Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Examining Patient Resistance to Psoriasis Treatment

Exp Opin Pharmacother; ePub 2018 Dec 27; Heath, et al

Psoriasis management includes a variety of treatments including localized therapies and systemic treatments; however, many patients report inadequate clinical response and resistance to therapy, according to a recent investigation. Currently, there is no treatment algorithm that incorporates effective strategies to tackle the various barriers leading to resistance. In this review, researchers evaluate the scope of resistance, the reasons it occurs, and provide strategies for overcoming resistance in both localized and systemic therapies for psoriasis. Key findings include:

  • Refractory psoriasis involves modifiable and non-modifiable factors that warrant different approaches to maximize clinical response.
  • Treatment-resistance to topical therapies may be due to poor adherence.
  • Improving adherence involves incorporating patients’ treatment preferences, improving the physician-patient relationship, and simplifying treatment regimens.
  • Treatment-resistance to systemic therapies can be due to non-adherence but can also be due to ineffective dosing, development of anti-drug antibodies, and severe disease that necessitates multiple drugs.
  • After addressing non-adherence, strategies to maximize systemic therapies include increasing the dosage, combining treatments, drug switching, and incorporating pharmacogenetics.
Citation:

Heath MS, Kolli SS, Dowling JR, Cline A, Feldman SR. Pharmacotherapeutic strategies for standard treatment-resistant psoriasis. [Published online ahead of print December 27, 2018]. Exp Opin Pharmacother. doi:10.1080/14656566.2018.1559819.

This Week's Must Reads

HLA Antigen Mismatch Linked with Skin Cancer Risk, JAMA Dermatology; ePub 2019 Jan 23; Gao, Twigg, et al

Poor Prognosis for Thin Ulcerated Melanomas Found, J Am Acad Dermatol; ePub 2019 Jan 14; Hawkins, et al

Association Between AD and Mental Health Disorders, Dermatitis; ePub 2018 Dec 18; Hsu, Smith, et al

Nonsterile Gloves Safe for Skin Cancer Excisions, J Cosmet Dermatol; ePub 2019 Jan 20; Michener, et al

Adult Atopic Dermatitis Profile Varies with Age, J Allergy Clin Immunol; ePub 2019 Jan 24; Zhou, et al

Must Reads in Psoriasis

CD123 Can Help Distinguish Psoriasis from AGEP, J Cutan Pathol; ePub 2019 Jan 22; Vyas, et al

Metabolic Syndrome Linked to Psoriasis Risk, Br J Dermatol; 2019 Jan; Snekvik, et al

Causal Link Found Between BMI and Psoriasis, PLoS Med; ePub 2019 Jan 31; Budu-Aggrey, et al

Membership in Psoriasis Patient Group Beneficial, Arch Dermatol Res; 2018 Dec; Langenbruch, et al

Examining the Role of Keratinocytes in Psoriasis, J Invest Dermatol; ePub 2019 Jan 23; Ekman, et al