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EDITORIAL
Year : 2022 | Volume
: 40
| Issue : 2 | Page : 65-66
The other side of biologics for psoriasis
Chao-Chun Yang
Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
Correspondence Address:
Dr. Chao-Chun Yang
Department of Dermatology, National Cheng Kung University Hospital, 138 Sheng Li Rd., 704 Tainan
Taiwan
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ds.ds_29_22
The treatment for moderate-to-severe chronic plaque psoriasis advances greatly on account of the introduction of biologics in recent years. The list of biologics expanded rapidly, from anti-tumor necrosis factor-alpha (TNF-α), anti-interleukin (IL)-12/23, and anti-IL17 to anti-IL-23. As the biologics evolve, the treatment efficacy for psoriasis increased dramatically.[1] Almost or complete clearance of skin lesions could be achieved in a significant proportion of psoriasis patients by the use of biologics.[2]
Despite the great advancement in treatment efficacy, the safety profiles and economic burden of biologics are also important issues to be considered when applying these updated treatments to psoriasis patients.[3],[4] Among the side effects, the activation of latent tuberculosis (TB) gained much attention, especially in countries with higher prevalence of TB, owing to its frequent association with the use of anti-TNF-α. In this issue of Dermatologica Sinica, Huang and Tsai demonstrated that an extremely low rate of seroconversion (<1%) in patients using anti-IL-23 biologics, including guselkumab and risankizumab, for more than 1 year,[5] and reactivation of latent TB was not found. The findings suggested a low risk of TB infection or reactivation of anti-IL23 biologics.
COVID-19 pandemic has a profound impact on the medical system and the strategies to cope with this new infection are increasingly demanded. In patients with immune-mediated inflammatory diseases, the adjustment of ongoing medications, including biologics and immunosuppressants, when COVID-19 infection is confirmed, is critical and increasingly encountered. A review article in this issue of Dermatologica Sinica provides the state-of-the-art information on this question.[6]
Intralesional injection of triamcinolone acetonide for alopecia areata is a common clinical practice but debates exist regarding the concentration for optimal efficacy and a low rate of adverse effect such as skin atrophy. Su et al. conducted a meta-analysis on this topic and an optimal concentration of triamcinolone acetonide was suggested.[7]
The connection between brain and skin may be more intense than you thought, due to their common ectodermal origin. The diagnosis of skin diseases relies on the visible morphological signs but a comprehensive care requires careful approaches to the internal invisible symptoms. In this issue of Dermatologica Sinica, Bondade et al. provided a review on the “skin-brain axis” and its impact on dermatological practice.[8]
The way to a comprehensive and effective dermatological management is there, when you look at the other side of diseases and treatments.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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