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March 15, 2023
Novel Drugs Approved for Psoriasis in 2022: Tapinarof, deucravacitinib, and spesolimab-sbzo are new medications discussed in this update. Tapinarof is a topical cream for the treatment of plaque psoriasis, and deucravacitinib is an oral tablet indicated for moderate to severe plaque psoriasis. Spesolimab-sbzo is an intravenous infusion approved for generalized pustular psoriasis flares. These medications offer patients additional treatment options to limit the symptoms of psoriasis, which is a complex, immune-mediated disease state.
Upon completion of this chapter, the reader will be able to:
Discuss the etiology of, and risk factors for, psoriasis.
Describe the pathophysiology and clinical presentations of psoriasis.
Delineate treatment goals for patients diagnosed with psoriasis.
Develop an appropriate treatment and care plan for patients diagnosed with psoriasis.
Recommend nonpharmacological and pharmacological treatments for psoriasis.
Recommend appropriate monitoring parameters for patients diagnosed with psoriasis.
Provide education for patients and caregivers as part of the psoriasis care plan.
Psoriasis is a chronic inflammatory condition that exhibits a cyclical pattern of relapse and remission. There is currently no cure for the disease and treatment is designed to manage signs and symptoms associated with the disease.1 Remission may last years in some, whereas, in others, exacerbations may occur every few months. Patient factors known to exacerbate psoriasis are stress, environmental factors including seasonal changes, and certain medications.2 Depression, alcohol-related problems, cardiovascular diseases, metabolic syndrome, irritable bowel disease (Crohn’s and ulcerative colitis), and skin cancers are select comorbidities associated with the most severe forms of psoriasis.1 Severity of the condition ranges from mild to severely disabling. Thus, management of psoriasis is lifelong, and treatment changes according to the illness severity at the time. Treatment should be individualized to meet patient needs. The disease may cause emotional distress requiring empathy and caring attitude, when making treatment decisions.
EPIDEMIOLOGY AND ETIOLOGY
Psoriasis is a common chronic inflammatory skin disorder with a prevalence of 2% to 3% worldwide. The prevalence in the United States is approximately 3.2%, while African, African American, and Asian populations have an estimated 0.4% to 0.7% prevalence of the disease.3 While the overall incidence rate does not differ between men and women, the disease may present at any age, with new diagnoses peaking between ages 15 and 30 and again from 50 to 60 years.3 Psoriasis can manifest as several different types including plaque, flexural (aka inverse or intertriginous), erythrodermic, pustular, guttate, nail, and psoriatic arthritis (PsA). Eighty to ninety percent of patients diagnosed with psoriasis present with plaque psoriasis. Plaque psoriasis presents with red-pink lesions of varying sizes covered with silvery-white scales.2 Approximately 30% to 33% of patients with psoriasis have ...