Biological treatment of psoriasis

Abstract Psoriasis is the most common, inflammatory, chronic skin disease, with possible systemic manifestations. It affects about 2-3% of the population and is equally common in women and men. Many factors, such as environmental, hormonal, genetic and immunological, play a role in the development of psoriasis. Interleukin 22 and 23 (IL-22, IL-23) as well as tumor necrosis factor alpha (TNF-α) play an important role in the pathogenesis of this disease. The cause of psoriatic lesions is uncontrolled excessive proliferation of the epidermis, accompanied by parakeratosis and increased expression of transforming growth factor α (TGF-α), a ligand of the epidermal growth factor receptor (EGF). The treatment choice for psoriasis depends on the severity of the disease as assessed on available scales. In the first place, topical medications are used to treat this disease. More advanced external treatments include phototherapy (ultraviolet radiation type B - UVB) or psoralen plus ultraviolet radiation type A (UVA). A patient with severe psoriasis can be treated with systemic medications such as methotrexate, cyclosporine, acitretin, and biological drugs. The decision to use biologics should be carefully considered, based on the clinic and the patient's individual risk profile. The types of biological drugs for the treatment of psoriasis are selected depending on the severity of the disease and comorbidities. The main indication for biological treatment is moderate to severe psoriasis. Groups of biological drugs have been distinguished on the basis of their mechanisms of action. These are: tumor necrosis factor α (Tumor Necrosis Factor-α TNF-α) inhibitors, IL-17 / IL-23 p40 inhibitors, IL-17A inhibitors, IL-17 receptor A, IL-23 p19. The studies conducted so far indicate the well-documented safety and tolerability of biological drugs used in psoriasis. Biological therapy, despite the possibility of side effects, is considered a safe, well-tolerated and the preferred therapeutic method, especially in patients with moderate to severe psoriasis.