Pharmacological and non-pharmacological methods of psoriasis therapy with particular emphasis on biopharmaceuticals

Abstract

Psoriasis is a chronic, inflammatory and recurrent skin disease of an autoimmune nature. Genetic, behavioral and environmental factors influence the onset, course and severity of skin lesions. Precursor factors conditioning the formation of psoriatic lesions may include, among others, strong psychological stress, trauma, acute infection - mainly infections caused by Streptococcus species, surgery, hormonal changes, as well as alcohol abuse, smoking, and taking certain medications. In the course of psoriasis, increased proliferation of mainly keratinocytes is observed at the tissue level, while increased secretion of proinflammatory cytokines and adipokines is observed molecularly. The goal of psoriasis treatment is to reduce clinical changes, prolong remission, prevent complications, and restore the patient's life and professional fitness. The choice of treatment should enable control of the course of the disease while reducing side effects that may negatively affect the patient's life. Due to, among others, the genetic conditions underlying the disease, complete recovery is not possible, resulting in frequent relapses. The choice of method depends on the severity of skin lesions, the frequency of relapses and the course of the disease. In order to assess the severity of psoriatic lesions and choose the appropriate treatment, measuring scales are used, which are mainly based on the physician's visual assessment of psoriatic lesions and the patient's subjective feelings. However, one correct treatment regimen cannot be demonstrated, and each therapy should be individually tailored to the patient. In the treatment of psoriasis, PUVA photo chemotherapy, UVB irradiation, photo protection, glucocorticosteroids, retinoids, vitamin D analogues, reducing agents, keratotic agents, and immunosuppressant - cyclosporin, methotrexate and hydroxycarbamide as well as biological therapy affecting specific mediators of immune reactions are used. Unfortunately, despite the molecularly targeted treatment, the phenomenon of drug resistance is observed.