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REVIEWS
PSORIASIS: EMERGING THERAPEUTIC STRATEGIES
Alice B. Gottlieb
Abstract | Psoriasis is a chronic inflammatory skin disorder that is characterized by thickened, scaly plaques, and is estimated to affect ~13% of the Caucasian population. Traditional treatments, although effective in patients with limited disease, have numerous shortcomings, including inconvenience and toxicity. These drawbacks mean that many patients experience cycles of disease clearance, in which normal quality of life alternates with active disease and poor quality of life. However, as this review discusses, recent advances have highlighted the key role of the immune system in the pathogenesis of psoriasis, and have provided new defined targets for therapeutic intervention, offering hope for safe and effective psoriasis treatment.
TOPICAL THERAPY
Therapy applied to the skin.
PHOTOTHERAPY
Ultraviolet light irradiation therapy.
Psoriasis is a common immune disorder whose main manifestation is in the skin. It most frequently begins in young adults, and is a lifelong condition. Traditional treatments for the disease have several shortcomings, including inconvenience (as is the case with TOPICAL
THERAPY and PHOTOTHERAPY) and toxicity (as is the case with psoralen plus UVA irradiation (PUVA), acitretin, methotrexate and cyclosporine)1,2.The challenge for treating moderate-to-severe psoriasis is not the induction of disease clearance both cyclosporine and methotrexate clear a high percentage of patients3.
However, current treatments are used intermittently due in large part to inconvenience and/or toxicity. So, patients experience cycles of clearance with normal quality of life that alternate with active disease and poor quality of life46.There is therefore a need for safe and effective long-term maintenance of disease clearance for patients with moderate-to-severe psoriasis. For patients with limited psoriasis that does not greatly affect quality of life, the need is to develop better topical therapies.
Epidemiology and clinical manifestations
The most common form of psoriasis (psoriasis vulgaris or plaque-type psoriasis) is characterized by the presence of red, raised scaly plaques that can cover any body surface. Common sites of involvement include the scalp, extensor aspects of the extremities, the lower back and genitals. Two other potentially life-threatening forms of
the disease occur rarely: erythrodermic and generalized, pustular psoriasis. In children especially, streptococcal infection can induce the guttate, or raindrop-like, form of psoriasis. Palmarplantar psoriasis can be limited to the hands and feet, but it is frequently disabling2.
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