Immunomodulatory drugs for psoriasis

doi:10.1136/bmj.327.7416.634

BMJ 2003;327:634-635 (20 September), doi:10.1136/bmj.327.7416.634

Editorial

Immunomodulatory drugs for psoriasis

New "biologics" offer much promise

The first 150 words of the full text of this article appear below.

With a prevalence of 2-3%, psoriasis is among the most commonskin diseases. Clinical hallmarks comprise erythematous plaquescovered by silvery scaling and a chronic recurrent course. Psoriasisis now considered an autoimmune disease in which antigen presentationto cutaneous T helper cells triggers secretion of cytokines,causing proliferation of keratinocytes and expression of adhesionmolecules on endothelial cells. These attract additional effectorT cells from the circulation, which are then activated in anantigen specific manner, leading to secretion of more cytokinesand perpetuation of the process.¹

Although topical treatments are sufficient for many patients,about 20% need additional systemic drugs. All of these beara considerable potential for serious side effects, such as hepatotoxicityand nephrotoxicity (methotrexate, cyclosporine),^2
3 teratogenicity(oral retinoids),⁴ and cancer (PUVA, which is psoralen and longwave ultraviolet radiation; cyclosporine),^5
6 which limits theirlong term use. The limitations of treatments on the one handand . . . [Full text of this article]