What is the Best Treatment for Psoriasis?

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Answered by: Tammy, An Expert in the Dermatology - General Category
To better understand the main treatment options for psoriasis, Tammy News sat down with acclaimed dermatologist Dr. Stoner after his recent presentation at the Psoriasis Academy.

"There are several ways to approach psoriasis," Dr. Stoner, , Head of Dermatology at the University of Here, tells Tammy News. "Many patients respond well to topical treatments, such as ointments, and steroids, but those with more severe psoriasis or those in non-compliance with these treatment options, can now be placed on either a TNF inhibitor or a momoclonal antibody."



TNF-alpha

Inflammatory disorders, such as psoriasis, rheumatoid arthritis, and psoriatic arthritis are most often treated with either a monoclonal antibody, which has been created from a parent cell of tumor necrosis factor (TNF), or drugs that interfere with TNF receptors by acting as a TNF inhibitor.

“TNF-alpha,” says Dr. Stoner, “plays a key role in the progress of inflammatory diseases because it is the dominant regulator of the inflammatory response in several organ systems. It is the main driver that makes many important decisions on how the body responds to, in most of my cases, the treatment of psoriasis.”



TNF-alpha (TNFa) is a cytokine produced by monocytes and macrophages, two types of white blood cells that dictate the immune response by increasing the transport of white blood cells to sites of inflammation.

“Inhibition of this action,” Dr. Stoner explains, “reduces the inflammatory response, which is vital to treating autoimmune diseases.”

TNF Inhibitors

TNF inhibitors are fusion proteins produced through expression of recombinant DNA, engineered to link the gene for soluble TNF receptor 2 to the gene for the Fc component of human immunoglobulin G1 (IgG1). Using TNF inhibitors produces a continuous protein fusing TNF receptor 2 to IgG1.

TNF inhibitors bind to TNFa and decrease its role in inflammatory diseases such as rheumatoid arthrisits, psoriasis, and ankylosing spondylitis.

Monoclonal Antibodies

Monoclonal antibodies (mAb or moAb) are mono-specific antibodies composed of identical immune cells, which are all clones of a unique parent cell.

MAbs neutralize the biological activity of TNFa by binding to the soluble (free floating in the blood) and trans-membrane (located on the outer membranes of T cells and similar immune cells) forms of TNFa. This inhibits or prevents the binding of TNFa with its receptors.

Focusing on the Patient

“Both are invaluable for patient care in the fields of dermatology and rheumatology,” says Dr. Stoner, “but in my practice we tend toward the use of TNF inhibitors in the treatment of psoriasis because we’ve found these to be less taxing on the organ systems of our patients, though each option should be evaluated on a case-by-case basis.”

Patient-focused care is critical in the treatment of psoriasis and all inflammatory diseases, especially given the high number of associating co-morbidities, such as cardiovascular disease and diabetes. Each patient is an individual with individual responses to various treatment plans.

Dr. Stoner concludes: "My best approach is to keep open, trusting lines of communication with my patients so that together we can determine what is the best treatment for psoriasis for them."

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