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1 Treatment of Psoriasis Jai Il Youn, M.D. Department of Dermatology Seoul National University College of Medicine & Hospital E mail : jaiil@snu.ac.kr Abstract Psoriasis is a common, chronic skin disease. The goal of therapy is always to use the appropriate medication to achieve the desired effect while minimizing side effect. The three types of traditional therapies for treatment of psoriasis are topical therapies, phototherapies and systemic therapies. Topical steroid, vit D derivatives are frequently prescribed with other agents. Broad band UVB, PUVA and narrow band UVB therapies are most commonly used phototherapy. Three main systemic agents now used for moderate to severe psoriasis are retinoid, cyclosporine and methotrexate. Psoriasis is recently found to be an T cell mediated immunologic disease. This lead to the developing new targeted immunobiologic agents.the newer biologic agents appear to combine greater efficacy of treatments with less toxicity by targeting T cell activation or specific mediator, TNF. Keywords : Psoriasis; Phototherapy; Retinoid; Cyclosporine; Biologics 150

2 Type of psoriasis treatment Topical agents in the treatment of psoriasis Factors influencing choice of psoriasis therapy Side reactions of topical steroid 151

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4 Phototherapeutic agents in the treatment of psoriasis 153

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6 Systemic agents in the treatment of psoriasis 155

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8 Strategies for biologic therapies of psoriasis T alefacept T efalizumab, alefacept Th1/Th2 IL 10 TNF etanercept, infliximab 157

9 :, 1996: Krueger JG. The immunologic basis for the treatment of psoriasis with new biologic agents. J Am Acad Dermatol 2002; 46: Dubertret L. Psoriasis from clinic to therapy. 1st ed. Paris: Medcom, 2005: Seville RH. Advances in the use of anthralin. J Am Acad Dermatol 1981; 5: Montes LF, Wilborn WH, Brody I. Low strength anthralin in Psoriasis. J Cut Pathol 1979; 6: Farber EM, Abel EA, Charuworn A. Recent advances in the treatment of psoriasis. J Am Acad Dermatol 1983; 8: Scott LJ, Dunn CJ, Goa KL. Calcipotriol ointment. A review of its use in the management of psoriasis. Am J Clin Dermatol 2001; 2: Park SB, Suh DH, Youn JI. A pilot study to assess the safety and efficacy of topical calcipotriol treatment in childhood psoriasis. Ped Dermatol 1999; 16: Langner A, Verjans H, Sfapor V, Molt M. 1, 25 dihydroxy vitamin D3 (Clcitriol) ointment in psoriasis. J Dermatol Treat 1992; 3: ,,. Calcitriol. 2005; 43: Marks R. The role of tazarotene in the treatment of psoriasis. 158

10 Brit J Dermatol 1999; 140(Suppl): LeVine MJ, White HA, Parrish JA. Components of the Goeckerman regimen. J Invest Dermatol 1979; 73: Ingram JT. The approach to psoriasis. Br Med J 1953; 2: LeVine MJ, Parrish JA. Outpatient phototherapy of psoriasis. Arch Dermatol 1980; 116: Parrish JA, Fitzapatrick TB, Tannenbaum L, Pathak MA. Photochemotherapy of psoriasis with oral methoxsalen and longwave ultraviolet light. New Eng J Med 1974; 291: British Photodermatology Group guidelines for PUVA. Br J Dermatol 1994; 130: Stern RS, Lange R. Non melanoma skin cancer occurring in patients treated with PUVA five to ten years after first treatment. J Invest Dermatol 1988; 91: Parrish JA, Jaenicke KF. Action spectrum for phototherapy of psoriasis. J Invest Dermatol 1981; 76: Van Weelden H, Faille B, Young E, Van der Leun JC. A new development in UVB phototherapy of psoriasis. Brit J Dermatol 1988; 119: Walters IB, Burack LH, Coven TR, Gilleaudean P, Krueger G. Suberythemogenic narrow band UVB is markedly more effective than conventional UVB in treatment of psoriasis vulgaris. J Am Acad Dermatol 1999; 40: Lowe NJ, Prystowsky JH, Bourget T, Edelstein J, Nychay S, Armstrong R. Acitretin plus UVB therapy for psoriasis; comparisons with placebo plus UVB and acitretin alone. J Am Acad Dermatol 1991; 24: Lebwohl M, Ellis C, Gottlieb A, Koo J, Krueger G, Linden K, et al. Cyclosporine consensus conference: with emphasis on the treatment of psoriasis. J Am Acad Dermatol 1998; 39: Lebwohl M, Ali S. Treatment of psoriasis. Part 2. systemic therapies. J Am Acad Dermatol 2001; 45: Roenigk HH Jr, Maibach HI, Weinstein GD. Guidelines on methotrexate therapy for psoriasis. Arch Dermatol 1972; 105: Roenigk HH Jr, Maibach HI, Weinstein GD. Methotrexate therapy for psoriasis: guideline revisions. Arch Dermatol 1973; 108: Roenigk HH Jr, Auerbach R, Maibach HI, Weinstein GD. Methotrexate guidelines revised. J Am Acad Dermatol 1982; 6: Sterry W, Barker J, Boehncke WH, Boss JD, Chimenti S, Voorhees. Biological therapy in the systemic managements of psoriasis: International consensus conference. Brit J Dermatol 2004; 151: Lebwohl M, Christophers E, Langley R, Ortonne JP, Roberts J, Griffiths CEM. An international, randomized, double blind, placebo controlled phase 3 trial of intramuscular alephacept in patients with chronic plaque psoriasis. Arch Dermatol 2003; 139: Leonardi CL, Papp KA, Gordon KB, Menter A, Feldmann SR, Gottlieb AB, et al. Extended efalizumab therapy improves chronic plaque psoriasis: Results from a randomized phase III trial. J Am Acad Dermatol 2005; 52:

11 30. Goffe B, Cather JC. Etanercept : An overview. J Am Acad Dermatol 2003; 49: S Chaudhari U, Romano P, Mulcahy LD, Dooley LT, Baker DG, Gottlieb AB. Efficacy and safety of infliximab monotherapy for plaque type psoriasis: a randomised trial. Lancet 2001; 357: Peer Reviewer Commentary 160

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A 617 Special Issue Diabetic Retinopathy Won Ki Lee, M.D. Department of Ophthalmology The Catholic University of Korea College of Medicine Kangnam St. Mary s Hospital E mail : wklee@catholic.ac.kr Abstract R