Treatment of Psoriasis (eBook)

Contents 6
List of contributors 7
Preface 9
Introduction: History of psoriasis and psoriasis therapy 11
Introduction 11
Ancient history: Lepra, psora, psoriasis 11
Distinguishing psoriasis as a distinct entity 12
Advancements in the description of psoriasis 13
Understanding pathophysiology 13
History of treatment of psoriasis 14
Psoriasis treatment discoveries of today and tomorrow 17
References 17
The pathophysiology of psoriasis 21
Introduction 21
Clinical presentations 22
Histopathology 22
Principles of immunity 23
Implicating dysregulation of immunity 23
Intralesional T lymphocytes 25
T lymphocyte stimulation 25
T lymphocyte signaling 25
Natural killer T cells 26
Dendritic cells 27
Cytokines 28
TNF-alpha 28
Genetic basis of psoriasis 29
Conclusion 29
References 30
Psoriasis and psoriatic arthritis: a clinical review 33
Introduction 33
Clinical features 33
Epidemiology 40
Systemic associations 40
Psoriatic arthritis 42
Conclusions 46
References 46
Topical therapy I: corticosteroids and vitamin D analogs 51
Introduction 51
Topical corticosteroids 51
Topical vitamin D analogs 56
References 61
Topical therapy II: retinoids, immunomodulators, and others 67
Introduction 67
Topical retinoids 67
Topical immunomodulators 71
Other topical treatments 74
References 76
Ultraviolet and laser therapy 81
Introduction 81
Ultraviolet B 82
UVB and topicals 84
Balneophototherapy 87
Home UVB 88
UVB and systemics 88
Lasers 91
Ultraviolet A 91
Systemics and UVA 96
UVA1 97
Narrowband UVB 98
pUVA 98
Combination UVA and UVB 98
Other combinations 99
Phototherapy in special populations 100
Future developments in light therapy 102
Conclusion 103
References 103
Traditional systemic therapy I: methotrexate and cyclosporine 113
Methotrexate 113
Cyclosporine 118
Comparison of the efficacy of methotrexate and cyclosporine 124
References 124
Traditional systemic therapy II: retinoids and others ( hydroxyurea, thiopurine antimetabolites, mycophenlic acid, sulfasalazine) 131
Retinoids 131
Adverse effects of retinoids 133
Hydroxyurea 134
Adverse effects of hydroxyurea 136
Thiopurine antimetabolites 137
Adverse effects of thiopurine antimetabolites 140
Mycophenolic acid 141
Adverse effects of mycophenolic acid 143
Sulfasalazine 144
Adverse effects of sulfasalazine 145
Combination, rotational, and sequential therapy 146
References 146
Biologic therapy for psoriasis: an overview of infliximab, etanercept, adalimumab, efalizumab, and alefacept 151
Introduction 151
Efficacy 151
Safety 157
Efalizumab (Raptiva 161
) 161
Alefacept (Amevive 164
) 164
Conclusion 166
References 166
Biologic and oral therapies in development for the treatment of psoriasis 169
Introduction 169
Small molecule targets 169
Cytokine targets 171
Other targets 172
Conclusion 173
References 173
Quality of life issues in psoriasis 175
Introduction 175
Quality of life measures 175
Physical impact 176
Psychosocial impact 178
Social and demographic variables 179
Treatment and quality of life 180
What can we do? 182
Conclusions 183
References 184
Index 189