Treatments for severe psoriasis

Abstract

Methotrexate, cyclosporin, acitretin and narrowband ultraviolet B phototherapy help most patients with severe psoriasis. However, toxicity tends to limit the dose and duration of therapy, so other treatments are being developed. Biological therapies of proven benefit in severe psoriasis include etanercept, adalimumab and infliximab, which target tumour necrosis factor. Lymphocytes are the target of other therapies including efalizumab and alefacept. Biological therapies have a range of safety concerns which differ from, but overlap with, those of other systemic treatments for psoriasis. In Australia, the Pharmaceutical Benefits Scheme subsidises therapeutic trial of approved biological therapies in severe psoriasis if traditional therapies are insufficiently effective or are contraindicated by intercurrent disease or adverse effects. ongoing therapy is only subsidised for patients whose psoriasis significantly improves. Care must be taken when withdrawing efalizumab or cyclosporin in case of rebound disease.