Via practica 5/2012

View of clinical immunology on targeted therapy of psoriasis

Psoriasis is a chronic recurrent skin disorder significantly influencing quality of life. Up to 30 % patients suffer simultaneously from joint inflammation. Actually we classify psoriasis as an auto-inflammatory disease – out of this knowledge proceed new therapeutic strategies. Dendritic antigen presenting cells play a crucial role in the pathogenesis; their cytokines IL-12 and IL-23 activate naive T-cells to the Th1 and Th17 subpopulations. Cytokines of these cells cause chronic skin inflammation with keratinocytes hyperplasia, neovascularisation, vasodilatation a more inflammatory cell influx, and leading to psoriatic plaque formation. Knowledge of individual cytokines role has led to the development of targeted strategies interfering with concrete cytokine pathways. To the most perspective strategies in the treatment of psoriasis belong antibody directed against common p40 subunit of IL-12 a IL-23 (anti-p40, ustekinumab). This therapy leads to significant symptom relief in most patients by application only once in every 12 weeks, contributing to important improvement of quality of life in patients with moderate to severe psoriasis.

Keywords: psoriasis, auto-inflammatory diseases, targeted therapy, ustekinumab