1 / 8

Psoriasis

Psoriasis. A review of therapeutics. A definition from Clinical Evidence Naldi L and Rzany B. Clinical Evidence 2006 ;15:1-4 (Search Date July 2006).

ratana
Télécharger la présentation

Psoriasis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Psoriasis A review of therapeutics

  2. A definition from Clinical EvidenceNaldi L and Rzany B. Clinical Evidence 2006;15:1-4 (Search Date July 2006) • Chronic plaque psoriasis, or psoriasis vulgaris, is a chronic inflammatory skin disease that is characterised by well demarcated erythematous scaly patches on the extensor surfaces of the body and scalp • The lesions may itch, sting, and occasionally bleed • Dystrophic nail changes are found in more than a third of people with chronic plaque psoriasis, and psoriatic arthropathy occurs in 1% to more than 10% • The condition waxes and wanes, with wide variations in course and severity among individuals • Other varieties of psoriasis include guttate, inverse, pustular, and erythrodermic psoriasis

  3. Community-based Emollients Topical coal tar Topical dithranol Topical vitamin D & analogues Topical corticosteroids Topical retinoids plus combinations treatment for specific sites Hospital-led therapy Phototherapy Methotrexate Oral retinoids Cyclosporin Hydroxurea Azathioprine Systemic steroids TNF-alpha drugs T-cell drugs – efalizumab, alefacept Many therapiesNaldi L and Rzany B. Clinical Evidence 2006;15:1-4 (Search DateJuly 2006)

  4. British Association of Dermatologists Guidelines – Recommendationswww.bad.org.uk  Accessed 25/04/08 • Emollients should be used to soften scaling and reduce any irritation • For localised plaque psoriasis one or more of the following topical preparations can be tried • A tar-based cream, or a tar/corticosteroid mixture • A moderate potency topical corticosteroid (e.g. 0.05% clobetasone butyrate); stronger agents can be used on palms and soles or on the scalp • A vitamin D analogue • Calcipotriol with betamethasone dipropionate as a combination product • A vitamin A analogue (tazarotene) • A dithranol preparation • Important to use a keratolytic agent (e.g. 5% salicylic acid in emulsifying ointment) first when there is significant scaling, or other treatments may fail

  5. NICE guidance on etanercept and efalizumab  1NICE TA103, July 2006 • Etanercept, within its licensed indications, is recommended for the treatment of adults with plaque psoriasis only when the following criteria are met: • The disease is severe (PASI score of 10 or more andDLQI score >10) • The psoriasis has failed to respond to standard systemic therapies, or the person is intolerant to, or has a contraindication to, these treatments • Etanercept treatment should be discontinued in patients whose psoriasis has not responded adequately at 12 weeks • Further treatment cycles are not recommended in these patients • An adequate response is defined as either: • a 75% reduction in the PASI score from when treatment started (PASI 75), or • a 50% reduction in the PASI score (PASI 50) and a five-point reduction in DLQI from when treatment started

  6. NICE guidance on etanercept and efalizumab 2NICE TA103, July 2006 • Efalizumab, within its licensed indications, is recommended for the treatment of adults with plaque psoriasis under the circumstances detailed for etanerceptonly if their psoriasis has failed to respond to etanercept or they are shown to be intolerant of, or have contraindications to, treatment with etanercept • Further treatment with efalizumab is not recommended in patients unless their psoriasis has responded adequately at 12 weeks (as defined for etanercept) • Use of etanercept and efalizumab for psoriasis should be initiated and supervised only by specialist physicians • If a person has both psoriasis and psoriatic arthritis their treatment should be managed by collaboration between a rheumatologist and a dermatologist

  7. NICE guidance on infliximabNICE TA134, Jan 2008 • Infliximab, within its licensed indications, is recommended as a treatment option for adults with plaque psoriasis only when the following criteria are met • The disease is verysevere (PASI score of 20 or more andDLQI score >18) • The psoriasis has failed to respond to standard systemic therapies, or the person is intolerant to, or has a contraindication to, these treatments • Continue beyond 10 weeks only if an adequate response to treatment within 10 weeks has occurred, defined as either: • a 75% reduction in the PASI score from when treatment started (PASI 75), or • a 50% reduction in the PASI score (PASI 50) and a five-point reduction in DLQI from when treatment started • NICE TA for adalimumab expected June 2008

  8. Summary • Psoriasis is one of the most common skin conditions seen in primary care • Most common form is chronic plaque psoriasis • Can cause poor quality of life and some complications can be life threatening • Many patients can be managed in primary care • Emollients useful as long-term management • Evidence base limited, especially for older treatments • More severe psoriasis needs specialist care • Self-help groups can be beneficial

More Related