Biologics in Psoriasis

As a better understanding of cutaneous diseases has been gained, more specific, targeted therapies have emerged. More recently, many of the T-cell immune mediated inflammatory changes seen in psoriasis have been elucidated, leading to the development of biologics that specifically act on immunological mechanisms, which are thought to be pathogenic in psoriatic lesions. By acting on specific immunological actions in the large cascade that results in psoriasis, many of the systemic toxicities that accompanied older treatments such as methotrexate and cyclosporinemay be avoided. Currently, there are three biologics approved in the United States for the treatment of psoriasis including alefacept, efalizumab, and etanercept, with several others currently under clinical investigation. A summary of the biologics currently used for the treatment of psoriasis can be found in Table 9.1.