Psoriasis: immunopathogenesis and evolving immunomodulators and systemic therapies; U.S. experiences.
BACKGROUND
Psoriasis is a chronic inflammatory skin disorder that is presently without a permanent cure. Up to 40% of patients with psoriasis also develop psoriatic arthritis. The mainstay armamentarium to treat psoriasis systemically includes methotrexate, cyclosporin and oral retinoids, all with significant potential for toxicity and the need for close laboratory supervision. The although the exact mechanism of psoriasis is still unclear, the involvement of T-cell-mediated cytokine expression in the aetiology of psoriasis is becoming clearer. The goal of modern treatment is to target such immune responses that lead to the formation of psoriatic plaques and psoriatic arthritis using selective immunomodulating pharmacotherapy. The advantages of these biological agents are less toxic systemic side-effect profiles that will improve the quality of life in psoriatic patients.


OBJECTIVE
This review article describes current and emerging selective immunotherapies and systemic therapies for the treatment of psoriasis, and will briefly discuss disease immunopathogenesis.


METHODS
Literature review.


CONCLUSIONS
Given the role of the inflammatory immune responses in the pathogenesis of psoriasis, the goal of modern medicine and pharmacotherapy lies in the design and use of specific targets in cell-mediated immune reactions and the modulation of the expression of various inflammatory cytokines. The clinical evidence of efficacy of some of these new biological immunomodulatory agents from several U.S.-based research studies and clinical experiences is convincing.
Kormeili
T
T
Clinical Research Specialists, UCLA School of Medicine, 2001 Santa Monica Blvd Suite 490 W, Santa Monica, CA 90404, USA.
Lowe
N J
NJ
Yamauchi
P S
PS
D016207:Cytokines / Q000276:immunology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007167:Immunotherapy / Q000379:methods*; D011565:Psoriasis / Q000276:immunology* / Q000628:therapy*; D013601:T-Lymphocytes / Q000276:immunology; D014481:United States
D016207:Cytokines; D007155:Immunologic Factors; D007166:Immunosuppressive Agents