Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland.
Clin Rev Allergy Immunol. 2018 Feb;54(1):102-113. doi: 10.1007/s12016-018-8668-1.
Over the last decade, the management of psoriasis has witnessed a paradigm shift. Thanks to the increasing knowledge about the pathogenesis of psoriasis, targeted treatments with monoclonal antibodies have been developed. These antibodies, which target the pathogenic TNF/IL-23/IL-17-pathway, were shown to be safe and efficacious in the management of most patients with moderate to severe chronic plaque psoriasis. Recently, molecular and genetic studies in pustular and erythrodermic psoriasis have identified additional inflammatory pathways, providing evidence that psoriasis is a heterogeneous disease and highlighting the requirement for personalized disease characterization for treatment optimization. In this article, we will review these advances and provide an update on the currently available treatment arsenal. We discuss the efficacy and safety profile of these individual therapeutic agents and describe their use in special indications. We will also describe the current understanding of psoriasis as a systemic disease associated with multiple comorbidities and illustrate its impact in the management of psoriatic patients. Finally, we discuss ongoing therapeutic developments as well as unmet needs and future perspectives in the field of psoriasis.
在过去的十年中，银屑病的治疗方法发生了重大转变。由于对银屑病发病机制的认识不断增加，已开发出针对单克隆抗体的靶向治疗方法。这些针对致病 TNF/IL-23/IL-17 通路的抗体已被证明在治疗大多数中重度慢性斑块型银屑病患者中是安全有效的。最近，脓疱型和红皮病型银屑病的分子和遗传学研究确定了其他炎症途径，这为银屑病是一种异质性疾病提供了证据，并强调了为优化治疗而进行个体化疾病特征描述的必要性。在本文中，我们将回顾这些进展，并提供目前治疗方法的最新信息。我们讨论了这些治疗药物的疗效和安全性，并描述了它们在特殊适应症中的应用。我们还将描述目前对银屑病作为一种与多种合并症相关的系统性疾病的认识，并说明其对银屑病患者管理的影响。最后，我们讨论了正在进行的治疗进展以及该领域未满足的需求和未来展望。
