Evidence-based guidelines of the spanish psoriasis group on the use of biologic therapy in patients with psoriasis in difficult-to-treat sites (nails, scalp, palms, and soles).
Psoriatic lesions affecting the scalp, nails, palms, and the soles of the feet are described as difficult-to-treat psoriasis and require specific management. Involvement of these sites often has a significant physical and emotional impact on the patient and the lesions are difficult to control with topical treatments owing to inadequate penetration of active ingredients and the poor cosmetic characteristics of the vehicles used. Consequently, when difficult-to-treat sites are involved, psoriasis can be considered severe even though the lesions are not extensive. Scant information is available about the use of biologic therapy in this setting, and published data generally comes from clinical trials of patients who also had moderate to severe extensive lesions or from small case series and isolated case reports. In this article we review the quality of the scientific evidence for the 4 biologic agents currently available in Spain (infliximab, etanercept, adalimumab, and ustekinumab) and report level i evidence for the use of biologics to treat nail psoriasis (level of recommendation A) and a somewhat lower level of evidence in the case of scalp involvement and palmoplantar psoriasis.
Servicio de Dermatología, Hospital Universitari Sagrat Cor, Barcelona, España. Electronic address: msanchezreg@hotmail.com.
M
M
Sánchez-Regaña
Servicio de Dermatología, Hospital Universitari Sagrat Cor, Barcelona, España.
M J
MJ
Aldunce Soto
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
I
I
Belinchón Romero
Servicio de Dermatología, Hospital Universitari de Sabadell-Corporació Parc Taulí, Sabadell, Universitat Autònoma de Barcelona, Barcelona, España.
M
M
Ribera Pibernat
Servicio de Dermatología, Hospital Reina Sofía, Tudela, España.
R F
RF
Lafuente-Urrez
Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol. Badalona, Universitat Autònoma de Barcelona, Barcelona, España.
J M
JM
Carrascosa Carrillo
Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol. Badalona, Universitat Autònoma de Barcelona, Barcelona, España.
C
C
Ferrándiz Foraster
Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.
L
L
Puig Sanz
Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, España.
E
E
Daudén Tello
Servicio de Dermatología, Hospital de Sant Joan Despí-Moisès Broggi, Sant Joan Despí, Barcelona, España.
D
D
Vidal Sarró
Servicio de Dermatología, Complejo Hospitalario de Jaén, Jaén, España.
R
R
Ruiz-Villaverde
Servicio de Dermatología, Complejo Hospitalario Universitario de La Coruña, La Coruña, España.
E
E
Fonseca Capdevila
Servicio de Dermatología, Complejo Hospitalario Universitario de Vigo, Vigo, España.
M C
MC
Rodríguez Cerdeira
Servicio de Dermatología, Hospital Clínic, Universitat de Barcelona, Barcelona, España.
M M
MM
Alsina Gibert
Servicio de Dermatología, Hospital Universitario Virgen de la Victoria, Málaga, España.
E
E
Herrera Acosta
Unidad Clínica de Dermatología, Hospital de Alcañiz, Instituto Aragonés de Ciencias de la Salud, Alcañiz, España.
S E
SE
Marrón Moya
D001685:Biological Factors / Q000627:therapeutic use*; D001691:Biological Therapy; D019317:Evidence-Based Medicine; D005533:Foot Dermatoses / Q000188:drug therapy*; D006229:Hand Dermatoses / Q000188:drug therapy*; D006801:Humans; D009260:Nail Diseases / Q000188:drug therapy*; D011565:Psoriasis / Q000188:drug therapy*; D012536:Scalp Dermatoses / Q000188:drug therapy*
D001685:Biological Factors
Biologic agents; Biológicos; Cuero cabelludo; Nails; Palmas; Palms; Plantas; Psoriasis; Scalp; Soles; Uñas