1,720,981 research outputs found
The need for long-term continuous therapy in moderate to severe chronic plaque psoriasis
No full textPsoriasis is a chronic inflammatory disease, which may have relevant impact on quality of life, and thus requires treatment over long periods of time (e.g., years) for effective control. Conventional systemic therapies for moderate to severe psoriasis, such as cyclosporin, methotrexate, retinoids and phototherapy have proved effective in suppressing symptoms, but the occurrence or fear of side effects prevent their prolonged use. Therefore, traditional therapy is used intermittently, with early relapse of the disease and not satisfactory long-term disease control. Biological agents represent an important advance in psoriasis treatment and there is general agreement to consider them along-side current conventional therapies for patients candidate to systemic therapy. Two categories of biological agents are currently available for the treatment of psoriasis and/or psoriatic arthritis: T-cell-modulators (efalizumad) and anti-TNF-α agents (etanercept, infliximab, adalimumab). Discontinuation of these drugs is associated with disease relapse in a median time of 60-70 days. Efalizumab provides a good efficacy/safety profile for patients with psoriasis, and is the drug with the longest published trial (>36 months), and is particularly indicated for an effective and safe long-term control of psoriasis
Considerations for Systemic Treatment of Psoriasis in Obese Patients
No full textPsoriasis is an immune-mediated inflammatory skin disease frequently associated with metabolic disorders, including diabetes, dyslipidaemia and metabolic syndrome. Moreover, a growing number of studies confirm the association between psoriasis and obesity. It has been found that obesity, as measured by body mass index >30 kg/m2, can double the risk of incident psoriasis. A positive correlation between different measures of adiposity and the severity of psoriasis has also been reported. Epidemiologic studies have also provided robust evidence confirming the association between obesity and psoriatic arthritis. Genetic, metabolic and environmental factors are all likely to contribute to these associations. Adipose tissue is an active endocrine and paracrine organ that has a key role in lipid and glucose metabolism as well as inflammation. Fat tissue is traditionally distributed into two main compartments with different metabolic characteristics, i.e. the subcutaneous and visceral adipose tissue. Particular attention has been devoted to visceral adiposity because of its contribution to inflammation and atherosclerosis. The association between psoriasis and obesity should be properly considered when choosing a systemic treatment, because it could exert negative effects on metabolic parameters, including liver enzymes, serum lipids and renal function. Obesity may increase the risk of liver and renal toxicity from methotrexate and cyclosporine. Moreover, obesity can compromise the effectiveness of systemic treatments for psoriasis (conventional and biological therapies). Dermatologists are also expected to promote a healthy lifestyle and weight loss for obese patients because they could improve metabolic parameters and responsiveness to psoriasis therapie
Effective management of psoriasis symptom worsening durino efalizumab therapy without discontinuing treatment: A case study.
No full textEfalizumab is an effective therapy for the long-term treatment of chronic plaque psoriasis. However, regardless of the type of antipsoriatic treatment a patient is receiving, natural fluctuations in symptom severity occur throughout the course of the disease, and need to be managed appropriately. Here, we report the case of a patient with moderate chronic plaque psoriasis resistant to conventional treatments, who initially showed an excellent response to efalizumab (1 mg/kg per week, subcutaneous injection), but then experienced symptom exacerbation after 8 weeks of treatment. This worsening of symptoms was successfully controlled using a short course of concomitant methotrexate treatment (15 mg/week, intramuscular injection). After 1 month, the clinical signs had cleared, methotrexate treatment was stopped and efalizumab therapy was continued. These results show the effective use of a short course of concomitant methotrexate to control fluctuations in psoriasis severity in a patient receiving efalizumab therapy in general clinical practice
The expectations of patients with psoriasis during an office consultation
No full textstudo che ha valutato le aspettative dei pazienti con psoriasi durante una visita ambulatoriale
Complicanze dell'obesità: la cute
No full textL’obesità è considerata uno dei maggiori problemi di salute pubblica e la sua incidenza sta aumentando in tutte le fasce di età, inclusa l’infanzia e l’adolescenza. L’obesità comporta un maggior rischio di sviluppare comorbilità di tipo cardiovascolare, respiratorio, metabolico, epato-biliare ed ortopedico ma anche complicanze dermatologiche, predisponendo allo sviluppo e/o aggravando patologie cutanee preesistenti od intercorrenti
Targeting TNF-a in psoriasis and psoriatic arthritis.
No full textBackground: Psoriasis is an immune-mediated chronic inflammatory disease triggered and maintained by inflammatory mediators, including TNF-alpha. Objective/methods: To summarize the role of anti-TNF-alpha agents psoriasis therapy, focusing on the mechanisms and biological pathways involved, by reviewing relevant literature. Results/conclusions: The three TNF-alpha antagonists currently available (etanercept, infliximab and adalimumab) are effective in the therapy of psoriasis and psoriatic arthritis. Certolizumab pegol and golimumab are TNF-alpha inhibitors not approved for therapy of psoriasis yet. In addition to neutralizing soluble TNF-alpha, TNF-alpha blockers bind to membrane TNF-alpha and change the behavior of TNF-alpha-expressing cells, resulting in hastened cell cycle arrest and apopotosis, and suppresion of cytokine production. TNF-alpha blockers may also affect adaptive immune responses by reducing T helper cell (Th)1 and Th17 responses, and favoring the development of T-regulatory cells. TNF-alpha antagonists can regulate differentiation and activation of osteoclasts, thus reducing bone destruction in psoriatic arthritis. Anti-TNF-alpha agents differ in their pharmacokinetics and pharmacodinamic properties, which is reflected in their therapeutic and safety profiles. The safety of TNF-alpha antagonists has been established, and patient selection and monitoring allow risk minimization
Drug-induced lupus erythematosus
No full textRevisone dell aletteratura sul lupus eritematoso farmaco-indotto, con enfasi sugli aspetti cutane
Psoriasis, the liver, and the gastrointestinal tract
No full textPsoriasis is a common chronic inflammatory, immune-mediated skin disease that is frequently associated with comorbidities including psoriatic arthropathy, chronic inflammatory bowel diseases, and cardio-metabolic disorders. In particular, nonalcoholic fatty liver disease affects about half of patients, Crohn's disease 0.5% and celiac disease 0.2-4.3% of patients with psoriasis. Some shared genetic traits as well as common inflammatory pathways may underlie these associations. The presence of comorbidities has important implications in the global approach to patients. In particular, traditional systemic antipsoriatic agents could negatively affect cardio-metabolic comorbidities as well as nonalcoholic fatty liver disease and may have important interactions with drugs commonly used by psoriasis patients. Moreover, patients with psoriasis should be encouraged to drastically correct their modifiable cardiovascular and liver risk factors, in particular obesity, alcohol consumption, and smoking habit, because this could positively affect both psoriasis and their life expectance
Combining etanercept and acitretin in the therapy of chronic plaque psoriasis: a 24-week, randomized, controlled, investigator-blinded pilot trial
No full textCombining etanercept and acitretin in the therapy of chronic plaque psoriasis is effective as a 50 mg week dose of etanercept in a 24-week, randomized, controlled, investigator-blinded pilot tria
The diagnostic and therapeutic challenge of early psoriatic arthritis
No full textPsoriasis is a complex disease involving the skin, nails and
musculoskeletal structures. Psoriatic arthritis (PsA) affects
peripheral joints, entheses, the synovial sheaths of tendons
and the axial skeleton. PsA is now recognised as a potentially
debilitating disease, with bone erosions and deformities
affecting about half of patients and arising early after disease
onset. Because PsA usually coincides with or follows the
development of psoriasis, dermatologists are in a strategic
position to diagnose and manage early PsA. In general, patients
with severe psoriasis appear to have a higher risk of
arthritis than patients with mild psoriasis. In addition, scalp
lesions, nail dystrophy and intergluteal/perianal lesions have
been found to be associated with a higher risk of PsA development.
The diagnosis of PsA is based primarily on clinical
features, and several classification criteria have been developed.
Ultrasonography, magnetic resonance imaging and
bone scintigraphy, rather than standard radiography, are the
most accurate and effective diagnostic imaging approaches
for documenting early PsA. The therapeutic strategy for early
PsA should be aimed at inducing lasting remission, preventing
permanent damage and possibly modifying the natural
disease course
- …
