Keck School of Medicine, Department of Dermatology, University of Southern California Los Angeles.
Department of Medicine, Imperial College London, London, United Kingdom.
JAMA. 2020 May 19;323(19):1945-1960. doi: 10.1001/jama.2020.4006.
Approximately 125 million people worldwide have psoriasis. Patients with psoriasis experience substantial morbidity and increased rates of inflammatory arthritis, cardiometabolic diseases, and mental health disorders.
Plaque psoriasis is the most common variant of psoriasis. The most rapid advancements addressing plaque psoriasis have been in its pathogenesis, genetics, comorbidities, and biologic treatments. Plaque psoriasis is associated with a number of comorbidities including psoriatic arthritis, cardiometabolic diseases, and depression. For patients with mild psoriasis, topical agents remain the mainstay of treatment, and they include topical corticosteroids, vitamin D analogues, calcineurin inhibitors, and keratolytics. The American Academy of Dermatology-National Psoriasis Foundation guidelines recommend biologics as an option for first-line treatment of moderate to severe plaque psoriasis because of their efficacy in treating it and acceptable safety profiles. Specifically, inhibitors to tumor necrosis factor α (TNF-α) include etanercept, adalimumab, certolizumab, and infliximab. Other biologics inhibit cytokines such as the p40 subunit of the cytokines IL-12 and IL-13 (ustekinumab), IL-17 (secukinumab, ixekizumab, bimekizumab, and brodalumab), and the p19 subunit of IL-23 (guselkumab, tildrakizumab, risankizumab, and mirikizumab). Biologics that inhibit TNF-α, p40IL-12/23, and IL-17 are also approved for the treatment of psoriatic arthritis. Oral treatments include traditional agents such as methotrexate, acitretin, cyclosporine, and the advanced small molecule apremilast, which is a phosphodiesterase 4 inhibitor. The most commonly prescribed light therapy used to treat plaque psoriasis is narrowband UV-B phototherapy.
Psoriasis is an inflammatory skin disease that is associated with multiple comorbidities and substantially diminishes patients' quality of life. Topical therapies remain the cornerstone for treating mild psoriasis. Therapeutic advancements for moderate to severe plaque psoriasis include biologics that inhibit TNF-α, p40IL-12/23, IL-17, and p19IL-23, as well as an oral phosphodiesterase 4 inhibitor.
全球约有 1.25 亿人患有银屑病。银屑病患者有大量的发病率和增加的炎症性关节炎、心血管代谢疾病和心理健康障碍的发生率。
斑块状银屑病是银屑病最常见的类型。在银屑病的发病机制、遗传学、合并症和生物治疗方面取得了最快的进展。斑块状银屑病与许多合并症有关，包括银屑病关节炎、心血管代谢疾病和抑郁症。对于轻度银屑病患者，局部治疗仍然是主要的治疗方法，包括局部皮质类固醇、维生素 D 类似物、钙调神经磷酸酶抑制剂和角质松解剂。美国皮肤病学会-国家银屑病基金会指南建议将生物制剂作为中度至重度斑块状银屑病一线治疗的选择，因为它们在治疗该病方面的疗效和可接受的安全性。具体来说，肿瘤坏死因子-α（TNF-α）抑制剂包括依那西普、阿达木单抗、certolizumab 和英夫利昔单抗。其他生物制剂抑制细胞因子，如细胞因子 IL-12 和 IL-13 的 p40 亚单位（乌司奴单抗）、IL-17（司库奇尤单抗、依奇珠单抗、倍他米罗单抗和布罗达单抗）和 IL-23 的 p19 亚单位（古塞库单抗、替利珠单抗、瑞莎珠单抗和米利珠单抗）。抑制 TNF-α、p40IL-12/23 和 IL-17 的生物制剂也被批准用于治疗银屑病关节炎。口服治疗包括传统药物，如甲氨蝶呤、阿维 A、环孢素和新型小分子阿普米司特，它是一种磷酸二酯酶 4 抑制剂。最常用于治疗斑块状银屑病的光疗是窄谱 UV-B 光疗。
银屑病是一种炎症性皮肤病，与多种合并症相关，并大大降低了患者的生活质量。局部治疗仍然是治疗轻度银屑病的基石。中重度斑块状银屑病的治疗进展包括抑制 TNF-α、p40IL-12/23、IL-17 和 p19IL-23 的生物制剂，以及一种口服磷酸二酯酶 4 抑制剂。
