受中度至重度银屑病影响的患者的管理可能具有挑战性,特别是在患有严重传染病[结核病(TB)的患者中,乙型肝炎和丙型肝炎,艾滋病毒,COVID-19]。的确,在开始银屑病的全身治疗之前和期间,应排除这些感染。目前,四种常规全身药物(甲氨蝶呤,富马酸二甲酯,阿维酮,环孢菌素),四类生物制剂(抗肿瘤坏死因子α,抗白细胞介素(IL)12/23,抗IL-17s,和抗IL-23],和两个口服小分子(apremilast,deucravitinib)已获得中重度银屑病治疗许可。这些药物中的每一种都具有独特的安全性特征,在开始治疗前应予以考虑。的确,一些合并症或危险因素可能会限制它们的使用。在这种情况下,本文的目的是评估患有严重感染性疾病的中重度银屑病患者的治疗.
The management of patients affected by moderate-to-severe psoriasis may be challenging, in particular in patients with serious infectious diseases [tuberculosis (TB), hepatitis B and C, HIV, COVID-19]. Indeed, these infections should be ruled out before starting and during systemic treatment for psoriasis. Currently, four conventional systemic drugs (methotrexate, dimethyl fumarate, acitretin, cyclosporine), four classes of biologics (anti-tumour necrosis factor alpha, anti-interleukin (IL)12/23, anti-IL-17s, and anti-IL-23], and two oral small molecules (apremilast, deucravacitinib) have been licensed for the treatment of moderate-to-severe psoriasis. Each of these drugs is characterized by a unique safety profile which should be considered before starting therapy. Indeed, some comorbidities or risk factors may limit their use. In this context, the aim of this manuscript was to evaluate the management of patients affected by moderate-to-severe psoriasis with serious infectious diseases.