• electrostimulation
• psoriasis

• Psoriasis/therapy
• Humans
• Electric Stimulation Therapy/methods
• Cytokines/metabolism
• Animals
• Signal Transduction
• Cyclic AMP/metabolism

• 2023-JC-YB-746 the Natural Science Basic Research Plan in Shaanxi Province of China
• 32071517 the National Natural Science Foundation of China

• Nonbiologic
• oral
• pharmacodynamics
• pharmacokinetics
• psoriasis
• safety

• Humans
• Administration, Oral
• Dermatologic Agents/pharmacokinetics
• Dermatologic Agents/pharmacology
• Dose-Response Relationship, Drug
• Drug Monitoring/methods
• Polymorphism, Genetic
• Precision Medicine/methods
• Psoriasis/drug therapy
• Psoriasis/genetics
• Severity of Illness Index

• Humans
• Methotrexate/therapeutic use
• Interleukin-17
• Tumor Necrosis Factor-alpha
• Psoriasis/drug therapy
• Cyclosporine
• Biological Factors/therapeutic use
• Biological Products/pharmacology
• Biological Products/therapeutic use
• Cytochrome P-450 Enzyme System
• Treatment Outcome
• Thalidomide/analogs & derivatives

• Autophagy
• Phytochemicals
• Psoriasis

• Animals
• Humans
• Psoriasis/drug therapy
• Autophagy
• Skin
• China
• Databases, Factual

• Inflammatory pathways
• Insulin resistance
• Non-alcoholic fatty liver disease
• Pathogenesis
• Psoriatic disease

• Humans
• Non-alcoholic Fatty Liver Disease
• Metabolic Syndrome/complications
• Obesity/complications

• K23 DK119460 NIDDK NIH HHS
• R01 AR073324 NIAMS NIH HHS
• UL1 TR001442 NCATS NIH HHS
• P42 ES010337 NIEHS NIH HHS
• P30 DK120515 NIDDK NIH HHS
• R01 DK124318 NIDDK NIH HHS
• U01 DK061734 NIDDK NIH HHS
• P01 HL147835 NHLBI NIH HHS
• R01 DK121378 NIDDK NIH HHS
• R01 DK106419 NIDDK NIH HHS

• nanocarriers
• novel drug delivery systems
• psoriasis
• topical therapy
• transdermal

• Cyclosporine
• facial sebopsoriasis
• low dose
• recalcitrant

• Chronic plaque psoriasis
• combination therapy
• methotrexate and cyclosporine
• randomised controlled trial

• Adverse events
• Drug survival
• Long-term
• Psoriasis
• Safety
• Systemic therapy

• Almirall S.A.

• biologics
• cyclosporine
• methotrexate
• psoriasis
• tapering

• Cyclosporine/adverse effects
• Dermatologic Agents/adverse effects
• Humans
• Methotrexate/adverse effects
• Psoriasis/diagnosis
• Psoriasis/drug therapy
• Quality of Life
• Severity of Illness Index

• Clinical guidelines for psoriasis
• dermatology
• nonbiologic systemic
• psoriasis
• psoriasis guidelines
• skin disease

• Acitretin/therapeutic use
• Cyclosporine/therapeutic use
• Drug Monitoring
• Humans
• Methotrexate/therapeutic use
• Piperidines/therapeutic use
• Psoriasis/drug therapy
• Pyrimidines/therapeutic use
• Thalidomide/analogs & derivatives
• Thalidomide/therapeutic use

• Administration, Oral
• Administration, Topical
• Biological Therapy
• Humans
• Immunosuppressive Agents/therapeutic use
• Phototherapy
• Psoriasis/therapy
• Treatment Outcome

Research on psoriasis pathogenesis has largely increased knowledge on skin biology in general. In the past 15 years, breakthroughs in the understanding of the pathogenesis of psoriasis have been translated into targeted and highly effective therapies providing fundamental insights into the pathogenesis of chronic inflammatory diseases with a dominant IL-23/Th17 axis. This review discusses the mechanisms involved in the initiation and development of the disease, as well as the therapeutic options that have arisen from the dissection of the inflammatory psoriatic pathways. Our discussion begins by addressing the inflammatory pathways and key cell types initiating and perpetuating psoriatic inflammation. Next, we describe the role of genetics, associated epigenetic mechanisms, and the interaction of the skin flora in the pathophysiology of psoriasis. Finally, we include a comprehensive review of well-established widely available therapies and novel targeted drugs.

• chronic skin disease
• inflammation
• psoriasis

Psoriasis is a chronic inflammatory disease. In the treatment of psoriasis, cyclosporine is commonly prescribed systemic agents. However, long-term use of cyclosporine is not recommended because of side effects such as nephrotoxicity or hypertension.

To ascertain the improved safety of rotational therapy using cyclosporine and methotrexate, we investigated the frequency of abnormal results in laboratory test after long term rotational therapy using cyclosporine and methotrexate.

From January 2009 to June 2014, patients who were treated with cyclosporine or methotrexate were enrolled. The clinical data and usage of medications were reviewed. Laboratory tests were conducted before starting the treatment and regularly follow-up. The occurrences of any laboratory abnormalities during the treatments were investigated.

A total of 21 psoriatic patients were enrolled. The mean of medication period and cumulative dose of cyclosporine and methotrexate were 497.81±512.06 days and 115.68±184.34 g in cyclosporine and 264.19±264.71 days and 448.71±448.63 mg in methotrexate. Laboratory abnormalities were found in total two patients after rotational therapy: two patients (9.5%) in aspartate aminotransferase/alanine aminotransferase and one patient (4.8%) in uric acid. No laboratory abnormalities were found in renal function test.

We found that the rotational approaches using cyclosporine and methotrexate reduced the possibility of the development of nephrotoxicity. In addition to other advantage such as quick switching from one agent to another, the rotational therapy using cyclosporine and methotrexate can minimize the adverse events during the systemic treatment of chronic plaque psoriasis.

• Clinical chemistry tests
• Combined modality therapy
• Cyclosporine
• Methotrexate
• Psoriasis

Psoriasis is a potentially debilitating inflammatory dermatosis affecting 0.2%-4.8% of the population worldwide causing a significant occupational, personal or psychosocial morbidity to these patients for life. The basic aim of psoriasis therapy is to control the disease to maximum possible extent and improve the patient’s quality of life. Management of triggers for flare-ups, lifestyle modifications, and dietary supplements are often recommended. Intermittent or rotational therapy with frequent alterations in treatment options is usually needed to reduce toxicity of anti-psoriatic drugs in the absence of safer alternatives. Currently, several biological agents categorized as either T-cell targeted (e.g., Alefacept, Efalizumab) or cytokine modulating (e.g., Adalimumab, Infliximab, Etanercept) are available for treating severe psoriasis. However, their high cost is often precluding for most patients. The usefulness of systemic (methotrexate, cyclosporine, acitretin or several other therapeutic agents) or topical (tar, anthralin, corticosteroids or calcipotriol ointments, phototherapy with or without psoralens) therapies has been well established for the management of psoriasis. The literature is also replete with benefits of less used non-standard and unconventional treatment modalities (hydroxycarbamide, azathioprine, leflunomide, mycophenolate mofetil, isotretinoin, fumarates, topical calcineurin inhibitors, peroxisome proliferator-activated receptors agonists, statins, sulfasalazine, pentoxifylline, colchicine, grenz ray therapy, excimer laser, climatotherapy and balneophototherapy, peritoneal dialysis, tonsillectomy, ichthyotherapy, etc.). These can be used alternatively to treat psoriasis patients who have mild/minimal lesions, are intolerant to conventional drugs, have developed side effects or achieved recommended cumulative dose, where comorbidities pose unusual therapeutic challenges, or may be as intermittent, rotational or combination treatment alternatives.

• Acetretin
• Azathioprine
• Balneophototherapy
• Calcineurin inhibitors
• Calcipotriol
• Calcium dobesilate
• Climatotherapy
• Colchicine
• Cyclosporine
• Dapsone
• Excimer laser
• Fumarates
• Grenz ray therapy
• Hydroxycarbamide
• Ichthyotherapy
• Isotretinoin
• Leflunamide
• Methotrexate
• Mycophenolate mofetil
• Pentoxifylline
• Peritoneal dialysis
• Phototherpy
• Plaque psoriasis
• Peroxisome proliferator-activated receptors agonists
• Statins
• Sulfasalazine
• Tonsillectomy

• Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Antibodies, Monoclonal/administration & dosage
• Antibodies, Monoclonal/adverse effects
• Antibodies, Monoclonal/therapeutic use
• Arthritis, Psoriatic/diagnosis
• Arthritis, Psoriatic/drug therapy
• Arthritis, Psoriatic/genetics
• Arthritis, Psoriatic/immunology
• Clinical Trials as Topic
• Drug Therapy, Combination
• Early Diagnosis
• Glucocorticoids/administration & dosage
• Glucocorticoids/adverse effects
• Glucocorticoids/therapeutic use
• Humans
• Immunosuppressive Agents/administration & dosage
• Immunosuppressive Agents/adverse effects
• Immunosuppressive Agents/therapeutic use
• Practice Guidelines as Topic
• Psoriasis/diagnosis
• Psoriasis/drug therapy
• Psoriasis/genetics
• Psoriasis/immunology

Cyclosporine A (CsA) is one of the most effective systemic drugs available for the treatment of psoriasis, as evidenced by the results of several randomized studies and by a prolonged experience in dermatological setting. In clinical practice, CsA is usually used for the induction of psoriasis remission at a daily dose included in the range of 2.5–5 mg/kg and with intermittent short-term regimens, lasting on average 3–6 months. The magnitude and rapidity of response are dose dependent, as well as the risk of development of adverse events. Therefore, the dose should be tailored to patient's needs and general characteristics and adjusted during the treatment course according to both the efficacy and tolerability. Some studies support the feasibility of pulse administration of CsA for a few days per week for both the induction and the maintenance of response in psoriasis patients. This paper will review the data on CsA regimens for plaque-type psoriasis and will focus the attention on dose, treatment duration, novel schedules, and role in combination therapies, including the association with biologicals.

Apart from clinical outcomes, the "real-world" outcomes of intermittent short-course cyclosporine treatment remain poorly documented.

To evaluate various outcomes of short-course cyclosporine treatment for severe psoriasis; and to describe dermatologists' use of the Rule of Tens.

A 12-week pharmacoepidemiological study; 112 evaluable patients recruited by 43 dermatologists.

The mean initial cyclosporine dose was 2.88±0.74 mg/kg/day. At 12 weeks, 64.3% of patients were continued beyond the study period at mean dose of 2.51±0.91 mg/kg/day. Percent body surface affected, Psoriasis Area Severity Index score, and patient and physician rating of psoriasis severity decreased significantly, while quality of life (QoL) improved significantly. Median patient satisfaction at 12 weeks was 85 (0~100 scale). Patient-reported non-adherence was 43.9% and 56.1%, respectively at both the time points (p=0.18). In modeling on logarithmized outcomes variables, living along was consistently the single most important (negative) determinant of therapeutic and patient outcomes. Safety and tolerance parameters were similar to the ones reported in the literature. Only 7.3% of physicians correctly identified the measures included in the Rule of Tens and the Rule's criterion for inferring severe psoriasis.

With adequate monitoring and patient adherence, cyclosporine treatment reduces the severity of severe psoriasis, improves QoL, and is appropriately tolerated; leading to high patient satisfaction. Social support is a key determinant of therapeutic and patient outcomes and patients living along may require clinical attention. The relevance of the Rule of Tens was not evident.

• Cyclosporine
• Pharmacoepidemiology
• Psoriasis
• Treatment outcome

• Cyclosporine/chemistry
• Cyclosporine/therapeutic use
• Dermatologic Agents/chemistry
• Dermatologic Agents/therapeutic use
• Dermatology
• Education, Medical, Continuing
• Humans
• Skin Diseases/drug therapy
• Skin Diseases/immunology

Psoriasis is a common, chronic inflammatory skin disease which is associated with a number of significant co-morbidities including: impairment of quality of life; cardiovascular disease; and a seronegative arthritis known as psoriatic arthritis. Our understanding of the pathogenesis of psoriasis has developed at a remarkable rate in recent years. These new insights have significantly changed our perception of the condition and have led to the development of several new treatment strategies. Biological agents have proved a major step forward in therapeutic options for psoriasis. The ability to clear, or almost clear, cutaneous disease has changed the outcomes and expectations of many patients with this disease. The impact on both physical and psychological health may be great. This review covers the clinical features and management of psoriasis with specific reference to new therapeutic options.

• biological therapy
• management
• psoriasis
• treatment