[A case of excellent response to efalizumab. Experience in the University Hospital of Salamanca].

Before initiating treatment with efalizumab, or with any other biological treatment, it is necessary to use objective assessment techniques that allow us to evaluate the activity on course of psoriasis, thus being able to justify the indication of biological therapy and to evaluate the percentage of response to treatment, loss of response or its possible inefficacy. In spite of its limitations, Psoriasis Area and Severity Index (PASI) is the best available option. The definition of moderate psoriasis has been proposed as beginning with a baseline PASI = 7 while serious psoriasis has a score of, according to the different authors, 10 or 12. In the usual clinical practice, other parameters must also be evaluated in the definition of the seriousness of psoriasis and in the indication of establishing a systemic treatment since some forms of psoriasis have a more aggressive course (erythrodermic psoriasis, pustulous psoriasis) and there are locations (head, genitals, hands, etc.) that interfere more intensely with the quality of life of the patients, with increase of social dysfunction, physical incapacity and psychological deterioration. All of the patients treated with biological therapy in our hospital site fulfill the criteria established by the European Medicines Evaluation Agency (EMEA): adult patients with psoriasis in chronic moderate-to-serious ones who have not responded or in its use is contraindicated or who do not tolerate another systemic therapy, including, cyclosporine, methotrexate or phototherapy.