To the biological and systemic removal of psoriasis
“We are talking about new molecules, such as monoclonal antibodies directed against inhibitors of IL-17A/F, IL-36 or JAK, both for common forms of the disease and for less frequent ones, such as pustular psoriasis” , he underlines.
Between the systemic drugs Among these stand out: methotrexate, which causes the inhibition of DNA synthesis, stopping the S phase of cell division; ciclosporin, very effective oral molecule; acitretin, focused on pustular, palmoplantar and erythrodermic psoriasis; apremilast, second-line drug; and dimethyl fumarate, the oldest, with a very slow response and moderate efficacy.
AS biological drugs Anti-TNFs (tumor necrosis factor inhibitors) are available: etanercept, infliximab, adalimumab, certalizumab and biosimilars.
Also anti-IL23 (interleukin 23 inhibitors): ustekinumab, guselkumab, tildrakizumab and risankizumab; and anti-IL17 and 17AR (intelucin 17 inhibitors): secukinumab, ixekizumab, brodalumab and bimekizumab.
And do these molecules demonstrate serious adverse effects?
“They tend to be very safe drugs, which allow us to very selectively treat the disease, the systemic inflammation: practically no adverse effects occur, other than generating some type of respiratory infection, such as pharyngitis,” explains Dr. Iglesias Puzas.
<img decoding="async" width="681" height="353" data-attachment-id="360183" data-permalink="https://efesalud.com/quite-biologico-sistemico-psoriasis/psoriasis-2/" data-orig-file=" data-orig-size="681,353" data-comments-opened="0" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"1730385224","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}" data-image-title="Videoblog Dermatología: psoriasis." data-image-description="
Psoria in the abdominal area.
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Keys to psoriasis, a systemic disease
Psoriasis, a non-infectious disease, is defined by systemic, chronic, dermatological inflammation: the immune system causes abnormally rapid growth of skin cells.
It evolves clinically with periodic epidemics and remissions, the patient worsens or improves cyclically and is associated with other concomitant pathologies, in particular psoriatic arthritis.
The majority of people suffering from psoriasis (70%) suffer from the mild form, while 20% reach the moderate stage and 10% the severe stage. It basically occurs in two age groups: between 10-30 and 50-60 years.
The most common clinical form, in 90% of cases, is psoriasis vulgaris in plaques or erythematous and scaly lesions; They can itch and cause pain, even bleeding episodes.
These bounded plaques are usually found along the body, although they most affect the extension surfaces of the elbows, knees, and in the lumbosacral area or lower back. It also affects the scalp.
There are other clinical forms of psoriasis, such as inversion thin inflamed spots in the skin folds of the breast, groin and buttocks; in drops more common in children and young adults, appearing as spots covered with a thin scale.
Also, nail affecting fingernails and toenails specifically or in the context of more generalized psoriasis.
The two most surprising and stigmatizing clinical forms of psoriasis are pustular usually palmoplantar, which develops rapidly and forms pus vesicles; and psoriasis erythrodermic in very few cases, covering almost the entire surface of the skin with a scaly rash.
What is the origin of psoriasis from a systemic point of view?
“Psoriasis is a multifactorial disease, although in reality it is a predisposition of the immune system; That is, many patients have a genetic background favorable to this pathology”, clarifies the dermatologist of the San Carlos Clinic.
“At the same time, when genetics combines with certain factors (microbial infections, cold and dry climate, exposure to smoking, alcoholism, certain medications or certain autoimmune diseases) we will be faced with possible triggers of psoriasis,” he adds.
And what role do interleukins play in this psoriatic process?
“They are proteins produced by leukocytes and other cells in the body. If these proteins, whose function is cellular communication, are altered, they often mediate inflammation, a situation that occurs in some immunological diseases,” he explains.
Common signs of psoriasis range from a mild, bumpy rash, with dandruff-like scales, to rashes all over the body, which vary in color depending on the patient’s skin tone: purplish in dark skin or black and reddish in skin white.
Additionally, the patient may notice cracked, dry skin, possibly bleeding, and may experience itching, burning, or irritation. These rashes may also disappear after a few weeks or months.
And what is the outcome of these innovative drugs, the prognosis for most patients?
“The prognosis, fortunately, is very good and effective for the vast majority of patients because we already have many treatment options. It has nothing to do with dealing with the psoriasis today to what was done fifteen years ago,” compares.
“Not only can we treat any manifestation of the disease, but we are moving towards directly connecting the drug to each patient’s profile; absolutely personalized medicine,” he attests.
Dr. Iglesias Puzas, what advice do you give to the population so that we can find out for sure whether the psoriatic disease has given its bitter face to our skin?
“If a person observes or experiences strange skin symptoms, it is always mandatory to seek primary care or dermatology consultation, depending on the circumstances. We will diagnose the disease and choose the most appropriate treatment,” he advises.
“We have an arsenal of effective drugs, capable of whitening, improving the patient’s lesions and obtaining more and more time without the appearance of these lesions, with exceptional tolerance”, reiterates and concludes the dermatologist.
Achieving the natural state of the skin once psoriasis has arisen is as important as developing and maintaining normality in personal, family and social life. Only then will psoriasis stop being stigmatized.
Interview between Time.News Editor and Dr. Iglesias Puzas on Psoriasis Treatments
Time.News Editor: Welcome, Dr. Iglesias Puzas! Thank you for joining us to discuss the advancements in the treatment of psoriasis. To start, could you give us a brief overview of psoriasis and its implications for those living with this condition?
Dr. Iglesias Puzas: Thank you for having me. Psoriasis is a chronic, non-infectious disease characterized by systemic inflammation and the abnormally rapid growth of skin cells. This leads to red, scaly patches on the skin, predominantly affecting areas like the elbows, knees, and lower back. Most patients experience cycles of flare-ups and remissions, and it’s important to note that psoriasis is often linked with more serious conditions, such as psoriatic arthritis.
Time.News Editor: That makes it clear how deeply impactful this disease can be on a person’s life. You’ve mentioned several types of psoriasis, but could you touch on the most common forms and their symptoms?
Dr. Iglesias Puzas: Certainly! The most prevalent form is psoriasis vulgaris, which appears as raised, red patches with silvery scales. About 90% of psoriasis patients experience this type. Other forms include inverse psoriasis, which presents as smooth, red patches in skin folds; guttate psoriasis, often seen in children and young adults, characterized by small, drop-like lesions; and the more severe forms like pustular psoriasis and erythrodermic psoriasis, which can cover large areas of the body and are quite debilitating.
Time.News Editor: With a variety of forms of psoriasis comes the need for diverse treatment options. What’s exciting in the realm of treatment currently?
Dr. Iglesias Puzas: We’re witnessing a significant evolution in psoriasis treatments, especially with the introduction of new molecules like monoclonal antibodies that target specific interleukins. For instance, the inhibitors of IL-17A/F, IL-36, and JAK are promising for both common and less frequent forms of the disease, like pustular psoriasis.
Time.News Editor: Could you elaborate on some of these systemic therapies and their mechanisms?
Dr. Iglesias Puzas: Sure! Among systemic drugs, we have methotrexate, which inhibits DNA synthesis and slows down cell division. Cyclosporin is another effective oral drug, while apremilast serves as a second-line treatment. Biological drugs are also making waves, including anti-TNF drugs like etanercept and adalimumab, and anti-IL23 and anti-IL17 drugs such as ustekinumab and secukinumab. These drugs work by blocking specific pathways in the immune response that contribute to skin inflammation.
Time.News Editor: That sounds very promising for many patients! With such powerful treatments, are there concerns regarding side effects?
Dr. Iglesias Puzas: Generally, these therapies are well-tolerated and quite safe, with the most common side effects being mild respiratory infections like pharyngitis. It’s crucial, however, for healthcare providers to monitor patients closely, especially since they may have underlining comorbidities.
Time.News Editor: On the topic of origins, what can you tell us about the underlying causes of psoriasis?
Dr. Iglesias Puzas: Psoriasis is multifactorial, often stemming from a genetic predisposition. Certain environmental triggers, such as infections, stress, smoking, and even weather can exacerbate the condition. Understanding these triggers can help in managing the disease effectively.
Time.News Editor: That highlights the complexity of psoriasis. Lastly, Dr. Puzas, what message would you want to share with our readers who might be dealing with psoriasis or have loved ones affected by it?
Dr. Iglesias Puzas: I want to emphasize that psoriasis is a manageable, chronic disease. Advances in treatment mean that many patients can achieve clear or nearly clear skin. It’s also important for individuals to work closely with their healthcare team to find the right treatment for their specific condition and lifestyle. They aren’t alone in this journey, and support is available.
Time.News Editor: Thank you, Dr. Iglesias Puzas. Your insights shed light on an often misunderstood condition, and we appreciate your time and expertise!
Dr. Iglesias Puzas: Thank you for the opportunity to discuss psoriasis and its treatments. It’s been a pleasure!
