Di Cesare Antonella, Ricceri Federica, Rosi Elia, Fastame Maria Thais, Prignano Francesca
Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy.
Biomedicines. 2022 Nov 10;10(11):2879. doi: 10.3390/biomedicines10112879.
Psoriasis is a chronic, inflammatory skin disease that may occur at any age, with a bimodal peak of incidence around the age of 16-20 years of age (early onset) and 57-60 years (late-onset). It is estimated that roughly 70% of patients develop the disease before the age of 40, which coincides with the reproductive years. Moreover, psoriasis is a chronic disease, meaning that, with increased life-duration expectancy, the number of patients affected with psoriasis aged over 65 years is going to increase and represent a big therapeutic challenge. Actually, no specific drug recommendation is available, based only on the age of the patients, while therapeutic prescription should take into account that elderly patients have more comorbidities than younger patients, with polypharmacy and an increased risk of drug interactions. Women with psoriasis are more likely to report a worse influence of the disease on their quality of life, and they are more susceptible to the development of depression. Furthermore, pregnancy and lactation represent a major contraindication to several systemic agents, and only a few studies exist providing the safety of certain drugs during these periods of life of a woman, such as certolizumab pegol. In this paper, we discuss systemic therapeutic strategies, including conventional and biological therapies, in a special subset of patients affected with moderate-to-severe psoriasis focusing on elderly patients and on female patients in fertile age, pregnancy, and lactation.
银屑病是一种慢性炎症性皮肤病，可发生于任何年龄，发病有两个高峰，分别在16 - 20岁左右（早发型）和57 - 60岁（晚发型）。据估计，约70%的患者在40岁之前发病，这与生育年龄相符。此外，银屑病是一种慢性病，这意味着随着预期寿命的延长，65岁以上银屑病患者的数量将会增加，这构成了一个巨大的治疗挑战。实际上，仅根据患者年龄并无具体的用药建议，而治疗处方应考虑到老年患者比年轻患者有更多的合并症，存在多种药物联合使用及药物相互作用风险增加的情况。患银屑病的女性更有可能报告该疾病对其生活质量有更严重的影响，且她们更容易患抑郁症。此外，妊娠和哺乳期是多种全身用药的主要禁忌证，仅有少数研究提供了某些药物在女性这些生命阶段（如赛妥珠单抗）的安全性。在本文中，我们讨论了针对中重度银屑病患者的一个特殊亚组（重点关注老年患者以及育龄期、妊娠和哺乳期的女性患者）的全身治疗策略，包括传统疗法和生物疗法。
