New treatments for psoriasis: biological and immunological therapy

The revolution in the treatment of psoriasis has been brought by the latest generation biological medicines.

As psoriasis is caused by an activation of the skin's defenses and inflammation, drugs have been designed that can block the pathways through which this inflammation occurs. They are molecules designed using complex genetic engineering techniques, and therefore very expensive. In general, they are usually administered through public health systems, which cover the costs.

• Biologics are revolutionizing the treatment of psoriasis.
• Unlike the current ones, these allow to control psoriasis on a continuous basis.
• Treatment with these new drugs must be individualized, and agreed between the patient and his dermatologist. They have a large cadre of dermatology specialists.

How they act

Some biologics block a molecule called tumor necrosis factor. They are etanercept, adalimumab, and infliximab. Others block other pathways of inflammation, such as ustekinumab, or secukinumab. Some have been in use for more than 10 years, and others are about to be approved for clinical use.

In addition, a new generation of smaller molecules is about to hit the market that also block some points in the inflammation process. These new drugs include apremilast, tofacinib, or voclosporin, among others.

The side effect profile of all these new treatments is very acceptable, although they can alter the immune system and trigger infections. Any patient who takes them must follow strict controls at their dermatologist.

Classic psoriasis treatments

Psoriasis can be treated with medications applied to the skin (creams, ointments, lotions or gels) when it is not very extensive. Corticosteroids, derivatives of vitamin D, derivatives of tar or others are usually used.

If psoriasis is very extensive or topical treatment fails to control it, oral or injected medications such as cyclosporine, methotrexate, or acitretin should be used. There is also the possibility of treating it by phototherapy, a treatment based on different types of ultraviolet light, which is administered in hospitals. These treatments have been used for decades, and they are safe, although they are not without side effects such as inflammation of the liver or kidney, or increased blood pressure.

How to decide the treatment for each patient?

Lano treatment is the same for all patients. It must be individualized, and agreed between the patient and his dermatologist. Mild forms that affect a small body surface area should be treated with topical products. If the extent of psoriasis increases, or the appearance of psoriasis, it is necessary to establish treatments that are administered orally or parenterally (injected).

Each treatment has a specific efficacy and side effect profile, so the same treatment will not be given to a young patient as an elderly patient, a person who has liver or kidney disease, or who may have an infection.

Each patient has expectations and a different way of seeing their disease. Some people will prefer not to take medication and go regularly for phototherapy if their daily schedule allows it. Others will choose to take or stick medications on a daily or weekly basis.

Patients weigh the benefit they can get, and the likelihood of having a side effect with treatment, and can choose to treat or not.

What should be the expectations of the treatment at the present time?

Fortunately, we have reached a situation in the control of psoriasis in which we can assure almost all patients a continuous and effective control of the disease, without actually curing it. Until relatively recently, psoriasis treatment was sequential and rotating, changing treatment modalities based on disease control and the appearance of side effects. Now it is possible to control psoriasis continuously with biological treatments.

It is important that patients with psoriasis are aware that there are very effective treatments for their disease, available in the official health system. They are often patients who have been the victims of deception and "miracle" treatments spread over the internet that have no basis other than illicit enrichment. For correct guidance on their disease, the patient should go to their dermatologist and supplement their information with that of very active patient associations such as Acción Psoriasis.