Antipsoriatics

Agents for the treatment of psoriasis; a distinction is made between agents for external and internal treatment.

• For external therapy, the following substances are used in particular: dithranol, vitamin D derivatives, tazarotenes, keratolytics, tars, PUVA bath therapy, PUVA cream therapy, selective ultraviolet phototherapy, UV radiation, photosol therapy, glucocorticoids.
• The following substances are available internally:
• Fumaric acid ester
• Acitretin
• Methotrexate
• Ciclosporin A
• Glucocorticoids
• Etanercept
• Infliximab (monoclonal antibody against TNF alpha): The first Infliximab biosimilar has been available in Germany since February 2015.
• Etanercept
• Adalimumab

• Golinumab

• certolizumab pegol

• Apremilast

• Guselkumab (humanized antibody directed against interleukin-23: ) Interleukin-23 activates the proliferation of T cells (T-helper cells, Th-17 cells), NK cells and possibly macrophages and osteoclasts. After binding to its receptor, the JAK/STAT signalling cascade is activated and the phosphoinositid-3-kinase ( PI3K ) of RAC-alpha serine/threonine kinase (AKT) and NF-kappaB is triggered. The IL-23 antibody is able to reduce the number of pathological Th17 cells.

  Guselkumab is approved as an effective treatment option for moderate to severe psoriasis. The antibody is injected subcutaneously and can be used as first-line therapy in adult patients with moderate to severe plaque psoriasis since November 2017.

  The human IgG antibody ustekinumab (as well as briakinumab) binds to the common p40 subunit of unbound IL-12 and -23 and inhibits their binding to the common receptor IL-12R on the surface of naive T cells. Both cytokines promote T-cell differentiation into mature Th1 and Th17 cells and their release of TNF-α and IFN-γ. Ustekinumab inhibits T-cell differentiation and the release of proinflammatory cytokines and is highly effective in psoriasis and psoriasiarthritis.

  Secukinumab (SEC) is the first IL-17-A inhibitor approved for psoriasis and psoriatic arthritis.

The treatment depends on the clinic and the problems of the individual patient, s.a. psoriasis, s.a.u. psoriasis vulgaris.