psoriatic skin.  There are multiple mechanisms of action associated with PUVA, including effects on the skin immune system.
 
Dark glasses must be worn during PUVA treatment because there is a risk of [[cataracts]] developing from exposure to ultraviolet A light. PUVA is associated with [[nausea]], [[headache]], [[Fatigue (physical)|fatigue]], burning, and itching. Long-term treatment is associated with [[Squamous cell carcinoma|squamous-cell]] and [[melanoma]] [[skin cancer]]s.
 
===Alternative Therapy===
 
*[[Antibiotics]] are not indicated in routine treatment of psoriasis. However, antibiotics may be employed when an infection, such as that caused by the bacteria [[Streptococcus]], triggers an outbreak of psoriasis, as in certain cases of guttate psoriasis.
 
*Climatotherapy involves the notion that some diseases can be successfully treated by living in particular climate. Several psoriasis clinics are located throughout the world based on this idea. The Dead Sea is one of the most popular locations for this type of treatment.
 
*In Turkey & in Croatia (Altermedica), doctor fish which live in the outdoor pools of spas, are encouraged to feed on the psoriatic skin of people with psoriasis. The fish only consume the affected areas of the skin. The outdoor location of the spa may also have a beneficial effect. This treatment can provide temporary relief of symptoms. A revisit to the spas every few months is often required. Best known is the spa “Kangal Thermal Springs”, near the Turkish village of Kavak. According to the testimony of numerous psoriasis patients, the fish lead to a significant relief. This spa is located south of the historic silk road in Anatolia. The next big city is Sivas. Treatment in this hot spring has been examined until now in two small clinical trials, with positive results.<ref> Ozcelik S, Polat HH, Akyol M, Yalcin AN, Ozcelik D, Marufihah M. Kangal hot spring with fish and psoriasis treatment. J Dermatol. 2000 Jun;27(6):386-90.</ref> <ref>Grassberger M, Hoch W. Ichthyotherapy as alternative treatment for patients with psoriasis: a pilot study. Evid Based Complement Alternat Med. 2006 Dec;3(4):483-8.</ref>
 
*Some people subscribe to the view that psoriasis can be effectively managed through a healthy lifestyle.  This view is based on anecdote, and has not been subjected to formal scientific evaluation. Nevertheless, some people report that minimizing stress and consuming a healthy diet, combined with rest, sunshine and swimming in saltwater keep lesions to a minimum.  This type of "lifestyle" treatment is suggested as a long-term management strategy, rather than an initial treatment of severe psoriasis.
 
*A number of patients have reported significant improvements from sun and sea water: unfortunately, salt alone does not have any effect.  Sea water contains so many minerals and different life forms (thousands of species of bacteria alone<ref>{{cite web |url=http://www.abc.net.au/science/news/stories/2006/1702359.htm |title=News in Science - Oceans a complex, diverse bug soup - 01/08/2006 |accessdate=2007-07-22 |format= |work=}}</ref>) that it will be hard to determine which of these is causing the observed effects.  Interestingly, people in the tropics differentiate between "live" and "dead" sea water: "live" sea water is water that has never been covered.
 
*Some psoriasis patients use herbology as a holistic approach that aims to treat the underlying causes of psoriasis.  Some alternative therapies consider Oil of Oregano to be a powerful herbal method of treatment.
 
*A psychological symptom management programme has been reported as being a helpful adjunct to traditional therapies in the management of psoriasis.<ref>{{cite web |url=http://www.refer.nhs.uk/ViewRecord.asp?ID=637&Print=1 |title=Research Findings Register: summary number 637 |accessdate=2007-07-22 |format= |work=}}</ref>
 
*It is claimed that [[Magnesium sulfate|Epsom salt]] may have a positive effect in reducing the effects of psoriasis.(The Home Remedies Handbook)
 
*There are claims that Neem oil has been in documented use in India for 6000 years.  There are claims that this documentation is fraudulent.<ref>{{cite web |url=http://www.pinch.com/skin/pshame.html#neem |title=Psoriasis Hall of PShame |accessdate=2007-07-22 |format= |work=}}</ref>
 
*It is claimed that yoga and meditative practices help psoriasis patients by 'detoxifying' the body and by the reduction of stress.
 
* Sulphur has been used for many years as a safe treatment in the alleviation of Psoriasis.
 
* [[Fasting]] is used by some to treat mild forms of psoriasis.


==References==
==References==

Revision as of 18:12, 16 June 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Medical Therapy

Therapies are administered according to disease severity and assessed by the Psoriasis Area and Severity Index (PASI, ranging from 0 to 72), which takes into account appearance and extension of the lesions. Interventions in medical therapy for psoriasis comprise of:

  • Topical therapy
  • Phototherapy
  • Systemic therapy (Immunosuppressive agents)
  • Biological therapy

Topical therapy[1]

  • Medicated creams and ointments applied directly to psoriatic lesions can help decrease inflammation, remove built-up scale, reduce skin turn over, and clear affected skin of plaques.
  • Approved drugs that can be used as topical therapy for acute management of psoriasis include:
  1. Corticosteroids
  2. Vitamin D analogues (calcipotriol)[2]
  3. Tar
  4. Dithranol (anthralin)
  5. Tazarotene (a retinoid)
  6. Calcineurin inhibitors (Tacrolimus and primecrolimus- used specially foe flexural or facial psoriasis)
  7. Aloe vera extract 0.5 % hydrophilic cream[3]
  8. Anti-IL-8 monoclonal antibody cream
  9. Betamethasone 17-valerate 21-acetate plus tretinoin plus salicylic acid[4]
  10. Fish oil plus occlussion[5]
  11. Combination of nicotinamide and calcipotriene[6] 
  • Combined treatment with vitamin D/corticosteroid on either the body or the scalp has significantly better outcomes than vitamin D alone.[7]
  • The disadvantages of topical agents are variably that they can often irritate normal skin, can be time consuming and awkward to apply, cannot be used for long periods, can stain clothing or have a strong odour. As a result, it is sometimes difficult for people to maintain the regular application of these medications.
  • Abrupt withdrawal of some topical agents, particularly corticosteroids, can cause an aggressive recurrence of the condition.
  • Some topical agents are used in conjunction with other therapies, especially phototherapy.

Phototherapy[8]

  • It has long been recognized that daily, short, non-burning exposure to sunlight helped to clear or improve psoriasis.
  • Niels Finsen was the first physician to investigate the therapeutic effects of sunlight scientifically and to use sunlight in clinical practice. This became known as phototherapy.
  • Narrow band part of the UVB spectrum (311 to 312 nm) is most helpful for psoriasis. Exposure to UVB several times per week, over several weeks can help people attain a remission from psoriasis.
  • Ultraviolet light treatment is frequently combined with topical (coal tar, calcipotriol) or systemic treatment (retinoids) as there is a synergy in their combination.
  • The Ingram regime, involves UVB and the application of anthralin paste.
  • The Goeckerman regime combines coal tar ointment with UVB.

Systemic therapy

Type of agent Mechanism of action Name Molecular target Formulation Administration route
Biologic Anti-T cells Alefacept CD2 Human LFA-3/IgG1 fusion protein IM or IV
Efalizumab CD11a Humanized IgG1 monoclonal antibody SC
Abatacept CTLA-4 Human CTLA4–Ig-IgG1 fusion protein SC or IV
Anticytokine Etanercept TNF Human TNF-R (p75)-lgG1 fusion protein SC
Infliximab TNF Mouse-human IgG1 chimeric monoclonal antibody IV
Adalimumab TNF Human IgG1 monoclonal antibody SC
Ustekinumab IL-12p40 (IL-2, IL-23) Human IgG1 monoclonal antibody SC
Briakinumab (discontinued in USA in 2011) IL-12p40 (IL-12, IL-23) Human IgG1 monoclonal antibody SC
Guselkumab IL-23p19 Human IgG1 monoclonal antibody SC
Brodalumab IL-17R Human IgG2 monoclonal antibody SC
Ixekizumab IL-17 Humanized IgG4 monoclonal antibody SC
Secukinumab IL-17 Human IgG1 monoclonal antibody SC or IV
Fezakinumab IL-22 Human IgG1 monoclonal antibody SC or IV
Small molecule PDE4 inhibitor Apremilast PDE4 NA Oral
JAK inhibitor Tofacitinib JAK1 and JAK3 NA Oral
Baricitinib JAK1 and JAK2 NA Oral
PKC inhibitor AEB071 PKC NA Oral
A3AR agonist CF101 A3AR NA Oral

SC: Sub-cutaneous

IV: Intra-venous

IM: Intra-muscular

NA: Not Applicable

PDE4: Phosphodiesterase 4

JAK: Janus Kinase

PKC: Protein Kinase C

References

  1. ↑ Smith CH, Barker JN (2006). "Psoriasis and its management". BMJ. 333 (7564): 380–4. doi:10.1136/bmj.333.7564.380. PMC 1550454. PMID 16916825.
  2. ↑ Ashcroft DM, Po AL, Williams HC, Griffiths CE (2000). "Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis". BMJ. 320 (7240): 963–7. PMC 27334. PMID 10753146.
  3. ↑ Syed TA, Ahmad SA, Holt AH, Ahmad SA, Ahmad SH, Afzal M (1996). "Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study". Trop. Med. Int. Health. 1 (4): 505–9. PMID 8765459.
  4. ↑ Naldi L, Rzany B (2009). "Psoriasis (chronic plaque)". BMJ Clin Evid. 2009. PMC 2907770. PMID 19445765.
  5. ↑ Escobar SO, Achenbach R, Iannantuono R, Torem V (1992). "Topical fish oil in psoriasis--a controlled and blind study". Clin. Exp. Dermatol. 17 (3): 159–62. PMID 1451289.
  6. ↑ Levine D, Even-Chen Z, Lipets I, Pritulo OA, Svyatenko TV, Andrashko Y, Lebwohl M, Gottlieb A (2010). "Pilot, multicenter, double-blind, randomized placebo-controlled bilateral comparative study of a combination of calcipotriene and nicotinamide for the treatment of psoriasis". J. Am. Acad. Dermatol. 63 (5): 775–81. doi:10.1016/j.jaad.2009.10.016. PMID 20599292.
  7. ↑ "Topical treatments for chronic plaque psoriasis - Mason - 2013 - The Cochrane Library - Wiley Online Library".
  8. ↑ Naldi L, Rzany B (2009). "Psoriasis (chronic plaque)". BMJ Clin Evid. 2009. PMC 2907770. PMID 19445765.

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