Feature Article

Therapies for psoriasis: beyond lesion control

THEONE PAPPS, Stephen Shumack


© sUZe777/isToCKphoTo.CoM
© sUZe777/isToCKphoTo.CoM


Conventional therapies for psoriasis that aim to decrease skin turnover have not met the needs of all patients. Novel biologic therapies that target the underlying immune mechanisms of psoriasis can be effective and well tolerated. They include the cytokine modulators infliximab, adalimumab, etanercept, ustekinumab, guselkumab, secukinumab and ixekizumab, and the enzyme inhibitor apremilast.

Key Points

  • Psoriasis is a common disease involving chronic inflammation of the skin, nails or joints that often decreases quality of life.
  • Traditional management aims to decrease skin turnover and control disease, rather than cure; options include topical medications, phototherapy and, for patients with resistant or widespread disease, systemic acitretin, methotrexate or ciclosporin.
  • Moderate-to-severe psoriasis or involvement of special sites such as the scalp, genitals, palms or soles warrants specialist referral.
  • Recent improved understanding of the immune mechanisms underlying psoriasis has led to novel biologic therapies that specifically target cytokines and enzymes involved in its pathophysiology.
  • Targeted therapies for psoriasis include inhibitors of tumour necrosis factor-alpha (infliximab, adalimumab, etanercept), interleukin-23 (ustekinumab, guselkumab), interleukin-17 (secukinumab, ixekizumab), phosphodiesterase 4 (apremilast) and janus kinase (tofacitinib, which is not currently approved in Australia).
  • Targeted biologic therapies are effective, well tolerated and may have a better long-term safety profile than conventional systemic therapies.