Editorials

Immunomodulatory drugs for psoriasis

BMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7416.634 (Published 18 September 2003) Cite this as: BMJ 2003;327:634
  1. Wolf-Henning Boehncke, professor ([email protected])
  1. Department of Dermatology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany

    New “biologics” offer much promise

    With a prevalence of 2-3%, psoriasis is among the most common skin diseases. Clinical hallmarks comprise erythematous plaques covered by silvery scaling and a chronic recurrent course. Psoriasis is now considered an autoimmune disease in which antigen presentation to cutaneous T helper cells triggers secretion of cytokines, causing proliferation of keratinocytes and expression of adhesion molecules on endothelial cells. These attract additional effector T cells from the circulation, which are then activated in an antigen specific manner, leading to secretion of more cytokines and perpetuation of the process.1

    Although topical treatments are sufficient for many patients, about 20% need additional systemic drugs. All of these bear a considerable potential for serious side effects, such as hepatotoxicity and nephrotoxicity (methotrexate, cyclosporine),2 3 teratogenicity (oral retinoids),4 and cancer (PUVA, which is psoralen and long wave ultraviolet radiation; cyclosporine),5 6 which limits their long term use. The limitations of treatments on the one hand and a growing understanding …

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