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Psoriasis: New Drugs for an Old Disease

Published: 24/08/2016

Psoriasis pic

Dr Nilesh Morar, Consultant Dermatologist

MBChB cum laude, FC Derm, MMed Derm, FRCP, D Phil (Oxon)

Psoriasis is a chronic, genetic, autoimmune disease that can be triggered by environmental factors. In psoriasis, the skin cell cycle changes so that there is an increased  turnover of skin cells that builds up and forms scales.  Most psoriasis causes red patches or areas of thickened skin with an overlying silver scale.   Psoriatic arthritis affects 20% – 30% of those who have psoriasis, causing red, swollen and painful joints.

Although any part of the skin may be affected, the scalp is commonly affected and may be itchy and scaly.   The typical areas involved are on the elbows, knees, palms, soles and lower back. The groins, genitals and areas prone to friction and sweating may also become red and inflamed. The finger and toenails can develop pits and become thickened and discoloured.

There are many triggers for psoriasis which include:

  • bacterial infection
  • stress
  • smoking
  • alcohol
  • injury to the skin
  • a change in weather
  • certain medications

 

Traditional therapy includes topical agents (moisturiser, steroid creams, Vitamin D and tar- based creams), phototherapy (a course of UVB or UVA light treatment) and oral (systemic) medication which mainly work by reducing inflammation by suppressing the immune system. Over the past decade, tremendous advances have been made for the treatment of moderate to severe psoriasis and new drugs continue to be developed.

Biologic drugs are given by subcutaneous injection or intravenous infusion and are drugs that are derived from living cells cultured in the laboratory. They differ from traditional systemic drugs for psoriasis, as they target specific parts of the immune system (proteins or cytokines) that are important in the pathogenesis of psoriasis, and thus, interrupt the inflammatory process. These include drugs that block tumour necrosis factor-alpha (TNF-alpha) e.g. etanercept, adalimumab  and infliximab; drugs that block  interleukins 12 and 23 e.g. ustekinumab and interleukin 17-A blockers e.g. secukinumab. The biologics can increase the risk of infection and so, screening for any infection, such as tuberculosis, is important. There are rare side effects on the nervous system or the risk of developing blood disorders and certain types of cancer hence pre-screening and monitoring is required during treatment.

Most recently, new ‘small molecule’ treatments are taken orally which target specific molecules within immune cells. Apremilast is a targeted phosphodiesterase-4 inhibitor and is an option for patients who prefer not to take a general immunosuppressive drug.

 

The Lister Hospital

The Lister Hospital has a long history of treating patients with psoriasis. Once an assessment by a Dermatologist has been made, the different therapeutic options can be considered.

Referrals

Dr Nilesh Morar and his team at Dermatology Treatment Centre treat patients with mild, moderate and severe psoriasis. Clinics are held at the Lister Hospital Chelsea Outpatient Centre at 280 Kings Road.

For appointments with Dr Morar and his team, please contact:

Tel: 020 7881 4000 / 020 3301 8171

Email: nmorar@dermwithnm.co.uk

www.dermwithnm.co.uk

 


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