Immunomodulators in the Treatment of Psoriasis
Psoriasis is a chronic T lymphocyte mediated systemic inflammatory disease characterised by recurrent exacerbations and remission of thickened, erythematous and scaling plaque and multiple comorbidities. Based on morphology and extend of involvement dermatosis may range from innocuous lesion to wide spread life threatening pustular and erythrodermic forms. Psoriasis is a multifactorial skin disease and it involves a complex pathogenesis. It can be explained by a immunological disregulation of cell function along with differentiation or proliferation of keratinocyte. Psoriasis treatment aims to reduce skin inflammation and to clear skin. Conventional therapy usually includes topical, light and systemic medications. All the three therapies are found to be good for the treatment but are associated with a number of side effects like increased skin sensitivity, burning, skin staining, xerosis and alopecia etc. Nowadays various recent therapeutic advances are attempting to control the T cell expression by the suppression of same and are correlates with the clinical remission. Immunomodulators and biological therapy contribute a new way for psoriasis therapy. These drugs are more safer, effective and selective immunosuppressive agents as compared to conventional agents. This review summarisesthe variousimmunomodulators used in the treatment of psoriasis
Keywords: Psoriasis, conventional therapy, immunomodulators
2. Lowes MA, Kikuchi T, Fuentes-Duculan J, Cardinale I, Zaba LC, Haider AS, Bowman EP, Krueger JG. Psoriasis vulgaris lesions contain discrete populations of Th1 and Th17 T cells. Journal of Investigative Dermatology. 2008 May 1; 128(5):1207-11.
3. Das RP, Jain AK, Ramesh V. Current concepts in the pathogenesis of psoriasis. Indian journal of dermatology. 2009 Jan; 54(1):7.
4. Ogawa E, Sato Y, Minagawa A, Okuyama R. Pathogenesis of psoriasis and development of treatment. The Journal of dermatology. 2018 Mar; 45(3):264-72.
5. ORTONNE JP. Aetiology and pathogenesis of psoriasis. British Journal of Dermatology. 1996 Oct; 135:1-5.
6. Sonkoly E, Wei T, Janson PC, Sääf A, Lundeberg L, Tengvall-Linder M, Norstedt G, Alenius H, Homey B, Scheynius A, Ståhle M. MicroRNAs: novel regulators involved in the pathogenesis of psoriasis?. PloS one. 2007 Jul 11; 2(7):e610.
7. Ippolito F, Carducci M, Fazio M, Giacalone B, Giannolti B, Carli P, Massone L, Borghi S, Chimenti S, Legge A, Lisi P. Short-and long-term considerations concerning the management of plaque psoriasis with low-dose cyclosporin. Dermatology. 1993; 187:19-29.
8. Rebora A. Conventional therapies for psoriasis. Reumatismo. 2007:77-80.
10. McClure SL, Valentine J, Gordon KB. Comparative tolerability of systemic treatments for plaque-type psoriasis. Drug safety. 2002 Nov 1; 25(13):913-27.
11. Kormeili T, Lowe NJ, Yamauchi PS. Psoriasis: immunopathogenesis and evolving immunomodulators and systemic therapies; US experiences. British Journal of Dermatology. 2004 Jul; 151(1):3-15.
12. Papp KA, Tyring S, Lahfa M, Prinz J, Griffiths CE, Nakanishi AM, Zitnik R, Van De Kerkhof PC, Etanercept Psoriasis Study Group. A global phase III randomized controlled trial of etanercept in psoriasis: safety, efficacy, and effect of dose reduction. British Journal of Dermatology. 2005 Jun; 152(6):1304-12.
13. Romero-Mate A, Garcia-Donoso C, Cordoba-Guijarro S. Efficacy and safety of Etanercept in psoriasis/psoriatic arthritis. American journal of clinical dermatology. 2007 Jun 1; 8(3):143-55.
14. Gottlieb AB. Infliximab for psoriasis. Journal of the American Academy of Dermatology. 2003 Aug 1; 49(2):112-7.
15. Antoni C, Manger B. Infliximab for psoriasis and psoriatic arthritis. Clinical and experimental rheumatology. 2002 Nov 1; 20(6; SUPP/28):S-122.
16. Menter A, Tyring SK, Gordon K, Kimball AB, Leonardi CL, Langley RG, Strober BE, Kaul M, Gu Y, Okun M, Papp K. Adalimumab therapy for moderate to severe psoriasis: a randomized, controlled phase III trial. Journal of the American Academy of Dermatology. 2008 Jan 1; 58(1):106-15.
17. Li S, Wang H, Peng B, Zhang M, Zhang D, Hou S, Guo Y, Ding J. Efalizumab binding to the LFA-1 αL I domain blocks ICAM-1 binding via steric hindrance. Proceedings of the National Academy of Sciences. 2009 Mar 17; 106(11):4349-54.
18. Hansen ND, Madsen C, Stenager E. Progressive multifocal leucoencephalopathy. The Italian Journal of Neurological Sciences. 1996 Dec 1; 17(6):393-9.
19. Berger JR, Houff SA, Major EO. Monoclonal antibodies and progressive multifocal leukoencephalopathy. InMAbs 2009 Nov 1 (Vol. 1, No. 6, pp. 583-589). Taylor & Francis.
20. Efalizumab FDA Warning. Retrieved 7 December 2008
21. Scheinfeld N. Therapy-resistant psoriasis treated with alefacept and subsequent narrow band ultraviolet B phototherapy with total clearing of psoriasis. Dermatology online journal. 2005; 11(2).
22. Krueger GG, Langley RG, Leonardi C, Yeilding N, Guzzo C, Wang Y, Dooley LT, Lebwohl M. A human interleukin-12/23 monoclonal antibody for the treatment of psoriasis. New England Journal of Medicine. 2007 Feb 8; 356(6):580-92.
23. Gottlieb AB, Evans R, Li S, Dooley LT, Guzzo CA, Baker D, Bala M, Marano CW, Menter A. Infliximab induction therapy for patients with severe plaque-type psoriasis: a randomized, double-blind, placebo-controlled trial. Journal of the American Academy of Dermatology. 2004 Oct 1; 51(4):534-42.
24. SchÖn MP, Detmar M, Parker CM. Murine psoriasis-like disorder induced by naive CD4+ T cells. Nature medicine. 1997 Feb; 3(2):183.
25. Wang B, Roskos L, Osborn K, Lu H, Kim M, Pasumarthi R, Raie N, Tabrizi M. A population pharmacokinetic (PK) analysis of ABX‐IL8, a fully human monoclononal IGG2 antibody, in psoriasis patients. Clinical Pharmacology & Therapeutics. 2005 Feb; 77(2):P91.
26. Afra TP, Razmi TM, Dogra S. Apremilast in psoriasis and beyond: Big hopes on a small molecule. Indian dermatology online journal. 2019 Jan; 10(1):1.
27. Kushwaha AS, Repka MA, Murthy SN. A novel apremilast nail lacquer formulation for the treatment of nail psoriasis. AAPS PharmSciTech. 2017 Nov 1; 18(8):2949-56.
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